This study aimed to gain insight into the clinical practices and attitudes of currently practicing play therapists working with children with a parent with a substance use disorder. Participants in the study were play therapists credentialed by the Association for Play Therapy, either as a Registered Play Therapist™ or Registered Play Therapist-Supervisor™. A total of 198 play therapists participated in the study. Results demonstrated that variables including prior education, caseload of children affected by parental substance use, and the number of years since obtaining a mental health licensure explained 16% of the variance in participant attitude scores on the Drug and Drug Problems Perceptions Questionnaire (DDPPQ). Specifically, education (β = -.335, rs2 = .884, p < .001) was found to be a significant predictor of play therapist attitudes towards substance users as it explained 88% of the variance accounted for in the effect. Additionally, although not found to be significant, caseload (β = -.134, rs2 = .325, p = .058) was found to explain 33% of the variance accounted for in the effect. This initial exploration of play therapists' attitudes towards substance users provides strong evidence towards the importance of education and training in substance use disorders. Further exploration of play therapists' educational backgrounds in substance use and clinical experiences of working with children affected by parental substance use.

This dissertation explored a number of themes associated with adolescent drug and alcohol prevention among culturally diverse Northern Australian adolescents. It was undertaken because important differences are often associated with specific cultural groups and local knowledge is often needed as a means of informing effective prevention programs. Five studies are presented, each, with its own hypotheses, results and conclusions that examine influences on the common dependent variable of adolescent substance use. In consultation with teachers a new universal school-based drug and alcohol prevention program was developed addressing the four most commonly used substances among Australian adolescents, namely alcohol, cigarettes, cannabis and inhalants. The program was predicated on the social influence and alcohol harm minimisation models and was successful in reducing alcohol initiation and increasing cannabis and inhalant refusal self-efficacy among non-initiates. Program delivery is equally as important and program content and prevention programs utilising interactive teaching have been found to be more effective in preventing adolescent substance use than those delivered in a didactic or non-interactive style. The implementation evaluation found that teachers delivered less of the interactive program contents (49%) compared with the non-interactive components (84%). Quality of program delivery may have explained the limited efficacy of the school program to reduce cigarette use and to deter use among those who had already initiated substance use. Additionally three descriptive studies explored variables representing risk and protection for adolescent substance use. Key finding were that cultural identity was observed to be protective of both Indigenous and Non-Indigenous alcohol initiation but was associated with risk for Indigenous youth who had any number of drinking friends; that drinking parents had a strong direct effect on adolescent drinking independent of friends’ use; and a lack of school connectedness was associated with increased adolescent smoking and drinking. This dissertation demonstrated that a school drug education program in its self cannot effectively prevent adolescent drug use. While improvements can be made to current teaching practices, school curricula need to be supplemented with multi-modal programs that aim to selectively reduce parental substance use and improve the school experience for all students.

Background: Parental substance use puts children at risk for poor outcomes. Estimates indicate that 66% of substantiated cases of maltreatment are of parents with substance use disorders (SUD). Some parents with SUD have the opportunity to be treated through two accountability courts including Drug Courts (DC) and family treatment courts (FTC). Purpose: Little is known about the children of parents who participate in treatment through DC’s via the criminal justice system. This study examined differences in parents and their children who receive treatment through FTC’s and DC’s with the notion that DC’s could serve as an important treatment venue for improving child outcomes, which is a major focus of FTCs. Methods: The data used for these analyses are the baseline data of a quasi-experimental study involving two DC’s and two FTC’s across Georgia. The intervention included the implementation of evidence-based parenting and trauma services at one drug court and at one family treatment court, while the other courts served as controls. At each court, participants, one other caregiver, and one child were invited to participate in the project by completing an annual assessment. This included computerized surveys and a videotaped play and talking activity with each adult with the child. Measures included demographics, parenting behaviors, mental health measures, social support, and child mental health measures. All data used in the analyses were collected at baseline and thus prior to intervention. Participants were 80 DC triads and 25 FTC triads (DCP, another caregiver, and child). Results: Compared to DC, FTC clients were more likely to be female (p = p = p =.014). They also had younger children (p = .05) and were more likely to have custody of those children (p =.0015). Parents in FTCs compared to those in DC reported greater social support (p =.05) and better family functioning (p =.03). Parents in DCs reported poorer parental involvement and poorer monitoring of children than FTCs, but no differences in positive parenting (p =.13), inconsistent discipline (p =.27), or child abuse potential (total risk > 9, p =.42; total risk >12, p =.37). Regarding mental health, DC clients reported a greater number of symptoms or poor mental health than FTC. No differences were found for education level (p =.96), parent-child communication skills (p =.38), post-traumatic stress symptom severity (p =.62), or child behavior problems. Conclusion: These data show some differences between FTC participants and DC participants that can affect child outcomes. FTC parents were more involved in their children’s lives and DC parents had greater mental health problems that could interfere with parenting. Interventions are needed, especially for DC client to strengthen the parent-child relationship and improve parenting outcomes.

Increasing understanding of the risk and protective factors for adolescent nonmedical use of prescription drugs (NMUPD) could inform prevention efforts. Several correlates have been identified, including parental factors, perceptions about use and accessibility, social norms, and age. However, these constructs have rarely been simultaneously examined using paired data from parents and adolescents. We aimed to examine the relative influence of these correlates among dyads (N = 349) of mothers and adolescent daughters. Using multiple logistic regression, daughters’ past NMUPD and inclination for future NMUPD were regressed onto descriptive norms for friend use, perceived drug accessibility and risk of harm from use, daughter age, mothers’ disapproval about use, mothers’ past NMUPD and inclination for future NMUPD, and the mother-daughter relationship quality. Akaike weights and lasso regressions were also estimated to evaluate the relative importance of each correlate. Higher descriptive norms for friend use, older age, and mothers’ inclination for NMUPD were risk factors for daughters’ NMUPD, while a closer mother-daughter relationship and mothers’ disapproving attitudes towards NMUPD were protective factors. The three analysis approaches were corroborative. Results suggest friend descriptive norms, mother-daughter relationship quality, and mothers’ attitudes about NMUPD are important prevention targets.