Attachment parenting, resilience but sometimes things go very wrong

There are some very good resources to help parents offer their children good parenting. Virtually every parent I have ever met, even abusive ones, have loved their children even if they didn't know how to love them well. But what leads children who have had good parenting into trouble?

Resources:

Dr. Sears website for attachment parenting

Dr. Michael Unger's resiliency project

Dr. Gabor Mate's website

Drug addiction and pregnancy

A New Jersey court determined that a mother had not abused her child when she sought help for her painkiller addiction. She was placed on methadone. Her baby showed signs of withdrawal after birth causing child protection to intervene.  The fact that she sought treatment was seen favourably. Thus she was determined to have not been grossly negligent.

The case is worrying.  By implication had she not sought treatment then she would be negilgent placing her in the position of abusing her baby. This not only shames mothers with addiction but drives them away from help for fear of the implications.

Many women who are addicts do not get pregnant by choice. They are not seeking pregnancy. Most addicted women are victims of abuse. Many pregnancies occur within patterns of inter personal violence. I wonder what happens when we see the mother and the baby as victims together both in need of support. This case did not seem to seek to criminalize the mother as cases elsewhere have done. This is good  

Now we need to bring a harm reduction and support lens to these cases

The war on drugs is a war on children

There have been two publications in the past week or so that have struck me as profound evidence that the war on drugs is an utter failure. Let me say up front, I see addiction as a health issue.

The first report is from The National Academies and is a report titled, The growth of incarceration in the United States: Exploring causes and consequences.  It points out that the USA incarcerates more people than any other country in the world and that drug issues are the prime reason.  The report concludes:

The change in penal policy over the past four decades nay have had a wide range of unwanted social costs, and the magnitude of crime reduction benefits is highly uncertain (p.7)

The report also brings into question mandatory minimum sentences and long sentences. They note that incarceration is used when there are less intrusive and more beneficial options.  If imprisonment is not reducing crime, then why use it as the prime response pattern. Insanity is defined as doing the same thing over and over expecting different results.

The second report comes from the London School of Economics titled Ending the drug wars. It concludes:

The pursuit of a militarised and enforcement-led global ‘war on drugs’ strategy has produced enormous negative outcomes and collateral damage. These include mass incarceration in the US, highly repressive policies in Asia, vast corruption and political destabilisation in Afghanistan and West Africa, immense violence in Latin America, an HIV epidemic in Russia, an acute global shortage of pain medication and the propagation of systematic human rights abuses around the world. 

These reports tells us that, despite over 40 years of prohibition and interaction as the prime social policy approach for which literally billions of dollars have been spent, we have not been successful in even reducing the problem. The LSE report notes that prices have been falling while purity has been increasing.

What neither of these reports talk about directly is the impact that the prohibition approach has on children:

1. When a parent is incarcerated, the child essentially loses the parent. When incarceration is for long periods, then the child must go through a grieving process that leaves the child with an emotional hole. As the Adverse Childhood Experiences research shows, incarceration of a parent has long term impacts;
2. The child is more likely to exposed to violence when a parent has an active addiction as the parent must go through illegal channels;
3. The family system lives in fear when the addiction is present but health resources are seriously underfunded;
4. Incarcerating a parent is more likely to impact the child's economic survival;
5. More chance of being brought into care

We also know that untreated addiction has long lasting impacts on a child. Thus, if we shift our focus to one where health resources are enhanced, then the impact on children will be more intact families and more present parents. As well, rehabilitation is likely to be much less expensive.

Drug Courts can be quite effective fir child protection

Some lovely new research by Bruns et al. has shown that drug courts can be quite effective in working with substance abusing parents in the child protection system. This matters. As they point out, substance abuse is one of the most significant issues in child protection. They note prior research showing that it is related to higher involvement in foster care; longer duration in care and poorer reunification rates. In addition, they highlight that it can often take many months before parents are connected to needed treatment resources

Drug Treatment Courts have a solid history of working within the criminal court system in various jurisdictions.

The aim of most drug courts is to use the court process to facilitate a coordinated, team-based, and inter- disciplinary approach to treat individuals who have been charged with an offense related to their addiction or substance involvement (p.2).

Family Drug Treatment Courts aim to increase reunification, family safety as well as parental abstinence. To my knowledge, they are not yet common within the child protection system, so this review may well assist in raising such an approach as an important tool for child protection systems.

A study of four FTDCs in sites across the United States found that participants enrolled in treatment more quickly, received treat- ment services for a longer mean duration, and were more likely to complete treatment successfully than parents in regular dependency courts. (p.3).

However, the published research data base remains small and is not been subject to the kind of disciplined review that might give long term confidence. The present study helps to fill the gap and shows positive results including entering treatment faster, completing and having better child protection outcomes. The children were more frequently returned to parental care.

This promising research adds to the idea that structured, comprehensive substance abuse interventions that include the courts can substantially improve outcomes. This might be an approach that is worth considering in more jurisdictions.

Reference:

Bruns, E.J.,, Pullmann, M.D., Weathers, E.S., Wirschem, M.L. &. Murphy, J.K. (2012). Effects of a multidisciplinary family treatment drug court on child and family outcomes: Results of a quasi-experimental study. Child Maltreatment, In Press. doi: 10.1177/1077559512454216
 

 

Neonatal Abstinence Syndrome

Research published today in the medical journal JAMA is frankly alarming.

The rate of newborns diagnosed with neonatal abstinence syndrome (NAS) in the U.S. nearly tripled over the last decade, according to a JAMA study.

Using national databases, researchers examined trends in maternal opiate use and NAS diagnoses from 2000 to 2009. Among the findings:

• NAS diagnoses rose from 1.20 per 1000 hospital births in 2000 to 3.39 per 1000 in 2009.
• At the same time, maternal opiate use increased almost fivefold, from 1.19 to 5.63.
• Hospital length of stay for NAS remained relatively steady, averaging 16 days.
• Total hospital charges for NAS rose nearly fourfold, from $190 million to $720 million.

The researchers estimated that in 2009, roughly one infant was born every hour with symptoms of drug withdrawal.

This research along with others that have been appearing on the dramatic rise of opiates, particularly those such as Oxycodone, Oxycontin and others should be causing society to be up in arms against big pharama. But it is also a wake up call that we must be looking at why addiction continues to be such a major force in our society. Prevention is going to come when we truly seek to consider:

* why families are so emotionally fractured;
* children are born into families that are so busy that true emotional presence is missing;
* sexual and physical abuse and maltreatment remain all to frequent occurrences; and
* we are societies where dominance, control and greed have taken such power over love, care, acceptance and nurturance.

Sure, there are genetic predispositions for addiction, but it is environment (e.g. family, community and society) where things like addiction emerge or not.

The cost to society of children born with NAS and FASD is enormous.