Introduction
The problem of drug abuse is relevant to many countries of the world. It is especially dangerous in the context of pregnancy, motherhood, and parenting. The baby’s attachment plays an essential role in the mother, with whom the child builds an emotional connection. Women abusing drugs are often “unduly punitive, authoritarian, and less receptive to the needs of their children” (Alvarez-Monjaras, Rutherford, & Mayes, 2019, p. 321). This behavior can ultimately lead to an unstable attachment between mother and child, which has several negative consequences for infant development. Thus, health care providers must help mothers cope with the psychological and emotional problems associated with drug misuse.
This paper aims at discussing the issues of the behavior of women abusing drugs about their children. In particular, the general causes of drug addiction among women are discussed and cultural and social preconditions, as well as the characteristics of the psychological and emotional state associated with addiction, are analyzed. Further, social inequality and discrimination in the emergence and spread of the issue are evaluated. Finally, the theory behind the behavioral features associated with the problem under consideration is explained. Promotion and behavior change strategies to improve the current situation are also discussed.
Relationship Between Drug Misusing and Motherhood
Substance abuse is a problem in the population of many modern countries. According to the data, in the US alone, 21 million people aged 12 and over are affected by this problem (Fridman, 2019). Even though there are twice as many male drug users as females, there has been an increase in the number of reproductive age or pregnant drug addicts women in recent years. According to statistics, 90% of women opioid users are at the age of childbirth, 4.5% of pregnant women are misusing substances (Parolin & Simonelli, 2016). For instance, in Europe, from 6.5 to 11% of women with a substance abuse issue become pregnant every year. (Parolin & Simonelli, 2016). Annually 400,000 infants in the US and 30,000 in Europe are born to drug-addicted women (Parolin & Simonelli, 2016). Thus, many people in the world suffer from problems associated with the negative impact of drugs on the birth and development of children.
Substance Use Disorder is characterized by physiological and psychological dependence, the development of addiction, the leading role in the occurrence of which is played by reward mechanisms. Such reinforcement processes can be either positive or negative. For example, a pleasant experience of use leads to a greater likelihood of re-taking the substance. Conversely, long-term addiction to the drug prolongs the behavior associated with drug use, making extinction more difficult, considered negative reinforcement (Cataldo, Azhari, Coppola, Bornstein, & Esposito, 2019). Thus, at the neurobiological level, drug use initiates the activation of the same neural circuits responsible for expressing signals of maternal behavior (Parolin & Simonelli, 2016). As a result, the mother is less sensitive to the baby’s emotional cues, which are now considered stressful.
Substances abuse affects the emotional and psychological state of a person. The problem is especially relevant for women because motherhood is a natural crisis that “may be further complicated by addiction” (Alvarez-Monjaras et al., 2019, p. 321). In turn, a mother’s drug abuse can pose risk factors for the child’s physical and psychological health. Substance misuse during pregnancy can lead to prematurity and decreased growth rates (Porreca, De Palo, Simonelli, & Capra, 2016). Drugs also harm the mother’s child-care behavior. The mother may tend to ignore the child and show indifferent or incoherent attitudes. Parenting methods can include physical punishment and threats and are characterized by cruelty and intolerance. The maternal behavior of a woman drug abuser can be emotionally distracted, which leads to further improper adaptation of the child. Moreover, from 43 to 79% of children affected by parental abuse were born into a family with one or two drug-addicted parents (Parolin & Simonelli, 2016). Thus, substance abuse can harm pregnancy and parenting, but, for some women, the child becomes an incentive for addiction treatment.
Contributing Factors and Social Determinants
The causes and nature of Substance Use Disorder for men and women are different. Thus, women are characterized by more frequent drug use at a very early age (9-10 years). The onset of drug addiction at a more mature age (35-40 years) is often the result of separation or divorce. Women prone to the disorder suffer from a lack of family support, which leads to feelings of loneliness (Fridman, 2019). Thus, if men are more likely to take drugs in response to social problems (poverty, relationships with society, and peers), women react in this way to family or relationship problems (emotional, sexual, psychological). Drug addicted women often report feeling shame and anxiety about public opinion, which affects their perception of themselves (Parolin & Simonelli, 2016). Substance addiction is also subject to gender discrimination; society condemns women more than men, which leads to a distortion of women’s self-worth (Fridman, 2019). Thus, Substance Use Disorder in women is characterized by a response to psychological and emotional problems exacerbated by the social factor of stigmatization.
Family holds a special place among the causes of drug abuse. Both genders are at greater risk if their family has a history of addiction. However, women are most closely associated with psychological and emotional responsibilities toward family members, so a woman’s Substance Use Disorder can be more destructive to the family (Fridman, 2019). Women often report traumatic experiences from early life coming from their families (Meulewaeter, De Pauw, & Vanderplasschen, 2019). Childhood experiences of physical, emotional, or sexual abuse, as well as parental neglect, increase the chances of developing addiction in the future. Thus, a disrupted emotional connection with a caregiver can cause developmental issues and have a significant impact on mental and physical health. It also was found that many drug misusing women suffer from “major depressive disorder, anxiety disorder, eating disorder, and posttraumatic stress disorder” (Fridman, 2019, p. 8). Thus, depression is often a prerequisite for starting substance abuse. Drug use is a defense mechanism that helps women cope with emotional trauma.
