Supporting pregnant and parenting women with substance-related problems by addressing emotion regulation and executive function needs

Abstract

Treatment of maternal substance-related problems is often complicated by complex pictures of risk, including mental and physical illness and social-contextual risk. In motherhood, systemic barriers, such as lack of childcare and stigma, further complicate access and sustained treatment engagement. Integrated programs are designed to address this issue by providing treatment for substance use, as well as services to address other maternal, parenting, and child needs, ideally at a single access point. Despite growth in integrated programs, a common theoretical framework to inform service provision is lacking. This has resulted in considerable heterogeneity among integrated programs and hindered multi-site evaluation. This study sought to develop a theoretical model of integrated treatment, with a focus on the therapeutic relationship and how the relationship serves to support two common areas of need in this population: emotion regulation (ER) and executive functions (EF). As part of a multi-site evaluation of integrated substance use treatment, six client focus groups (N = 50) were conducted to explore client perspectives on integrated treatment and specifically aspects of the therapeutic relationship they found most/least helpful. Thematic analysis revealed approaches and behaviors of counselors that support ER and EF. These themes are presented and contextualized within the literature that addresses ER and EF risk from a mental health and socio-contextual risk perspective. A theoretical model of these processes is presented, along with practice and policy implications.

Keywords:

• Substance use
• mother
• integrated treatment
• executive function
• emotion regulation

Acknowledgements

Funding for this study is provided by the Canadian Institutes of Health Research and the Ontario's Ministry of Health and Long-Term Care (PHE 135920). Salary support for KU is provided by a Canada Research Chair in Substance Use, Addiction, and Health Services Research from the Canadian Institutes of Health Research. We would like to acknowledge the helpful input of our advisory panel as well as the invaluable support and participation of program staff and clients.

Disclosure statement

The authors report no conflicts of interest.