Quality of Life Research

, Volume 26, Issue 5, pp 1327–1335 | Cite as

Recovery support mediates the relationship between parental warmth and quality of life among women with substance use disorders

  • Suzanne BrownEmail author
  • Bryan Victor
  • Laurel M. Hicks
  • Elizabeth M. Tracy



Historically, recovery from substance use disorders (SUD) has focused exclusively on the use or non-use of the addictive substance(s). More recently, SAMSHA [1] has defined recovery in a more holistic way, using quality of life (QoL) as a measure of recovery for individuals with substance use and mental health disorders. However, little is known about the myriad experiences that inform and affect QoL for individuals with substance use disorders. Using an attachment informed stress-buffering framework, the purpose of this study was to examine the contribution of parental warmth and recovery support to QoL among women in substance abuse treatment.


Linear regression and bootstrapping were used to examine direct and mediated effects of parental warmth and recovery support on QoL among 318 women recruited from three inner-city women-only addiction treatment programs. Relationships were assessed across three domains of quality of life: physical, psychological, and social.


Parental warmth and recovery support were directly associated with psychological and social QoL, when controlling for the influence of trauma symptoms. Recovery support mediated the relationship between parental warmth and QoL across psychological and social QoL domains.


Findings suggest that interventions that focus on attachment-related constructs to enhance recovery support may improve quality of life among women with SUD.


Women Substance dependence Recovery support Quality of life Parental warmth 



The project described was supported by Award Number R01DA022994 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Drug Abuse or the National Institutes of Health.


This study was funded by the National Institute of Drug Abuse grant number RO1DA022994.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in this study.


