Violence Experience and Parenting Among Women in Treatment for Opioid Dependence

Background and Purpose:  A large literature documents that women with substance-use problems often have experienced violence in their close relationships and within their communities (e.g., El-Bassel et al., 2000).  Substance using women are also are at elevated risk for child maltreatment and problematic parenting behavior, attitudes, and experiences (e.g., Hans, 2002).  The goal of this paper is to explore whether challenges in parenting experienced by women with opioid-dependence problems are related to adult exposure to violence and to trauma-related psychological symptoms. 

Methods:  Research participants included 123 urban low-income African-American mothers of 12- to 20-month-old infants.  Half of the mothers were receiving methadone treatment for heroin dependence, and half were a non-treatment community comparison group.  Adult exposure to community violence was examined using questions from the National Crime Victimization Survey and to intimate partner violence using the Conflict Tactics Scale (Straus et al., 1996).  Post-traumatic stress symptoms were measured using the Millon Clinical Multiaxial Inventory-III (Millon. 1994) and dissociative symptoms using the Dissociative Experiences Scale (Bernstein & Putnam, 1986).  Parenting attitudes were assessed using the Adult-Adolescent Parenting Inventory (Bavolek, 1989), parenting stress using the Parenting Stress Index (Abidin, 1983), and parenting behavior using video-recorded observations coded with the Parent-Child Observation Guide (Bernstein et al., 1987).

Results.  Hierarchical regression analyses were computed with parenting measures as dependent variable, first in models with only opioid dependence and demographic variables as predictors, and second in models adding measures of violence exposure and psychological symptoms as predictors.  Women being treated for opioid dependence were more likely to report parenting stress (β=.27), parenting attitudes lacking empathy for the child (β=.37), and parenting attitudes expecting parent-child role reversal (β=.28),  Opioid dependent women were not more likely to endorse attitudes favoring corporal punishment, and they did not differ from other mothers in sensitivity or harshness displayed in brief video recordings.  Opioid-dependent women also were more likely to have experienced partner violence, rape, and physical assault and to have elevated levels of PTSD and dissociative symptoms. 

Followup analyses showed that the associations between maternal drug dependence and parenting variables were largely attributable to the experience of violence and to trauma-related psychological symptoms.  Role reversing parenting attitudes were particularly strongly related to adult violence exposure.

Conclusions and Implications.  This study replicates previous research showing that women with substance use problems are more likely than other women to have experienced multiple kinds of violence, to have trauma-related psychological symptoms, and to be at risk for problematic parenting.  This study extends previous research in showing that much of the risk for parenting among women with substance use problems may be related to violence exposure and trauma-related mental health problems.  The findings suggest it is important that substance abuse treatment services for women be integrated with services supporting their mental health needs and their needs as parents.  The linkages between women’s experiences of violence and their parenting suggests that many women in addictions treatment would benefit from the availability of trauma-informed parenting interventions such as Child Parent Psychotherapy (Lieberman et al., 2005).