Abstract
A growing body of neurobiological and psychological research sheds light on the mechanisms underlying the development and maintenance of opioid use disorder and its relation to parenting behavior. Perinatal opioid use is associated with risks for women and children, including increased risk of child maltreatment. Drawing from extant data, here we provide an integrated mechanistic model of perinatal opioid use, parenting behavior, infant attachment, and child well-being to inform the development and adaptation of behavioral interventions for opioid-exposed mother–infant dyads. The model posits that recurrent perinatal opioid use may lead to increased stress sensitivity and reward dysregulation for some mothers, resulting in decreased perceived salience of infant cues, disengaged parenting behavior, disrupted infant attachment, and decreased child well-being. We conclude with a discussion of Mindfulness-Oriented Recovery Enhancement as a means of addressing mechanisms undergirding perinatal opioid use, parenting, and attachment, presenting evidence on the efficacy and therapeutic mechanisms of mindfulness. As perinatal opioid use increases in the United States, empirically informed models can be used to guide treatment development research and address this growing concern.
Highlights
In the United States, from 1999 to 2014, the prevalence of maternal opioid use disorder (OUD) at delivery increased four-fold from 1.5 per 1,000 births to 6.5 per 1,000 births (Haight et al, 2018)
We address this limitation, present a conceptual model of the mechanisms underlying perinatal opioid use and child well-being, and consider how the use of a MBI, Mindfulness-Oriented Recovery Enhancement (MORE), may address the mechanisms outlined in the proposed model during pregnancy
More research is needed to learn about perinatal opioid use and develop targeted treatments
Summary
In the United States, from 1999 to 2014, the prevalence of maternal opioid use disorder (OUD) at delivery increased four-fold from 1.5 per 1,000 births to 6.5 per 1,000 births (Haight et al, 2018). Though outside of the scope of this article, the impacts of poverty, trauma, and stigma are essential to understanding the experiences of pregnant women with OUD and any proposed intervention and we ask readers to keep this context in mind. Focusing on attachment and parenting behavior during pregnancy may capitalize on enhanced motivation for change in the prenatal period In this manuscript, we address this limitation, present a conceptual model of the mechanisms underlying perinatal opioid use and child well-being, and consider how the use of a MBI, Mindfulness-Oriented Recovery Enhancement (MORE), may address the mechanisms outlined in the proposed model during pregnancy. The ultimate goal of developing this model is to inform the development and adaptation of behavioral interventions for opioid-exposed mother–infant dyads
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