Background to the study
The negative impact of parental substance use on children has been documented by multiple studies and reviews, especially on children of alcoholics [
1,
2]. Besides prenatal substance exposure that can have negative physical and developmental consequences [
1,
3,
4], psychological effects may additionally impair the affected children’s development. For example, children and adolescents affected by parental substance use show and conduct higher rates of emotional disorders, such as anxiety disorders and depression [
5‐
7], social behaviour disorders [
8,
9], or hyperactivity disorders [
10,
11].
With regard to substance-use problems, records of children with substance-abusing parents (CSP) have often shown an earlier onset of substance use [
12], drunk experiences [
13], increased binge drinking rates [
14] and an elevated risk of developing substance-use disorders (SUD) at a younger age than comparable peers [
15]. Overall, approximately 33 to 40% of the CSP develop SUD [
16,
17]. SUD can be transmitted intergenerationally via several pathways, where genetic disposition, environmental factors as well as cognitive and psychological processes are relevant [
18]. With regard to cognitive processes, CSP often have the same positive expectations about the effects of substance use as their parent [
19]. As an important psychological factor, CSP later come to favour substance use as a maladaptive coping mechanism when experiencing stress and strain, having learned this strategy from the substance-using parent as a model [
20].
Dysfunctional family characteristics may also have an impact on the maladaptive development of CSP. In their home environments, CSP are frequently exposed to psychological stress due to physical and psychological violence, volatile parenting, recurrent family conflicts [
1,
21,
22] as well as a range of socioeconomic and health disadvantages resulting from their families’ financial problems and their parents’ complex health condition (e.g. psychiatric comorbidity) [
23]. Length, type and frequency of exposure to parental substance-use and related parental behaviour have been seen as fundamental etiopathogenic factors for maladaptive developmental pathways [
16]. Hence, it is important to offer early interventions to promote a healthy child development. Early prevention programmes are not only helpful on an individual level, but also in reducing societal costs related to delinquency, mental and physical disorders and child maltreatment [
24‐
26].
Despite the urgent need, prevention programmes targeting CSP are still lacking in Germany, especially with respect to an evidence-base on effectiveness and practicability [
27]; “Trampoline” is, by so far, the only one of its kind [
28,
29]. Central topics of intervention are parental addiction and related problems as well as coping strategies (see below). This programme uses versatile modules that are suitable for the developing stages of 8–12-year-old boys and girls.
The prior randomised-controlled “Trampoline” trial demonstrated efficacy by comparing the manualised, psychoeducational preventive group intervention “Trampoline” with the results of a non-educational “fun and play” group of the same duration in a nationwide German sample of outpatient alcohol and drug treatment facilities; “Trampoline” has been proven to be effective in improving stress coping skills, reducing psychological distress due to parental substance addiction, improving psychological well-being as an aspect of quality of life and improving children’s self-concept and feelings of autonomy as well as the child-parent relationship [
29]. Compared to the control group, “Trampoline” achieved a substantially more pronounced long-term reduction in psychological distress tested in a 6-month follow-up. Additionally, it demonstrated clear superiority over the control group regarding addiction-related knowledge. Manual adherence was good (84%), and children, parents and trainers showed high acceptance towards the programme [
28,
30].
In sum, it can be concluded that “Trampoline” is effective for CSP. Nevertheless, this programme can still be improved with regard to significance of effect and relevant outcomes such as emotion regulation skills, an important element of stress management skills. Mindfulness training is a promising method to enhance children’s socioemotional resilience and the efficacy of existing prevention programmes in various psychological disorders and SUDs through imposing a positive impact on self-regulatory processes [
31‐
33], including emotion regulation [
34]. Mindfulness, defined as “systematic development of attention to present-moment experience with an attitude of accepting and non-judging” [
35,
36], is expected to foster the ability to become more aware of habit-linked, affective states and bodily sensations and observe these experiences from a more detached and less reactive perspective rather than attempting to escape or distance oneself from unpleasant feelings and sensations [
37,
38]. A recent review [
34] demonstrates that mindfulness-based stress reduction (MBSR) is associated with improvements in emotion regulation, including recognition and management of emotions, emotional well-being, interpersonal relationships and stress reduction.
Aims and objectives of the study
The aim of our ongoing study is to assess the effectiveness of a mindfulness-augmented version of the original “Trampoline”-programme (“Trampoline-Mind”) for children aged 8–12 years, have at least one substance-abusing parent and are suffering from emotional and/or behavioural problems. The effectiveness of the intervention will be tested in a multicentre cluster-randomised controlled trial with three points of measurement (pre, post and follow-up) while comparing it to the original “Trampoline”-programme and treatment-as-usual (TAU). It is hypothesised that “Trampoline-Mind” is feasible and effective for CSP and has had a positive impact on relevant predictors of SUD and other mental disorders. In detail, a mindfulness-augmented version of “Trampoline” is expected to improve children’s application of stress coping strategies in favour of problem-focused stress coping and constructive-palliative emotion regulation over avoidant stress coping and destructive-anger-related emotion regulation compared to the established “Trampoline”-programme. This suggests that CSP can benefit from integrating mindfulness components in the existing programme. As a secondary hypotheses, it is expected that “Trampoline-Mind” reduces distress due to parental substance use as well as internalising and externalising problem behaviours more effectively than the original “Trampoline” programme.
Moreover, by including mindfulness elements and using reliable and objective measures in a rigorous research design, this study allows the evidence on mindfulness-based interventions to be enlarged. Mindfulness training has an established evidence base, but only for adults [
34]. Nevertheless, recent research has also supported the feasibility and efficacy of mindfulness-based techniques for children and adolescents [
32,
39]. However, the current evidence is largely restricted to non-clinical settings, such as school settings [
34], and it remains untested whether mindfulness-based interventions are effective in the prevention of SUD and related disorders among a highly vulnerable group such as CSP. Therefore, the study presented here will make use of a cluster-randomised-controlled trial longitudinal study design to establish profound evidence on the efficacy of the mindfulness-based “Trampoline-Mind” programme in a clinical and youth welfare setting, targeting the highly vulnerable group of CSP.