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BACKGROUND: About one in every 8 children under age 17 in the U.S. live a parent who has a substance use disorder; with the majority under age five. While child welfare involvement due to fetal alcohol spectrum disorder have remained static, involvement due to neonatal abstinence syndrome has increased dramatically since 2014. Research on treatment accessibility have identified stigma as a significant barrier to women, particularly for pregnant women and mothers.
METHODS: Descriptive Phenomenology was used to describe the experiences of stigma of mothers with opioid use disorder (OUD). Mothers (n=20) participating in an outpatient treatment program that includes medication for opioid use disorder (MOUD), individual and group counseling, social work and family support services were interviewed regarding the impact on their children during OUD treatment and recovery. A semi-structured interview schedule was used to guide the interviews and thematic analysis was used identify themes related to stigma.
FINDINGS: Our sample included 20 mothers between the ages of 25 and 65 years. Fifteen percent identified as African American or Black, 60% as white and 25% as Latina/Hispanic. Fifteen percent identified as LGBTQ and all participants were cisgender. All of our participants had children under the age of 10 years at the onset of their addiction and through initial treatment seeking and recovery. Our analysis identified several main themes and subthemes related to sigma: Internal, External, and Healing from Stigma. External stigma subthemes identified were stigma in the recovery community, general public, family and in healthcare setting. One internal stigma subtheme identified was shame. Two tertiary-level subthemes, medication for opioid use disorder, and gender/sexual orientation, were also identified in all of the main categories. Subthemes identified in healing from stigma were personal growth, advocacy, and self-forgiveness.
IMPLICATIONS FOR POLICY OR PRACTICE: Despite efforts to combat it, the opioid epidemic is set to remain the predominate public health challenge of the next decade. Increases in parental OUD result in adverse childhood experience and increased risk of opioid use disorder carrying over to future generations. Punitive drug policies often cause more harm to families and perpetuate the stigma of addiction. Our study supports the critical need for interventions that are tailored for the specific needs of families affected by OUD and that are culturally appropriate for the needs of minority parents seeking treatment for OUD.