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! Parental!Substance!Use,!Family!Support!and!Outcome!Following!Treatment!for!Adolescent! Psychoactive!Substance!Use!Disorders!! ! ! Author&

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! Stephen!D.!Whitney,!John!F.!Kelly,!Mark!G.!Myers,!&!Sandra!A.!Brown!! ! ! Citation&
Below&please&cite&this&resource&in&APA&style.&For&guidance&on&citation&format,&please&visit& http://owl.english.purdue.edu/owl/resource/560/01/&

! Stephen!D.!Whitney!MS!,!John!F.!Kelly!PhD!,!Mark!G.!Myers!PhD!&!Sandra!A.!Brown!PhD! ! (2002):!Parental!Substance!Use,!Family!Support!and!Outcome!Following!Treatment! ! for!Adolescent!Psychoactive!Substance!Use!Disorders,!Journal!of!Child!&!Adolescent! ! Substance!Abuse,!11:4,!67:81!! ! ! Summary&

Below&please&provide&a&brief&summary&of&this&resource.&If&an&abstract&is&available,&feel&free&to&copy&and&paste&it&here.&

! ! Families!are!found!to!play!an!important!role!in!adolescent!substance!abuse.!This! study!examined!family!variables!that!may!influence!adolescent!substance!use!during!the!6! months!following!inpatient!treatment:!(1)!parental!substance!use;!(2)!family!aftercare! attendance;!and,!(3)!adolescent!ratings!of!family!helpfulness.!It!was!hypothesized!that!the! effects!of!parental!substance!use!on!adolescent!use!would!be!mediated!by!family!aftercare! attendance!and!family!helpfulness!ratings.!Adolescent!inpatients!(N!=!103;!M"age!=!16)! were!assessed!during!treatment!and!6!months!later.!Results!revealed!no!relationship! between!either!parental!substance!use!and!family!aftercare!attendance!or!reports!of!family! helpfulness.!More!frequent!family!aftercare!attendance!and!higher!ratings!of!!

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!!!!!!!!!!!!!!!!!!!!!!!!!!P.!O.!Box!6448!!Reno,!NV!89513!!Phone:!760:815:3515!!staciemathewson@me.com! !

This article was downloaded by: [Kay Israelite] On: 16 January 2013, At: 13:06 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Child & Adolescent Substance Abuse

Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wcas20

Parental Substance Use, Family Support and Outcome Following Treatment for Adolescent Psychoactive Substance Use Disorders
Stephen D. Whitney MS , John F. Kelly PhD , Mark G. Myers PhD & Sandra A. Brown PhD
a b c a b c c

University of Washington University of California, San Diego/San Diego State University Joint Doctoral Program

Veterans Affairs San Diego Healthcare System and University of California, San Diego Version of record first published: 15 Oct 2008. To cite this article: Stephen D. Whitney MS , John F. Kelly PhD , Mark G. Myers PhD & Sandra A. Brown PhD (2002): Parental Substance Use, Family Support and Outcome Following Treatment for Adolescent Psychoactive Substance Use Disorders, Journal of Child & Adolescent Substance Abuse, 11:4, 67-81 To link to this article: http://dx.doi.org/10.1300/J029v11n04_04

PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

Parental Substance Use, Family Support and Outcome Following Treatment for Adolescent Psychoactive Substance Use Disorders
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Stephen D. Whitney John F. Kelly Mark G. Myers Sandra A. Brown

ABSTRACT. Families are found to play an important role in adolescent substance abuse. This study examined family variables that may influence adolescent substance use during the 6 months following inpatient treatment: (1) parental substance use; (2) family aftercare attendance; and, (3) adolescent ratings of family helpfulness. It was hypothesized that the effects of parental substance use on adolescent use would be mediated by family aftercare attendance and family helpfulness ratings. Adolescent inpatients (N = 103; M age = 16) were assessed during treatment and 6 months later. Results revealed no relationship between either parental substance use and family aftercare attendance or reports of family helpfulness. More frequent family aftercare attendance and higher ratings of
Stephen D. Whitney, MS, is affiliated with the University of Washington. John F. Kelly, PhD, is affiliated with the University of California, San Diego/San Diego State University Joint Doctoral Program. Mark G. Myers, PhD, and Sandra A. Brown, PhD, are affiliated with the Veterans Affairs San Diego Healthcare System and University of California, San Diego. Address correspondence to: Mark Myers, PhD, Psychology 116B, V.A. Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161 (E-mail: mgmyers@ucsd.edu). This study was supported by grants from the National Institute on Drug Abuse (R29DA-09181), the National Institute on Alcohol Abuse and Alcoholism (R01AA-07033), and the Research Service of the Department of Veterans Affairs. Journal of Child & Adolescent Substance Abuse, Vol. 11(4) 2002 http://www.haworthpressinc.com/store/product.asp?sku=J029 2002 by The Haworth Press, Inc. All rights reserved.

