Next Article in Journal
Early Memory and Executive Function as Predictors of Language Development: Evidence for Early Cognitive Foundations in a Taiwanese Cohort
Previous Article in Journal
Analysis of Clinical Characteristics of Refractory Food Protein-Induced Allergic Proctocolitis
Previous Article in Special Issue
Validity Study of the Spanish Version of the Parental Stress Index (PSI-4) in Its Two Forms (Long Form and Short Form)
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Children
Volume 12
Issue 11
10.3390/children12111496
children-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

When Mothers and Fathers Are ‘Gone’: Predicting Intergenerational Cycles of Risk in Opioid-Involved Parents

by
Maria Khan
and
Kimberly Renk
*
Department of Psychology, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816, USA
*
Author to whom correspondence should be addressed.
Children 2025, 12(11), 1496; https://doi.org/10.3390/children12111496
Submission received: 23 September 2025 / Revised: 31 October 2025 / Accepted: 2 November 2025 / Published: 4 November 2025
(This article belongs to the Special Issue The Power of Early Intervention: Promoting Mental Health and Well-Being in Very Young Children and Their Families)
Browse Figures
Versions Notes

Highlights 

  • What are the main findings?
  • The opioid epidemic and adverse childhood experiences (ACEs) are two major concerns for child welfare systems in the United States of America.
  • This study examined a high-risk sample of 101 parents (75 mothers and 26 fathers) who were opioid-involved, who had a child in the 0- to 5-year age range, and who were receiving medication-assisted treatment in the United States of America.
  • What are the implications of the main findings?
  • Mothers’ ACEs significantly predicted their ratings of disorganized attachment patterns with their young children, with depression and trauma symptoms explaining greater variance than ACEs alone.
  • Fathers’ ACEs were not predictive of insecure/disorganized attachment patterns with their young children.

Abstract

Background/Objectives: The opioid epidemic and adverse childhood experiences (ACEs) are two major concerns for child welfare systems. Little is known, however, regarding the mechanisms that perpetuate intergenerational cycles of ACEs and insecure/disorganized parent–young child attachment patterns in the context of parents’ opioid use. Methods: A high-risk sample of 101 parents (75 mothers and 26 fathers) who were opioid-involved, who had a child in the 0- to 5-year age range, and who were receiving medication-assisted treatment in the United States of America participated in this study. Parents were mostly White/Caucasian and single. Direct pathways between parents’ reported ACEs and their perceived parent–young child attachment patterns, as well as indirect pathways through substance use severity, depression, and trauma symptoms, were examined. Results: PROCESS analyses suggested that mothers’ ACEs significantly predicted their ratings of disorganized attachment patterns with their young children, with depression and trauma symptoms explaining greater variance than ACEs alone. The results indicated that fathers’ ACEs were not predictive of insecure/disorganized attachment patterns with their young children. Substance use severity was not predictive of parent–child attachment patterns for mothers or fathers. Conclusions: Generally, these findings highlighted different patterns among mothers and fathers’ ACEs, their ratings of parent–young child insecure/disorganized attachment, and their psychological sequelae. These findings further suggested the utility of trauma- and attachment-informed parenting interventions for high-risk mothers and fathers in breaking intergenerational cycles of risk.

