The effectiveness and cost-effectiveness of treatment and child welfare interventions for parents with a substance use disorder in England

Parental substance use disorder (SUD) is associated with poor outcomes for parents and their children. There is a paucity of evidence on the types of interventions received by parents with SUD and their effectiveness and cost-effectiveness, especially in England. Data from a national administrative database is used to analyse whether sociodemographic characteristics affected the types of interventions parents received and subsequent outcomes, and whether integrated treatment and child welfare support was a more effective or cost-effective option than treatment only, via three interconnected studies: 1) a descriptive and exploratory study of characteristics, 2) a quasi-experimental study on effectiveness and 3) a cost-effectiveness analysis. Parents are not a homogenous group, with those not living with children appearing to have the most complex support needs in the treatment system. The likelihood of receiving integrated support varied between mothers and fathers, and parents living and not living with children. Parents who received treatment in a residential setting were more likely to complete, and treatment plus parenting and/or family recovery support appeared to be more effective than treatment alone for non-opiate/ alcohol users. Among opiate users, delivery of parenting and/or family recovery support was only associated with better treatment outcomes for fathers not living with their children. Further analysis which focused on parents with an alcohol use disorder suggested that treatment plus parenting and/or family recovery support was cost-effective. This PhD sets out 14 detailed findings which bring novel evidence together and 10 research recommendations for the field. The strength of this thesis is that it adds to the limited evidence base and provides researchers with replicable techniques to be adopted and adapted in various jurisdictions. Using the recommendations presented, policymakers and decisionmakers can make informed decisions on how best to support families.