Women who abuse cocaine while they are pregnant often share many characteristics, such as addiction, poverty, and low literacy levels. However, they differ in the quality of care they give their children, a NIDA-funded study says. In fact, how well cocaine-addicted mothers care for their infants appears to be strongly influenced by the type and severity of psychological problems these women suffer from, according to the study. The quality of care these mothers provide is important because it affects the cognitive development of their cocaine-exposed infants, the study notes.
"Self-reported symptoms of psychological problems among addicted women really did affect maternal caregiving," says Dr. Judy Howard of the University of California at Los Angeles (UCLA), who directed the study. This finding indicates that drug abuse treatment programs should work on other issues, such as mental health problems, in addition to helping addicted mothers become abstinent, Dr. Howard says.
The UCLA study of cocaine-addicted women and their infants was one of NIDA's Perinatal-20 treatment research demonstration projects. The 5-year program, which ended last year, evaluated the effectiveness of providing comprehensive therapeutic programs that include drug abuse treatment plus a range of additional social and health services for drug-abusing women of child-bearing age and their children. The projects in the program have yielded new information about the characteristics and treatment needs of pregnant and parenting women who abuse drugs. (See "NIDA's Perinatal-20 Projects," NIDA NOTES, November/December 1994)
The cocaine-abusing women in the study, which was conducted by Dr. Howard and Dr. Leila Beckwith, also of UCLA, were similar demographically to the women in many of the other Perinatal-20 projects. On average, they were about 29 years old, had less than a high school education, were single, had a history of being physically or sexually abused, and belonged to minority groups. The women had a long history of cocaine and other drug abuse.
Despite their similarities, including heavy drug use, "these women are not a homogeneous group," stresses Dr. Howard. The women in this study exhibited a wide range of psychological symptoms and maternal caregiving abilities that affected the development of their infants, she says. Specifically, mothers who reported more symptoms of a narcissistic, paranoid, histrionic, or borderline personality disorder were the least sensitive caregivers. In turn, many of these mothers' babies showed signs of delayed cognitive development at 6 months of age, Dr. Howard notes.
Recently, Dr. Howard and her colleagues conducted a further analysis of the data collected about the women's drug use and parenting behaviors 6 months after they gave birth. That analysis indicates that although the women who exhibited the most severe psychological symptoms reduced their drug use, they were still the least sensitive caregivers.
"These findings suggest a clinically significant relationship between a mother's psychopathology and her ability to care for her newborn, which, in turn, might negatively affect her child's development," says Dr. Elizabeth Rahdert, a research psychologist with NIDA's Division of Clinical and Services Research, who has been involved with the Perinatal-20 program since its inception. In addition, the finding that many of these women have severe mental health problems suggests that treatment programs should include a psychiatric component to assess and address women's mental health problems on an individual basis, Dr. Rahdert says. Social service programs that do not have mental health professionals on their staff can make sure women receive the therapy they need by establishing strong links to the mental health care system within their communities, says Dr. Rahdert.
Mental health professionals should play a key role in drug treatment for drug-abusing mothers, agrees Dr. Howard, but they need to be trained in addiction-related problems, she says. In the final analysis, the study's findings argue for comprehensive treatment programs and coordination of addiction treatment, mental health, and pediatric services to adequately meet the needs of these women and their children, concludes Dr. Howard.
Sources
- Howard, J.; Beckwith, L.; Espinosa, M.; and Tyler, R. Development of infants born to cocaine-abusing women: Biologic/Maternal influences. Neurotoxicology and Teratology 17(4):403-411, 1995.
- Howard, J.; Espinosa, M.; and Beckwith, L. Psychological status and parenting behaviors in cocaine-using mothers. Abstract presented at the 58th Annual Scientific Meeting of the College on Problems of Drug Dependence, San Juan, Puerto Rico, 1996.