Suchman, N., Pajulo, M., DeCoste, C., & Mayes, L. (2006). Family Relations, 55, 211-226.
Most healthcare professionals would agree that effective interventions are needed for drug using mothers and their children. Some providers focus on the children and the effects of drugs in utero although growing evidence suggests that the importance of the quality of care in the first 5 years of life also has significant impact on a child's growth and development. Other providers focus on the drug-using woman, projecting that when she is drug free, both she and her children will benefit. This study from Yale Child Study Center encompasses both mother and child concerns and reviews research on six parenting programs.
The overview of the six evaluated parenting programs for drug-using women revealed two basic approaches: (a) cognitive/behavioral approaches that teach limit setting, time outs, and rewards as methods of effective parenting, and (b) relational approaches that emphasize emotional relationships and the recognition of emotional states and cues. In all six programs, it was difficult to engage mothers in treatment, but in three of the six programs, mothers who were receiving parenting interventions were more likely to have periods of abstinence from drug use. The Yale-based Mothers' and Toddlers' Program was then developed building on emotional/relational components found effective in the reviewed studies, with particular attention to identifying a child's emotional cues. As comorbid psychiatric disorders and poverty occur frequently with drug use, the outpatient treatment also included services for psychiatric, pragmatic, and social concerns. To increase maternal sensitivity to children's emotional cues, mothers met weekly with a therapist for up to 20 weeks on-site at the drug treatment clinic.
Preliminary results of the program have been promising for both mothers and children. The authors link this success to brain pathways, for the same pathways linked to pleasure, motivation, and drug use are also linked to an adult's capacity to invest in the care of children. As the women became more emotionally "in sync" with their children, a simultaneous decrease in the reward pathway associated with drug use occurred.
Limitations with the approach include the need for carefully trained and supervised clinicians and comprehensive services, but the long-term cost effectiveness, and a win-win situation for mothers and children make this an intervention worth pursuing.
Linda Beth Tiedje