Journal of Substance Abuse Tre

Regular article

Interpersonal maladjustment as predictor of mothersT response to a

relational parenting intervention

Nancy E. Suchman, (Ph.D.)a,*, Thomas J. McMahon, (Ph.D.)a, Suniya S. Luthar, (Ph.D.)b

aYale University School of Medicine, Psychosocial Substance Abuse Research Center, VA-CT Healthcare System,

950 Campbell Ave. (151D), West Haven, CT 06516, USAbDepartment of Human Development, Teachers College, Columbia University, New York, NY 10027-6696, USA

Received 6 September 2003; received in revised form 2 May 2004; accepted 15 June 2004

Abstract

In previous work, Luthar and Suchman (2000, Development & Psychopathology, 12, 235) reported results of a randomized clinical

trial testing the efficacy of the Relational Psychotherapy MothersT Group (RPMG) for methadone-maintained mothers. In this extension,

we examined maternal interpersonal maladjustment as a predictor of differential response to RPMG versus standard drug counseling (DC).

We predicted that RPMG mothers with high levels of interpersonal maladjustment would improve on parent-child relationship indices,

whereas DC mothers with high levels of interpersonal maladjustment would show no improvement. Fifty-two mothers enrolled in the

study completed baseline, post-treatment and 6-month followup assessments and a subset of 24 btargetQ children between the ages of

7 and 16 completed measures on mothersT parenting. As predicted, results of hierarchical regression analyses indicated moderate

interpersonal maladjustment � treatment interaction effects for all parenting outcomes at post-treatment and for a subset of outcomes at

followup. Plotted interactions confirmed predictions that, as maternal interpersonal maladjustment increased, parenting problems improved

for RPMG mothers and remained the same or worsened for DC mothers. Results indicate the potential value of interpersonally oriented

interventions for substance-abusing mothers and their children. D 2004 Elsevier Inc. All rights reserved.

Keywords: Parent-child relations; Parent training; Parenting skills; Family relations; Child abuse

1. Introduction

In previous work, Luthar and Suchman (2000) tested the

efficacy of the Relational Psychotherapy MothersT Group

(RPMG), an adjunct parenting intervention for mothers in

methadone maintenance, in comparison with standard drug

counseling (DC) provided at methadone clinics. Concep-

tually derived from Interpersonal Psychotherapy (Klerman,

Weissman, Rounsaville, & Chevron 1984) and relational

theories of womenTs drug addiction (Finkelstein, 1996),

RPMG was designed to concurrently foster opiate addicted

mothersT interpersonal development in multiple relational

contexts (i.e. peers, family, and children) and provide direct

0740-5472/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved.

doi:10.1016/j.jsat.2004.06.003

* Corresponding author. Tel.: +1 203 937 3486, ext. 7430; fax: +1 203

937 3472.

E-mail address: nancy.suchman@yale.edu (N.E. Suchman).

guidance for resolving common parenting dilemmas encoun-

tered by addicted mothers. Results from the randomized

clinical trial indicated that RPMG was more effective

than DC for reducing mothersT maltreatment of children

and improving mother-child affective relationships; post-

treatment results were largely sustained at the 6-month

followup. (See Luthar & Suchman, 1999, 2000 for support-

ing rationale and detailed report of the clinical trial).

In the present analysis of data from that study, we sought

to evaluate whether maternal interpersonal maladjustment

would be a predictor of differential parenting outcomes (e.g.

child maltreatment, positive parenting behaviors) in RPMG

vs. DC. Interpersonal maladjustment, (the degree to which

destructive interpersonal behaviors such as arguments,

excessive control, and passivity interfere with oneTs capacityto seek support and assistance), is highly prevalent among

substance abusing women (Amaro & Hardy-Fanta, 1995;

atment 27 (2004) 135–143

N.E. Suchman et al. / Journal of Substance Abuse Treatment 27 (2004) 135–143136

Byington, 1997; Finkelstein, 1996; Harden, 1998; Hender-

son, Boyd, & Mieczkowski, 1994; Mayes, 1995) and often

viewed as a major impediment to their treatment success.

