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. Author manuscript; available in PMC: 2022 Sep 12.
Published in final edited form as: Subst Use Misuse. 2021 Sep 12;56(14):2106–2114. doi: 10.1080/10826084.2021.1972313

Maternal Substance Abuse and the Mother-Child Relationship in Late Childhood

Megan Bears Augustyn 1,*, Celia J Fulco 2, Della Agkebe 3, Kimberly L Henry 4
PMCID: PMC8734208  NIHMSID: NIHMS1766817  PMID: 34514950

Abstract

Objective:

This study examines the relationship between maternal substance abuse and various aspects of the mother-child relationship in late childhood while accounting for mental health and comorbid substance abuse and mental health among a predominantly racial minority sample.

Methods:

Using 369 mother-child dyads from the Rochester Intergenerational Study (64% Black, 17% Hispanic, and 8% mixed race/ethnicity), multilevel generalized linear models examined the effects of a maternal substance abuse history, a history of clinical depression, and comorbid substance abuse and depression histories on both maternal and child reports of five aspects of the mother-child relationship (i.e., warmth, consistent discipline, maternal knowledge, involvement, and conflict).

Results:

A maternal substance abuse history alone was unrelated to each aspect of the mother-child relationship as perceived by the mother or child, with the exception of child perceptions of maternal knowledge of behavior. Alternatively, a history of depression or comorbid histories of substance abuse and depression were negatively related to warmth, consistent discipline, involvement, and conflict but only as perceived by the mother.

Conclusions:

This study reinforces the need for integrated treatment programs for women with substance use problems, particularly programs that incorporate mental health and parenting components. Moreover, it highlights specific targets for intervention that can reduce subsequent maternal substance abuse and improve offspring outcomes. The divergence in observed effects across reporter also suggests that future research should use multiple reporters to examine the interpersonal consequences associated maternal substance abuse.

Keywords: Substance abuse, depression, parenting, comorbidities, reporter bias

Research consistently indicates differential consequences of substance abuse, including alcohol, cannabis, and illicit drugs, across sex and gender roles (National Institute of Drug Abuse [NIDA], 2020). For women, in particular, it has cascading consequences for offspring. Oftentimes, research focuses on the effects of maternal substance abuse on fetal development and early childhood outcomes via exposure to substances in utero, through breastmilk, or in the home, and its association with harmful parenting, including neglect and abuse (National Research Council, 2014; Smith & Wilson, 2016). Other work examines the effects of maternal substance abuse on offspring psychosocial maladjustment and problem behaviors in childhood or adolescence (Ruish et al., 2018; Smith & Wilson, 2016), including early-onset substance use and substance abuse (Biederman et al., 2000; Yule et al., 2013).

Key to understanding the intergenerational consequences of maternal substance abuse, though, is the potentially ill effect of maternal substance abuse on the mother-child relationship. Through this relationship, defined in terms of affection and behavior, a child develops or may struggle to develop the skills needed to transition from a state of dependence to independence and prosocial behavior (Fortuna & Knafo, 2014). Parenting behaviors such as knowledge and supervision, discipline, and involvement are all aspects of the mother-child relationship that predict offspring outcomes (e.g., Brook et al., 2010; Hoeve et al., 2012). Moreover, emotional affection and warmth, which instills feelings of safety, protection, and support, is known to promote independence, self-esteem, and prosocial behavior among youth (Malekpour, 2007; Hoeve et al., 2012). Importantly, various aspects of the mother-child relationship are known risk factors for offspring maladaptation across race/ethnicity and likely mediate the relationship between maternal substance abuse and emotional and behavioral problems in offspring in line with Family Interactional Theory (Brook et al., 1990) and the Family Stress Model (Conger & Conger, 2002). Given the importance of culture in the construction of expectations and behaviors associated with parenting across race/ethnicity (Bornstein, 2009) and evidence to suggest that both consequences and treatment outcomes are worse for comorbid mental health and substance use issues among racially and ethnically minoritized individuals compared to whites (Assari et al., 2018; Nam et al., 2017), more research is needed to better understand the ill effects of maternal substance abuse on aspects of the parent-child relationship, particularly among racial minority mother-child dyads.

