I comportamenti di parenting nel contesto del Disturbo da Uso di Sostanze: implicazioni dei fattori psicopatologici e cognitivi per l’assessment e l’intervento

Substance Use Disorder (SUD) represents an increasing global risk factor for disability and premature death, with significant economic costs. Nearly 90% of women who struggle with SUD are in child rearing age and maternal SUD is a risk factor for parenting and child development. Besides the direct effects of substance exposure, quality of parenting in the home represents an important mediator of undesired developmental outcomes. Compared to low-risk populations, mothers with SUD show less optimal caregiving behaviors in diverse contexts, being less sensitive and responsive to children’s signals, and more hostile and interfering with their activities. These negative parenting behaviors are linked undesired developmental outcomes and a higher risk to be involved with child protective services. Therefore, quality of parenting behaviors across different domains constitute one of the main targets of investigation in the condition of SUD, to avoid unfavorable developmental outcomes in children though targeted interventions. Furthermore, a wide array of studies shows the relevance of investigating SUD-related characteristics, as co-occurring psychopathology or parental cognitive impairments, to better understand which mechanisms could further detriment quality of parenting in SUD and support/obstacle interventions. The current thesis focuses on quality of parenting behaviors in the context of maternal SUD, considering the psychopathological and cognitive mechanisms involved, and identifying a possible intervention protocol that could consider these aspects. The first part of the work provides a general overview of parenting, considering some of the mechanisms involved in the process of taking care in early infancy and childhood. In chapter 1 we discuss the role of parenting behaviors in shaping child development, identifying how their quality can be influenced by cognitive resources or the presence of psychopathological symptoms in the adult. The second part of the work will focus specifically on parenting in the context of SUD, a high-risk condition for quality of care and for child development. In Chapter 2 we will present an empirical study aimed at investigating quality of parenting behaviors through cluster analysis in mothers with SUD. In chapter 3 we will discuss the results of a study aimed at examining the role of maternal alexithymia, a specific type of psychopathology, on quality of parenting behaviors in mothers with SUD. In the empirical study in Chapter 4 we will report on a longitudinal study investigating the effect of parental psychological symptoms and executive functioning on the development of parent-child relationships during a residential program for drug addiction. In chapter 5 we will present a proposal for a randomized controlled trial aimed at modifying quality of parenting behaviors in mothers with SUD considering the intervening role of cognitive and psychopathological mechanisms. Finally, in the last section we will provide a general discussion of the topics developed through the work, highlighting some methodological challenges and some empirical and clinical implications based on the results of our empirical studies. Globally our results confirm that SUD represents a risk condition for parenting and quality of parent-child relationships. Patterns of mother-child interactive behaviors are more likely to present difficulties within this group, but these are subjected to variability. Differences in quality of parenting behaviors are linked to the presence of co-occurring psychopathology and cognitive resources, and these two mechanisms play an important role in the ongoing of interventions. Thus, quality of parenting behaviors should represent one of the main focuses of assessment and intervention in mothers with SUD, but they should be considered also in the light of psychopathology and cognitive functioning.