Within the framework of relational theories of womenTsaddiction (Byington, 1997; Finkelstein, 1996), interpersonal

dysfunction is a precipitant of psychological distress that

bspills overQ into parenting practices. In light of these vul-

nerabilities, we were interested in determining if mothers

reporting higher levels of interpersonal maladjustment

would be more responsive to RPMG—with its central focus

on peer and parent-child relationships—than to standard

drug counseling.

Although no studies to our knowledge have examined

predictors of response to relational parenting interven-

tions, previous work has identified predictors of behav-

ioral parent training outcomes as well as interpersonal

therapies for depression. In addition to socioeconomic

disadvantage, parental psychopathology, parental stress

and inadequate parenting skills (Kazdin, 1997; Webster-

Stratton, 1998; Webster-Stratton & Hammond, 1999), a

number of relational factors have also predicted poor

response to parent training, including marital discord

(Dadds, Schwartz, & Sanders, 1987), single marital status

among parents in low socioeconomic strata (Webster-

Stratton, 1985), and lack of involvement in social, school,

and community networks (Dumas & Wahler, 1983;

Webster-Stratton, 1998). There is also evidence (Dadds

et al., 1987) that, for parents experiencing marital discord,

supplementing child management training with a rela-

tional couplesT intervention can improve parentsT responseto behavioral parent training.

Studies examining predictors of differential response to

interpersonally oriented therapies have also identified a

number of matching effects. In the NIMH Treatment of

Depression Collaborative Research Program, Interpersonal

Psychotherapy (IPT) was found to be less effective than

cognitive-behavior therapy in treating patients with avoi-

dant personality traits (Barber & Muenz, 1996), equally

effective for patients with high levels of perfectionism or

need for approval (Blatt, Quinlan, Pilkonis, & Shea, 1995),

and more effective among patients with obsessive person-

ality traits (Barber & Muenz, 1996) or lower levels of

social dysfunction (Sotsky et al., 1991). Although the last

finding linking lower levels of social dysfunction to better

response to IPT suggests that low levels of interpersonal

maladjustment might similarly be associated with a better

response to the conceptually similar RPMG, two factors

preclude this prediction. First, the findings reported by

Sotsky and colleagues (1991) were found in primarily male

subjects and therefore may not generalize to an all-female

population. Second, unlike IPT, RPMG is an intensive

interpersonal group treatment targeting improvement in the

parent-child relationship. Based on RPMGTs intensive

interpersonal focus, we expected to see an interaction

between mothersT level of interpersonal maladjustment and

response to the two therapies. Specifically, in this analysis

we expected that mothers with high levels of interpersonal

maladjustment receiving RPMG would show improvement

on parent-child relationship indices (e.g., risk for child

maltreatment, positive parenting) whereas mothers receiv-

ing DC alone would show either no improvement or a

decline on these indices.

2. Materials and methods

2.1. Overview of procedures

Heroin-addicted mothers interested in participating in

parenting groups were recruited at three methadone clinics

in New Haven, CT. Recruitment occurred via several

means, including referrals from counselors, visits made by

research assistants to ongoing drug-counseling groups and

medication lines, and referrals from mothers who had

already participated in the study. To be eligible for

inclusion, mothers had to (a) be in methadone treatment

for a heroin problem, (b) have children less than 16 years

of age, and (c) report subjective experiences of problems

with parenting. Exclusion criteria included conditions that

would impede benefit from group therapy such as

cognitive deficits, psychotic thought processes, and suici-

dality (for a more detailed description of methods, see

Luthar & Suchman, 2000).

All eligible mothers who expressed interest in the

study met with a research assistant who explained the

nature of the study and completed consent procedures.

Mothers were enrolled in the study as openings occurred.

Initial assessments were scheduled with those who agreed

to participate and mothers were randomized to either

RPMG or the comparison condition (DC) for a duration

of 48 weeks (24 weeks treatment, 24 weeks followup).

The RPMG condition entailed weekly RPMG groups in

addition to standard treatment at the clinic, whereas in

the comparison condition mothers received standard

treatment alone.

