Contemporary ethical problems in the therapy addicted mothers The evaluation of a possible intervention for dependent parents requires a multidisciplinary focus, in which scientific fields such as: healthcare, social work, psychology, pedagogy, sociology, and law are intertwined. Competences of dependent parents represent interest, willingness to change, ability to educate, self-forgiveness. The complexity of various factors, with the specific past of individual cases, places parenting and addiction in conditions in which it is necessary to intervene in an integrated and multidisciplinary manner within the framework of therapy and assistance.

In Italy, there are various open discussions involving hospitals, counseling centers, social service facilities, and the third sector on this topic.

The aim of our contribution is to make visible the place of therapeutic communities in the search for a solution to the problem of drug-addicted mothers. The inspiration was our experience and direct involvement in activities with dependent mothers in the Community of Pope John XXIII. in Italy.

The incidence of pregnancy in drug-using mothers is due to important information obtained from midwives (Cedap15) in the Piemonte region in the years 2003-2005. Of the 167 women who gave birth in this region, 167 women used psychoactive substances. Female drug users, unlike those who did not use drugs, had not completed any education and were unemployed. A significant number of abortions based on voluntary termination of pregnancy are recorded among these users. The first visit to the gynecologist is recorded only in the first trimester of pregnancy. Children with low birth weight and small head circumference were born to drug users and smokers. (Mizzotti, 2006)

In Palmieri's (et al., 1991) studies of addicts in prisons in 1990, the following data were recorded from 100 respondents (73 men and 27 women) with respect to the female population:

  • 37% of dependent women have not completed any education,
  • 40.8% of women have divorced parents,
  • 29.8% have one of their siblings (brother/sister) addicted,
  • 18.5% are married or living in the same household with a partner,
  • 55.5% of women have at least one child,
  • with regard to the mentioned initial addiction: 26% of women started using drugs after the birth of a child (4.8% for men) and 7.3% of women after divorce (1.4% for men, on the contrary).

In recent years, research interest in dependent parents has been increasing. Zacchello and Gianquinto (1991) state that 25% of the addicted population is made up of women of childbearing age, where 2500-3000 pregnancies among women using narcotic substances are registered in 1 year and 80% of them end in childbirth.

In a Dutch study by Gorrini and Brer (2004), interesting results are presented, where: 26.5% of children are entrusted to relatives (usually grandparents) or other families; 5% are adopted, 2% are placed in institutions, and only 59.2% of children live with at least one parent (in 30% with both parents).

The dependence of a single mother, as opposed to the dependence of both parents, determines differences and diversity in child care, as well as separation from the dependent mother. Conversely, if only the father is dependent, the child lives with the parents or grandparents.

  • most of the parents are divorced (48%), 40% live in a joint household, 11% are single parents or widowers;
  • interventions by Ser. T were implemented in 73.6% of cases of dependent mothers, on the contrary, 28.1% of dependent fathers; it also records in 56.4% of cases personality disorder-bordeline and in 10.2% antisocial behavior, mood swings of addicted women.

The data obtained in the Chicago study of mothers using drugs during pregnancy emphasize that there are no significant differences in the amount of drugs used during pregnancy in relation to race, social class, age; on the contrary, they are in the type of dependence. Black women from lower social classes use hard drugs - mainly cocaine, unlike white women with higher incomes who prefer alcohol. Another element is family relationships. The majority of alcohol addicts report addiction in their parents, and up to half of women with addiction have experienced sexual abuse during childhood; usually the partner of an addicted woman uses psychoactive substances and they are often victims of domestic violence. (Hans, 1999)

A longitudinal American study of 252 addicted mothers emphasizes that in 22% of the women interviewed, the child's father had problems with drugs or alcohol (the probability in this case was 1.6 times greater in heavy cocaine users compared to soft drugs and 2.6 times higher compared to those who did not use the drug). A significant relationship between the father's drug/alcohol history and the mother's psychological and physical habit during pregnancy was examined. Relative data for fathers who use drugs/alcohol, among other things, indicate that a greater proportion of them are in prison (p=.001) and unemployed (p=.04) at the time of the child's birth in contrast to fathers who do not use drugs. Considering the results of newborn examinations, there is a difference in the values ​​of weight and height between the children of addicted fathers and fathers who do not use drugs (3003 vs. 3213g; p=.005 and 47.5 vs. 48.6cm; p=.01). The conclusions of the study state the results of knowledge and attitudes usually attributed to the use of dependent mothers supplemented by the genetic and social influence of the father. (Frank et al., 2002)

According to H. Drobná, from January 1995 to April 1999, 101 newborns were born in Slovakia to mothers addicted to drugs. The age range is between 13 and 40 years old. The actual number of addicts is about 5-10 times higher than the registered number. (In: Ondrejkovič, 1999, p. 111)

Pregnancy is not a desired decision, it is seen as an unfortunate accident. The diagnosis of pregnancy is made late, certainly because of irregular menstruation, the vagueness and confusion of signs and physical symptoms of pregnancy, little interest and care for one's own body or an irresponsible approach with constantly postponing the problem to the next day. M. Canestrani, M.D. Micheli (1997) conducted research at the Maternal-Infantile Center from 1980-1992 following 421 heroin-addicted women. In their research, they state that 44.8% of clients present only in the 2nd trimester of pregnancy.

