Nurturing Program for Families in Substance Abuse Treatment and Recovery

Norma Finkelstein, Ph.D., Executive Director
Institute for Health and Recovery (IHR)
349 Broadway
Cambridge, MA 02139


(617) 661-3991           Fax: (617) 661-7277

The Nurturing Program for Families in Substance Abuse Treatment and Recovery is a family skills training program designed to strengthen relationships in families affected by parental substance abuse when the parent is in treatment or recovery. The program is intended to be provided as a component of substance abuse treatment or through family and community service agencies. Parents need not be participating in a formal treatment program in order to participate in or benefit from the program. However, parents should have at least three months of abstinence. The Nurturing Program for Families in Substance Abuse resulted from an adaptation of the Nurturing Program for Parents of Children Birth to Five Years Old, developed by Dr. Stephen Bavolek, Executive Director of the Family Nurturing Center. The program was modified during implementation at two women's residential substance abuse treatment programs. The goals of the program include: (1) reducing risk factors contributing to substance use/abuse by both parents and children in families affected by parental substance abuse; (2) enhancing relationships between parents and children (i.e. strengthening family protective factors); and (3) strengthening parent's sobriety.

The program consists of 18 sessions, each 90 minutes. The program can be adapted to less sessions, and 1 hour each. It may be offered in once or twice weekly sessions. The program is designed to be used in a variety of settings: residential or outpatient treatment programs; community and family service agencies; and early intervention programs. While the parenting curriculum is for parents only, a companion volume, Family Activities to Nurture Parents and Children has been developed to provide guidelines for family activities when the program is implemented with parents and children together. There are no restrictions as to ages of children, or special characteristics of families or family members. Family Activities includes activities in which all family members can participate, from toddlers to adults. Activities are defined by activity level, specifying whether the activity would be calming or active. Emphasis is placed on group interaction, creative representations, and physically active games or process, in order to promote interest and accommodate different learning styles.

For parents, family life and family relationships are critical areas for building coping skills, and incorporating theses areas of concern into treatment programs can promote successful treatment and reduce relapse risk by keeping parents in treatment longer, and increasing their self-esteem and sense of competence as parents. Intermediate objectives include: (a) Improved family relationships, characterized by appropriate expectations, enhanced empathy, use of alternatives to corporal punishment and appropriate roles; (b) enhanced sense of competence and satisfaction of parents in relationships with their children; and (c) reduced risk of relapse.

The program has been evaluated in several contexts: as a CSAP demonstration project; and as replication projects in both women's residential treatment programs and women's and children's residential treatment programs. All studies used the Adult-Adolescent Parenting Inventory (AAPI) as a pre-post measure. Evaluation in the original CSAP demonstration project employed a quasi-experimental design with repeated measures. The AAPI was administered at three points: at admission, three months after admission, or at discharge if it occurred before completing three months; and at the completion of the program. At the two treatment programs 66 of the 170 women completed the initial assessment completed both pre and post measures. Twenty-six in program one and 40 in program two. The findings from program one show significant improvement in all four parenting domains measured: Inappropriate Expectations, Lack of Empathy, Corporal Punishment, and Role Reversal. The findings from program two also showed a significant increase in Empathy, and Appropriate Roles. In addition data on abstinence and relapse collected from women who had left treatment indicate that the completion of the modified Nurturing Program was related to longer lengths of abstinence, with an average estimated time to relapse being 14.7 months for completers and 9.4 months for non-completers.

Implementation Costs:

The Nurturing Program Curriculum costs $35.00 plus $7.00 shipping and handling; Family Activities Manual, $13.00 plus $4.00 shipping and handling. To implement the program agencies will need: newsprint pads, masking tape, markers, paints, crayons, blocks etc. In addition, audio cassette players and music; videos "Shaking, Hitting, Spanking, What to do instead, and "Nurturing Touch", both available from Family Development Resources. Child care, transportation, refreshments and other incentives are suggested.

Training Costs:

Training is not required, although it is preferred. Program training is designed to meet the needs of those implementing the program. Training formats range from half-day to three-day programs. Training programs have included as many as 50 participants or as few as eight. Costs for workshops or trainings are based on an hourly rate of $100-$200 per hour of training, including preparation and travel time. Training rates are negotiable. Travel costs, to be paid by training sponsor, vary and are not included in the hourly rate.