Each participant was asked to identify one of her children

about whom she was most concerned, and these identified

children of age 7 years and older were brought in to

complete assessments whenever possible. Mothers and

target children were assessed at baseline, post-treatment,

and 6-month followup. Although all of the measures

completed by mothers were written at a fourth grade reading

level and mothers were typically able to read and respond to

items independently, a research assistant was available to

assist those participants who were unfamiliar with certain

words or phrases when necessary. During interviews with

younger children (e.g., ages 7–11) the research assistant was

seated facing the child, read each item aloud, and the child

marked his or her response on an answer form that was

beyond the research assistantTs viewing range. Older

children (e.g., ages 12–16) were typically able to complete

questionnaires independently.

N.E. Suchman et al. / Journal of Substance Abuse Treatment 27 (2004) 135–143 137

To compensate families for time spent in assessments,

a staggered reimbursement schedule was used, such that

mothers and children were paid, $15 and $5 respec-

tively, for baseline assessments, $30 and $10 on

treatment completion, and $50 and $15 at the 6-month

followup assessment.

As in all clinical research involving parents and minor

children, the research protocol required that all instances of

possible child abuse and neglect be reported to the proper

authorities (e.g., the state Department of Children and

Families). The research protocol also required that mothers

and children identified as being at risk for serious or

heightened psychological disturbance be assisted in obtain-

ing appropriate followup evaluation and treatment. At-risk

mothers and children were identified and brought to the

attention of the Project Director, N. S., either by the research

therapists conducting RPMG or by research assistants

conducting assessment interviews. Specific guidelines for

identifying mothers and children at risk (e.g., verbal

acknowledgement of abuse or neglect during assessment

interviews or group sessions, scores beyond clinical cut-off

scores on research questionnaires) were established and the

clinical status of all active research participants was

reviewed in weekly clinical supervision meetings with the

RPMG clinical supervisor and weekly research staff meet-

ings with the Project Director.

During the study, minor children of four mothers were

identified by the research and/or research clinicians as

being at risk for abuse and neglect. Three instances

involved mothers with open cases at the state child

welfare services, so the mothersT methadone clinicians

contacted the respective case workers to report the

incidents. One instance involved potential abuse by a

stepfather. In this case the mother chose to make a report

to child welfare before leaving the methadone clinic.

Because this study was conducted in conjunction with

standard treatment at methadone clinics, referrals of

mothers for further evaluation and treatment was done

by their methadone clinicians. During the study, five

children were identified as being at risk for psychosocial

maladjustment. The Project Director met with mothers to

discuss concerns and arrange referrals to child guidance

clinics for further evaluation.

2.2. Sample

Sixty-one mothers enrolled in methadone maintenance

were randomized to treatment. Of the 37 mothers assigned to

RPMG, 32 completed treatment and post-treatment assess-

ments and 28 of the treatment completers also completed

followup assessments. Of the 24 mothers assigned to DC, 20

completed treatment and post-treatment assessments and 19

of the treatment completers also completed followup assess-

ments. Of the 52 mothers who completed post-treatment

assessments, 18 had children younger than 7 years of age, and

10 were unable to bring their children to the clinic at both

post-treatment and followup. Thus, post-treatment and fol-

lowup assessments were obtained for a total of 24 children

(12 RPMG, 12 DC).

Demographic data for the sample are reported elsewhere

(see Luthar & Suchman, 2000). On average, mothers in the

sample were single, Caucasian, high-school educated women

between 27 and 41 years of age. The majority of mothers

met criteria for low SES on HollingsheadTs two-factor

scale (Hollingshead & Redlich, 1958). Participants had an

average of 2.3minor children less than 16 years of age in their

care. The mean age for target children in the sample was 9.5

(SD = 4.5). Mothers and children in the two conditions

(RPMG and DC) did not differ significantly on any

demographic variable.

2.3. Treatment

2.3.1. RPMG intervention

The RPMG groups were led by female therapists in

order to optimize womenTs comfort in discussing sensitive

issues such as those relating to their own victimization.