When considering the effects of a maternal history of substance abuse on the mother-child relationship, it is important to account for maternal substance abuse in the context of maternal mental health, particularly depression – a malady that often accompanies a substance use disorder, particularly among women (Garey et al., 2020). Approximately 7.7 million women age 18 and older had a substance abuse disorder (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019) and approximately 12 million had a major depressive episode in 2018 alone (National Institute of Mental Health, 2019). Moreover, approximately 4.3 million women had both a substance use disorder and serious mental illness in 2018 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019). This comorbidity is not surprising given that women who suffer from a substance abuse disorder are two times more likely to also suffer from a mood disorder and vice versa (National Institute on Drug Abuse, 2018). Comorbid substance abuse and depression is often linked to common risk factors (either biological or environmental), the neurophysiologic changes to the brain caused by substances that increase the likelihood of depression, and the self-medication hypothesis, whereby those who suffer from depressive symptoms use substances to alleviate distress (Muesser et al. 1998; Levy, 2019). The latter is particularly evident among minority women who have limited access to healthcare (Steele, Dewa, & Lee, 2007) and/or experience discrimination (Clark et al., 2015). Therefore, an investigation of the effects of a maternal substance use disorder in the context of other mental health maladies, particularly depression, is prudent given the overlap in prevalence, the greater personal and social impairment associated with this comorbidity (Davis et al., 2008), and the implications for treatment programming. For instance, while women with a substance use disorder are more likely to receive treatment if it co-occurs with major depression (Zhou et al., 2019), mothers with dual diagnosis demonstrate poorer treatment outcomes for substance abuse compared to those without a dual diagnosis (Connors, Grant, Crone, & Whiteside-Mansell, 2006). Furthermore, Blacks, in general, have lower rates of recovery (Milligan et al., 2013), often due to one-size-fits all models that ignore cultural differences (Kaliszweski, 2020) and additional barriers to continued treatment and recovery (e.g., fewer job opportunities, poverty; Williams, 2008).

In this research, we explore differences in various aspects of the mother-child relationship among mothers with a lifetime history of a substance abuse disorder alone in contrast to mothers without a lifetime history of a substance abuse disorder as well as mothers with a history of depression alone and comorbid substance abuse and depression in a predominantly Black and Hispanic sample of mother-child dyads. We focus on depression given that it is highly comorbid with other mental health issues and symptoms, including anxiety (Kalin, 2020). We also focus on various aspects of the mother-child relationship during late childhood given that this developmental stage is often after the initial onset of maternal substance abuse (SAMSHA, 2019) and depression (Mayo Clinic, 2019), and it is when a child traditionally begins the transition to independence (Centers for Disease Control, 2020) and the parent-child relationship as perceived by the mother and child is critical to subsequent development and behavior in adolescence (Suchman, Pajulo, DeCoste, & Mayes, 2006; Brook et al., 2010).

Method

Data

Data come from the Rochester Intergenerational Study (RIGS), the intergenerational extension of the Rochester Youth Development Study (RYDS). A full description of these companion studies is presented by Thornberry and colleagues (2018). RYDS began in 1988 with a sample of 1,000 7th and 8th grade public school students from Rochester, New York. RYDS was designed to assess the causes and consequences of adolescent delinquency and drug use. Males were oversampled (at a ratio of 3:1) as were those living in high-crime areas of the city. At the onset of RYDS, the average age of the focal participants was 13.6 years old and73% were male. Approximately 68% were Black while 17% were Hispanic and 15% were White.

In 1999, the Rochester Intergenerational Study (RIGS) recruited all firstborn, biological children of RYDS participants who were two years of age or older (average age of child in Year 1 was six). In each subsequent year, new firstborn children were added to the RIGS sample when the child turned two. Both the RYDS participant and the child’s other caregiver (if it was the mother) completed annual interviews through the child’s seventeenth birthday. The child completed interviews from age 8 onward. Data were last collected in 2019 (Year 20 of RIGS). Five hundred and thirty-nine families participated in RIGS and analyses revealed that across 45 characteristics (for measurement see Thornberry et al. 2003), the sample of parents adequately represented the initial RYDS population. Both RYDS and RIGS protocols were approved by the Institutional Review Board at the State University of New York, Albany.

Sample

Our sample consists of the focal participants of RIGS, the firstborn biological child of RYDS participants, and their biological mother. Of the potential 539 mother-child dyads available for analysis, 124 mother-child dyads were excluded from the sample because the mother did not complete at least one (of two) Computerized Diagnostic Interview Schedule Version IV (CDIS-IV) interviews administered between 2004 and 2011, which are used to assess maternal disorder status. An additional 46 mother-child dyads were excluded because there was no information regarding the mother-child relationship from both the mother and child in the same year at least once between the child ages of nine and 11. This resulted in 369 mother-child dyads available for analysis. Since out outcomes representing the mother-child relationship were assessed annually between ages 9 and 11, we have 999 dyad-years available for analyses (i.e., the number of mother-child dyads multiplied by the number of yearly interviews for each dyad). Of these dyads, 128 mothers participated in RYDS (241 were the biological mothers of male RYDS participants children). The final sample of dyads was 64% Black, 17% Hispanic, 8% mixed race/ethnicity (Black and Hispanic), and 11% White. Approximately 50% of the children were male and the average birthyear was 1995. Attrition analyses indicated that across an array of demographic characteristics (i.e., RYDS participant sex, child sex, race/ethnicity, child birth year, RYDS community arrest rate), the final sample of mother-child dyads (n=369) did not vary significantly from the initial sample of mother-dyads (n=539; p<.05).

