CHILDREN OF SUBSTANCE
USING PARENTS: PATHWAYS TO
RISK AND RESILIENCE
Rina D. Eiden, Ph.D.
Research Institute on Addictions
State University of New York at Buffalo
Cocaine: Historical Overview
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1980s: cheaper “crack” cocaine
Headlines from the late 1980s:
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Forgetting the Scientific Method (Coles, 1993):
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Ignoring previous research (poverty, other drugs)
Over-interpreting outcome (small effects)
There is life after birth - quality of caregiving?
Early 1990s: Rush to Judgement; Crack Baby Myth; Saying “Goodbye” to the “Crack Baby”.
Backlash:
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"A Time Bomb in Cocaine Babies,"
"Disaster In Making: Crack Babies Start to Grow Up."
Crack was “interfering with the central core of what it is to be human.”
“Maternity wards around the country ring with the
high-pitched ‘cat cries’ of crack babies."
Mothers using cocaine during pregnancy incarcerated.
Attack on scientists as advocates of drug use;
being inept researchers;
being personally corrupt;
having funding withdrawn.
The late 1990s:
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Well designed longitudinal studies with appropriate control groups, consideration of postnatal environment
Birth outcomes – birthweight, gestational age, IUGR, subtle effects on cognition
Reactivity to stress and regulation of arousal
Lots of variation
Developmental Cascade Model
Maternal & Child Health Study
 Focus away from Teratology alone
 Caregiving Context matters
 Regulation of arousal  self-regulation &
social competence  risky behaviors
 Understand change with age –when to target
 Developmental Psychopathology model
Many pathways to risk – mediating
processes inform prevention
Heterogeneity in outcome
Maternal & Child Health Study
Intake Screens (n=4800)
Eligible (n = 340)
Ineligible
- Health Interview
- HIPAA authorization
- Medical Record Review
Not Enrolled
No show within target
dates; Foster care
mother not
interested; Could not
locate.
n = 120
Maternal Age < 18
Major medical problems
Plural infant; Other
substance use; No match
Cocaine
Positive Self-Report,
Urine, or Hair
n = 119
Control
Potential match based on
maternal age, education,
infant gender, ethnicity
n = 101
Times of Assessment
Variables
1
7
13
24
36
48
K
2nd
Maternal Substance Use
x
x
x
x
x
x
x
x
Caregiving Environment
x
x
x
x
x
x
x
x
Mother-Child Interactions
x
x
x
x
x
x
x
Reactivity/Regulation
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Self-Regulation
Behavior in School &
Teacher Reports
Some contact and measurement of child outcomes every 6 months
Reactivity
Latency, intensity, duration of negative affect, autonomic changes, cortisol
Regulation
Attentional/coping strategies – look away, look at adult, look at mom
Does prenatal cocaine exposure 
infant autonomic regulation
0.025
RSA Change Baseline to Arm
Restraint: 13 Months
0.02
0.015
0.01
Boys
0.005
Girls
0
Control
Cocaine
-0.005
-0.01
-0.015
Schuetze, Eiden, & Danielwicz, 2009
Cocaine Group Status
YES! BOYS
MORE.
Does prenatal cocaine exposure
 infant stress reactivity
20
% change in Cortisol μg/dL from
Pretask to Peak Value
18
16
14
12
10
Boys
Girls
8
6
4
2
0
Control
Cocaine
YES!
ONLY
BOYS
Does prenatal cocaine exposure 
behavioral reactivity/regulation
Eiden et al., 2009
YES! WHEN STRESS WAS HIGH
Cocaine Effects Maternal
Behavior
 Animal Studies: Acute and Chronic Heavy
Cocaine Administration in Pregnancy 
Inappropriate aggression toward intruder 
pups getting injured.
 Animal Studies: Acute and Chronic Heavy
Cocaine Administration in Pregnancy 
Lower Maternal Oxytocin.
 Animal Cross Fostering Studies: Untreated
animals treat cocaine exposed pups
differently – they elicit lower maternal care.
