The Stigma of Maternal Substance Use

Dr. Mark Cody Smith, board-certified Pediatrician and Neonatologist

Stigma is the process of labeling, stereotyping, social rejection, exclusion and extrusion, as well as the internalization of community attitudes in the form of shame(White, 2009).  Mothers with substance use disorder (SUD) or a history of SUD face heavy stigmatization (Betsy Hardy, BSN, 2017).  Stigma is a known barrier to treatment seeking.  In the past, SUD in women was considered a selfish, moral failure, resulting in intentional harm to family and children.    However, we now know that SUD in women is a treatable medical condition.  How can mom’s battle the stigma of SUD? Below is a series of Q&A to help answer this question.

How do women in a stigmatized status maintain self-esteem?

  1. Positive self-affirmation: a positive statement you say to yourself to combat negative thoughts (Cascio et al., 2016). Examples include, “I can do this,” “I am not my mistakes,” I believe in myself.”.
  2. Self-forgiveness: forgiving yourself is hard but doing so can decrease anxiety and depression (Peterson et al., 2017). Ex: “I realize I have made mistakes, but I forgive myself.”
  3. Practice Self-Compassion:
    1. Self-kindness: instead of judging yourself, look at your flaws and inadequacies gently and understand them and accept them because no one is perfect!
    1. Connect with shared humanity: We (humanity) all make mistakes and feel inadequate at times!
    1. Mindfulness: this is a mental state you achieve by purposely focusing on your awareness of the present moment, while calmly acknowledging and accepting your feelings, thoughts, and bodily sensations (Garland & Howard, 2018).
  4. Self-Determination: you understand that you are in control of your life and have an innate ability toward growth, integration, and health (Sharma & Smith, 2011).  You can identify things in your life that you’d like to change and take one small step at a time toward that change. Remember that growth takes time!
  5. Self-care: your physical and mental health are integrally connected. Eat healthy, exercise, and address medical and mental health conditions with the help of medical professionals.

How do mother’s with SUD fit in with mainstream society?

Surround themselves with supportive people who are rooting for their recovery. They may find support through religious/church groups or peer support groups.  These supports allow them to build bonds and relationships outside of the “substance using community”  and helps recovering individuals maintain a substance-free lifestyle within mainstream society (Lee & Boeri, 2017)

How do mother’s with SUD live with the identity of a former substance user?

Rather than identifying as former substance user, identify as being recovered. By doing so moms can gain a sense of belonging and acceptance within the community. After this, they can move toward other identities such as a renewed identity such as occupational or educational motivations/dreams or even and aspirational identity in which you set new goals (Dingle et al., 2015).

How does SUD affect the maternal role?

Women have traditionally been seen as the gatekeepers, caregivers, and central organizing factor in their family units.  70% of women in addiction treatment have children and more likely to have primary responsibility for their children creating difficulties in attending regular treatment sessions due to lack of childcare (Nelson-Zlupko et al., 1996; SAMHSA, 2007).  Stigma, prolonged isolation, and fear of legal actions are common are major barriers for mother’s seeking care. Successful parenting is a primary goal for parents as they enter recovery (Pajulo & Kalland, 2015).

Moms desire to provide the best care or their children. Raising children has been associated with improved engagement in drug substance-treatment programs. Incorporation of family members in the recovery process contributes to preventing or extending time to relapse providing greater potential for involvement in supportive family relationships and treatment adherence (Villegas et al., 2017).

Neural pathways driving parenting and attachment behaviors seem to be the same pathways negatively impacted or dysregulated by substance use disorder (Rutherford et al., 2015). The single most important factor in a child’s recovery from exposure during pregnancy to opioids is the quality of nurturance the child receives from primary caregivers.  As young children develop, their early emotional experiences literally become embedded in the architecture of their brains.” (Shonkoff et al., 2004). “The way a mother experiencing Perinatal Substance Use Disorder is treated, and her view of herself as being a capable (or incapable) mom, will impact how her relationship and attachment with her baby develops (Renbarger et al., 2020).” 

In conclusion, stigma can be a major barrier for mother’s with SUD. However, there are ways to overcome these barriers to successful treatment in order to be great mother’s and raise healthy children.

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