Sessions were led by a clinical psychologist who was

assisted by a drug counselor from the methadone clinic,

thus bringing therapeutic expertise across diverse domains

including child development, womenTs psychology, and

addiction-related issues. No patients from the drug

counselorTs individual case load were enrolled in the

study, to insure that the drug counselorsT training in the

RPMG approach did not influence standard treatment of

subjects enrolled in the study. All sessions were semi-

structured, and a therapistTs manual (Luthar, Suchman, &

Boltas, 1997) providing a detailed outline for addressing

each session topic was used. Prior to beginning their

groups, all therapists delivering the RPMG intervention

received training that involved discussions on underlying

theory and specific therapeutic skills, review of session

videotapes, and an overview of the therapist manual

contents. Each group session was videotaped and RPMG

therapists received clinical supervision on a weekly basis.

2.3.2. Standard drug counseling

Treatment in the methadone clinics entailed participation

in weekly, 1-hr counseling groups in addition to pharmaco-

logical intervention (methadone) and periodic meetings with

case managers to secure basic needs (e.g., employment,

housing, welfare benefits, legal aid, and psychiatric referrals).

The weekly groups provided the standard drug counseling

that is used in methadone clinics (see Mercer, Carpenter,

Daley, Patterson, & Volpicelli, 1994; Zackon, McAuliffe, &

ChTien, 1994). Typically led by certified drug counselors andnurses, these groups are generally focused on providing

information on the unfolding of addictions, specific triggers

and pitfalls of addictive behaviors, changing addictive life-

styles, and developing coping strategies to avoid relapses.

The counselorTs stance involves frequent use of didactic

approaches and confrontation of behaviors viewed as

N.E. Suchman et al. / Journal of Substance Abuse Treatment 27 (2004) 135–143138

counterproductive to the goal of abstinence (Mercer et al.,

1994; Zackon et al., 1994).

2.4. Measures

2.4.1. Child maltreatment

The Parental Acceptance/Rejection Questionnaire

(PARQ; Rohner, 1991), a 60-item measure rated on a

4-point scale, was used to assess child maltreatment. The

PARQ yields a composite Maltreatment score comprised of

four subscales: Aggression/Hostility (e.g., bI tell my child

that s/he gets on my nervesQ), Neglect/Indifference (e.g., bIignore my child as long as s/he does not do anything to

disturb meQ), Undifferentiated Rejection (e.g., bI tell my

child I am ashamed of him/her when s/he misbehavesQ),and low expressed Warmth/Affection (e.g., reversed item:

bI try to help my child when s/he is scared or upsetQ).Parallel versions of the PARQ respectively assess mothersTand childrenTs perceptions of maternal behaviors. Compo-

site scores between 90 and 110 on both the mother and

child versions are considered to be within normal limits;

scores above 110 indicate risk for child maltreatment

(Rohner, 1991). Adequate psychometric properties have

been documented for the PARQ (Rohner, 1991). For

this sample, CronbachTs alpha coefficients for the four

subscales ranged between .72 and .89 (median .85) for

the mothers and between .72 and .94 (median .88) for

the children.

2.4.2. Positive parenting

The Parent-Child Relationship Inventory (PCRI;

Gerard, 1994), a 78-item measure rated on a 4-point scale,

served as the measure for positive parenting behaviors. The

PCRI consists of six content subscales, including Commu-

nication, Involvement, Limit Setting, Autonomy, Satisfac-

tion and Support. Three of these subscales were used to

measure mothersT positive parenting behaviors: Communi-

Table 1

Results of two-way ANOVAs examining differences in attendance, additional serv

maladjustment, and treatment � MIM interaction

Treatment (RPMG vs. DC) F

Matern

(MIM

Post-tx Followup Post-tx

Attendance 1.10 n/a .42

Additional services

Medical .00 2.41 .01

Employment 2.84 .70 .05

Drug .21 1.14 .38

Legal .27 .92 .47

Family .26 .46 .35

Psychosocial .29 2.28 .28

Other .85 .38 .01

Social Desirability .01 .07 .55

* p b .05.