Maternal Scale Items
 Positive Involvement
 Expressed positive affect*
 Connectedness*
 Quality of verbalizations
 Harshness
 Angry, hostile voice*
 Expressed negative affect*
 Displeasure, disapproval,
criticism*
 Angry, hostile mood*
 Sensitivity
 Positive physical contact
 Contingent response
 Structures envt.*
 Reads child’s cues
Infant Behavior
 Positive Affect
 Expressed positive affect
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Happy, pleasant, cheerful
mood*
 Communicative Competence
 Negative Affect
 Expressed negative affect
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Irritable, angry mood
Consolability/Soothability
 Responsiveness
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Social Behavior Child Responds*
Alertness, interest*
Attentional Abilities*
Infant Reactivity Moderates
Maternal Warmth/Sensitivity
5
4.5
4
3.5
Low Reactive
3
High Reactive
2.5
2
1.5
1
Control
Eiden, Schuetze, & Coles, 2011
Cocaine
Foster Care
 By Kindergarten age, 47% of children in the
cocaine group were in foster/kin care.
 Of these, 82% entered foster care as newborns.
 About 10% entered foster care after 1 year.
 About 71% experienced no care changes once in
foster care.
 The remainder experienced between 1-4
changes in caregiving situation.
Foster Care
 Caregiving environment in foster care families –
different from biological care.
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Lower maternal psychopathology,
lower partner violence,
lower postnatal substance use,
greater presence of male caregivers,
higher maternal education.
 Lots of variability in quality of care.
 Children in foster care were more heavily
exposed.
Measurement of Self-Regulation
Measuring self-regulation
Measuring self-regulation
Measuring self-regulation
Measuring self-regulation
Predicting Self-Regulation
Cocaine Group
Status
.42**
.23**
Maternal Harshness
Intensity 2 Years
-.36**
Child SelfRegulation 3
Years
-.26**
Foster Care Status
Eiden, Schuetze, Veira, Cox, Jarrett, & Johns, 2011. Frontiers in Child and
Neurodevelopmental Psychiatry
Predicting Externalizing in K
Cocaine Group
Status
.20**
.42**
Foster Care
Status
Maternal
Aggression
Intensity 2 Years
-.37**
Child SelfRegulation 3 Years
-.16*
Externalizing
K Teacher
Report and
Observations
.16*
-.21*
Food
Insecurity/Hunger
Eiden, Coles, Schuetze, & Colder, 2014. Psychology of Addictive Behaviors.
Teacher reports of child behavior
62
*
*
60
*
58
56
Control
Cocaine NF
54
Cocaine Foster
52
50
48
Hyperactivity
Attention Prob.
Conduct Prob.
Maternal Sensitivity is protective
50
45
40
Child Behavior Problem K
Raw Scores
35
30
Low Maternal Sensitivity
25
High Maternal Sensitivity
20
15
10
5
~36% of children
0
No Violence Exp.
Some Violence Exp.
Veira, Finger, Schuetze, Colder, Godleski, & Eiden, 2014. Psychology of Violence
Maternal Harshness increases risk
50
45
40
Child Behavior Problem K
Raw Scores
35
30
Low Maternal Harshness
25
High Maternal Harshness
20
15
10
5
0
No Violence Exp.
Some Violence Exp.
Externalizing Problems
54
Externalizing Behavior Problems
(T scores)
52
50
Hi Risk Cocaine
Hi Risk No Cocaine
48
Lo Risk Cocaine
Lo Risk No Cocaine
46
44
Normative
42
18m
24m
30m
36m
42m
48m
54m
Molnar, Levitt, Schuetze, & Eiden, 2014. Development and Psychopathology.
Development is a transactional
process
It is not all about mothers
 Caregiving Context:
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Mother
Father
Siblings
Extended Family
Teachers
Peers
School
Neighborhood
Male Caregiver
 88% had male adult in their lives
 Only 39% provided daily caregiving
 Study of children of alcoholic fathers
 Recruited when children were 1 year of age from
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birth records
Both biological parents in household
High risk births excluded
Mothers who drank during pregnancy excluded
226 Families – 97 Control, 95 Father – Alcohol
abuse/dependence, 34 Both alcohol problems.
Times of Assessment
Variables
12
18
24
36
48
Parental Substance Use
x
x
x
x
x
Parenting (Observations, child
report, parent report)
x
x
x
x
Attachment Security
x
x
x
4th
6th
8th
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Substance use cognitions (norms,
beliefs, expectancies, motives)
x
Impulsive decision-making, risk
taking, risky sex, substance use
onset, use/abuse
x
Social Competence
(Observations, parent report,
teacher report)
Behavior Problems (Observations,
parent report, teacher report)
x
x
x
Self-Regulation (Lab measures,
parent report)
x
x
x
x
K
11th
X
x
x
x
x
x
x
x
x
Developmental Cascade Model
-.22**
.32**
-.29**
Father
Alcoholic
SelfRegulation 3Y
Externalizing
Problems K
.18*
Externalizing
Problems
4th/6th
Maternal
Warmth 2Y
.20**
-.17*
Maternal
Warmth K
.26**
Peer
Delinquency
8th
Parental
Monitoring 6th
.21**
-.27**
Parents’
Alcohol Norms
8th
Eiden, Lessard, Colder, Livingston, Casey, & Leonard, In review.