  1. 1.
    Substance Abuse and Mental Health Service Administration. (2007). Results from the 2006 national survey on drug use and health: National findings. Rockville: Office of Applied Studies.Google Scholar
  2. 2.
    Porter, K. (2004). Measuring disease: a review of disease specific quality of life measurement scales. Journal of Biosocial Science, 36(1), 124–124. doi: 10.1017/s0021932004225524.CrossRefGoogle Scholar
  3. 3.
    Donovan, D., Mattson, M. E., Cisler, R. A., Longabaugh, R., & Zweben, A. (2005). Quality of life as an outcome measure in alcoholism treatment research. Journal of Studies on Alcohol, 2(15), 119–139. doi: 10.15288/jsas.2005.s15.119.CrossRefGoogle Scholar
  4. 4.
    Bredemeier, J., Wagner, G. P., Agranonik, M., Perez, T. S., & Fleck, M. P. (2014). The World Health Organization Quality of Life instrument for people with intellectual and physical disabilities (WHOQOL-Dis): evidence of validity of the Brazilian version. BMC Public Health, 14(1), 538. doi: 10.1186/1471-2458-14-538.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cazzorla, C., Del Rizzo, M., Burgard, P., Zanco, C., Bordugo, A., Burlina, A. B., et al. (2012). Application of the WHOQOL-100 for the assessment of quality of life of adult patients with inherited metabolic diseases. Molecular Genetic Metabolism, 106(1), 25–30. doi: 10.1016/j.ymgme.2012.02.008.CrossRefGoogle Scholar
  6. 6.
    O’Connell, K. A., & Skevington, S. M. (2012). An international quality of life instrument to assess wellbeing in adults who are HIV-positive: A short form of the WHOQOL-HIV (31 items). AIDS and Behavior, 16(2), 452–460. doi: 10.1007/s10461-010-9863-0.CrossRefPubMedGoogle Scholar
  7. 7.
    Tracy, E. M., Laudet, A. B., Min, M. O., Kim, H., Brown, S., Jun, M. K., et al. (2012). Prospective patterns and correlates of quality of life among women in substance abuse treatment. Drug and Alcohol Dependence, 124(3), 242–249. doi: 10.1016/j.drugalcdep.2012.01.010.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Brown, S., Jun, M. K., Min, M. O., & Tracy, E. M. (2013). Impact of dual disorders, trauma, and social support on quality of life among women in treatment for substance dependence. Journal of Dual Diagnosis, 9(1), 61–71. doi: 10.1080/15504263.2012.750147.CrossRefPubMedGoogle Scholar
  9. 9.
    Laudet, A. B., Morgen, K., & White, W. L. (2006). The role of social supports, spirituality, religiousness, life meaning and affiliation with 12-step fellowships in quality of life satisfaction among individuals in recovery from alcohol and drug problems. Alcoholism Treatment Quarterly, 24(1–2), 33–73. doi: 10.1300/j020v24n01_04.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Laudet, A. B., & Stanick, V. (2010). Predictors of motivation for abstinence at the end of outpatient substance abuse treatment. Journal of Substance Abuse Treatment, 38(4), 317–327. doi: 10.1016/j.jsat.2010.01.007.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Laudet, A. B., & White, W. L. (2008). Recovery capital as prospective predictor of sustained recovery, life satisfaction, and stress among former poly-substance users. Substance Use & Misuse, 43(1), 27–54. doi: 10.1080/10826080701681473.CrossRefGoogle Scholar
  12. 12.
    Bizzarri, J., Rucci, P., Vallotta, A., Girelli, M., Scandolari, A., Zerbetto, E., et al. (2005). Dual diagnosis and quality of life in patients in treatment for opioid dependence. Substance Use Misuse, 40(12), 1765–1776. doi: 10.1080/10826080500260800.CrossRefPubMedGoogle Scholar
  13. 13.
    Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  14. 14.
    Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1997). The link between substance abuse and posttraumatic stress disorder in women—a research review. American Journal on Addictions, 6(4), 273–283. doi: 10.3109/10550499709005058.PubMedGoogle Scholar
  15. 15.
    Smith, K. W., & Larson, M. J. (2003). Quality of life assessments by adult substance abusers receiving publicly funded treatment in Massachusetts. American Journal of Drug Alcohol Abuse, 29(2), 323–335. doi: 10.1081/ada-120020517.CrossRefPubMedGoogle Scholar
  16. 16.
    Russo, J., Roy-Byrne, P., Reeder, D., Alexander, M., Dwyer-O’Connor, E., Dagadakis, C., et al. (1997). Longitudinal assessment of quality of life in acute psychiatric inpatients: reliability and validity. Journal of Nervous and Mental Disease, 185(3), 166–175. doi: 10.1097/00005053-199703000-00006.CrossRefPubMedGoogle Scholar
  17. 17.
    Ventegodt, S. (1999). A prospective study on quality of life and traumatic events in early life—a 30-year follow-up. Child: Care, Health and Development, 25(3), 213–222. doi: 10.1046/j.1365-2214.1999.00100.x.Google Scholar
  18. 18.
    Alsaker, K., Moen, B. E., & Kristoffersen, K. (2008). Health-related quality of life among abused women one year after leaving a violent partner. Social Indicators Research, 86(3), 497–509. doi: 10.1007/s11205-007-9182-7.CrossRefGoogle Scholar
  19. 19.
    Rees, S., Silove, D., Chey, T., Ivancic, L., Steel, Z., Creamer, M., et al. (2011). Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function. Journal of the American Medical Association, 306(5), 513–521. doi: 10.1001/jama.2011.1098.PubMedGoogle Scholar
  20. 20.
    Lazarus, R. S. (1966). Psychological stress and the coping process. New York, NY: McGraw- Hill.Google Scholar
  21. 21.
    Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. doi: 10.1037//0033-2909.98.2.310.CrossRefPubMedGoogle Scholar
  22. 22.
    Warren, J. I., Stein, J. A., & Grella, C. E. (2007). Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders. Drug and Alcohol Dependence, 89(2–3), 267–274. doi: 10.1016/j.drugalcdep.2007.01.009.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bowlby, J. (1969). Attachment and loss (Vol. Book, Whole). New York: Basic Books.Google Scholar