cation (e.g., bMy child tells me all about his or her friendsQ),Involvement (e.g., bSometimes I wonder how I would

survive if anything were to happen to my childQ), and Limit

Setting (e.g., reversed item: bI have a hard time getting

through to my childQ). T-scores of 40 and below on any

of the subscales indicate clinically significant problems

(Gerard, 1994). The PCRI also contains a 5-item Social

Desirability scale (e.g., bI have never had any problems with

my childQ) to identify parents who are responding with a

defensive response set. Scores of 9 and below on the Social

Desirability Scale suggest that a subject is trying to appear

to be an excellent parent. Adequate psychometric properties

have been reported for the PCRI (Gerard, 1994; Heinze &

Grisso, 1996), and for this sample, CronbachTs alpha

coefficients for the subscales ranged between .61 and .80,

with a median of .77.

2.4.3. Maternal interpersonal maladjustment

The Social Adjustment Scale (SAS-SR; Weissman &

Bothwell, 1976), a 48-item measure rated on a 5-point

scale that has been used extensively with methadone

patients (Kosten, Rounsaville, & Kleber, 1987; Rounsa-

ville, Kosten, Weissman, & Kleber, 1986), served as the

measure of interpersonal maladjustment. The SAS consists

of five qualitative subscales: Instrumental Role Perform-

ance, Friction, Interpersonal Relations, Feelings and

Satisfactions, and Global Judgments. Two of these

subscales focus explicitly on maladaptive interpersonal

behavior. The Interpersonal Relations Subscale (e.g.,

bHave you been able to talk about your feelings and

problems with at least one of your friends/relatives/partner

during the last 2 weeks?Q) was designed to identify

reticence, hypersensitivity, withdrawal, and dependency in

relationships in social, family, and marital contexts. The

Friction Subscale (e.g., bHave you had any arguments with

people at work in the last two weeks?Q) assesses

the prevalence of open arguments and opposition in

ices, and social desirability scores by treatment group, level of interpersona

al Interpersonal Maladjustment

) (High vs. Low) F

Treatment � MIM

interaction F

Followup Post-tx Followup

n/a .09 n/a

4.33* .21 4.13*

.42 .50 .22

.01 .41 .37

.92 1.48 2.82

.04 .00 .33

.07 .00 1.61

.14 .37 .00

1.36 .14 .18

l

Table 2

Hierarchical regression analyses examining maternal interpersonal maladjustment (MIM) � treatment interaction for mothersT maltreatment risk

Criterion Step

Maltreatment risk (M)a (n = 52) Maltreatment (C)b (n = 24)

Post-tx Followup Post-tx Followup

hc R2D h R2D h R2D h R2D

Interpersonal Maladjustment (IM) 1 .18 .01 .15 .01 .86 .20* 1.03 .28**

Treatment (RPMG vs. DC) 2 �12.95 .08* �11.71 .07* �13.43 .13* �1.46 .00

IM � Treatmentd 3 �1.15 .06* �.96 .05+ �1.01 .06+ �1.11 .08+

Total R2 .15 .13 .39 .36

a MothersT reports.b ChildrenTs reports.c As recommended by Aiken & West (1991), unstandardized coefficients are reported because standardized coefficients are inappropriate with

interaction terms.d Interaction terms are computed with centered variables.

* p b .05.

** p b .01.+ p b .10.

Wk80

90

100

110

120

Mal

trea

tmen

t Ris

k (M

oth

er's

rep

ort

)

0 024 2448 48Low MIM High MIM

RPMG DC

Fig. 1. Mean scores for low and high levels of maternal interpersonal

maladjustment (MIM) at weeks 0, 24, and 48: Mother’s report.

N.E. Suchman et al. / Journal of Substance Abuse Treatment 27 (2004) 135–143 139

relationships in work, social, and family contexts.

Adequate psychometric properties for the SAS have been

established (Weissman & Bothwell, 1976).