Measures

Maternal perceptions of the parent-child relationship.

We examine five aspects of the mother-child relationship as reported by the mother each year from child age 9 to 11. The first four were assessed using a 5-point scale (1=never to 5=always). Maternal warmth is based on an abbreviated version of the Hudson Index of Parenting Attitudes (Hudson, 1982). It is the mean of 11 items that assessed the frequency of maternal affection toward the child (; α=.82-.86 for child ages 9-11). Consistent discipline is the mean of four items indicating how often the mother exerted similar discipline practices and whether the child was able to get out of punishment (α=.70-.75 for child ages 9-11). Maternal knowledge is based on three items assessing how often she knew where the child was, what the child was doing, and who the child was with; α=.68-.79 for child ages 9-11). Involvement was measured as the mean of 4 items that assessed how frequently the mother did various activities with the child (e.g., celebrate family events, take places; α=.66-.70 for child ages 9-11). For Maternal Warmth, Consistent Discipline, Maternal Knowledge and Involvement, we exponentiated each measure (due to the positive skew) in order to better approximate a normal distribution. Finally, Conflict is a count measure from 11 items where the mother reported about whether the mother and child fought about various things (e.g., talking back, helping around the house).

Child perceptions of the parent-child relationship.

We also examine five aspects of the mother-child relationship as reported by the child each year between ages nine and 11 given that mothers and offspring often have overlapping, yet distinct, views of their relationship (Burk & Laursen, 2010: p. 658). Although the items are the same, the first four scales included measures that were assessed on a 4-point scale (1=never to 4=a lot). As such, we rescaled each measure to a 5-point scale for comparability with maternal measures. These include Child Warmth to the mother (Hudson, 1992; α=.63-.67 for child ages 9-11), Consistent Discipline (α =.70-.75 for child ages 9-11), Maternal Knowledge (α=.63-.68 for child ages 9-11), and Involvement (α=.63-.79 for child ages 9-11). Again, for Child Warmth, Consistent Discipline, Maternal Knowledge, and Involvement, we exponentiated each measure (due to the positive skew) in order to better approximate a normal distribution. Similar to the maternal measure, Mother-child Conflict is a count of 11 items indicating whether the child fought with one’s mother about various things.

Maternal Disorders.

The measure of maternal disorder status is assessed at the mother-child dyad level (one measure per dyad) and is not assessed yearly. Between 2004 and 2011, the CDIS-IV was administered up to two times, irrespective of child age. The CDIS-IV is based on the Diagnostic and Statistical Manual, Edition 4 (DSM-IV; Robins et al., 2000) and includes indicators of lifetime abuse or dependence of alcohol, cannabis, amphetamines, cocaine, inhalants, or hallucinogens (hereafter referred to as substance abuse) and a lifetime incidence of a major depressive episode. Using data from one or both CDIS-IV interviews if two interviews were completed, we classified each mother as having 1) no history substance abuse or a depressive disorder, 2) a history of substance abuse only, 3) a history of a depressive disorder only, or 4) comorbid substance abuse and depressive disorder. This nominal variable is referred to as maternal disorder status. Approximately 73% of mothers had no history of substance abuse or a depressive disorder, 6% had a history of substance abuse only, 17% had a history of a depressive disorder only, and 5% had a history of substance abuse and a depressive disorder.

Control variables.

Based on previous research and theory regarding factors related to parent-child relationships (Brook et al., 1990; Conger & Conger, 2002), we include an array of time-varying and time-stable covariates as controls. The following time-varying covariates were assessed yearly at child ages nine to 11: the number of sources of parenting support as reported by the mother, a count of three different aspects of financial hardship experienced by the mother in the past year, and child age to account for age trends in the outcomes. Time-stable controls include a binary indicator of child sex (female serves as the reference), a set of dummy variables representing the child’s race/ethnicity (Black, White, and Mixed; Hispanic serves as the reference group), child birth year to account for cohort effects, and community arrest rate for the initial RYDS participant. Descriptive information for all covariates is included in Table 1.

Table 1.