1. Introduction

The opioid epidemic has garnered growing concern (e.g., [1,2,3]), particularly in child welfare systems in the United States of America. In fact, rates of opioid prescriptions, opioid misuse, and opioid-related overdose deaths have been on the rise since the 1990s [4]. These increased rates prompted professionals in the United States of America to describe opioid use disorder as a public health emergency in 2017 [5]. Given this constellation of opioid-related issues, understanding the pathways of risk for intergenerational cycles of adverse childhood experiences (ACEs), insecure/disorganized attachment patterns between parents and their young children, and substance use in opioid-involved populations has become even more important, especially when planning for appropriate parenting and other interventions. Exposure to parents’ substance use itself is considered an ACE, with 25.6% of participants in the original ACEs Study endorsing that they had been exposed to a parent who was substance-involved [6]. Further, parents’ substance use increases their risk of maltreating children, removal of children from their care, and failure to achieve reunification after a removal has occurred [7,8]. This increased risk is likely related to these parents’ greater parenting stress, decreased attentiveness and engagement, and harsher discipline. Thus, efforts meant to break intergenerational cycles and to prevent maladaptive outcomes for young children necessitate a lens that is both trauma-informed and attachment-focused [9]. Consistently, the goal of this study was to examine potential pathways from ACEs to perceived insecure/disorganized attachment patterns in a sample of mothers and fathers who were opioid-involved.
When examining intergenerational cycles, attachment needs to be considered. Such consideration is particularly important in families with young children, as young children actively form attachments with caregivers. Of particular interest for this study, attachment theory has demonstrated the importance of young children establishing safe and secure internal working models from which they can view their world [10]. Safe and secure internal working models, or mental maps of relationships, are formed when young children are cared for consistently and reliably by caregivers who are warm but firm. When internal working models are not safe and secure, young children (and individuals, in general) display heightened risk of insecure or even disorganized attachment, as well as later emotional regulation difficulties, poor coping skills, and relationship insecurity [11]. ACEs (e.g., abuse, neglect, and household dysfunction), especially at the hands of primary attachment figures, can be highly detrimental to young children’s early internal safety representations [12]. Understanding pathways to insecure/disorganized attachment patterns is important because childhood adversity is far from uncommon and because the majority of children who were maltreated were perpetrated against by a parent [6].
Much of the literature has considered direct consequences stemming from childhood adversity and other ACEs. Infants are predisposed biologically to attach to their caregivers, as caregivers protect [13], foster learning of regulation, and shape brain development via early interaction [14]. Thus, the connection between childhood adversity and insecure attachment is salient. Childhood adversity has been related consistently to insecure attachment for caregivers during their own childhoods [12] and for parents’ own young children during their parenting [15,16]. Further, childhood adversity is related to maladaptive coping mechanisms (e.g., substance use) [6,17] and to psychological sequelae (e.g., depression and trauma symptoms) [18]. Rather than being independent, these parental risk factors tend to coexist [19], with these factors being possible mechanisms of connection between ACEs and perceived insecure/disorganized attachment patterns. Further, these factors need to be considered in the context of life stressors [20].
In fact, research has suggested a significant intergenerational component to childhood adversity [21,22], substance use [23], and attachment [12]. Retrospective and prospective data indicate that these variables increase individuals’ risk of maltreating their own children, using substances themselves, and fostering insecure attachment with their own children. Less is known, however, regarding why such intergenerational cycles continue to repeat, as few studies have investigated the overlapping predictive and indirect relationships needed to understand parent–young child attachment [24]. Thus, this study examined both direct and indirect pathways among ACEs, perceived insecure/disorganized attachment patterns, and psychological sequelae. As such intergenerational cycles have been examined less in fathers than mothers [25], attempts were made to include both mothers and fathers in this study. Overall, it is vital to identify ports of entry for breaking these cycles so that young children do not have to endure the same issues as previous generations.