2.4.4. Treatment Services Review

The Treatment Services Review (TSR; McLellan,

Alterman, Woody, & Metzger, 1992) was used to measure

treatment that was received in addition to the study

interventions in seven domains (i.e., medical, drug,

legal, employment, family, psychosocial, and other). The

TSR is a 10-min structured interview that records the

number of professional services (e.g., doctor appointments,

medications, family therapy sessions) and discussion

sessions (e.g., group or individual counseling sessions,

Narcotics Anonymous meetings) that a patient received (on

site or through referral) in each of seven problem areas

during the course of the previous 30 day period. Mothers

were administered the TSR monthly during treatment

and followup phases and were instructed to report services

they received in addition to their respective study

intervention groups.

2.5. Data analyses

2.5.1. Data reduction and preliminary analyses

Empirically and conceptually related (r N .60) subscales

from the same measure were combined in two instances: the

Communication and Involvement subscales (r = .62) from

the PCRI were summed to form a composite Affective

Interactions scale (CronbachTs a = .88). The Interpersonal

Behaviors and Friction subscales from the SAS-SR (r = .60)

were summed to form a composite interpersonal maladjust-

ment scale (CronbachTs a = .75). To insure that change in

parenting measures was a function of group assignment and

not group differences in attendance or social desirability, we

conducted a series of two-way ANOVAs to test for group

differences (e.g., RPMG vs DC, high vs. low interpersonal

adjustment, and treatment � Interpersonal adjustment inter-

actions) for attendance, additional treatment services, and

social desirability.

2.5.2. Aptitude by treatment interactions

In a series of hierarchical regressions, scores for mater-

nal interpersonal maladjustment were entered in Block 1,

followed by treatment condition (RPMG = 1; DC = 0) in

Block 2, and interpersonal maladjustment � treatment

interactions in Block 3 (Pedhazur & Schmelkin, 1991;

Smith & Sechrest, 1991). Following recommendations of

Aiken and West (1991), we centered the interpersonal

maladjustment score before computing the interaction

term. We used the residual variance remaining after

baseline parenting scores were regressed on post-treatment

parenting scores as the dependent measure representing

change from baseline to post-treatment (24 weeks). Like-

wise, we used the residual variance remaining after

baseline parenting scores were regressed on followup

parenting scores as the dependent measure representing

Mal

trea

tmen

t R

isk

(Ch

ild's

rep

ort

)

Wk80

90

100

110

120

0 024 2448 48Low MIM High MIM

RPMG DC

Fig. 2. Mean scores for low and high levels of maternal interpersonal

maladjustment (MIM) at weeks 0, 24, and 48: Child’s report.

N.E. Suchman et al. / Journal of Substance Abuse Treatment 27 (2004) 135–143140

change from baseline to followup (48 weeks). This method

provides a reliable estimate of change that is not affected

by correlations between scores across time points (see

Cohen and Cohen (1983, pp. 413–425) for a detailed dis-

cussion on measuring change).

To minimize Type II error (i.e., failure to reject the null

hypothesis when it should have been rejected), we followed

the suggestions of Pedhazur and Schmelkin (1991, p. 558)

to set the alpha level for interactions at .10 (the authors

suggest setting alpha between .10 and .25). Given the

relatively small sample size, setting the alpha level at .10

allowed effects of moderate size that might be significant in

a larger sample (e.g., R2D N .04; Cohen, 1988, 1990) to be

considered meaningful. For outcomes with significant

interactions terms, we conducted a median split of maternal

interpersonal maladjustment scores for RPMG and DC

groups, respectively, and plotted the mean residuals

representing change from baseline scores on each parenting

measure at post-treatment and followup for each of the four

groups. To place these findings within a meaningful clinical

Table 3

Hierarchical regression analyses examining maternal interpersonal maladjustment

Criterion Step

Affective interactions

Post-tx

ha R2D

Interpersonal Maladjustment (IM) 1 .06 .01

Treatment Condition 2 5.51 .14**

IM X Treatmentb 3 .33 .05*

Total R2 .20

a As recommended by Aiken & West (1991), unstandardized coefficients are

terms.b Interaction terms are computed with centered variables.

* p b .05.