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Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com> 2002 by The Haworth Press, Inc. All rights reserved.]

helpfulness were associated with less adolescent use during follow-up. Findings highlight the importance of family behaviors on adolescent substance abuse treatment outcome. [Article copies available for a fee from The

KEYWORDS. Adolescent, substance abuse, family treatment, family support

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INTRODUCTION The role of parents has received extensive theoretical and empirical attention with regard to adolescent substance abuse. Banduras social-cognitive-learning theory (1992) posits interacting determinants of human behavior which include intra-personal factors (e.g., beliefs, expectancies, attitudes, and temperament) as well as environmental or contextual factors (e.g., familial and social). The behaviors of others with whom an individual interacts are perceived as important determinants of behavior. Subsequently, parental attitudes and behaviors are expected to have considerable impact on the behavior of their offspring following substance abuse treatment. Indeed, parental and family functioning has been strongly associated with both adolescent substance use and abuse. A study by Stewart and Brown (1993) revealed that long-term improvement in adolescent substance use problems following inpatient treatment was associated with improvement in their families overall level of functioning. Barrett, Simpson, and Lehman (1988) found that family support (family communication of love and positive reinforcement) was related to reductions in problem behaviors (drug and alcohol use, school problems, and legal involvement) during the first three months following treatment. In a large study (N = 2,317 adolescents) conducted by Hsieh, Hoffemann and Hollister (1998) greater parental involvement in treatment, measured in terms of parental attendance at Alanon/Alateen meetings, was found to be associated with higher rates of abstinence during the 6-months after treatment. From a social-learning theory perspective, two parental behaviors particularly relevant to increasing the likelihood of salutary changes in adolescent substance use behavior following treatment include parental alcohol and other drug use and parental involvement in aftercare treat-

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ment (a critical component of the continuum of care in most treatment programs). For example, a study by Brown, Mott, and Myers (1990) revealed that an important correlate of successful outcome for adolescents following treatment was pre-treatment exposure to alcohol abusing models in the family. This issue is particularly salient since studies of adolescents treated for substance use disorders reveal that they most often come from families with a history of substance abuse (Stewart & Brown, 1993). Given the importance of contextual factors for substance abusing youth, parents who use or abuse substances may inadvertently model and reinforce substance use behavior in their offspring who are attempting to make changes in this regard. Furthermore, parents who use or abuse alcohol and/or other drugs may not be able to effectively monitor their adolescents behavior. They also may not be able or willing to provide instrumental or emotional support to their children who are attempting to abstain from alcohol and other drugs. Furthermore, because of the focus on abstention from alcohol and other drug use at aftercare meetings, these same parents may be less likely to attend. Given theoretical explications and empirical support with regard to the important influence of parental behaviors on adolescent substance use following treatment, these parents may miss out on the education and support such groups provide. Subsequently, they may lack the knowledge and skills necessary to prepare for, facilitate, and adjust to changes in their adolescent. While prior research has suggested that both parental aftercare attendance and parental alcohol and drug use are related to adolescent substance use treatment outcome (e.g., Brown, 1993; Stewart & Brown, 1993; Hsieh, Hoffmann, & Hollister, 1998), the mechanisms through which such parental behavior operates remains unclear. One potential mechanism may be that adolescents view parents who use/abuse substances and/or do not attend aftercare meetings as being less helpful in their efforts to abstain from alcohol and other drugs. This perceived lack of support may arouse negative feelings (e.g., loneliness and neglect) affecting adolescent self-esteem and identity. Adolescents may try to counter these negative feelings by reconnecting with their substance-using peers, who provide surrogate support and attention, resulting ultimately in a return to substance use. Negative affect has been implicated as a significant factor in both adult and adolescent relapse (Mckay, 1999; Greenfield, Weiss, Muenz, Vagge, Kelly, Bello, & Michael, 1998; Brown, Myers, Mott, & Vik, 1994; Marlatt & Gordon, 1985). Several studies have found that greater parental support toward adolescents is associated with later onset or no initial adolescent illicit

