A systematic review of the nuances of attachment, bonding and parenting for mothers in addiction recovery

Background: There is much focus internationally on the importance of mother-child bonding which is seen as a core component of attachment theory.  For mothers in addiction recovery, the identity and role of parenthood is often a key motivating factor for accessing support. The aim of this presentation is to understand from the perspective of the mother her experiences of motherhood while in addiction recovery and to explore the intersection with attachment theory as well as infant and child development.

Methods: Qualitative studies reporting women’s experiences of motherhood and addiction recovery were identified using a PICO framework to determine inclusion and exclusion criteria. A systematic search of CINAHL, Medline, Embase, ASSIA, PsycInfo, Web of Science and Grey Literature was undertaken in 2022 and 2023. The limiters Humans, English Language and Timeframe (2017 to present) applied. Quality appraisal of articles was completed independently by two reviewers using the CASP framework for Qualitative Research. Study details, participant characteristics, methods for data collection, analysis and research findings were extracted from all included studies using a customised data extraction tool. Data were synthesised and one main finding related to the experience of attachment, bonding and parenting for mothers in addiction recovery.

Results: Synthesis revealed three mother-child attachment and parenting related themes: 1) anticipated or actual separation 2) reunification and reestablishing connection and 3) challenges in connecting with children and being a mother in addiction recovery. Mothers sometimes withdrew from bonding for fear of separation, especially if they had a previous experience of involuntary separation. Separation largely occurred due to voluntary or involuntary care orders with child protection services but could occur due to hospital policies at birth for babies with neonatal abstinence syndrome, accessing residential addiction treatment that did not support children to join their mothers and incarceration. Following periods of separation, it was challenging to repair bonding especially if connection time was limited during separation. Many mothers experienced nuanced challenges such as “wanting to do it differently” where they had experienced trauma as a child or had a child removed from their care previously. This feeling of “wanting to do it differently” presented a difficulty in terms of knowing what they did not want to do in terms of parenting but with uncertainty as to what to do.

Conclusions: It is important to provide a broader range of support which holds the wellbeing and connection between mother and child central rather than the wellbeing of one or the other. Women suggest that integrating family specific services into addiction services are helpful to support them to address the need to be a responsible parent, as well as to expand the opportunity to support children who may also have been impacted by addiction.