Perinatal Substance Use and the Underpinnings of Addiction and Attachment: Implications for Parenting Interventions

Perinatal substance use (PSU; i.e., substance use during pregnancy and the first year postpartum) is a challenging public health concern with implications for both the mother and her child. Perinatal women with substance use disorders (SUDs) often have difficulties with parenting including displaying high levels of negative parenting behaviors (e.g., harshness and irritability) when interacting with their children and greater difficulty interpreting their children's cues. The overlap between the systems in the brain that are involved in addiction and parent-child attachment can shed light onto challenges with parenting and the formation of healthy parent-child relationships. Parenting interventions (and interventions more broadly) for perinatal women with SUDs should be informed by the interplay between addiction and attachment. We begin by reviewing the prevalence of PSU and common parenting challenges. We then provide context to these parenting challenges by reviewing current understanding of the interplay between systems implicated in addiction and parent-child attachment. Finally, we describe existing parenting interventions for perinatal women with SUDs and highlight the need for relationally focused interventions that are strengths based and person-centered. Understanding how the neurobiological process of addiction is intertwined with past and current attachment relationships should be leveraged to inform more accessible, acceptable, and effective interventions for pregnant and parenting women with SUDs. Additionally, we describe how understanding the ways in which addiction disrupts the formation of healthy parent-child attachment has foundational implications for the treatment of PSU and the training of new clinicians. Clinical Impact Statement Substance use during pregnancy and the postpartum period can cause changes in the brain that negatively impact parenting and the development of healthy parent-child relationships. Understanding these changes is essential for building more effective and compassionate parenting interventions to support caregivers and their new babies.