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substance use (Stice & Barrera, 1995; Anderson & Henry, 1994; Stice, Barrera & Chassin, 1993), but studies examining mechanisms through which such effects occur are lacking. The current study examines further the relationship between these variables and their influence on adolescent post-treatment substance use. It is predicted that greater parental substance use in the first 6 months post-treatment will be associated with more adolescent substance use in the same period. Also, greater parental substance use will be associated with less attendance by family members at aftercare meetings, which, in turn, will result in more adolescent substance use post-treatment. It also hypothesized that the effects of parental aftercare attendance and parental alcohol and drug use on adolescent substance use outcome will be mediated by adolescent perceptions of helpfulness (see Figure 1). METHOD Setting and Sample Participants (N = 103) were recruited from two private inpatient substance abuse treatment programs in metropolitan San Diego, California. The treatment facilities are based broadly on a Minnesota Model framework. A standard recommendation for treatment participants is that they and their families attend aftercare sessions at the treatment facility for education and support. Participants learn about substance abuse and the recovery process and they are also given the chance to express their own individual concerns and problems. Meetings last about one hour and are conducted weekly. Adolescents were recruited into the study if they met criteria for a psychoactive substance abuse or dependence diagnosis in accordance with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Press, 1994). Diagnoses were determined by structured interview using the Customary Drinking and Drug Use Record (CDDR; Brown, Myers, Lippke, Tapert, Stewart & Vik, 1998). Other eligibility criteria were: (1) the participation of a resource person who could provide corroborative information; (2) adequate ability to understand and comprehend the measures; (3) participants lived within 50 miles of the research facility; (4) no history of psychotic symptoms, independent of substance use; (5) between the ages of 14 and 18. Originally, a total of 181 subjects were eligible to participate in the current study. Of these, 42 (23%) withdrew or were unable to be con-

Whitney et al. FIGURE 1. Model of hypothesized relationships.

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Parental Alcohol/Drug Use

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Adolescent Perception of Family Helpfulness

Adolescent Substance Use Outcome

Parental Aftercare Attendance

tacted at the follow-up time-points leaving a total of 139 (77% of original sample). Thirty-six further cases were excluded due to missing data on at least one study variable at one of the time points. Univariate analyses were conducted to examine any systematic differences between included and excluded cases. Results revealed no significant differences between included and excluded cases on baseline measures of age, gender, ethnicity, number of days in inpatient treatment, substance use problem severity, or baseline frequency of substance use (ps > .33; see Table 1). The average age of the sample was approximately 16 years old (M = 15.79, SD = 1.09, range 14-18) and just over half were female (60.2%). The sample consisted primarily of white participants, but consisted of a substantial proportion of Hispanics (72% white, 20 % Hispanic, 8% other). Procedure Participants were recruited during inpatient treatment if parent and adolescent consented to the adolescents participation. Initial interviews and baseline measures of substance involvement and related behaviors were administered during hospitalization by trained masters-level and bachelors-level interviewers. The three month follow-up interviews were conducted by telephone while the 6 month interviews were com-

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TABLE 1. Comparison of baseline variables for included (N = 103) and excluded (N = 78) cases.
Comparison Variables Age Substance use problem severity Days abstinent at intake Days in inpatient treatment Included Cases 15.79 (1.09) 60.3 (16.42) 9.79 (9.7) 12.58 (9.01) White Hispanic Other Gender Male Female
Note: Cell ns vary due to missing data All comparisons not significant

Excluded Cases Mean (SD) 15.79 (1.17) 61.5 (16.81) 12.85 (10.35) 12.58 (9.37) Percent 72% 20% 8% 40% 60% White Hispanic Other Male Female 67% 18% 15% 53% 47%

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Ethnicity

pleted in person. Participants were paid $15 for the 3 month interview and $25 for the six month interview. Corroborative resource-persons (usually parents) were interviewed in the same way. Information from the two sources were compared and combined through detailed discussions during weekly meetings with the Principal Investigator and research personnel. This process resolved discrepant information and helped researchers determine the most accurate estimate of reported behaviors. This same format was used at the 3 month and 6 month follow up points. Also, to enhance reporting of substance use involvement during the follow-up period, saliva test strips (Alcostrip) were administered to detect recent use of alcohol, and urine samples for drug toxicology were obtained in cases where the adolescent denied any substance use during the follow-up period. Measures Demographics Background information regarding age, ethnicity and gender were recorded using the Structured Clinical Interview for Adolescents (Brown, 1987). Substance Involvement Substance use frequency during the preceding 90 days (30 days at baseline) was measured using the Timeline Follow Back (TLFB) proce-

