An Integrated Mechanistic Model of Mindfulness-Oriented Recovery Enhancement for Opioid-Exposed Mother-Infant Dyads

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.

Keywords: mindfulness; opioid misuse; parenting (MeSH); pregnancy; savoring.

Figure 1

Mechanisms of maternal substance use and child well-being model. This process model represents the connections between perinatal opioid use, parenting behaviors, and infant attachment development. As a mother encounters a stressor, her cognitive appraisal of the situation can drive adaptive coping, leading to positive affect, and engaged parenting behaviors. Alternatively, a negative cognitive appraisal may result in negative affect, promoting the process of allostasis—resulting in increased sensitivity to stress and dysregulation of reward processes. Allostatic load may lead to increased substance craving and substance use, which, over time, results in a decreased salience of infant cues, reduced engagement with the infant, and passive and disengaged parenting behavior. Gradually, the infant may develop an insecure attachment, being unable to rely on his mother’s response. Insecure attachment may then lead to an overall decrease in the child’s well-being. This model also highlights the process of dyadic synchrony. The infant’s affect and behavior also influence the mother’s affect and behavior. As the child learns that the mother’s behavior is unreliable, she may reach out to her mother through behavior that can be interpreted as stressful by her mother, which may reinforce her mother’s cycle of substance craving and use.

Figure 2

Mindfulness-Oriented Recovery Enhancement (MORE) targets mechanisms of maternal substance use and child well-being. MORE may interrupt several key processes in the proposed model of perinatal opioid use and child well-being. MORE promotes the process of mindful reappraisal, whereby a mother can change her perspective on a stressor to decreased her negative affect. MORE also fosters problem-focused and emotion-focused coping, during which a mother uses mindfulness practices to cope with emotional distress. MORE also targets the process of allostasis, reduces sensitization to stress, and increases sensitization to reward. MORE also provides strategies to cope with substance craving, decreasing the likelihood of substance use. Finally, mindful savoring may help women increase the salience of infant cues and promote engaged parenting behavior.