  24. 24.
    Wark, M. J., Kruczek, T., & Boley, A. (2003). Emotional neglect and family structure: impact on student functioning. Child Abuse & Neglect, 27(9), 1033–1043. doi: 10.1016/s0145-2134(03)00162-5.CrossRefGoogle Scholar
  25. 25.
    Datta, P., Marcoen, A., & Poortinga, Y. H. (2005). Recalled early maternal bonding and mother-and self-related attitudes in young adult daughters: A cross-cultural study in India and Belgium. International Journal of Psychology, 40(5), 324–338. doi: 10.1080/00207590444000366.CrossRefGoogle Scholar
  26. 26.
    Lung, F.-W., Huang, Y.-L., Shu, B.-C., & Lee, F.-Y. (2004). Parental rearing style, premorbid personality, mental health, and quality of life in chronic regional pain: A causal analysis. Comprehensive Psychiatry, 45(3), 206–212. doi: 10.1016/j.comppsych.2004.02.009.CrossRefPubMedGoogle Scholar
  27. 27.
    Sarason, B. R., Pierce, G. R., Shearin, E. N., Sarason, I. G., Waltz, J. A., & Poppe, L. (1991). Perceived social support and working models of self and actual others. Journal of Personality and Social Psychology, 60(2), 273. doi: 10.1037/0022-3514.60.2.273.CrossRefGoogle Scholar
  28. 28.
    Moreira, J. M., de Fátima Silva, M., Moleiro, C., Aguiar, P. C., Andrez, M., Bernardes, S., et al. (2003). Perceived social support as an offshoot of attachment style. Personality and Individual Differences, 34(3), 485–501. doi: 10.1016/s0191-8869(02)00085-5.CrossRefGoogle Scholar
  29. 29.
    Wallace, J. L., & Vaux, A. (1993). Social support network orientation: The role of adult attachment style. Journal of Social and Clinical Psychology, 12(3), 354. doi: 10.1521/jscp.1993.12.3.354.CrossRefGoogle Scholar
  30. 30.
    Skevington, S. M., Lotfy, M., & O’Connell, K. A. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13(2), 299–310.CrossRefPubMedGoogle Scholar
  31. 31.
    Helzer, J. E., & Robins, L. N. (1988). The diagnostic interview schedule—its development, evolution, and use. Social Psychiatry and Psychiatric Epidemiology, 23(1), 6–16. doi: 10.1007/Bf01788437.CrossRefPubMedGoogle Scholar
  32. 32.
    Elliott, D. M., & Briere, J. (1992). Sexual abuse trauma among professional women: Validating the Trauma Symptom Checklist-40 (TSC-40). Child Abuse & Neglect, 16(3), 391–398. doi: 10.1016/0145-2134(92)90048-v.CrossRefGoogle Scholar
  33. 33.
    Briere, J., & Runtz, M. (1989). The Trauma Symptom Checklist (TSC-33) early data on a new scale. Journal of Interpersonal Violence, 4(2), 151–163. doi: 10.1177/088626089004002002.CrossRefGoogle Scholar
  34. 34.
    Laudet, A. B., Magura, S., Vogel, H. S., & Knight, E. (2000). Support, mutual aid and recovery from dual diagnosis. Community Mental Health Journal, 36(5), 457–476. doi: 10.1023/a:1001982829359.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Parker, G., Tupling, H., & Brown, L. (1979). A parental bonding instrument. British Journal of Medical Psychology, 52(1), 1–10. doi: 10.1111/j.2044-8341.1979.tb02487.x.CrossRefGoogle Scholar
  36. 36.
    Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1(1), 16. doi: 10.1037/1082-989x.1.1.16.CrossRefGoogle Scholar
  37. 37.
    Allison, P. (1999). Multicollinearity in logistic regression. SAS Institute.Google Scholar
  38. 38.
    Apter, A. J., Reisine, S. T., Affleck, G., Barrows, E., & ZuWallack, R. L. (1999). The influence of demographic and socioeconomic factors on health-related quality of life in asthma. Journal of Allergy and Clinical Immunology, 103(1), 72–78.CrossRefPubMedGoogle Scholar
  39. 39.
    Cherepanov, D., Palta, M., Fryback, D. G., & Robert, S. A. (2010). Gender differences in health-related quality-of-life are partly explained by sociodemographic and socioeconomic variation between adult men and women in the US: evidence from four US nationally representative data sets. Quality of Life Research, 19(8), 1115–1124.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Carreon, D., & Noymer, A. (2011). Health-related quality of life in older adults: Testing the double jeopardy hypothesis. Journal of Aging Studies, 25(4), 371–379.CrossRefGoogle Scholar
  41. 41.
    Norusis, M. (2008). SPSS 16.0 statistical procedures companion. Upper Saddle River: Prentice Hall Press.Google Scholar
  42. 42.
    Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36(4), 717–731. doi: 10.3758/bf03206553.CrossRefGoogle Scholar
  43. 43.
    Kline, R. B. (1998). Structural equation modeling. New York: Guilford.Google Scholar
  44. 44.
    Musil, C. M., Warner, C. B., Yobas, P. K., & Jones, S. L. (2002). A comparison of imputation techniques for handling missing data. Western Journal of Nursing Research, 24(7), 815–829. doi: 10.1177/019394502762477004.CrossRefPubMedGoogle Scholar
  45. 45.
    Hawthorne, G., Herrman, H., & Murphy, B. (2006). Interpreting the WHOQOL-Bref: Preliminary population norms and effect sizes. Social Indicators Research, 77(1), 37–59. doi: 10.1007/s11205-005-5552-1.CrossRefGoogle Scholar
  46. 46.
    Scott, C. K. (2004). A replicable model for achieving over 90% follow-up rates in longitudinal studies of substance abusers. Drug and Alcohol Dependence, 74, 21–36.CrossRefPubMedGoogle Scholar
  47. 47.
    Tracy, E. M., & Johnson, P. J. (2007). Personal social networks of women with co-occurring substance use and mental disorders. Journal of Social Work Practice in the Addictions, 7(1–2), 69–90. doi: 10.1300/j160v07n01_05.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Suzanne Brown
    • 1
    Email author
  • Bryan Victor
    • 1
    • 2
  • Laurel M. Hicks
    • 1
    • 2
  • Elizabeth M. Tracy
    • 3
  1. 1.School of Social WorkWayne State UniversityDetroitUSA
  2. 2.Merrill Palmer Skillman InstituteDetroitUSA
  3. 3.Case Western Reserve Jack, Joseph, and Morton Mandel School of Applied Social SciencesClevelandUSA

Personalised recommendations