Descriptive Statistics

N Range Mean/Proportion SD
Time-varying Covariates (Level 1)
 Maternal Reports
  Warmth b 991 2.7-5 4.48 0.43
  Consistent Discipline b 983 1.5-5 3.64 0.71
  Maternal Knowledge of Activities b 999 2-5 4.70 0.43
  Involvement b 996 2-5 1.21 0.54
  Mother-child Conflict b 800 0-.91 0.28 0.19
 Child Reports
  Warmth b 991 2.11-4 3.37 0.33
  Consistent Discipline b 983 1.33-4 3.15 0.43
  Maternal Knowledge of Activities b 999 1.5-4 2.98 0.46
  Involvement b 996 1.33-4 2.52 0.45
  Mother-child Conflict b 800 0-1 0.30 0.22
 Financial Hardship a 999 0-3 0.37 0.76
 Maternal Support a 999 0-15 5.49 3.04
 Child Age a 999 9-11 10.00 0.82
Time-stable Covariates (Level 2)
 Maternal Disorder Status
  No Disorders 369 0.73 - 0,1
  Substance Use Only 369 0.06 - 0,1
  Depression Only 369 0.17 - 0,1
  Both Disorders 369 0.05 - 0,1
 Male 369 0.50 - 0,1
 Black 369 0.64 - 0,1
 White 369 0.11 - 0,1
 Mixed Race 369 0.08 - 0,1
 Birth Year a 369 1995.35 4.16 1988-2008
Community Arrest Rate a 369 4.29 2.01 0.12-7.87
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a

Each covariate was grand mean centered for analyses.

b

Each covariate was exponentiated and then the natural log was taken prior to analyses.

Analysis

In our data, variation in the parent-child relationship is partitioned into two levels. The dyad is Level 2, and it represents between parent-child dyad variation in our parent-child outcomes. Level 1 represents within-dyad variation across years (i.e., child age). Multilevel models were estimated because they take into account the nested structure of the data (i.e., time-varying factors nested within parent-child dyads) and allow within- (Level 1; e.g., maternal financial hardships) and between-level (level 2; e.g., maternal disorder status) characteristics to be modeled simultaneously (Raudenbush & Bryk, 2002). More specifically, generalized linear multilevel models were estimated for the continuous outcomes of warmth, consistent discipline, maternal knowledge, and involvement as reported by the mother and child, respectively, and each outcome was standardized prior to model estimation. Multilevel negative binomial models were estimated for the outcomes of mother-child conflict as reported by the mother and child, respectively, due to the count nature of the measures and evidence of overdispersion. For each outcome, which is assessed at Level 1, the multilevel model estimated the effects of the time-varying covariates (Level 1) on the change in perceptions of the mother-child relationship while accounting for the effects of the time-stable characteristics (Level 2), including maternal disorder status. All non-binary covariates were grand-mean centered prior to model estimation. Given the aims of this study, we did not allow the effects of the Level 1 covariates to vary across persons. Initially, no maternal history of a substance abuse disorder or depressive disorder served as the reference for maternal disorder status. However, to compare all disorder statuses to one another, we subsequently rotated the reference group and refit the multilevel models. We constructed 95% confidence intervals (CIs) in order to better ascertain variation in each estimate given that Gelman and colleagues (2012) argue that multilevel models produce precise estimates even when multiple comparisons are made. All analyses were performed in Stata 16 (StataCorp, 2020).

Results

Table 2 presents the results of the models estimating the relationship between maternal disorder status and each aspect of the parent-child relationship as perceived by the mother. No history of a substance abuse disorder or depressive disorder serves as the referent for maternal disorder status in Table 2. To achieve comparisons between disorder status, the reference group for maternal disorder status was rotated and the comparisons are reported in text. Mothers with a history of only a depressive disorder reported lower levels of warmth (b=−0.25, 95% CI [−0.49, −0.00]), less consistent discipline (b=−0.25, 95% CI [−0.49, −0.01]), and more conflict with the child (b=0.35, 95% CI[0.14, 0.55]) than mothers without a history of substance abuse and a depressive disorder. Mothers with a history of both substance abuse and a depressive disorder also reported lower levels of warmth toward their child (b=−.48, 95% CI[−.91, −.06]), less consistent discipline (b=−.54, se=.21, 95% CI[−.97, −.14]), and less involvement with their child (b=−.54, se=.20, 95% CI[−.94, −.15]) compared to mothers with no history of substance abuse or a depressive disorder. Mothers with a history of both substance abuse and a depressive disorder also perceived more conflict with their child compared to mothers who did not have a history of either disorder (b=.41, 95% CI[0.03, 0.78]). After rotating the reference group, only one difference between disorder status emerged: mothers with a history of substance abuse and a depressive disorder perceived lower levels of involvement with their child compared to those with a history of substance abuse only (b=−.60, 95% CI[−1.11, −.09]). It is also worth noting that none of the control variables, including maternal financial hardship and maternal social support, displayed a consistent relationship on each aspect of the mother-child relationship, as reported by the mother.

Table 2.

Multilevel models examining the relationship between maternal disorder status (no disorder status is the referent) and various aspects of the mother-child relationship as reported by the mother.