The variety of approaches to solving the problem is influenced to a large extent by the length and relationship to addiction. This problem requires not only a medical approach within the framework of detoxification, but mainly a crisis intervention with a comprehensive project and prognosis of other interested entities.

Important prerequisites are:

  • catching pregnancy earlier than in the third trimester;
  • assessment of the degree of addiction, method, amount and frequency of drug use, type of addiction;
  • evaluation of possible pathologies in psychiatry caused by addiction;
  • the attitude of relatives and a partner who is addicted;
  • planning the next project in the framework of detoxification with minimal risk of further access to the drug;
  • cooperation with other institutions: therapeutic community, departments of social and legal protection, counseling and psychological services.

According to the experience of the above-mentioned authors, up to 23% of women who come to centers for pregnant women stop using the drug only in the 3rd trimester with a slow and progressive integration into social life.

For drug-addicted mothers, it is essential to destroy drug addiction and at the same time address the causes of drug addiction. The mother matures on two levels: as an autonomous, free personality and a responsible mother who differentiates, understands her role from the role of the child and in motherhood replaces the "heroine void".

"The relationship that isn't: Any considerations."

Experts dealing with the issue of drug addiction in women often do not consider the mother-child dyad. The solution, in which the mother remains in the therapeutic process and the child is entrusted to the care of a physical person other than the parent, is current in the current thinking of many adepts.

Do we not forget that the dependent mother is already the mother of the child and that there is a relationship between them? Realized separation increases the risk of their good sticking, tying. A child pays a great price if he has to distance himself from his mother during a relatively important period for his existence. We should not forget that the bond that begins to form during pregnancy is strengthened through the relationship in everyday life. In this understanding, there must be a direction from the child to the mother. On the contrary, very often the motherhood of dependent mothers is considered a bond that does not exist. A mother is still being "searched for", and a drug addict "can" become a mother only in thoroughly verified and prepared conditions. We perceive superficiality in the separation of two persons at an important time of their connection, regardless of the fact that the connection between them already exists. We consider it very important to catch them at the right time and by providing conditions in which mother and child can grow and develop a relationship.

Bonding theory is the idea of ​​J. Bowlby, who emphasizes the clinging and bond of the child with the mother from the very beginning. Attachment develops gradually during infancy and the child needs many interactions with the caregiver. (Hašto, 2005)

"Community: A Relationship That Forms"

With the discovery of the key of return for mothers, the methodology of the Community of Pope John XXIII. in Italy she found flexible answers that allow personality growth and support in the mother-child dyad. For dependent mothers, it is possible to maintain and develop a good mother-child relationship. It is equally important to maintain growth and develop a connection with the child, even if they cannot live together for various reasons. An educational environment rich in stimuli and resources, such as a therapeutic community, is ideal for the co-presence of a mother and her children: for the mother in maturing and for the child by strengthening the emotional bond. In the community, mothers feel protected after previous difficulties and confusion (searching for a benefit, conflicts with a partner, in the family, fatigue from improper organization of the day). During the last period of experience, it became clear that in solving this problem, the necessary reconciliation of two worlds (the world of the mother and the world of the child) resulted in the understanding and mutual recognition of three dimensions that complement and influence each other: the drug-addicted mother, the mother-child dyad, the child. The mother's educational intervention has a significant impact on the child. Operators (therapists) must maintain this "emotional channel" which is essential for mother and child. The therapy methodology focuses on three main moments: acceptance, community, return.

1st phase of the program – admission

This phase lasts 3-6 months for mothers, for pregnant women it is individual, some mothers with children do not complete the first phase because they start the therapeutic program with the 2nd phase. They are dependent mothers with a child from 0-6 years old who need different rhythms and group dynamics than those found in the 1st phase of therapy. In this case, the 1st phase takes place in the community environment, which is part of the 2nd phase of therapy. Some mothers come to the Reception Center without their child. The child is entrusted to the care of other parents, grandparents or to the care of family-type communities - Family Home (still within the structure of the Community of Pope John XXIII). We are talking about children who are over 6 years old. They are not in daily contact with their mother. With the increasing claims and demands of the child, the mother at this stage must accept help from those who are entitled to it and have only the greatest prerequisites. His mother starts visiting him only in the 2nd phase of the program.

2nd phase of the program – community

The second phase of the program lasts 16-18 months and can be developed in different communities, with different characteristics and duration in order to correspond to the specific needs and characteristics of the participants from the Reception Centers. Dependent individuals tend to choose values ​​applicable to normal life.