The Present Study

Although childhood adversity and other ACEs have been examined widely, the variables noted above have yet to be examined collectively in an interactional model for parents who are opioid-involved (to the authors’ knowledge). Moreover, research has called for further study of the mechanisms by which ACEs and parent–young child attachment patterns may be related [24,26]. These relationships are particularly important for parents who are substance-involved and who consequently exhibit a higher risk of maladaptive parenting and insecure/disorganized attachment [7]. To date, research on parenting, attachment, and parents’ substance use has largely addressed the relationship between young children and their mothers [27], to the exclusion of fathers. Even with increasing rates of opioid misuse in the United States of America [28], especially in males [29], only one review of opioid use in fathers exists [1] to the authors’ knowledge.
To address these gaps in the literature, this study examined mediating factors that may be driving the relationships between parents’ ACEs and their perceptions of parent–young child insecure/disorganized attachment patterns. This study recruited a sample of mothers and fathers who were opioid-involved to examine the direct and indirect relationships between their ACEs and parent–young child attachment patterns using the parents’ substance use severity, depression, and trauma symptoms as mediators in a PROCESS mediational model [30]. It was expected that mothers and fathers’ ACEs would predict their respective ratings of insecure/disorganized attachment patterns with their young children and that substance use severity, depression, and trauma symptoms would serve as mediators in this relationship. It was hoped that information gained from this study would help to better inform parenting programs in facilitating secure attachment between mothers and fathers with their young children when substances are involved.

2. Materials and Methods

2.1. Participants

A sample of 101 parents (75 mothers and 26 fathers) who were opioid-involved, who had young children from 0 to 5 years of age, and who were receiving medication-assisted treatment services in Orlando, Florida, United States of America, were recruited for this study. Parents were recruited from a local outpatient methadone clinic (76% of mothers; 100% of fathers) and women’s residential substance-treatment facilities (24% of mothers). Parents were mostly independent (i.e., there were only four mother–father dyads who answered about a shared child). Eligibility criteria included receiving medication-assisted treatment (i.e., methadone, suboxone, or vivitrol), being at least 18 years of age, and having active involvement with their young children. Parents responded to study questionnaires about their oldest child between 0 and 5 years of age.
Mothers averaged 33.08 years of age, identified mostly as White/Caucasian (80%), and were mostly single (70.7%). Fathers averaged 34.62 years of age, identified mostly as White/Caucasian (73.1%), and were mostly single (73.1%). The young children for whom parents provided ratings averaged 2.83 years for mothers and 3.14 years for fathers. Less than half of the mothers (42.7%) and fathers (46.2%) reported living with their young child’s other parent. Mothers reported mostly being unemployed (60.3%) and having an average household income of <USD 20,000/year (51.3%). In contrast, fathers reported mostly being employed (84.6%) and having an average household income of <USD 40,000/year (72.9%). About 42.5% of mothers and 30.8% of fathers had completed some college. Regarding lifetime use of nonmedical substances, mothers averaged five substances, and fathers averaged six substances. Opiates were the ‘drug of choice’ for 87.8% of mothers and 60% of fathers. Most mothers (82.4%) and fathers (61.5%) were currently receiving methadone. See Table 1 for complete demographic data.

2.2. Procedure

This study was approved by the university’s IRB as well as by the research review committee of the partnering mental health agency. Researchers were available at the local outpatient methadone clinic and women’s residential substance-treatment facilities during times when individuals arrived for their medication-assisted treatment. Individuals were provided with a flyer about the study and were asked if they met the inclusion criteria. Those individuals who met the inclusion criteria and who agreed to participate reviewed a consent form (i.e., no identifying information was collected). Measures (described below) were then administered via a pencil-and-paper survey. Following completion, a debriefing form explaining the purpose of the study, as well as relevant resources for parenting programs, was distributed to participants. As an incentive, participants received a USD 5.00 Walmart gift card for their participation.

