“A Window of Opportunity”: Parenting and Addiction in the Context of Pregnancy

Abstract

Purpose of Review Maternal prenatal substance use presents a multilevel risk to child development and parenting. Although parenting interventions are increasingly integrated into substance use treatment, prenatal parenting processes have not received equal attention within these interventions. This article aims to synthesize the evidence on the specific prenatal risk factors affecting the development of early parenting of substance-using mothers, as well as interventions focusing on those factors. Recent Findings Both neurobiological and psychosocial risk factors affect the prenatal development of parenting in the context of maternal substance use. Maternal–fetal attachment, mentalization, self-regulation, and psychosocial risks are important in treatment and highly intertwined with abstinence. Although parenting interventions seem to be highly beneficial, most studies have not differentiated between pre- and postnatal interventions or described pregnancy-specific intervention elements. Summary Due to the salience of pregnancy in treating substance-using parents, interventions should begin prenatally and include pregnancy-specific parenting focus. Further research on prenatal interventions is warranted.

Prenatal Reflective Functioning as a Predictor of Substance-Using Mothers' Treatment Outcome: Comparing Results From Two Different RF Measures

“…Integrated treatments addressing both addiction and parenting, and allowing the children to be present in treatment are known to be superior to treatments focused on addiction alone (Pajulo et al, 2006 ; Neger and Prinz, 2015 ). Protecting children from the harm of substance use and learning to feel rewarded by interaction with the child, instead of substances, are at the core of perinatal substance use treatments (Van Scoyoc et al, 2016 ; Flykt et al, 2021 ).…”

“…To conclude, mothers with prenatal SUD need treatments that are multi-professional and comprehensive and should be started during pregnancy to prevent both fetal exposure and the development of dyadic interaction problems (Flykt et al, 2021 ). The parenting component of treatments should ideally include the following elements: First, direct support of sensitivity toward the infant (such as with the use of video feedback, van IJzendoorn et al, 2022 ) is vital.…”

“…A mother's prenatal substance use disorder (SUD) indicates a combination of severe, biopsychosocial risks for a healthy mother-child relationship and child development (Conners et al, 2004 ; Flykt et al, 2021 ). These include direct substance effects on the mother and the fetus, but typically also more distal risks, such as socioeconomic problems, mental health symptoms, and history of attachment insecurity and trauma.…”

“…Pregnancy is a period of both opportunity and vulnerability for mothers with SUD (Van Scoyoc et al, 2016 ; Flykt et al, 2021 ). Treatment motivation is often enhanced by a strong desire to protect the baby (Van Scoyoc et al, 2016 ).…”

“…During pregnancy, a mother's mind is also especially “open” to reorganizing previous attachment representations and creating new representations of the child and the self as a mother (Stern, 1995 ; Slade et al, 2009 ). Prenatal interventions thus have a unique potential to simultaneously reduce fetal substance exposure and help the mother emotionally bond with her baby, which in itself promotes abstinence (Massey et al, 2015 ; Flykt et al, 2021 ). However, pregnancy is also a period of heightened emotional upheaval and ambivalence, especially for mothers with SUD who often struggle to reorganize negative or traumatic childhood and couple relational experiences as part of their maternal identity (Söderström, 2012 ; Punamäki et al, 2013 ; Silva et al, 2013 ; Isosävi et al, 2016 ).…”