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2000 Jordan Institute
for Families

Vol. 2, No. 4
July 1997

Maternal Drug Abuse and Attachment

In the last issue of Practice Notes (see "Grandmothers Who Care for Drug-Exposed Children"), we wrote about grandmothers as caregivers of crack-exposed infants and young children. Here we continue this theme by discussing the consequences drug use during pregnancy can have on mother-infant attachment.

In the early 1990s, Lori Mundal and her colleagues conducted a study to determine whether infants of substance-using mothers are more at risk of removal than babies of women who do not use substances during pregnancy. Their research focused on two questions: 1) Do mothers who use substances during pregnancy exhibit more difficulty with maternal-infant attachment at or around birth than women who abstain? and 2) Are mothers who use substances during pregnancy more likely to have their babies separated from them at birth?

To find out, they compared the outcomes of 82 mothers, 60 of whom were substance users and 22 of whom were not.

What they found was that pregnant women who abused substances were more likely to experience complications during pregnancy, deliver prematurely, and have C-section births. Also, the infants of mothers who abused substances were placed in intensive care more frequently and stayed in the hospital longer after birth than the children of non-users.

Mundal and her colleagues also found that women who used substances during pregnancy had more difficulty attaching to their infants. They based this conclusion on the fact that, compared to non-using mothers, these women had less eye-to-eye contact with their infant, less affectionate touch, and focused less attention on the child.

As noted in the article "Effects of Attachment and Separation", the consequences of poor attachment at infancy can be serious. Mundal notes that poor infant-mother attachment can result in childhood mood disorders and learning difficulties. Children with attachment disorders are at higher risk for substance abuse and delinquent behaviors in their teenage years (p. 135).

Crack-exposed infants are at further risk because of the effects of the drug. These babies do not respond to the voices and faces of others around them because they lack the ability to organize environmental stimuli. Their emotions are constantly changing and they do not respond well to attempts of comfort. An infant who is withdrawn and irritable may be difficult for the primary caregiver to bond with; this can begin a cycle of rejection.

Child welfare workers must sometimes decide whether to let a crack-exposed infant return home with his or her mother upon hospital release. Monica Wightman (1991) has developed a model that social workers can use to help them make this specific placement decision. Based on a qualitative research study and guided by the concepts of ecological theory, her model considers factors at the individual, caregiver, family, environmental, and agency levels. Wightman notes that the model is "tailored to the unique needs of cocaine-exposed infants and their families. It may also act as a training vehicle for investigators who have limited experience in this arena" (p. 661).


Mundal, L., VanDerWeele, T., Berger, C., & Fitsimmons, J. (1991). Maternal-infant separation at birth among substance using pregnant women: Implications for attachment. Social Work in Health Care, 16(1), 133-143.

Wightman, M. (1991). Criteria for placement decisions with cocaine-exposed infants. Child Welfare, 70(6), 653-663.

1997 Jordan Institute for Families