What is this?

• Substance misuse is increasingly known to have different effects for men and women. In order to answer women’s unique risk factors, integrated interventions tailored to their needs have been developed. Women who misuse substances often have mental health issues, histories of physical or sexual abuse, they also often suffer from relationship problems such as domestic abuse and a lack of social support. Additionally,  women who are mothers may also have specific needs related to their parental role. Addiction may compromise their capacity to parent and access to  services may be complicated because of fear losing their children
• Integrated interventions aim to help mothers to cope with their substance misuse as well as to improve their parenting skills. Such integrated interventions combine addiction services with pre-natal, parenting and child-related services in a centralised ‘one-stop’ setting.

How is it meant to work?

• The Relational Psychotherapy Mothers’ Group uses a gender sensitive approach and, thus, only works with female therapists, psychologists and drug counsellors. The intervention aims at creating a positive environment based on the Rogerian constructs of acceptance, empathy and genuineness. This approach aims to create a setting in which women can consider the strengths and limitations of their current parenting approaches and develop more optimal approaches. This approach aims to empower women to change and build their capacity to make these changes.
• The Washington State MOMs Project used a philosophy of recovery framework which encourages women to move forward, set new goals, and take part in relationships and activities that are meaningful. Using a multidisciplinary team, women were encouraged to restructure their behaviours and practice positive interactions in a safe and non-judgmental environment. Women were also encouraged to identify their defence mechanisms so that they would prevent destructive behaviours.

What are the evaluated outcomes?

• Parenting outcomes

How effective is it?

Overall,  the integrated intervention approach had a positive effect on parenting outcomes, this is based on low strength of evidence. However, it is important to highlight that findings were mixed and therefore more research is needed to draw strong conclusions.

Mixed findings emerged for the Relational Psychotherapy Mothers’ Group. A study (Luthar and Suchman, 2000) showed that women who received the integrated treatment programme  did significantly better in terms of affective interaction scores than those who received the treatment as usual, however the effect was not present at a significant level anymore after six-months. A later study by the same author (Luthar et al., 2007) with a different sample displayed significant improvements in affective interaction, parental satisfaction and decreased child abuse risk scores between women who received the integrated treatment programme and the group which received the usual intervention. The Washington State MOMs Project studied by Huber (1999) did not demonstrate any effect on parenting outcomes.

The quality of evidence for the four randomised trials was rated as very low to moderate as the studies lacked detailed information and rigorousness regarding the study design and sample size were small.

Where has it been studied?

The four RCTs included in the systematic review all took place in the United States.

Who does it work for?

• The meta analysis targeted interventions for women only, their average age was 29 to 36 years and most of them had experienced trauma, had mental health problems, and were unemployed, single mothers. The studies targeted mothers with a varied ethnical background, reflecting the location of the studies. One intervention targeted pregnant women while the three other interventions involved mothers with children of a wide age range (infant to adolescents).
• The Relational Psychotherapy Mothers’ Group involved pregnant women and those with children up to sixteen years old.
• For the Washington State MOMs Project, women involved were in their second or third trimester of pregnancy. Half of the women involved had previous Children’s Services involvement and around 79% had been in prison. Many of them are identified as homeless.

When, where and how does it work?

• Programs were 3-12 months and had a high dropout rate
• The Relational Psychotherapy Mothers’ Group lasts 24 weeks while the Washington State MOMs Project is a prenatal intervention.
• The Mother’s and Toddlers Program and the Parent Education are two attachment based parenting interventions programs that have been associated with improved parenting outcomes, however these findings should be treated with caution as it is based on only one study.

What are the costs and benefits?

No costs and benefits analysis was conducted

In summary...

• Evidence is mixed on the effectiveness of interventions targeting mothers with substance abuse and integrating as well prenatal, parenting and child-related services.
• In particular, there is little evidence regarding parenting outcomes of mothers who have substance misuse issues.
• Further research is needed with a larger sample and relevant comparison group to evaluate the effectiveness of such integrated programs, especially on outcomes regarding the mothers and child. No studies have been led yet in the UK.