The Impact of Maternal Substance Use and Related Comorbidities on Maternal-Child Attachment

• In Event: 2-039 - New Perspectives on Maternal Drug-use: Risk and Protective Factors for Parenting, Child Development and Interventions

Integrative Statement

Introduction:
With increasing legalization of marijuana and the ongoing opioid crisis, the U.S. is experiencing a substantial increase in individuals using marijuana, opioids and other substances, including parenting women. During active drug use, cognitive and emotional impairment can occur, impacting functioning. While chronic/heavy substance users are often recognized as “unfit” parents, less is known about how lower/less frequent levels of use, including prescribed/therapeutic use, may impact parenting, parent-child attachment, and child development. Also unclear is how potential effects might be influenced by comorbid medical and mental health conditions. Finally, many of these women used substances during pregnancy, potentially impacting child development/child responses to parenting.

Aims or Hypotheses:
The presentation goal is to review existing research on substance use during early parenting, and to present findings from a prospective study examining associations between maternal substance use and toddler attachment. Specifically addressed will be: 1) Are substance-using mothers of infants/toddlers more likely than non-using mothers to experience poor parent-child attachment? 2) Are potential effects due to comorbid conditions such as pain, chronic illness, and depression/anxiety, or do they stem more directly from the substance use itself? 3) What are the developmental characteristics of toddlers/infants exposed prenatally to marijuana and/or opioids, and do these additionally affect the responses of the mother?

Study Population:
223 mother-toddler dyads recruited at first prenatal visit and followed until child age 15 months.

Methods:
Regular assessments during pregnancy included evaluation of substance use using validated tools and biochemical verification. Newborn outcomes were obtained through chart review, and a comprehensive child and parent assessment was completed at 15 months. Assessments of interest here include Parenting Stress Index (PSI; Attachment, Reinforces Parent, and Child Demandingness Scales), CESD-10 depression scale, Communication and Symbolic Behavior Scales (CSBS), Battelle Developmental Inventory, and Timeline Follow Back assessment of recent maternal substance use.

Results and Discussion:
Of the 223 participants, 40 (18%) reported current use of marijuana and/or opioids. All marijuana use was <4 times/week, with 53% reporting use for medical reasons. Most opioid use was reported for medical reasons (77%), with remaining recreational use all <4 times/week. Substance use was associated with lower levels of attachment in bivariate analyses, and with several background factors and higher levels of depression (Table 1). Prenatal exposure to substances with known teratogenic effects (tobacco, marijuana, opioids, alcohol) did not significantly predict (p>.05) child outcomes potentially affecting attachment (CSBS Social Score, Battelle Cognitive Quotient, PSI Reinforces Parent and Demandingness Scales), and thus were excluded from controlled analyses. After control for significant background factors, depression, and presence of chronic illness impacting daily functioning, substance use continued to predict decreased attachment (Table 2). While more data from large-scale well-controlled studies are needed to better understand the role of comorbid conditions and potential child development issues resulting from in utero substance exposure, maternal substance use even at low levels and for therapeutic purposes appears to predict attachment difficulties, with effects evident over and above background differences and physical and mental health comorbidities. Findings suggest an important target population for mother-child attachment-related interventions.

Author

• Beth Bailey, University of Colorado
  Presenting Author