** p b .01.+ p b .10.

context, we also plotted mean scores for each of the four

groups at each time point.

3. Results

3.1. Descriptive data and preliminary analyses

Means and SDs on all variables at baseline, post-

treatment, and followup are reported elsewhere (see Luthar

& Suchman, 2000). Mean scores at baseline for inter-

personal maladjustment were 2.0 (SD = .5) for RPMG

mothers and 2.0 (SD = .6) for DC mothers. These scores are

comparable to previously reported social adjustment mean

scores for opiate-addicted women in methadone treatment

(Kosten et al., 1987).

On average, the 37 mothers who completed RPMG

attended 18.9 sessions, (SD = 4.1, range = 12 to 24) and

the 20 mothers who completed DC attended 17.75 sessions

(SD = 4.0, range = 12–24). On average, the five mothers

who left RPMG treatment early completed five sessions

(SD = 3.8, range = 1 to 11) and the four mothers who

left DC treatment early completed six sessions (SD = 4.2,

range = 2 to 11). Results of two-way ANOVAs (see

Table 1) indicated no significant group difference or group

interactions for attendance, treatment services received, or

social desirability with the exception of medical services;

mothers in the control group who had high levels of

interpersonal maladjustment reported receiving signifi-

cantly more medical services at followup than mothers in

the other three groups.

On the PCRI Social Desirability Scale, the percentage of

RPMG mothers scoring at or below the cut-off score of 9

was 3% at baseline, 9% at post-treatment, and 4% at

followup. The corresponding percentages for DC mothers

were 15% at baseline, 10% at post-treatment, and 6% at

followup. Thus, a majority of mothers in the sample were

not responding defensively on the PCRI subscales. Finally,

no aptitude (interpersonal maladjustment) by covariate

(MIM) � treatment interaction for each positive parenting domain (n = 52)

Limit setting

Followup PostQtx Followup

h R2D h R2D h R2D

.05 .00 .07 .01 �.13 .04

4.48 .08* .02 .00 �1.57 .02

.13 .01 .35 .05+ .42 .11*

.09 .06 .17

reported because standardized coefficients are inappropriate with interaction

60

65

70

75

80

Aff

ecti

ve In

tera

ctio

ns

Wk 0 024 24Low MIM High MIM

RPMG DC

Fig. 3. Mean scores for low and high levels of maternal interpersonal

maladjustment (MIM) at weeks 0 and 24: Affective interactions.

N.E. Suchman et al. / Journal of Substance Abuse Treatment 27 (2004) 135–143 141

(baseline outcome measures) correlations were significant at

the .05 level and it was therefore assumed that constructs

were independent.

3.2. Aptitude by treatment interactions

3.2.1. MothersT and childrenTs reports of childmaltreatment risk

As shown in Table 2, the Interpersonal Maladjustment �treatment interaction accounted for significant variance and

indicated moderate effects in mothersT reports of maltreat-

ment at post-treatment (R2D = .06, p b .05) and at followup

(R2D = .05, p b .10).

Plotted means in Fig. 1 indicate that child maltreatment

scores for DC mothers with high levels of interpersonal

maladjustment at baseline were near or above the clinical

cut-off (indicating risk for maltreatment) at weeks 24 and

48 whereas mean scores for RPMG mothers with initially

high interpersonal maladjustment were near or within the

normal range.

Plotted scores in Fig. 2 indicate that child maltreatment

mean scores for DC mothers with high levels of inter-

personal maladjustment were at or beyond the clinical cut-

off at weeks 24 and 48, whereas mean scores for RPMG

mothers with initially high interpersonal maladjustment had

dropped to the low end of the normal range.

3.2.2. Positive parenting

Hierarchical regressions conducted for each positive

parenting domain (Table 3) indicated a significant

interaction effect at post-treatment for Affective Interac-

tions (R2D = .05, p b .05) and a trend for Limit Setting

(R2D = .05, p b .10) and for Limit Setting (R2D = .11,

p b .05) at followup.

