Integrated programs for mothers with substance abuse issues: a systematic review of studies reporting on parenting outcomes.
Niccols A., Milligan K., Sword W. et al. Harm Reduction Journal: 2012, 9:14.

The first systematic review of whether integrated substance use/parenting programmes improve the parenting of problem substance using mothers found remarkably few quality studies, but enough to suggest that such programmes can improve the prospects of often highly at-risk children.

Summary
Treatment for mothers with substance use problems may be an important opportunity to improve parenting and break the intergenerational cycle of addiction and dysfunction. However, such women find it difficult to use conventional systems of care (for reasons including fear of losing custody of children, guilt, stigma, and lack of transportation), and prefer comprehensive services provided in a caring, 'one-stop' setting. Researchers, clinicians, and policymakers also recommend that substance use treatment programmes address women's needs and those of their children through comprehensive, integrated services at the same site.

The result has been the development of numerous programmes integrating addiction treatment with on-site pregnancy, parenting, or child-related services. Typically these provide individual addiction treatment, maternal mental health services, trauma treatment, parenting education and counselling, life skills training, prenatal education, medical and nutrition services, education and employment assistance, child care, children's services, and aftercare.

However, no review has yet systematically assessed the impact of these programmes on the quality of parenting. The featured review aimed to fill this gap, specifically by seeking evidence on whether integrated programmes are more effective than usual addiction treatment, and whether some features of integrated programmes are associated with better parenting outcomes than others.

The analysts searched databases for studies published in English from 1990 to May 2011 and conducted other searches to ensure as far as possible that all relevant studies were identified. Of the 31 studies which reported on the quality of parenting, just four were randomised trials; three involved mothers with children and one pregnant women. The women averaged 29–36 years of age. Most had experienced trauma and mental health problems, and were unemployed, single mothers. The children ranged from infants to adolescents. Programmes lasted three to 12 months and had a high dropout rate.