Maternal Warmth Consistent Discipline Maternal Knowledge Maternal Involvement Mother-child Conflict
Est.[95% CI] Est.[95% CI] Est.[95% CI] Est.[95% CI] Est.[95% CI]
Time-varying Covariates
 Financial Hardship a −0.08 [−0.15, −0.02] −0.07 [−0.15, 0.00] −0.00 [−0.08, 0.08] −0.06 [−0.13, 0.03] 0.05 [−0.02, 0.12]
 Maternal Support a −0.02 [0.04, 0.00] −0.02 [−0.041, 0.00] −0.02 [−0.04, 0.00] 0.04 [0.01, 0.06] 0.03 [0.01, 0.05]
 Child Age a 0.03 [−0.01, 0.07] 0.04 [−0.01, 0.09] 0.01 [−0.05, 0.06] −0.02 [−0.08, 0.03] −0.05 [−0.10, 0.00]
Time-stable Covariates
 Maternal Disorder Status
  Substance Use Only −0.20 [−0.58, 0.19] −0.28 [−0.66, 0.10] −0.15 [−0.52, 0.23] 0.06 [−0.30, 0.42] 0.15 [−0.19, 0.49]
  Depression Only −0.25 [−0.49, −0.00] −0.25 [−0.49, −0.01] 0.05 [−0.18, 0.28] −0.13 [−0.36, 0.09] 0.35 [0.14, 0.55]
  Both Disorders −0.48 [−0.91, −0.06] −0.54 [−0.97, −0.14] −0.34 [−0.76, 0.06] −0.54 [−0.94, −0.15] 0.41 [0.03, 0.78]
 Male −0.11 [−0.29, 0.06] −0.14 [−0.31, 0.04] −0.18 [−0.35, −0.01] 0.04 [−0.13, 0.21] 0.08 [−0.08, 0.24]
 Black 0.04 [−.021, 0.30] −0.02 [−0.26, 0.23] −0.16 [−0.41, 0.08] 0.16 [−0.08, 0.39] −0.20 [−0.41, 0.02]
 White −0.20 [−.057, 0.16] −0.15 [−0.50, 0.19] −0.12 [−0.47, 0.23] 0.12 [−0.22, 0.46] 0.10 [−0.21, 0.41]
 Mixed Race −0.04 [−0.42, 0.35] −0.31 [−0.68, 0.06] −0.13 [−0.51, 0.23] −0.16 [−.052, 0.20] −0.05 [−0.38, 0.27]
 Birth Year a 0.02 [−0.00, 0.39] 0.01 [−0.01, 0.04] 0.02 [0.00, 0.04] 0.03[0.01, 0.05] −0.17 [−0.19, −0.14]
 Community Arrest Rate a −0.05 [−0.09, −0.00] −0.01 [−0.06, 0.04] 0.03 [−0.02, 0.07] −0.00 [−0.05, 0.04] −0.00 [−0.04, 0.04]
Variance .[95% CI] Variance .[95% CI] Variance .[95% CI] Variance .[95% CI] Variance .[95% CI]
Level 1 eij 0.29 [0.26, 0.32] 0.40 [0.36, 0.45] 0.47 [0.42, 0.53] 0.46 [0.41, 0.51] -
Level 2 μij 0.64 [0.54, 0.76] 0.53 [0.45, 0.66] 0.51 [0.42, 0.62] 0.47 [0.38, 0.58] 0.33 ]0.25, 0.44]
Level 1 N 991 983 999 996 936
Level 2 N 366 364 369 368 349
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Notes. The outcomes of mother-child warmth, consistent discipline, maternal knowledge, and involvement were exponentiated and then standardized prior to estimation. The outcome of mother-child conflict is a count variable and was estimated using a negative binomial distribution.

Abbreviations. Est. = estimate; CI = confidence interval; N = sample size

a

All non-binary covariates were grand mean centered.

Table 3 presents the results of the multilevel models examining the differences in various aspects of the mother-child relationship as reported by the child across maternal disorder status. Again, no history of either disorder serves as the referent status. Interestingly, no differences in child perceptions of warmth, consistency in discipline, involvement, and mother-child conflict emerge across maternal disorder status when these aspects of the mother-child relationship are reported by the child. However, perceived maternal knowledge was lower among children whose mothers had a history of substance abuse compared to mothers without a history of substance abuse or a depressive disorder (b=−.43, 95% CI [−.84, −.01]). Rotating the reference group for maternal disorder status failed to demonstrate additional differences between maternal disorder status groups and the various aspects of the mother-child relationship studied. Furthermore, none of the control variables demonstrated a consistent, significant effect on any aspect of the mother-child relationship as reported by the child. However, child birth year was related to three of the five aspects of the mother-child relationship as reported by the child –discipline, knowledge, and involvement - although not always in the same direction.

