Most popular posts of 2015 – #9 – Opiate-addicted Parents in Methadone Treatment: Long-term Recovery, Health and Family Relationships

LrgWord_FamilyI recently came across this 10 year follow-up of parents in methadone treatment and their children from 2011.

Here’s a review of their outcomes.

First, here’s their definition of recovery:

Recovery status was based on recent drug use, history of drug problems, and history of incarceration. Long-term recovery was defined as no recent drug use (self-report or urinalysis [UA]) and no drug problems or incarcerations for at least 10 years (LHC data). Moderate recovery was defined as no recent drug use and no history of drug problems or incarcerations in the past 5 years.

Here are the outcomes for their definition of recovery:

Of the 144 parents in the original study, 34 (24%) had died. Nineteen (13.2%) appeared to meet our criteria for recovery for at least 10 years. Another 14 (9.7%) met these criteria for 5 to 10 years. Ten (7%) could not be characterized on recovery because they could not be located or contacted. The remaining 46% of the original sample did not meet our criteria for recovery because they experienced continuous or intermittent drug use or incarceration.

If that definition of recovery is a little too muddy for you, here’s some of the data on drug use.

Of the parents who reported no drug problems in the past 10 years (n = 37), over a third (n = 16) self-reported using illegal drugs in the previous 30 days and did not consider this a problem. Forty-nine percent of parents interviewed reported some illegal drug use in the past 30 days

Did they stay in treatment over the 10 years?

Forty-one percent of the parents reported participating in some form of drug treatment every year, and 32% were in methadone treatment every year. Methadone treatment was intermittent for 43% of the sample.

What about criminal justice involvement?

Arrests and convictions were common (90% had some WA state criminal record in the past 10 years), and periods of incarceration over the last 10 years were reported by 54% of parents interviewed, compared to a lifetime prevalence rate of arrests in the United States of 3%.

Mortality?

Mortality among the addicted parents was high. Thirty-two (25%) of the 130 families experienced the death of the addicted parent, and in 2 cases both parents had died before the long-term follow-up interview (34 deaths total). For comparison, mortality in the general population of Washington State was 7.5% 25in 2005 and 14.8% among heroin users in the Seattle metropolitan area.

Mental health?

Mental health was also compromised. Forty-eight percent met DSM III criteria for a major depressive disorder in the last 10 years. . . .  Twenty-one percent felt their mental health was not good every day (mean days = 12.47, SD = 11.53). This is a high compared to the general population in Washington (mean days of mentally unhealthy days = 3.3).

Employment?

Unemployment was common. At the time of the interview, 52% reported no employment in the past year (55% of women and 40% of men, NS), compared to the unemployment rate for Washington State, which was 5.5% in 2005.29 Forty-one respondents (35 women, 6 men, NS) reported no time in the past 10 years in which they were employed more than 30 hrs/week for at least 9 months.

Stable housing?

Thirty-six percent reported at least one year in which they did not have a regular place to live. There were no differences by gender. Four parents reported being homeless during the entire 10-year period and were homeless at the time of the long-term follow-up interview. Parents in long-term recovery were less likely to report homelessness (5.3%) compared to those in shorter term recovery (35.7%) or those still using (44.8%, X2 = 10.0, p = .007).

The experience of the kids?

Overall, however, this study fills an important gap in the literature by providing a window into the lives of parents struggling with drug addiction. Our study shows similar negative long-term outcomes for opiate-addicted parents in methadone treatment as other studies have found for more general populations of drug addicts and methadone clients.

. . .

Very few of the children were doing well at the long-term follow-up. As previously reported,9 only 24% of the children met criteria for functional resilience by being constructively engaged in school or work, not having abused drugs, and avoiding criminal charges in the last 5 years.

Keep in mind that this is the treatment frequently referred to as the “most effective” treatment. You should ask, “Compared to what? And, as for what outcome measure?”

Further,  recent media coverage of the issue paints anyone who raises these kinds of questions as out-dated, moralistic, simple-minded and one-wayers. Some coverage comes close to implying that anyone who questions ORT is enabling overdose deaths.

I’m not saying a reasonable person could not reach a different position than I have. But, I have a hard time understanding how a reasonable person could be so certain that they try to dismiss, censor and discredit others by questioning their ethics, intelligence and motives.

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