Date of Award


Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Philosophy (PhD)


College of Graduate Studies

First Advisor

Charlene Pope

Second Advisor

Martina Mueller

Third Advisor

Gigi Smith

Fourth Advisor

Janet York


More than 8 million children in America live with at least one parent who is has a substance use disorder (SAMHSA, 2009). Parental substance use disorder (SUD) is a major risk factor for many adverse child health outcomes, including increased risks for child abuse and neglect, malnutrition, poorer academic performance, behavioral and emotional problems, and child substance use disorders (DHHS, 2009). These findings, coupled with a national economic impact of illegal drug use estimated at $193 billion (SAMHSA, 2011) support the need for effective parenting interventions that promote drug abstinence and long-term recovery for parents with SUD. Many recovering parents face overwhelming personal and environmental stressors when attempting to transition back into the parenting role from active addiction. Family dynamics and parenting relationships often suffer during and after the recovery process due to loss of income, the inability to support family, child custody disputes, fractured trust in the relationship, and loss of effective parental engagement and modeling behaviors with the child (Skinner et al, 2011). Health promotion for these parents would need to target personal and socioecological factors that foster perceived parenting capabilities (parental self-efficacy), parenting behaviors, and sobriety during recovery (Raynor, 2013). Evidence strongly links parental self-efficacy (PSE) to parenting behaviors and child health outcomes (Coleman & Karraker, 2000; Sevigny & Loutzenhiser, 2010; Shumow & Lomax, 2002). PSE is one‘s personal belief in their ability to parent effectively (Coleman & Karraker, 2000). Higher PSE levels are generally associated with better parent and child health outcomes, whereas lower PSE levels are strongly associated with poorer parent and child health outcomes (Coleman & Karraker, 2000; Jones & Prinz, 2005). Parenting challenges, coupled with low PSE levels and ineffective coping, may be a powerful trigger for return to drug use (Raynor, 2013). Many experts agree that drug misuse is generally a result of inadequate attempts to deal with personal and environmental stressors (Jaremko, Sterling, & Van Bockstaele, 2015; Amlung & Mackillop, 2014; Skinner, Haggerty, Fleming, Catalano, & Gainey, 2011). Lack of stress modifiers such as self-care behaviors (SCB) can increase vulnerability to substance use for recovering parents (Lucock, et al., 2011). Taking care of ―self‖ (i.e. SCB) in a way that facilitates better health outcomes in parental recovery may be a critical component to effectively parenting one‘s children (Cederbaum, Guerrero, Barman-Adhikari, &Vincent, 2015; Shambley-Ebron & Boyle, 2006). Limited research explores the relationship of SCB, PSE and parenting behaviors within the context of parental recovery from SUD (Raynor, 2013). Interventions have primarily focused on drug abstinence without a specific focus on the parenting role (Nichols & al, 2012). Although prior studies link individual stress and coping to substance misuse (National Institute on Drug Abuse, 2015), and studies show positive long-term effects of integrating resilience building measures in family-focused interventions to improve child outcomes (Kumpfer et al, 2010), few studies describe the relationship of SCB on PSE and parenting behaviors for parents in recovery, as a basis to improve parenting interventions to facilitate long term recovery. This dissertation explores SCB and parenting outcomes (e.g. PSE, resilience, and parenting behaviors) for adult individuals in recovery from SUD. Specifically, the following research questions were addressed in this dissertation: 1) Guided by the social ecological model (SEM), what are the contextual factors that influence parental self-efficacy (PSE) for parents recovering from substance use disorders? 2) In the context of a policy analysis that examined constructs of social justice, how does identified legislation (that effect governmental assistance for children in response to parents‘ substance misuse) impact child outcomes? 3) How does the existing literature describe, conceptualize, and measure self-care behaviors (SCB) for parents in the general population for its application to parents with a history of SUD? 4) What are the quantitative findings from an observational mixed-methods feasibility study that explored associations of self-care to parenting outcomes for adults who are in recovery from SUD? and 5) Applying constructivist grounded theory, what are the perceptions of self-care, community supports, and parenting for adult individuals in recovery from SUD? This body of work provides deeper understanding about parenting in the context of recovery from SUD and highlights the need to further explore the role of SCB in parenting and recovery outcomes for mothers and fathers in early recovery. Lastly, examination of self-care, resilience, PSE, and parenting behaviors for adult individuals in recovery from SUD is feasible although there were recruitment and scheduling challenges identified in the study findings. Establishing feasibility and acquiring estimates of outcome variability provide preliminary evidence for larger scale randomized controlled trials to examine various self-care interventions and their effect on parenting and sustained recovery outcomes for mothers and fathers in early recovery. Future research will need to explore the extent to which different types of SCB influence parenting and recovery outcomes by gender. Also more research should explore the unique experiences of minorities and health disparities in long-term recovery. This dissertation is useful for administrators, researchers, mental health providers, and health policy makers because it provides fundamental information regarding the role of self-care, described self-care behaviors, and preferred supports for high-risk parents in early recovery from SUD. The findings underscore the perceived importance of self-care to parenting and recovery outcomes for adult mothers and fathers who are recovering from SUD while parenting in the home environment. Improving the efficacy of treatment services for parents in recovery may require acknowledging the strengths inherent in parents‘ individualized self-care strategies and preferred supports to improve their own and their children‘s well-being, especially when parental recovery is jeopardized by complex personal and socioecological factors.


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