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dure (Sobell & Sobell, 1992) adapted for multiple substances. Substance use problem severity was measured using the Personal Involvement Scale of the Personal Experiences Inventory (PEI; Winters, Stinchfield & Henly, 1993). This scale measures severity of substance involvement, has been shown to have excellent internal consistency, as well as good construct and criterion validity for youth (Winters, Stinchfield & Henly, 1993). Reliability analysis with the current sample also revealed a high internal consistency (Cronbachs alpha = .94). Family Helpfulness
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Adolescents report of family helpfulness in their recovery efforts was obtained using the Structured Clinical Interview for Adolescents (Brown, 1987). Subjects were asked to rate, on a 1-100 scale (100 = extremely helpful), how helpful their families had been in their efforts to stay clean and sober at three and six months following discharge from treatment. Parental Drug and Alcohol Use Adolescents report of parental drug and alcohol use was obtained using the Structured Clinical Interview for Adolescents (Brown, 1987). Subjects were asked to rate how much their mothers and fathers were drinking and using drugs, and if their parents use increased or decreased during the six months post-discharge. Parental alcohol and drug and other drug use was classified using Cisin and Cahalan (1968) categories of: (1) nondrinker, (2) infrequent or occasional drinker, (3) moderate or social drinker, or (4) heavy or alcoholic. Parents drug use was similarly rated: (1) non-drug user, (2) infrequent or occasional user, (3) sporadic heavy and intermittent user, (4) problem drug user. These ratings were compared with parent self report of substance use, and coded to reflect both sources of information. Aftercare Participation The frequency of family members attendance in aftercare was assessed using the Structured Clinical Interview for Adolescents and Parents (Brown, 1987) at the 6 month time period. Independent self-reported estimates were obtained from parents and adolescents and, where discrepancies occurred, the most conservative estimates (i.e., lowest) were recorded during weekly meetings with the Principal Investigator and research personnel.

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RESULTS Preliminary Analyses Variables were initially examined with regard to their distributional qualities. Three variables had an undesirably large skew: number of aftercare meetings family members attended, and number of days adolescents were abstinent both at 3 and 6 months after treatment. Because these variables were not adequately normalized by linear transformations they were subsequently categorized to facilitate inferential analyses. Number of aftercare meetings family members attended was grouped into four categories: No attendance (n = 35, 34%), Less than monthly (n = 19, 18%), At least once per month, but less than weekly (n = 38, 37%) and, weekly or more (n = 11, 11%). Post-treatment frequency of alcohol and other drug use by adolescents was categorized into three groups: 1 = major relapsers (participants used more than twice a week, on average); 2 = minor relapsers (participants who used no more than twice a week on average, and 3 = abstainers. Previous investigations have demonstrated the empirical and clinical utility of this trichotomous outcome classification system (for details see Brown, Vik, & Creamer, 1989; Brown et al., 1994). To control for possible substance use and treatment experience confounds with substance use outcome at follow-up, univariate analyses were conducted. Frequency of substance use prior to treatment entry was not related to post-treatment use during either the first (r = .15, p = 12), or second (r = .10, p = 34) follow-up periods, or in relation to the entire six month follow-up period (r = .07, p = 49). Duration of inpatient stay produced a significant trend in relation to the first follow-up period (r = .17, p = .09), was not related to substance use outcome during the second follow-up period (r = .15, p = 14), but was significantly related to substance use outcome during the entire six month period (r = .22, p = .03) and was thus retained as a control variable for the relevant analyses. Rates of Pre/Post-Treatment Use Participants were found to use substances on 32.6% of days in the past 30 days at treatment intake (M = 9.79, SD = 9.70). Just over a quarter (29%) of adolescents reported complete abstinence from alcohol and other drugs during the first three months, and were abstinent an average of 87% of days (M = 78.28, SD = 20.57). At 6 month follow-up point slightly over a quarter (29%) reported complete abstinence, and the subjects were abstinent on average 76% of days (M = 68.19; SD = 29.24)