Table 3.

Multilevel models examining the relationship between maternal disorder status (no disorder status is the referent) and various aspects of the mother-child relationship as reported by the child.
Child Warmth Consistent Discipline Maternal Knowledge Maternal Involvement Mother-child Conflict
Est.[95% CI] Est.[95% CI] Est.[95% CI] Est.[95% CI] Est.[95% CI]
Time-varying Covariates
 Financial Hardship a −0.01 [−0.05, 0.03] −0.03 [−0.07, 0.02] 0.01 [−0.02, 00.04] −0.01 [−0.03, 0.02] 0.02 [−0.05, 0.09]
 Maternal Support a 0.00 [−0.01, 0.02] 0.00 [−.01, 0.02] −0.00 [−0.01, 0.01] 0.00 [−0.00, 0.01] 0.00 [−0.02, 0.02]
 Child Age a −0.00 [−0.03, 0.02] −0.01 [−0.03, 0.02] 0.00 [−0.01, 0.02] 0.01 [−0.01, 0.03] −0.00 [−0.05, 0.04]
Time-stable Covariates
 Maternal Disorder Status
  Substance Use Only −0.36 [−0.79, 0.06] −0.08 [−0.51, 0.35] −0.43 [−0.84, −0.01] −0.34 [−0.77, 0.09] 0.18 [−0.33, 0.70]
  Depression Only −0.03 [−0.30, 0.23] −0.06 [−0.33, 0.21] −0.17 [−0.43, 0.09] −0.03 [−0.30, 0.24] 0.29 [−0.36, 0.95]
  Both Disorders −0.05 [−0.52, 0.41] 0.03 [−0.44, 0.50] −0.31 [−0.76, 0.14] −0.18 [−0.64, 0.29] 0.01 [−0.55, 0.57]
 Male −0.06 [−0.25, 0.14] −0.12 [−0.32, 0.08] −0.21 [−0.41, −0.02] −0.13 [−0.32, 0.07] 0.06 [−0.14, 0.26]
 Black 0.16 [−0.11, 0.44] 0.05 [−0.23, 0.33] −0.06 [−0.33, 0.21] −0.02 [−0.30, 0.25] −0.33 [−0.61, −0.04]
 White −0.26 [−0.66, 0.13] 0.23 [−0.18, 0.63] −0.05 [−0.44, 0.34] −0.11 [−0.51, 0.29] −0.38 [−0.79, 0.03]
 Mixed Race 0.10 [−0.32, 0.52] 0.23 [−0.20, 0.66] −0.07 [−0.48, 0.35] −0.07 [−0.49, 0.36] −0.26 [−0.69, 0.16]
 Birth Year a −0.04 [−0.06, 0.02] 0.04 [0.01, 0.06] −0.08 [−0.10, −0.06] −0.08 [−0.10, 0.05] −0.01 [−0.03, 0.02]
 Community Arrest Rate a −0.02 [−0.08, 0.03] −0.05 [−0.11, −0.00] 0.02 [−0.03, 0.07] 0.01 [−0.04, 0.06] −0.02 [−0.07, 0.03]
Variance (SE) Variance (SE) Variance (SE) Variance (SE) Variance (SE)
Level 1 eij 0.09 [0.08, 0.10] 0.12 [0.11, 0.14] 0.04 [0.04, 0.05] 0.04 [0.04, 0.05] -
Level 2 μij 0.86 [0.74, 1.00] 0.87 [0.75, 1.02] 0.85 [0.73, 0.98] 0.89 [0.77, 1.04] 0.74 [0.58. 0.93]
Level 1 N 991 983 999 996 936
Level 2 N 366 364 369 368 349
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Notes. The outcomes of mother-child warmth, consistent discipline, maternal knowledge, and involvement were exponentiated and then standardized prior to estimation. The outcome of mother-child conflict is a count variable and was estimated using a negative binomial distribution.

Abbreviations. Est. = estimate; CI = confidence interval; N = sample size

a

All non-binary covariates were grand mean centered

Figure 1 assists in the interpretation of our estimated models. The top portion of Figure 1 depicts the distance between the predicted mean (in z-score units) and 95% CIs for maternal warmth, consistent discipline, maternal knowledge, and involvement across maternal disorder status. The grand mean (i.e., 0 since the outcomes were standardized) as reported by the mother and child, respectively, net of controls is also depicted. Notably, all of the 95% CIs for the mean of each aspect of the mother-child relationship as reported by the child includes 0, the grand mean for the sample. In addition, all of the 95% CIs around the predicted means overlap, indicating no significant differences in perceptions of each aspect of the mother-child relationship as reported by children across maternal disorder status. Alternatively, the 95% CIs for the predicted mean of warmth, consistent discipline, and involvement, do not include 0, indicating a significant difference in perceptions between mothers with a history of substance abuse and depression and the full sample and further implicating the relevance of comorbidity in relation to maternal perceptions of the mother-child relationship.

