Cumulative Risk and Substance Use in Adoptees: Moderation by Adoptive Parent Stress

• Published date: 01 April 2021
• Author: Austin J. Blake,Jill M. Waterman,Cara J. Kiff,Jose Guzman,Audra K. Langley
• Date: 01 April 2021
• DOI: http://doi.org/10.1111/fare.12522

A J. BArizona State University

J M. WUniversity of California, Los Angeles

C J. KPrivate Practice

J G  A K. LUniversity of California, Los Angeles

Cumulative Risk and Substance Use in Adoptees:

Moderation by Adoptive Parent Stress

Objective: To test whether low adoptive parent

stress buffers the effect of preadoptive risk on

substance use among adoptees.

Background: Adoptees are especially suscepti-

ble to substance use in adolescence, potentially

because they often experience multiple early

risk factors. Because caregiver stress and child

behavior problems are linked, degree of par-

enting stress may serve as a buffer in reducing

adoptee substance use.

Method: In a longitudinal study of 82 adoptees,

we tested whether cumulative preadoptive risk,

parenting stress, and their interaction predicted

substance use in adolescence.

Results: Parents’ parenting stress, but not chil-

dren’s preadoptive risk, predicted later sub-

stance use. Higher risk children were more pos-

itively and negatively affected by variations in

parent stress.

Conclusions: Parenting stress is a malleable

risk and protective factor in the development of

substance use among adoptees.

Implications: Prevention and intervention

programs for adoptive families should target

Department of Psychology, Arizona State Univer-

sity, ASU Psychology Building, Tempe, AZ 85281

(ajblake3@asu.edu).

Key Words: adoption, parenting stress, substance use.

parenting stress to reduce the risk of later youth

substance use.

Youth who are adopted from foster care repre-

sent a unique population that is exposed to both

heightened risk and the opportunity for marked

resilience (Zill & Bramlett, 2014). These youth

tend to experience elevations in early cumulative

risk factors, such as maltreatment and parental

substance use, which increase their likelihood of

problematic substance use later in adolescence

and young adulthood (Enoch, 2011; Tieman

et al., 2005; Young-Wolff et al.,2012).However,

a positive adoptive family environment may

act as a potential buffer against such risk (del

Pozo de Bolger et al., 2018). Although limited

research demonstrates that parental stress may

moderate the association of early life stress and

youth delinquency, including substance use (van

der Voort et al., 2013; Whitten & Weaver, 2010),

there are no specic studies that examine how

cumulative risk relates to substance use pat-

terns in youth who were adopted after foster

care. The present longitudinal, multi-informant

study advances current literature by using a sam-

ple of foster adoptees to test whether parenting

stress in adoptive parents moderates the effect

of preadoptive cumulative risk on substance use

patterns in adolescence and young adulthood,

accounting for other key variables (i.e., prenatal

Family Relations 70 (April 2021): 653–669653

DOI:10.1111/fare.12522

654 Family Relations

substance exposure, temperament, postadoption

adversity, child age) that explain variation in

substance use.

Family resilience theory provides one frame-

work to explain why low parenting stress may

buffer the effect of early risk on later substance

use among children adopted from foster care.

The family resilience framework recognizes

families as one of many contexts that promote

the vulnerability or protection of individuals

(Cowan & Cowan, 2006). Family resilience

theory posits that the ways in which families

adapt to challenges has repercussions not only

for the family has a whole, but also for out-

comes of individual members of the family

(Goldenberg & Goldenberg, 2012). As such,

parental resilience—in this case, parental stress

management—is key to the resilience of the

entire family system (Masten, 2018). Accord-

ing to family resilience theory, parental stress

management is a family-level protective factor

that should buffer against the impact of child

preadoptive risk factors to yield positive youth

adaptation, including low levels of substance

use in adolescence and young adulthood (Henry

et al., 2015). In particular, low parenting stress

may buffer the impact of children’s cumulative

risk (Evans et al., 2013), an important type of

risk that is common among adoptees. Although

prior research has revealed family resilience as a

mechanism by which at-risk youth are protected

from substance use (Henry et al., 2018), this

theory has not yet been tested among adoptive

families, particularly those adopting children

from foster care after infancy.

Substance Use Among Youth Adopted From

Foster Care

Children adopted from foster care are at height-

ened risk for later substance use, given the

variety of environmental and biological risk

factors that they possess. Children who enter

foster care in the United States often do so due

to birth parent substance use (U.S. Department

of Health and Human Services, 2018). Several

studies have demonstrated that adoptees with

genetic risk for substance use (i.e., a parent with

drug and alcohol use disorder history) are more

likely to use substances (Hopfer et al., 2003).

However, the majority of this research is

focused on children adopted at birth. Although

this allows for stringent testing of genetic

contribution to substance use, it obscures the

inuence of environmental exposure to parental

substance use disorder prevalent among foster

adoptees who are removed from the home later

in childhood or are placed in foster care before

adoption.

Preadoptive Environment as a Source of Risk

Exposure to parental substance use is asso-

ciated with a number of adverse childhood

experiences, such as maltreatment, parental

divorce or separation, and domestic violence

(Anda et al., 2002). These events, combined

with parental substance use, increase risk for

entry into foster care (Semidei et al., 2001).

Experience of these adverse events, in turn, are

associated with vulnerability to substance use.

Adolescents with a history of foster placement

are more likely to engage in substance use

(Tieman et al., 2005), and factors associated

with foster care itself (e.g., foster placement

instability, later age of adoption) may contribute

to risk (Howe, 1997; Stott, 2012).

Given the robust association between

maltreatment and substance use (Tonmyr

et al., 2010) and that maltreatment is commonly

experienced among foster youth both before

and after entry into care, maltreatment may

be one important risk factor in the onset and

maintenance of substance use in this population.

Importantly, these environmental risk factors

work in tandem, through the accumulation of

risk, which is often modeled within the the-

oretical framework of cumulative risk (Evans

et al., 2013). The cumulative risk framework

has been validated among studies of substance

use (Andersen & Teicher, 2009; Turner &

Lloyd, 2003), suggesting that level of cumu-

lative risk increases substance use outcomes

linearly and additively (Dube et al., 2003).

It must be noted that although components

of cumulative risk in research conducted on

children in general (e.g., maltreatment, parental

substance use) contribute to risk proles among

youth adopted from foster care, the latter group

experiences cumulative risk factors unique to

this specic population, such as multiple foster

placements and older age at placement. There-

fore, identifying the contribution of cumulative

risk to substance use behavior in foster adoptees

is vital to prevention efforts in this population.

Further, implementing a family resilience per-

spective informs prevention efforts at the family

level, rather than the individual child level, by