Having a substance use disorder (SUD) may adversely affect caregiving capacities. Reflective functioning (RF) and executive functioning (EF) are both important capacities for sensitive parenting, and are often impaired in a SUD. Only a few studies have explored the possible association between the two phenomena. In this study, we used a neuropsychological test battery to assess EF, and the Parent Development Interview to assess RF in a sample of mothers with a SUD (N = 43). Although parental RF (PRF) was associated with EF, when controlled for intelligence (IQ) and mental health, there was no significant association between EF and PRF. Mental health, however, showed a significant negative association with PRF. Splitting the group in two based on PRF level, mothers with a negative to low PRF exhibited more severe difficulties in SUD-related aspects, as well as in several EF components, compared to mothers with an adequate to high PRF, highlighting the association between EF and PRF. The results from this study contribute to enhance our understanding of the dynamics underlying vulnerability in PRF that mothers with small children may experience. We suggest EF to be a prerequisite for adequate PRF, and for interventions to be customized accordingly regarding parents with a SUD.
Mothers with a substance use disorder (SUD) are at risk for maladaptive parenting practices, and have heightened likelihood of having experienced childhood adversity themselves. In addition, parental reflective functioning (PRF), a capacity underlying sensitive caregiving, is often low in mothers with SUD. This study examines the relationship between PRF and aversive (emotional, physical, sexual abuse and neglect) and adaptive (safety and competence) experiences, in different developmental phases (early childhood, latency, and adolescence) in mothers with a SUD. A sample of 43 mothers with small children were interviewed with the Parental Developmental Interview to assess PRF, and they completed the Traumatic Antecedents Questionnaire regarding aversive and adaptive experiences. In addition, we used the Hopkins Symptoms Checklist-10 to control for mental health status and a battery of neuropsychological tests to control for executive functions. Results indicated that adaptive experiences in early childhood were positively related to PRF, and that experience of emotional abuse was negatively related to PRF. When separating the group of mothers in two sub-groups based on PRF level, results showed that mothers with negative to low PRF had significantly more experiences of adversities in early childhood and latency, and significantly less adaptive experiences in early childhood, latency and adolescence, compared to mothers with moderate to high PRF. In addition, mothers with adequate to high PRF reported experiencing significantly more types of adaptive experiences, and significantly less adversities compared to mothers with negative to low PRF. Results are discussed in relation to developmental trauma, resilience, epistemic trust and mistrust.
The interplay between pregnancy and addiction is usually studied quantitatively, and the focus is often on the adverse effects of intrauterine substance exposure. This study explores the perspective of the mothers‐to‐be by examining the subjective experience of pregnancy in substance‐addicted women. Fourteen women in family treatment for substance use disorder participated in eight focus groups. The data were analysed according to interpretative phenomenological analysis. The findings show that recognition of pregnancy was distorted and delayed, and strong feelings of ambivalence and guilt persisted throughout pregnancy, along with hope for change. Addiction and an intense preoccupation with external expectations are seen as a threat to intrauterine attachment and mental preparation for the caregiving role. Interventions must take into account the specific ways in which addiction influences the psychological processes of pregnancy; specifically, providing adequate social support and security should be considered.
Parental substance abuse undermines caregiving competency and increases the likelihood of abuse and neglect of children. Both research and clinical interventionsfocus disproportionally on maternal substance abuse, whereas the role of fathers with addictions is largely ignored. The study used a qualitative design to investigate fatherhood from the perspective of men with a substance addiction. Eight fathers in residential rehabilitation treatment programs participated in focus group discussions. Interpretative phenomenological analysis (IPA) was used to identify three figures of fatherhood: The good father, the bad father, and the invisible father. The three constructs are discussed in relation to Western trends and discourses of fathering and implications for childcare. Gender expectations and the father's right to participate on equal terms as the mother in the child's life are discussed against the notion of the best interest of the child. Conclusion: The drug-problem, gender expectations, couples conflicts, and professional practices related to child protection issues all influence these men's active participation as fathers. The fathering role in at-risk populations and the issue of co-parenting needs more attention in research, clinical interventions, and service programs. Implications for clinical practice are discussed.