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during the preceding 3 months. Thus, although complete abstinence from alcohol and other drugs was achieved by only a quarter of the subjects, a large reduction in substance involvement occurred during the 6 months after treatment. Tests of the Mediating Model According to Baron and Kenny (1986), it is necessary that the independent variable (IV; parental alcohol and/or drug use) predicts the dependent variable (DV; adolescent substance use outcome), the IV predicts the mediational variables (adolescent perception of family helpfulness and parental aftercare attendance) and the mediational variable predicts the DV in order to establish mediation. Finally, when the effect of the mediator(s) is/are controlled the relationship between the IV and DV is significantly reduced. Spearman rank order correlational analyses were performed to assess the interrelations between these variables (see Table 2). Results revealed no relationship between either parental alcohol use and adolescent substance use outcome ( = .01, p = .96), or parental drug use and adolescent substance use outcome ( = .14, p = .17) during the 6 month follow-up (controlling for length of inpatient stay). Neither parental alcohol use nor drug use was associated with family attendance at aftercare meetings ( = .01, p = .93, and = .08, p = .45, respectively). With regard to adolescent perceptions of family helpfulness, parental use of alcohol ( = .08, p = .94), drugs ( = .12, p = .24) and family aftercare attendance ( = .02, p = .88) were not found to be significantly related. The lack of significant relations between these variables precluded any further testing of the mediational hypothesis (Baron & Kenny, 1986). The measure of family helpfulness at 3 months post-discharge was examined with regard to its relationship to substance use outcome in the following 3 months (i.e., months 4-6). A one way analysis of variance (ANOVA) revealed a significant relationship between ratings of family helpfulness and days abstinent (F (2, 100) = 6.21, p = .003). However, a Levenes test of the group variances revealed a violation of the assumption of homogeneity (Levene = 4.35, p = .02). Heterogeneity of variance combined with unequal ns in the outcome groups (as was the case herein) has been shown to significantly inflate type I error rates with a standard parametric ANOVA (Clinch & Keselman, 1982). Consequently, a confirmatory analysis was undertaken using a Welchs W procedurea parametric modification to the standard ANOVA, which is robust to violations of the ho-

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TABLE 2. Spearman rank order correlational () relationships between variables.

1 1. Parental use of alcohol 2. Parental use of drugs 3. Family aftercare attendance 4. Family helpfulness 1 to 3 months 5. Family helpfulness 4 to 6 months .12 .01 .08 .03 .08 .08 .02

2 .08 .12 .02 .14 .13 .14

.02 .03 .14 .14 .23*

.32** .21* .33** .30**

.25* .36** .36** .48** .67** .84** -

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6. Days abstinent 1 to 3 months 7. Days abstinent 4 to 6 months 8. Days abstinent 1 to 6 months

** Correlation is significant at the 0.01 level (2-tailed) * Correlation is significant at the 0.05 level (2-tailed) N = 103

mogeneity assumption with unequal ns (Welch, 1951). The analysis confirmed the original result (Welchs W (2, 61.1)1 = 6.23, p = .003); adolescents who were abstainers rated family helpfulness higher (M = 82.7, SD = 29.1; n = 28) than adolescents who were minor relapsers (M = 66.4, SD = 32.1; n = 44) or major relapsers (M = 51.4, SD = 39.7; n = 31). Similarly, a standard parametric ANOVA test of adolescent ratings of family helpfulness at six months in relation to substance use outcome over the entire six month follow-up period revealed significant group differences (F (2, 100) = 8.63, p < .001) but was found to have both unequal ns and heterogeneity of variance (Levene = 17.41, p < .001). Subsequent analysis using Welchs modified parametric procedure confirmed the original finding (Welchs W (2, 52.5) = 21.64, p < .001): Adolescents who were abstainers rated family helpfulness higher (M = 91.7, SD = 13.58, n = 15) than adolescents who were minor relapsers (M = 63.2, SD = 37.9, n = 61) or major relapsers (M = 43.11, SD = 41.2, n = 27). Finally, correlational analysis revealed that more frequent aftercare meeting attendance by families was associated with more days abstinent during the 6 month follow-up period (controlling for duration of inpatient stay; = .25, p = .01; see Figure 2). DISCUSSION The current study examined the relationship between post-treatment parental alcohol and drug use with regard to adolescent substance use