2.3. Measures

Demographics. A brief demographic questionnaire asked about parents’ age, ethnicity, occupation, education, household, and other general characteristics. The questionnaire assessed lifetime use of substances to yield a total number of substances score (as laid out in [31]). The total number of substance scores demonstrated good internal consistency (α = 0.83).
Adverse Childhood Experiences (ACEs). The Adverse Childhood Experiences (ACEs) Questionnaire [6] assessed parents’ exposure to ACEs in the first 18 years of their lives. Parents endorsed exposure to each item in a Yes or No format, with Yes responses added to yield a Total Exposure score ranging from 0 to 10. The ACEs questionnaire had good internal consistency previously (α = 0.86) [19] and in this study (α = 0.82).
Parent–Young Child Attachment. The Experience in Close Relationships Scale (ECR) [32] assessed parents’ perceptions of insecure anxious and insecure avoidant attachment with their young children. As this scale was developed for adult attachment, the ECR was adapted for parent–young child attachment. The ECR contains two subscales constructed from 36 items that are rated on a 7-point Likert-type scale ranging from 1 (Disagree Strongly) to 7 (Agree Strongly). Insecure anxious attachment assessed parents’ perceptions of their young children’s fears of being left, needs for reassurance, and distress when parents are not available. Insecure avoidant attachment assessed parents’ perceptions of their young children’s discomfort with closeness, need for self-reliance, and reluctance to be dependent. The ECR has displayed excellent internal consistency (α = 0.91 for anxious; α = 0.94 for avoidant) in prior studies [32] and displayed excellent internal consistency when adapted for mother–young child attachment (α = 0.88 for anxious; α = 0.94 for avoidant) [19]. In this study, the ECR had good internal consistency (α = 0.87 for anxious; α = 0.87 for avoidant).
The Caregiving Helplessness Questionnaire (CHQ) [33] assessed parents’ perceptions of disorganized attachment with their young children. The CHQ consists of 25 items that are rated on a 5-point Likert-type scale ranging from 1 (Not Characteristic at All) to 5 (Very Characteristic) and that load into three factors (i.e., Mother and Child Frightened, Mother Helpless, and Child Caregiving). The Mother and Child Frightened subscale (which measures mothers feeling frightened by their child or their child feeling frightened by them) and the Mother Helpless subscale (which measures mothers’ feelings of being out of control when with their child) were significantly related to disorganized attachment patterns [34] and, thus, were used in this study. Internal consistency was good for Mother and Child Frightened (α = 0.83) and Mother Helpless (α = 0.89) in a previous study [19]. As the CHQ was designed for mothers, items were reformatted for use with ‘parents.’ Internal consistency for Parent and Child Frightened (later referred to as frightened–disorganized; α = 0.56 for parents altogether; α = 0.53 for mothers and α = 0.60 for fathers independently) and Parent Helpless (later referred to as helpless–disorganized; α = 0.64 for parents altogether and for mothers and fathers independently) was mostly adequate in this study.
Substance Use Severity. The Inventory of Drug Use Consequences (InDUC) [35] assessed parents’ consequences of lifetime use of substances. The InDUC consists of 50 items rated with a Yes or No format that yield a Total InDUC score. The InDUC demonstrated excellent internal consistency previously (α = 0.96) [36] and in this study (α = 0.95). The Minnesota Substance Abuse Problems Scale (M-SAPS) [37] assessed parents’ lifetime substance use-related problems. The M-SAPS consists of 61 items rated with a Yes or No format and yields a total score. The total score showed excellent internal consistency (α = 0.94) in this study.
A validated measure is yet to exist for assessing the intensity of parent-specific substance use difficulties. Thus, this study factored out parent-specific items from the InDUC and M-SAPS to create a brief parental substance use severity (SUS) scale. The SUS scale assessed the intensity of substance use consequences on caregiving, home, financial responsibilities, and interpersonal difficulties. The SUS contained 19 items rated with a Yes or No format, with items 1 through 11 originally belonging to the M-SAPS and items 12 through 19 originally belonging to the InDUC. Parents’ Yes responses were added to yield a total SUS score. The SUS displayed good internal consistency (α = 0.85) and was used for analyses in this study.
Depression. The Beck Depression Inventory-II (BDI) [38] assessed parents’ current depression symptoms. The BDI contains 21 items that are rated using a 0 to 3 scale, with higher ratings indicating increased severity of depression. The BDI total score had excellent internal consistency previously (α = 0.92) [38] and in this study (α = 0.93).
Trauma Symptoms. The Impact of Events Scale—Revised (IES-R) [39] assessed parents’ trauma symptoms as they relate to DSM-IV PTSD criteria. The IES-R consists of 22 items rated on a Likert-type scale ranging from 0 (Not at all) to 4 (Extremely) regarding distress over the past seven days from parents’ experienced trauma (in this case, the most traumatic of their ACEs). The IES-R consists of three subscales (Intrusion, Avoidance, and Hyperarousal), which yield a total stress score. The IES-R had excellent internal consistency for the total score previously (α = 0.96) [39] and in this study (α = 0.96).

