Maternal Substance Abuse may increase Abuse Risk in Children

 Exposure to a maternal, but not paternal, substance use disorder (SUD) may increase the risk for a subsequent SUD in offspring, new research suggests.

A long-term study of more than 500 mostly female individuals showed that a maternal, but not paternal, SUD was significantly associated with an SUD in study participants.

Although not statistically significant, there was also a trend for an increase in SUD risk when the exposure to parental SUD occurred during the offspring’s preadolescent years compared with the offspring’s preschool or adolescent years.

“Parental substance use exposure is a potentially modifiable risk factor for kids,” lead author Amy M. Yule, MD, from the Clinical Research Program in Pediatric Psychopharmacology at Massachusetts General Hospital in Boston, told Medscape Medical News.

“There are a lot of things you can’t modify, such as genetics. But this exposure from family is something that can be changed,” said Dr. Yule.

She noted that the study’s main take-home message is for clinicians to not only assess whether or not parents are using drugs but to also provide education.

“It’s important to tell them that they can change their child’s risk of having a use disorder by changing their own patterns of behavior.”

The findings were presented here at the American Academy of Addiction Psychiatry (AAAP) 22nd Annual Meeting & Symposium.

11-Year Follow-up

The original case-control family study included 2 groups of girls between the ages of 6 and 17 years who did (n = 140) or did not (n = 122) have a clinical diagnosis of attention-deficit/hyperactivity disorder (ADHD).

The group with ADHD had 157 biological siblings and 134 parents, whereas the group without ADHD had 133 siblings and 104 parents. Psychopathology and substance use were assessed for all subjects and their family members using structured psychiatric interviews.

For the current analysis, the investigators examined data on 532 of the total offspring (68% female) from baseline through the 11-year follow-up period.

The mean age of the offspring at the end of the follow-up period was 21.2 years (± 4.84).

Results showed that 33% of the parents had an SUD at baseline, 17% had a drug use disorder, and 26% had an alcohol use disorder. At the end of the 11-year follow-up, 31% of the offspring had an SUD of any type.

Maternal SUD exposure was significantly associated with the development of SUD in offspring (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.10 – 13.53; P = .03). This association was independent of ADHD diagnosis, familial risk, and socioeconomic status.

Paternal SUD exposure was not a significant risk factor for SUD development, and having ADHD did not significantly affect either paternal or maternal exposure as an SUD risk factor.

Exposure to parental SUD during latency was found to increase risk for SUD in offspring compared with exposure during preschool or adolescence, but it was not deemed significant (P = .06).

Larger Sample Needed

However, parental alcohol use disorders (either maternal or paternal) was significantly associated with subsequent offspring alcohol use disorders (OR, 2.29; P = .04).

In addition, independent of exposure to parental SUD, ADHD predicted both alcohol use disorders (OR, 1.65; P = .03) and drug use disorders (OR, 1.61; P = .02).

Study limitations included the fact that it used retrospective and subjective SUD reporting by offspring and that parental SUD status was assessed only at baseline.

“The literature is definitely mixed in terms of maternal vs paternal exposures, and whether it really matters. But moms are in the position of doing a little more of the child rearing. And for girls, especially, interpersonal relationships have a bigger impact on their risk of developing a substance disorder. So we can make sense of our findings in those ways,” said Dr. Yule.

“But if we had a larger sample, it would be interesting to see if the paternal exposure would then come through as a significant risk factor,” she added. 

Family Ties Important

“I thought this was an interesting population on how children are affected by their parents’ substance use,” Julie Van der Feen, MD, child and adolescent psychiatrist and medical director of the 2E Adolescent Residential Treatment Programs at McLean Hospital in Belmont, Massachusetts, told us.

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Dr. Van der Feen, who was not involved with this research, noted that the study reinforces the fact that clinicians need to screen for SUDs in parents, especially because that is something that can be passed down to their offspring.

“I think the key finding is when you have a patient, whether it’s an adolescent or it’s a parent, it’s important to look at the other members of the family and to look at the history of substance use. It’s often found across generations throughout a family, and you really need to keep track of all the different people involved,” she said.

“I also think it’s important that parents get the message that their use affects their children. And they need to start looking at prevention in general and keeping a close eye on their children, and making sure there’s family connectedness.”

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