Affective Themes Related to Parenting Among Mothers in Treatment for Opioid Use Disorder

Background and purpose: For mothers with substance use disorders (SUDs), parenting is a complex emotional experience. The representations mothers with SUDs have of their children and themselves as parents tend to include more negative qualities than those held by other women (Alvarez-Monjarás et al., 2019; Suchman et al., 2018). Negative affective characteristics of parenting representations are associated with experiences of trauma and co-occurring mental health disorders (Hans et al., 2021). However, little is known about the content of negative parenting emotions expressed by mothers with SUDs. This study examines the expression of four negative affective tones – frustration, anger, anxiety and guilt -- in a sample of mothers who are in treatment for opioid use disorder and who have preschool-aged children.

Methods: The sample included 150 African American women with children between 36 and 63 months of age (M = 48.5, SD = 7.4). All mothers lived in urban communities characterized by concentrated poverty and high crime rates. Women had been receiving treatment for heroin dependency for an average of 6.5 months through publicly-funded methadone clinics. The Working Model of the Child Interview (Zeanah et al., 1986) – an hour-long semi-structured interview – was used to generate mothers’ narratives of their children and themselves as parents. Coders trained to reliability rated transcripts on the degree to which specific affective tones were present. Follow-up thematic analysis was conducted on transcripts where “moderate” or “high” levels of four affects were expressed: frustration (n=13); anger (n=6); guilt (n=9); and anxiety (n=7). These follow-up analyses examined the themes mothers conveyed when expressing these emotions. Given the overlap in content themes related to anger and frustration, these two tones were combined into one category in the final analysis.

Results: Mothers’ frustration/anger was most often expressed while discussing challenging aspects of their child’s behavior or efforts to discipline their child. Additionally, frustration/anger was often expressed in describing complicated relationships with other caregivers of their child. Guilt tended to be expressed when mothers were describing their history of their substance misuse and how it may have affected their child and their relationship. Mothers also expressed general guilt about how they parented their child, not explicitly tied to substance misuse. Mothers expressed anxiety in the context of their child having been or potentially being injured or ill and about their relationship with their child.

Conclusions: The negative affective themes expressed by women in treatment for SUD convey an intense desire to have close relationships with their children and for their children to be healthy, safe, and well-behaved. While mothers’ SUD was central to many of their negative emotional experiences related to their child and parenting, their negative emotions were also reflective of parenting experiences distinct from substance misuse, such as frustration with an inability to manage child behavior or anxiety about the child’s health. The findings underscore the importance of providing supports for parents who are in substance use treatment and offers ideas that can inform the development of parenting interventions targeted for parents with histories of SUDs.