Academic journal article Family Relations

Parenting Interventions for Drug-Dependent Mothers and Their Young Children: The Case for an Attachment-Based Approach*

Academic journal article Family Relations

Parenting Interventions for Drug-Dependent Mothers and Their Young Children: The Case for an Attachment-Based Approach*

Article excerpt

Abstract:

Maternal substance abuse is the most common factor involved when children come to the attention of the child welfare system. Although there is a clear need for clinical trials to evaluate parenting interventions for drug-dependent women, few studies to date have systematically examined the efficacy of interventions for this population. We first review six published reports of outpatient interventions that aimed to enhance the caregiving skills of substance-abusing mothers caring for children between birth and 5 years of age. After discussing implications of these preliminary studies, we then describe an attachment-based intervention that addresses these implications and has demonstrated preliminary feasibility in a pilot trial.

Key Words: attachment, drug abuse, parent-child relationships, parent education, parenting interventions.

Maternal substance abuse, more than most other psychiatric or social problems (with the exception of poverty), is the most common factor involved when children are referred to the child welfare system because of suspected parental abuse or neglect (Child Welfare League of America, 1998; Department of Health and Human Services [DHHS], 1999). Observations of mother-child interactions involving mothers with histories of abuse and/or dependence on illicit drugs (e.g., heroin and cocaine) have indicated poor sensitivity, unresponsiveness to children's emotional cues, and heightened physical provocation and intrusiveness (Burns, Chethik, Burns, & Clark, 1997; Hans, Bernstein, Henson, 1999). Studies reporting drug-abusing mothers' views about parenting have indicated a lack of understanding about basic child development issues and ambivalent feelings about having and keeping children (Mayes & Truman, 2002; Murphy & Rosenbaum, 1999). It follows that there exists a strong need for interventions that target parenting deficits of parents who abuse and/or become dependent on illicit drugs.

Although prenatal exposure to illicit drugs, including heroin and cocaine, in utero may contribute to early delays in development, growing evidence suggests that the quality of care in the home environment during the first 5 years can also have a significant impact on children's developmental outcomes (see DHHS, 1999; Mayes & Truman, 2002). From birth to 5 years of age, a child's relationship with a primary caregiver is critical to the child's developing capacities for self-regulation, autonomy, and evolving expectations for relationships (Schonkoff & Phillips, 2000). The first 5 years of life therefore represent a window of opportunity during which therapeutic interventions with drug-abusing and -dependent parents are critical for promoting optimal child development (DHHS; Schonkoff & Phillips).

Cognitive and Relational Parenting Interventions

Parenting interventions for drug-abusing and -dependent parents have generally adopted cognitive behavioral and psychoeducational approaches, with the aim of improving child outcomes by replacing maladaptive parenting behaviors (e.g., harsh punishment) with adaptive ones (e.g., limit setting, use of time outs, rewards) that are thought to contribute to children's behavioral adjustment (Kumpfer, Alvarado, & Whiteside, 2003). These approaches are usually curriculum-based and provide opportunities for parents to learn and practice new parenting skills that are expected to increase their children's compliance and reduce their misbehavior (Ashery, Robertson, & Kumpfer, 1998). Because maternal drug abuse and dependence usually occur within the context of harmful psychosocial factors (e.g., poverty, unemployment, domestic violence, and family dysfunction), parent skills training is usually supplemented with case management services to assist mothers in receiving necessary services (DHHS, 1999).

An alternative approach to parenting intervention is a relational approach that emphasizes the emotional quality of the relationship between parent and child as the mechanism that promotes optimal child development. …

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