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outcomes during the 6 months following inpatient treatment. Adolescent ratings of family helpfulness and family attendance at aftercare meetings were evaluated as potential mediators of this relationship. Although no relationship was observed between post-treatment parental substance use and adolescent substance use outcome following treatment, family helpfulness and family attendance at aftercare meetings were associated with post-treatment substance use. Higher ratings of family helpfulness at the 3 months and 6 months post treatment were associated with lower levels of adolescent drug and alcohol use during the follow-up periods. Although it is difficult to determine the direction of this relationship (i.e., whether less adolescent substance use causes families to be perceived as more helpful or whether greater perceived helpfulness causes less adolescent substance use), the observed relation between these variables is similar to results reported in Brown, Myers, Mott, and Vik (1994), who discovered that improvement in family functioning was also associated with reductions in adolescent substance use. The hypothesis that attendance at treatment aftercare meetings would be positively related to adolescent outcome over the six month time period was supported by the present study. A prior study by Stewart and Brown (1993) found that improved family cohesion and expressiveness were related to youth improvements following treatment for substance abuse. It may be that parental aftercare meeting attendance is one factor responsible in helping facilitate these changes in family dynamics. Information obtained at these meetings regarding the recovery process may lead to more realistic expectations about, and adaptive ways of coping with, the focal adolescent, which, in turn, may reduce the likelihood of adolescent substance use. A related treatment finding was that a longer inpatient stay was uniquely associated with improved substance use outcomes during the six month follow up period. This is in keeping with other research, which has found similar positive linear associations between length of treatment and post-treatment substance use (e.g., Drug Abuse Treatment Outcome Study [DATOS], Anglin, Hser, & Grelle, 1997). Although both attendance at aftercare meetings and perceived family helpfulness were related to adolescent outcome, these two variables were not interrelated. This suggests that adolescents did not perceive their families attendance at aftercare meetings as helpful in their efforts to stay abstinent. This may be due to several factors. First, the lack of a relationship between family attendance at aftercare meetings and perceived family helpfulness may be due to adolescents perception that

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FIGURE 2. Categories of families attending aftercare with adolescent outcome during 6 months following treatment.

100% 90%

Proportion of Families Attending Aftercare

80% 70% 60% 50% 40% 30% 20% 10% 0% Abstainers Minor Relapse Category Major

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None
Less than monthly At least weekly Weekly or more

family attendance at aftercare meetings is not related to their own efforts to abstain. Second, parental aftercare attendance may lead to global changes in family functioning or parental attitudes that are not perceived by the adolescent as being specifically helpful to their efforts in abstaining from drugs and alcohol. More detailed studies are needed to determine specifically which aspects of parental and familial behavior these youth perceive as helpful in their efforts to stay abstinent. Such knowledge could lead to more focused and perhaps more effective recommendations for parents and families of substance abusing youth. Contrary to expectations, no relationship was found between parental drug and alcohol use and the other three variables of interest: family helpfulness, aftercare attendance or adolescent post-treatment outcome. The restricted range of parental substance use values, which included only a small proportion of heavy drinking or alcoholic parents (7%) and a large proportion of parents who did not use any drugs (96%), combined with the limited sample size, may have yielded insufficient power to detect effects. Examinations of this relationship in a larger, more homogenous sample may reveal different findings.

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For several reasons, the current findings must be interpreted carefully. The relatively small sample size may mean that current effect size estimates do not truly reflect population parameters. Also, the dropout rate and missing data lead to concerns regarding generalizability. However, these concerns are ameliorated by a failure to find any systematic differences on important baseline variables. There are several clinical implications from the findings of this study. First, aftercare is typically prescribed for parents who have adolescents entering drug and alcohol counseling. The results of this study support this prescription, suggesting parents should be encouraged to attend such meetings. Second, family dynamics and related adolescent perceptions of family helpfulness may have an important impact on adolescent substance use behavior following treatment. Further study is needed to reveal which specific parental behaviors are perceived by adolescents as supportive of their efforts to overcome alcohol and drug abuse. In summary, the present findings indicate that family attendance at aftercare meetings and greater adolescent perception of family helpfulness are associated with lower rates of post-treatment substance involvement for adolescents. These results reinforce the important role of the family in outcome following treatment for adolescent substance abuse and emphasize the value of providing parents with access to aftercare meetings following discharge. NOTE
1. W is approximately distributed as an F variable with a-1 numerator and 1/ denominator degrees of freedom (see Welch, 1951).

REFERENCES
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.: Author. Anderson, A.R. & Henry, C.S. (1994). Family system characteristics and parental behaviors as predictors of adolescent substance use. Adolescence, 29 (114): 403-420. Anglin, D.M., Hser, Y.I. & Grella. (1997). Drug addiction and treatment careers among clients in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11(4), 308-323. Bandura, A. (1992). Social cognitive theory. In: Ross Vasta (Ed) et al. Six theories of child development: Revised formulations and current issues. Jessica Kingsley Publishers, Ltd: London, England UK, 1-60.

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