It was mentioned earlier that women suffer to a greater extent from gender discrimination against substance misuse. Negative public attitudes towards addicts are a serious obstacle to medical care provision and the development of drug dependence treatment systems. At the structural level, such biases lead to a weakening of support for drug control policy; the health system focuses on public health. People who need help with addiction are more likely to refuse to go to health professionals to avoid stigma (Kulesza et al., 2016). Thus, it is necessary to eliminate the moralistic and punitive view of Substance Use Disorder to receive help.
Racial discrimination also influences the development and treatment of drug addiction. Thus, studies show that encountering racial discrimination leads to an increased risk of developing Substance Use Disorder. Cases of interpersonal racial discrimination lead to stressful conditions and worsening depressive symptoms, which, in turn, provoke drug abuse (Matsuzaka & Knapp, 2019). Even though there is no difference between the number of drug addicts depending on race, people of color seek help with more severe addiction cases, which is associated with economic barriers. Lower employment rates for Hispanics and Blacks in the United States, for example, affect access to quality health care (Matsuzaka & Knapp, 2019). Thus, drug addicts of color face interpersonal and systemic racism, which leads to frequent refusals from medical care, as well as a worsening of the situation of substance abuse. Such discriminatory restrictions, as well as family influence, can be defined as community factors influencing the current issue.
As noted, Substance Use Disorder harms parenting. Addiction in the context of motherhood can be assessed with the structural-developmental psychodynamic model of personality development that was initially proposed to study depression. According to this model, in the process of growth, a person is faced with a “dialectic transition between fostering and tending to relationships and bonds, and developing an independent and fully different sense of self” (Alvarez-Monjaras et al., 2019, p. 322). The integration of the two processes leads to forming a healthy personality, while excessive dependence on one of them can lead to psychopathologies. Thus, the degree of personal development integrity determines what emotions the mother will project onto the child. It will also affect the mother’s ability to comprehend and adapt her behavior to the child’s mental state (Alvarez-Monjaras et al., 2019). Thus, the model points to the intrapersonal factors of interaction with the child, depending on the mother’s personal development. The direct process of interaction with the child is an example of the interpersonal aspect.
Attachment Theory
The main model describing maternal behavior in the context of drug addiction is attachment theory. According to this perspective, from birth, a child needs to establish an emotional connection with a caregiver, to maintain closeness with them, especially in situations of external and internal stress (Meulewaeter et al., 2019). If the child does not receive an adequate response from the mother, insecure attachment develops between them, often with mothers abusing substances.
Attachment theory has been applied, in particular, to study the difference in the development of attachment styles in drug users and non-users. Vulnerability to drug abuse manifested itself not only as a result of interpersonal trauma but also as a result of the inability to self-regulate (Fridman, 2019). Research shows that self-regulation skills are shaped by the interaction of mother and child (Parolin & Simonelli, 2016). Thus, the caregiver with childhood attachment disorders retains them in adulthood and transfers them to their child.
Conclusion
The problem of motherhood for drug-addicted women is the inability to establish a secure attachment with a child due to emotional and psychological trauma. Consequently, the lack of full-fledged interaction negatively affects the child’s development, which has an impact on their entire future life and relations with depression and drugs. In modern society, gender, racial, and structural biases prevent drug misusing mothers from seeking professional help. Their inability to show an adequate response to the child’s emotional signals causes psychological trauma in childhood, which hinders harmonious personal development. The health system’s challenge is then to increase the availability of psychological help for these mothers so that they can receive addiction treatment. Thus, in the treatment of drug addicts, it is necessary to introduce strategies to develop attachment between the caregiver and the child based on the psychological trauma of the mother. The behavior of healthcare workers should be aimed at creating a safe and confidential system and establishing a trusting relationship between physicians and patients with Substance Use Disorder.
References
Alvarez-Monjaras, M., Rutherford, H., & Mayes, L. (2019). Personality organization and maternal addiction: A structural-developmental psychodynamic contribution. Psychoanalytic Psychology, 36(4), 321-327.
Cataldo, I., Azhari, A., Coppola, A., Bornstein, M., & Esposito, G. (2019). The influences of drug abuse on mother-infant interaction through the lens of the biopsychosocial model of health and illness: A review. Frontiers in Public Health, 7(45), 1-8.
Fridman, E. (2017). Insecure attachment and drug misuse among women. Journal of Social Work Practice in the Addictions, 19(3), 233-251.
Kulesza, M., Matsuda, M., Ramirez, J., Werntz, A., Teachman, B., & Lindgren, K. (2016). Towards a greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender. Drug and Alcohol Dependence, 169, 85-91.
Matsuzaka, S., & Knapp, M. (2019). Anti-racism and substance use treatment: Addiction does not discriminate, but do we? Journal of Ethnicity in Substance Abuse, 1-27.
Meulewaeter, F., De Pauw, S., & Vanderplasschen, W. (2019). Mothering, substance use disorders and intergenerational trauma transmission: An attachment-based perspective. Frontiers in Psychiatry, 10, 1-17.
Parolin, A., & Simonelli, A. (2016). Attachment theory and maternal drug addiction: the contribution to parenting interventions. Frontiers in Psychiatry, 7, 1-14.
Porreca, A., De Palo, F., Simonelli, A., & Capra, N. (2016). Attachment representations and early interactions in drug addicted mothers: A case study of four women with distinct adult attachment interview classifications. Frontiers in Psychiatry, 7, 1-11.