.30**
Adolescent SU
11th/12th
.21*
Implications
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Focus on promoting higher parental
warmth/sensitivity and appropriate
discipline.
Focus on parenting dimensions that affect
self-regulation.
The most optimal timing for such
interventions may be before 2 years of child
age.
Time interventions before critical
developmental transitions.
To prevent adolescent substance use, target
preventive interventions in middle school.
Target externalizing problems and
engagement with delinquent peers.
Clear parental norms against underage
drinking and substance use.
NIDA Prevention Principles
 Enhance protective factors and reduce risk factors.
 Address all forms of drug abuse including underage
use of legal drugs.
 Address type of drug abuse in local community.
 Tailor program to address risk specific to target
population – considering age, gender, ethnicity, etc.
 Highest risk periods – transitions
 Multi-component programs
Universal Programs
 Caring school community program (family
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+school). Elementary. www.devstu.org.
Guiding good choices. Parents. www.sdrg.org.
Life skills training program – elementary, middle,
high, transitions. www.lifeskillstraining.com.
Project ALERT – middle school
www.projectalert.com.
PATHS – elementary. www.pathstraining.com
Strengthening Families Program – family skills
training. www.strengtheningfamilies.org.
Family Programs
 Enhance relationship quality and parenting skills.
 Develop, discuss, and enforce family rules including
rules about substance abuse.
 Parental monitoring critical well before
adolescence.
 Brief, family-focused intervention - reduce later
risks of drug abuse.
 Incredible Years – incredibleyears.com (5 parenting
programs for different ages from birth to 12 years); 2
child problems (3-8 years), 2 teacher programs (3-8, 1-5
years).
School Programs
 Preschool
 Reduce aggression, enhance social skills and academics
http://incredibleyears.com
 Elementary School
 Enhance self-control, emotional awareness,
communication/social skills, and academics .
www.fasttrackproject.org
 Middle/High School
 Self-efficacy and assertiveness, drug resistance skills,
reinforce anti-drug attitudes, strengthen personal
commitments against drug abuse, enhance academics &
peer relationships.
http://www.extension.iastate.edu/sfp10-14
Selective Programs
 Coping Power – at-risk children in late elementary
and early middle school – school based.
www.copingpower.com
 Focus on Families – parents enrolled in methadone
treatment with children between 3 and 14 years of
age. www.strengtheningfamlies.org
 Strengthening Families – also for drug abusing
parents improve parenting skills. Child age 6-11.
www.strengtheningfamiliesprogram.org
 Children with Fetal Alcohol Spectrum Disorders –
MILE program (math interactive learning and
behavior problems, ages 3-10; GoFAR program –
self-regulation ages 4=9 years.
Family Check Up
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Parents or providers working with parents (2-17 years).
Web based assessment tools
For school setting – called Positive Family Support.
Universal – for all students. In-school Family Resource Center.
Selected – children and families exposed to several risk
factors.
 Individualized – Intensive family support for students and
families at highest risk.
https://reachinstitute.asu.edu/family-check-up
The school tab has training and implementation info.
The parent tab has videos for positive behavior support,
monitoring & limit setting, and for communication and problemsolving.
Acknowledgements
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National Institute on Drug Abuse:
R01DA013190
National Institute on Alcoholism and Alcohol
Abuse: R01 AA 10042
Drs. Claire Coles, Pamela Schuetze, Craig
Colder, Amol Lele, Michael Ray, Douglas
Granger, & Danielle Molnar.
Drs. Kenneth Leonard, Ellen Edwards, Kerry
Grohman.
Yvette Veira, Meghan Casey, Shannon Shisler
Toni, Larry, Callie Torchia; Torch Photography
Undergraduate & graduate students and
research analysts who worked on the
projects over the past 20 years.
Families
“Listen to the mustn'ts, child.
Listen to the don'ts.
Listen to the shouldn'ts, the
impossibles, the won'ts.
Listen to the never haves, then
listen close to me...
Anything can happen, child.
Anything can be.”
― Shel Silverstein