We present two communities dedicated to the therapy of addicted women and mothers with children: S. Andrea Therapeutic Community This community has been operating since 1982. 18-20 program participants with a wide range of problems live in the community: drug addiction, alcoholism, addicted mothers with their children, addicts with psychological problems, handicapped individuals. The community is mixed. During the day, there are 4 operators in the community with the supervision of a psychologist. Operators have their own families and do not live directly in the community. The community with its characteristics is also ideal for the development of children who are co-participants in the mother's program. The mother has space and time to devote herself and her child to a sufficient extent. A very effective therapeutic tool is the atmosphere of the family environment.

Sala Cesenatico Therapeutic Community The community has been operating since 1995. Only women and their children live in the community. The number of women is a maximum of 6. The organization of the day is the same as in other therapeutic communities with greater adjustments of free time adapted to the child's rhythm, focusing on play, sleep, feeding, rest and walks. There are two operators in the community who are married and live in the community with their three children.

Day care centers Another alternative to therapy are day centers where clients come from Reception Centers. These communities lend a helping hand to individuals whose recovery journey is closely related to their own family. It is open from 7:30 a.m. to 7 p.m., with the exception of Sundays. Clients return in the evening to their own families, who have constant control over them. As an example, we present: Day care center - San Makro This center has been operating since 1984. Drug addicts with psychological problems, addicts from broken families, addicts who have their own families (husbands and children), addicts who are divorced and addicted mothers with children come to the center. Dependent mothers are in the Day Center during the day and in the evening or at the weekend in their own family, in the Family House or in a foster family. Most mothers who have a child older than 6 years or several children are included in this program. During the day, the child is in a kindergarten, school or family-type community. The groups are mixed and can accept a maximum of 15-17 members. 3 operators work in this center.

3rd phase of the program – return

After successfully completing the 2nd phase of the program, drug-addicted mothers can be included in the Family Homes within the 3rd phase of the program. We are talking about mothers who need a model family in which both parents are present. The third phase for mothers lasts longer than for other program participants (1.5 - 2 years). The family community consists of a pair of parents, most often aged 31-40, and their own children. Young drug addicts, male or female, married or divorced, have the opportunity to identify with the imagined role of mother and father and also adopt it in everyday life. One of the criteria is a present and responsible fatherhood, which guarantees the balance of the family, perceiving the requirements and personal relationships of its members.

The role of the operator in the Community of Pope John XXIII.

The operator-mother-child relationship is a helping relationship. As part of therapy, dependent mothers have the opportunity to build a relationship with operators based on confrontation during child-rearing, exchange of experiences and an appropriate model of motherhood (for operators who have their own children and families). The operator can improve the mother-child relationship if:

  • works on changes in the mother's behavior;
  • provides the child with healing experiences together with other persons who understand and support him.

The operator's work with children who live in a therapeutic community consists in providing connections and positive emotions, not replacing the roles of parents, but supporting the mother-child relationship.

Community cooperation with a social worker

The professional approach of a social worker consists in the ability to individualize and evaluate the situation and environment in which the child will be placed and all the factors accompanying their physical growth, emotional and social development. An opinion on the part of judicial structures is also inevitable, which induces in drug addicts an attitude of open conflict for repeated arrests and quick convictions conditioned by the illegality that is present in their lives. Women tell social workers about their fears arising from the court's decision, in which the separation of the child from the mother is real. M. Canestrani and M. De Micheli (1997) report in their research the records of 421 pregnant women addicted to heroin in the period 1980-1992. 32% of children born to drug-addicted mothers were registered based on the decision of the juvenile court, 5% of those born end up in direct adoption.

A social worker is most often involved in solving the above-mentioned problems with dependent mothers:

  • lack of conditions for stable work due to prostitution, theft;
  • unreasonable living conditions;
  • repeated ties and sometimes during pregnancy;
  • conflicts with own parents, partner, presence of other children entrusted to care;
  • negligence.

Conclusion

In connection with the problem of drug-addicted mothers, the issue of timely help to an addicted mother before the birth of a child comes to the fore. It is strange that the problem and the search for a way out is relevant in most cases only at the time of childbirth or after it. In the framework of polyvalent social work, it is necessary to pay increased attention to the prevention of threats to the proper upbringing of the child, the violation of rights and obligations in the upbringing of the child, i.e. focus on working with the family to influence and rehabilitate the wider social environment and provide help not only to the individual but also to other family members.

From the point of view of therapy, we consider it correct to support the activities of resocialization centers for dependent mothers, enabling them to complete a therapeutic program together with their child. And in this direction, it is necessary to support an area that is theoretically known but not yet clarified in practice from the point of view of therapy and prevention itself.

Author: PhDr. Daša Toporcerová, PhD. List of bibliographic references

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The lecture was given at the international scientific conference Applied ethics in social work and other helping professions, which took place on October 20-21, 2010, in Piešťany and was published in the proceedings of this conference: MÁTEL, A. – SCHAVEL, M. – MÜHLPACHR, P. – ROMAN, T. 2010. Applied ethics in social work and other helping professions. Proceedings of the international scientific conference. Bratislava : VŠZaSP St. Elizabeth. 413 p. ISBN 978-80-89271-89-4.