Abstract
Growing evidence shows that attachment is a key risk factor for the diagnosis and treatment of clinical diseases in Axis I, such as drug addiction. Recent literature regarding attachment, psychiatric pathology, and drug addiction demonstrates that there is a clear prevalence of insecure attachment patterns in clinical and drug addicted subjects. Specifically, some authors emphasize that the anxious-insecure attachment pattern is prevalent among drug-addicted women with double diagnosis (Fonagy et al., 1996). The construct of attachment as a risk factor in clinical samples of drug-addicted mothers needs to be studied more in depth though. The present explorative study focused on the evaluation of parenting quality in a therapeutic mother–child community using attachment and personality assessment tools able to outline drug-addicted mothers’ profiles. This study involved 30 drug addicted mothers, inpatients of a therapeutic community (TC). Attachment representations were assessed via the Adult Attachment Interview; personality diagnosis and symptomatic profiles were performed using the Structured Clinical Interview of the DSM-IV (SCID-II) and the Symptom Check List-90-R (SCL-90-R), respectively. Both instruments were administered during the first six months of residence in a TC. Results confirmed the prevalence of insecure attachment representations (90%), with a high presence of U patterns, prevalently scored for dangerous and/or not protective experiences in infanthood. Very high values (>5) were found for some experience scales (i.e., neglect and rejection scales). Data also showed very low values (1–3) in metacognitive monitoring, coherence of transcript and coherence of mind scales. Patients’ different profiles (U vs. E vs. Ds) were linked to SCID-II diagnosis, providing insightful indications both for treatment planning and intervention on parenting functions and for deciding if to start foster care or adoption proceedings for children.
Highlights
In Italy, pregnant women or women who deliver under the influence of addictive substances receive a warning from the Substance Addiction Treatment Services (Ser.T) and the JuvenileLess-Protection Services (Social Services, Juvenile Court) with the aim to activate a protection protocol for the child’s conditions, since its birth or the very first months of life
Regarding the personality structure evaluated according to DSMIV-TR (American Psychiatric Association [APA], 2000), all participants reached SDD criteria in Axes I, Borderline Personality Disorder (BPD) criteria in axes II according to the Structured Clinical Interview for DSM-III-R (SCID-II) (First et al, 1997), general medical conditions at risk (Axes III), and, psycho-social and environmental problems (Axes IV)
Focusing on SCL-90-R, a peculiar finding is that neither the means of subscales nor the means of Global Severity Index (GSI) score ever overcame T = 65. This could be caused by a multiplicity of factors, which go beyond mothers’ psychopathology. Their self-reported symptomatology could highlight their tendency to “underscore” psychiatric symptoms partially, in order to prevent negative evaluations and its consequences in therapeutic community (TC): they tend to show themselves in a better way as a consequence of their accessing the community due to an assessment purpose in order to maintain their relationship with their children
Summary
In Italy, pregnant women or women who deliver under the influence of addictive substances receive a warning from the Substance Addiction Treatment Services (Ser.T) and the JuvenileLess-Protection Services (Social Services, Juvenile Court) with the aim to activate a protection protocol for the child’s conditions, since its birth or the very first months of life. Basing their perspective on the protection protocol for child’s conditions, health care services and Therapeutic Community’s (TCs) might improve their ability to define personalized mother–child dyad evaluation and treatment as soon as possible, in order to reduce risk of failure or not-useful therapeutic planning (Stocco et al, 2012). IWM develop from repeated interactions with caregivers www.frontiersin.org
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