Mothers with a substance use disorder (SUD) have been found to exhibit heightened experience of stress and deficits in executive functioning (EF) and in parental reflective functioning (PRF). Although experiences of stress, EF and PRF are important for caregiving capacities; no studies have explored associations between the phenomena in mothers with SUD. This study aimed to examine the association between EF (working memory, inhibition, and cognitive flexibility) and different forms of stress (parental stress, general life stress, and psychological distress) in 43 mothers with SUD with infants. We further aimed to investigate whether PRF had a mediating function between EF and the experience of stress. The mothers completed selfreport questionnaires regarding experiences of different types of stress, and we also used neuropsychological tests to assess EF and a semistructured interview to assess PRF. Results identified problems in EF were associated with higher parental stress and psychological distress but not with general life stress. Cognitive flexibility contributed uniquely to variance in parental stress, whereas working memory was a unique contributor to variance in psychological distress. PRF had a mediating function between EF and parental stress and between EF and psychological distress. Findings highlight the importance of considering individual differences in PRF when targeting EF in interventions trying to reduce the experience of parental stress and psychological distress in mothers with SUD.
Pregnancy and substance use -the Norwegian § 10-3 solution. 1 Ethical and clinical reflections related to incarceration of pregnant women to protect the foetus from harmful substances Research report Introduction Maternal substance addiction imposes several risks on the offspring from conception on. Most chemical components of the substances pass the placental barrier and represent a developmental hazard to the growing foetus (Moe et al. 2010). Pregnant women often find themselves torn between the wish to protect the foetus and failure to do so (Söderström 2011). The situation causes worry as well as moral in-dignation, and the welfare system is urged to act. In 1996, Norway passed a unique piece of legislation, at the time § 6-2a in the Social Service Act, now § 10-3, which made it possible to incarcerate pregnant drug-addicted women in order to protect the foetus. Although the paragraph is grounded on the ethical principle of nonmaleficence, there has been raised concern for unintended negative effects such ABSTRACT AIMS -This article highlights ethical and clinical dilemmas of incarceration of pregnant drug addicts mandated by § 10-3 of the Norwegian Municipal Health and Care Services act. MATERIAL -The material consists of two cases, Siri and Anna, and the ethical dilemmas posed by the use of § 10-3 in these cases.METHODS -Semi-structured in-depth individual interviews were conducted, audio-recorded and transcribed word for word. Transcripts were coded according to converging interests and possible ethical dilemmas and described in a case format. The practical and experiential consequences of the law are discussed in relation to the four main bioethical principles: respect for autonomy, nonmaleficence, beneficence and social justice. These are supplemented by the principles of relational ethics. RESULTS -The application of § 10-3 may lead to situations which distort the psychological preparation for parenthood and strains the helping relationship. The four principles approach seems to be an insufficient tool in grasping the complexity of the situation. CONCLUSIONS -Interventions to protect the foetus from the pregnant woman's use of substances demand elevated professional awareness of ethical and relational challenges and dilemmas. Relational ethics provides a framework to enhance reflexivity and a trusting therapeutic alliance. The potential for psychological change during pregnancy should be invested in. Hence, we suggest that during incarceration according to § 10-3, foetal protection and the promotion of parental competences should be given equal priority. KEY WORDS -Addiction, coercive treatment, ethical dilemmas, motherhood, pregnancy, relational ethics.
Although it is well documented that maternal substance abuse has a negative effect on the mother–child interaction, less is known about the pathways through which the interaction is compromised. The main objective of this research proposal is to describe an ongoing research project that focuses on associations between maternal executive function and the quality of mother–infant interaction when the mother has a history of substance abuse. We will also investigate the effects of multiple variables, including maternal relationship experiences, personality disposition, parental stress, comorbid mental illness, and addiction severity, on the dyadic interaction and child functioning. A group of 40–50 mothers with substance abuse problems and their infants aged 6–18 months will be included. The mothers will be assessed with neuropsychological tests, clinical interviews, self-administered questionnaires, and dyadic interaction observations as well as observation and assessment of child functioning. We will use a cross-sectional correlational design. The inclusion of the participants will end in October 2015. Further knowledge about the variables that are important for the mother–infant relationship can inform future research and clinical practice.
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