Figure 1. Standardized distance between the Predicted Mean and the Grand Mean (0 on the x-axis) for Positive and Negative Aspects of the Parent-child Relationship across Maternal Disorder Status Based on the Full Model Results.

Figure 1

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Note. Both the mother and the child had to report on the same behavior to be included in the analyses for each outcome (attachment: N=366, N*T=991; consistent discipline: N=364, N*T=983; maternal knowledge: N=369, N*T=999; involvement: N=368, N*T=996; and conflict: N=349, N*T=936).

The bottom portion of Figure 1 presents the predicted number of conflict items endorsed, as reported by the mother and child. For this aspect of the mother-child relationship, the 95% CIs around the predicted means overlap for each disorder status, but consistent with the previously reported results, the mean reported level of conflict as reported by the child is greatest among dyads where the mother only had a history of substance abuse and the mean as reported by the mother is greatest among dyads where the mother had a history of both substance abuse and a depressive disorder.

Discussion

This work investigated whether a lifetime history of a maternal substance abuse disorder is related to various aspects of the parent-child relationship (i.e., warmth, consistent discipline, maternal knowledge, involvement, and conflict) in late childhood among a predominantly Black and Hispanic sample of mother-child dyads, while accounting for a maternal history of depression. Our results indicate that a history of substance abuse alone appears to be unrelated to each of the studied aspects of the mother-child relationship as reported by the mother, but when a history of substance abuse co-occurred with a history of depression or mothers had a history of depression alone, lower levels of warmth, consistent discipline, and involvement and higher levels of mother-child conflict were reported by mothers. The suggested differences between mothers without a history of either substance abuse and depression and mothers with co-morbid substance abuse and depression is not altogether surprising given that comorbidity is known to worsen the course for individual disorders (National Institute on Drug Abuse, 2018), and Black women report greater adverse health consequences and poorer outcomes after treatment compared to white women when substance abuse co-occurs with a history of depression (Najt et al., 2011; Ransome et al., 2017).

On the other hand, maternal disorder status was unrelated to most aspects of the mother-child relationship as perceived by offspring. However, a history of substance abuse alone was related to lower levels of perceived maternal knowledge of child activities (compared to mothers who have no history of substance abuse or depression). This may be a function of perceived distraction/disinterest of the mother (perhaps due to ongoing substance use) or lack of communication with offspring due to lower wage employment opportunities that result from a history of substance abuse and require more time away from the child in order to generate needed income. Regardless of the mechanism, integrated treatment programs should work with women who have substance use problems to promote more attention to offspring. At a minimum, programs should stress parent-child communication because perceived parental knowledge is associated with a reduced likelihood of problem behavior among youth (Lippold et al., 2014), particularly urban, minority youth (Griffin et al., 2000).

The divergence in effects of maternal disorder status across mother and child reports is noteworthy and emphasizes the ongoing need to include multiple reporters in studies of the consequences of substance abuse. Both mother and child reports can and should be used to investigate the sequelae of maternal substance abuse (particularly when it co-occurs with a depressive disorder) on family functioning and offspring outcomes, as studies that are limited to one reporter (mother or child) will fail to elucidate the full impact of substance abuse, likely due to reporter bias. After all, differences in perceptions of the consequences of substance abuse are likely heightened in the context of substance abuse and co-occurring depression due to lower perceived self-efficacy and self-evaluations among those who suffer from these maladies (Connolly, Noel, & Mezo, 2017; Maddux & Meier, 1995), which may account for the significant findings among mothers with historical co-occurring disorders. Furthermore, efforts to utilize multiple reporters should also include observational reports of the parent-child relationship, if possible (e.g., parent-child conflict), in order to better explicate reporter bias and further understand the relationship between a maternal history of substance abuse, depression, and the parent-child relationship. This information could be useful to practitioners who work with mothers and attempt to address issues of self-esteem and negative maternal attitudes, which may be a perpetuating cause or symptom of substance use (Goodman et al., 1994) and depression (Sowislo & Orth, 2013).

