The Role of Children in Facilitating Desistance from Substance Use Among Urban African Americans

Background: Previous work has uncovered many of the risk factors associated with adolescent and young adult substance use disorders (SUDs).  However, previous work suggests that disadvantaged African Americans are less likely to recover from SUDs and tend to have a course of substance use problems that is more likely to extend into midlife than for Whites.  Yet, our understanding of factors that predict long-term substance use courses, as well as factors that facilitate recovery, remains largely unknown.  Previous qualitative studies suggest that children are often an impetus motivating disadvantaged individuals, in particular, to want to “get clean.” 

Method: Utilizing data from the Woodlawn Study, a community cohort study of urban African Americans assessed prospectively from ages 6 to 42, we answer the following research questions: (1) what role does parenting play in facilitating or hindering recovery from substance use problems in adulthood, and (2) does this association vary by gender?  We consider parenting timing, quality, co-residence, and support.  To answer these questions, we use latent class analysis to identify patterns of substance use problems that extend through age 42 and explore whether parenting in young adulthood differentiate patterns of substance use problems that extend into midlife.  In these models, we test for gender interactions as children may influence persistence or recovery differently for men and women.

Results: We find four distinct patterns of substance use problems through midlife based on DSM criteria for a substance use disorder including: no problems (67%), persistent problems (8%), late onset problems (12%), and recovery (13%).  Compared to those in the recovery class, those with persistent problems across adulthood were more likely to be noncustodial parents, were less likely to be in a household that contains children, and reported less support in caring for their children.  Those with persistent problems also rated their parenting as worse than the other three classes. 

Implications: These findings support previous qualitative working suggest that children may play a critical role in facilitating substance use recovery among African American adults.  Parenting support with particular attention to develop the parenting skills of minority, noncustodial parents, coupled with substance use treatment, may offer promise for decreasing the burden of substance use in midlife among urban African Americans.  The comprehensive health insurance reforms that are part of the Affordable Care Act make health insurance available to many more people and now require services for substance use disorders as “essential benefits.”  Thus, it is critical for the Department of Health and Human Services to consider evidence that minority substance using parents may need broad services including parenting support in addition to traditional drug treatment to achieve and maintain recovery.