Of the 404 opiate users recruited in 2003/4 to the ROSIE study, 212 (53%) had children aged 17 or under (a total of 370 children). Ninety-two of these participants had primary responsibility for one or more of their children. Women were significantly more likely than men to have primary responsibility for their children, 59% compared to 15.2%. At one-year follow-up completed questionnaires were obtained from 74 of the original 92 clients with children in their care at intake and from 213 of those not caring for children at intake. 

 

This study compares the groups at intake, and the outcomes at one year, rather than those at three years, based on evidence that ‘in general the greatest changes in outcome occur early in treatment, and that longer term outcomes do not exhibit further improvements’. As a limitation of the study, the author points out that a proportion of the participants were recruited through prisons or residential rehabilitation centres, and therefore could not have had children in their care. Additionally, participants were not randomly allocated to the different treatment modalities, which may have also affected the results.

At intake there was no significant difference in drug use between the two groups, with the exception of the rate of benzodiazepine use, which was lower among the group of participants with children in their care. 

 

At one-year follow-up significantly fewer of the group with responsibility for children were using heroin, benzodiazepines or cannabis. This group were also using heroin on significantly fewer days compared to the group without responsibility for children. However regression modelling revealed that having responsibility for children was a significant and positive predictor for using other opioids. Having responsibility for children was also a positive, butnon-significant. predictor of use of alcohol, illegal methadone and tobacco.

 

While both groups had experienced a reduction in psychological symptoms at one year, a greater number of significant reductions were experienced by the group who did not have responsibility for children. The analysis also showed that the group with responsibility for children experienced significantly more panic attacks.

 

The author concludes that having responsibility for children significantly improves the outcome of a client’s treatment for heroin use.  The results did suggest some worrying trends, including the use of alcohol and other opioids among the group with responsibility for children, which may indicate that this group had been substituting other substances for heroin. While the effects of parental substance misuse on children have been studied, the ways in which having custodial care of one or more children may affect a client’s drug treatment outcomes has not been widely researched. The author recommends that further research in this specific area would improve the effectiveness of drug and alcohol treatment and provide the maximum benefit to both the parent and the child.

 

1. The ROSIE study was Ireland’s first national, prospective, longitudinal drug treatment outcome study. It aimed  to ‘evaluate the effectiveness of treatment and other intervention strategies for opiate use’. In 2003/04, 404 opiate users who entered treatment were recruited, of whom 72% completed follow-up questionnaires one year and three years later.

2. Comiskey C (2012) A 3 year national longitudinal study comparing drug treatment outcomes for opioid users with and without children in their custodial care at intake. Journal of Substance Abuse Treatment Early online. www.drugsandalcohol.ie/17577