Overall, the divergence in findings across reporter should not be interpreted as though maternal substance abuse and depression are likely unrelated to offspring development (via parent-child relationships). Burk & Laursen (2010) found that both the shared variance between maternal and child perceptions as well as the unique variance of maternal perceptions of the mother-child relationship were linked to child behavior problems. Substance abuse treatment programs should be attuned to the acute, ill effects of substance abuse on women’s current and future relationships, particularly among women with a history of depression, and substance abuse treatment should be integrated with mental health and parenting services to not only dampen the chronicity and persistence of substance abuse and depressive symptoms but also to provide women with the interpersonal and parenting skills needed to build positive relationships. Given the low rates of treatment for substance abuse and/or depression, particularly among Black and Hispanic women, primary and secondary programming for at-risk children could also acknowledge substance abuse and mood disorders among mothers and encourage maternal self-efficacy and positive mother-child relationships that will promote healthy development of youth.

The findings presented herein should be replicated, if possible, with studies that allow for greater causal inference in order to confirm the observed importance of a history of depression and co-morbid substance use and depressive disorder history for the mother-child relationship as reported by the mother and a history of substance use alone with respect to maternal knowledge as reported by the child. Regardless of whether the observed relationships in this work are causal, these findings suggest that mothers with a history of a substance abuse disorder and a depressive disorder perceive poorer mother-child relationships. As such, maternal substance abuse treatment programs that account for co-occurring or historical depressive disorders and target parenting practices, such as Mothering from the Inside Out (Suchman, 2016) are a potential avenue to provide these women with the skills needed to promote or improve relationships with their child(ren). In fact, this work specifies several aspects of the mother-child relationship that can be targets for intervention, including efforts to increase affection and warmth towards the child, conflict-resolution skills, consistent discipline practices, and greater involvement with offspring. Not only will this benefit maternal perceptions of the mother-child relationship, which are related to subsequent offspring development (Pastorelli et al., 2016), but it may also decrease maternal substance use, as parenting interventions are associated with lower rates of substance use among women (Moreland & McRae-Clark, 2018; Suchman et al., 2006).

This work demonstrates that a history of both maternal substance abuse and depression or depression alone is negatively related to various aspects of the mother-child relationship as perceived by the mother, among a sample of predominantly Black and Hispanic mother-child dyads originating from one urban jurisdiction in the United States. However, only children of mothers who had a history of substance use alone reported less positive aspects of the mother-child relationship in the form of maternal knowledge. Still, we urge caution when interpreting this work given our sample size, the prevalence of each disorder status, and the number of statistical tests employed. Furthermore, the generalizability of the findings to other locales and racial/ethnic groups is unknown. Notwithstanding these limitations, as well as our inability to determine causality and include a broader array of covariates that may be related to the parent-child relationship, this work identifies a target population and intervention targets in order to promote maternal and offspring well-being. Future work should build upon this effort and attempt to disentangle the timing of substance abuse and depression and its causal effects on various aspects of the mother-child relationship, as well as the relevance and timing of other mental illnesses, such as anxiety disorders, that are often comorbid with substance abuse. Although not possible with these data, these efforts would further inform treatment programming by speaking to whether the relationship between maternal substance abuse, mood disorders, and various aspects of the parent-child relationship is short-term in relation or whether it is lasting, implicating the need for follow-up efforts to continue to strengthen mother-child relationships even in the absence of ongoing substance abuse and/or depressive symptoms.

Funding:

Support for the Rochester Youth Development Study has been provided by the National Institute on Drug Abuse (R01DA020195, R01DA005512), the Office of Juvenile Justice and Delinquency Prevention (86-JN-CX-0007, 96-MU-FX-0014, 2004-MU-FX-0062), the National Science Foundation (SBR-9123299), and the National Institute of Mental Health (R01MH56486, R01MH63386). Technical assistance for this project was also provided by an NICHD grant (R24HD044943) to The Center for Social and Demographic Analysis at the University at Albany. Points of view or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the funding agencies.

Footnotes

Declaration of Interest.

No potential competing interest are reported by the authors.

Contributor Information

Megan Bears Augustyn, Department of Criminology and Criminal Justice, The University of Texas at San Antonio, 4.220 Durango Building, 501 W. Cesar Chavez Blvd., San Antonio, TX 78207.

Celia J. Fulco, Department of Psychology, Colorado State University, 117 Statistics Building, 1801 Campus Delivery, Fort Collins, CO 80523

Della Agkebe, Department of Psychology, Colorado State University, 117 Statistics Building, 1801 Campus Delivery, Fort Collins, CO 80523

Kimberly L. Henry, Department of Psychology, Colorado State University, Colorado School of Public Health, 117 Statistics Building, 1801 Campus Delivery, Fort Collins, CO 80523

Data Availability.

The data used in this research are available from the principal investigator of the Rochester Intergenerational Study and the University at Albany. Current efforts are underway to publish the data through ICPSR in line with funding requirements.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data used in this research are available from the principal investigator of the Rochester Intergenerational Study and the University at Albany. Current efforts are underway to publish the data through ICPSR in line with funding requirements.

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