Plotted mean scores for affective interactions in Fig. 3

show that, regardless of their level of interpersonal mal-

adjustment, RPMG mothers reported improvement in

affective interactions whereas DC mothers reported no im-

provement. Plotted mean scores for limit setting indicated

similar trends with mean scores for RPMG mothers with

high levels of interpersonal maladjustment at weeks 24 and

48 approaching the clinical norm of 50 and mean scores for

DC mothers with high levels of interpersonal maladjustment

showing little movement away from the clinical cut-off score

of 40 at weeks 24 and 48.

4. Discussion

In the original report of the randomized clinical trial

(Luthar & Suchman, 2000), RPMG demonstrated greater

efficacy than DC for improving parenting behaviors across

targeted parenting domains. Results from this reanalysis of

that data indicate that the relationally oriented parenting

intervention, RPMG, may be particularly beneficial to

mothers whose high levels of interpersonal maladjustment

might otherwise interfere with their ability to benefit from

drug counseling alone. More importantly, findings from this

study indicate that interpersonally maladjusted mothers who

only receive drug counseling and do not receive any

additional treatment for parenting deficits are likely to be

at risk for child maltreatment and parenting deficits.

To our knowledge, no prior studies have examined

predictors of response to any type (traditional or relational)

of parenting interventions for substance-abusing mothers.

Moreover, although behavioral parent training programs

have not yet demonstrated lasting improvement in the

affective quality of parent-child relationships involving

parents with substance abuse problems (see Catalano,

Gainey, Fleming, Haggerty, & Johnson, 1999; Kumpfer,

1998), no studies have yet compared traditional behavioral

models to relational parenting models in terms of their

efficacy for substance-abusing mothers. As Kumpfer,

Alvarado, and Whiteside (2003) have noted in their review

of family-based interventions for substance use and misuse

prevention, the shortage of efficacy studies involving

parenting interventions that specifically target affective

components of parent-child relationships has thus far

precluded their comparison with behavioral approaches.

Given the risk that interpersonal maladjustment confers for

parenting and child maltreatment, there is a pressing need

for further systematic research testing parenting interven-

tions designed to improve the affective quality of family

relationships for this very vulnerable population.

Although limitations of the original pilot study have

been described elsewhere (Luthar & Suchman, 2000), two

limitations are particularly relevant to this study. First,

the sample size (of children in particular) is small, and it is

limited to mothers enrolled in methadone maintenance. Thus,

caution is warranted in generalizing findings, especially to

other groups of drug using mothers. Second, although pre-

liminary analyses showed no differences in group attendance,

N.E. Suchman et al. / Journal of Substance Abuse Treatment 27 (2004) 135–143142

additional services received, or socially desirable responding

in the RPMG and DC conditions, we could not rule out the

possibility that attending an extra group each week (e.g., the

RPMG group) accounted for group differences in change. In

an ongoing Phase 2 randomized clinical trial comparing

response to an adjunct RPMG group with a response to an

extra relapse prevention group we will be able to address

this limitation.

With these cautions in mind, we feel these findings

nonetheless indicate the need for continued investigation of

predictors of successful parenting treatment outcomes

among substance-abusing parents. This may be an espe-

cially needy group since they have been viewed as

notoriously bdifficultQ to treat because of their interpersonal

difficulties. In particular, our findings indicate the need for

further research examining the efficacy of supportive,

relationally-oriented parenting interventions for parents

whose interpersonal deficits might otherwise interfere with

their capacities to benefit from more behaviorally-oriented

parent training.

Acknowledgments

Preparation of this manuscript was supported by

Research Scientist Development Awards K23-14606 (Such-

man) and K21-DA00202 (Luthar) and by NIDA Grants

P50-DA09241, R01-DA10726, and R01-DA11498. We

gratefully acknowledge Bruce Rounsaville for his insightful

comments on this manuscript. We also would like to thank

members of the Child and Family Research Group at the

Yale University School of Medicine and staff members at

the APT Foundation methadone clinics for their invaluable

assistance and support. A limited portion of this manuscript

was presented as an abstract at the College on Problems of

Drug Dependence Annual Meeting.

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