3. Results

3.1. Descriptive Statistics

All data were screened for violations of missing data, normality, outliers, and differences between groups. Despite unequal sample sizes, both mother and father data were found to be distributed normally and to have equal variances. No outliers were identified for either group. Descriptive statistics were examined for each group (see Table 2), and independent-samples t-tests examined mean differences between groups (see Table 3).
Mothers and fathers reported overall low ACEs. Nonetheless, 52% of mothers and 42.1% of fathers reported four or more ACEs. No significant differences were found between this sample and another opioid-involved sample undergoing substance treatment [40] on the average ACE score for mothers, t(74) = 0.13, p < 0.70, or fathers, t(25) = −0.64, p < 0.24. Mothers reported overall low levels of avoidant, anxious, frightened–disorganized, and helpless–disorganized attachment with their young children. Fathers reported overall low levels of avoidant attachment but moderate levels of anxious attachment and low-to-moderate levels of frightened–disorganized and helpless–disorganized attachment with their young children.
Mothers and fathers reported having a moderate-to-high level of substance-related consequences on the InDUC (M = 36.51 and M = 39.58, respectively) and M-SAPS (M = 40.65 and M = 46.35, respectively). These scores exceeded those of the original clinical samples of women and men for the InDUC (i.e., M = 34.59 and 37.28, respectively) [35] and of both community and clinical samples for the M-SAPS (i.e., M = 28.50 and 34.70, respectively) [41]. On the SUS, mothers and fathers reported high overall parent-related substance use severity.
Mothers scored in the low-to-mild range, and fathers scored in the mild range for depression. Relative to the range of possible scores on the BDI, 58% of mothers and 61% of fathers fell within minimal range, 21% of mothers and 8% of fathers fell within mild range, 15% of mothers and 19% of fathers fell within moderate range, and 7% of mothers and 11% of fathers fell within severe range of depression. Mothers averaged low-to-moderate trauma symptoms, whereas fathers averaged moderate trauma symptoms.

3.2. Pearson Correlation Analyses

Multicollinearity was evaluated to verify that the variables of interest were not a cause of biased regression analyses. Next, separate Pearson (two-tailed) correlation analyses were conducted for mothers and fathers. Correlations provided evidence for the relationships among the variables of interest. Due to the number of correlations examined, a Bonferroni correction was considered, resulting in an adjusted p-value of 0.0003. See Table 4 and Table 5.

3.3. Mediation Analyses

To examine the overall model in predicting direct and indirect pathways from mothers and fathers’ ACEs to their perceptions of parent–young child insecure/disorganized attachment patterns with substance use severity, depression, and trauma symptoms as potential mediators, regression analyses were conducted using PROCESS [30].

3.3.1. First Set of Mediation Analyses: Mothers’ ACEs Predicting Mother–Young Child Attachment Patterns

First, the hypothesized path (i.e., direct effect) from mothers’ ACEs to mother–young child attachment patterns was examined. Contrary to our hypotheses, mothers’ ACEs did not predict significantly avoidant, F (1, 71) = 0.004, b = 0.003, t = 0.06, p < 0.95, R2 < 0.001, or anxious, F (1, 71) = 2.50, b = 0.07, t = 1.58, p < 0.12, R2 = 0.03, attachment patterns. As hypothesized, the paths from mothers’ ACEs to mother–young child frightened–disorganized, F (1, 72) = 6.76, b = 0.33, t = 2.60, p < 0.01, R2 = 0.09, and helpless–disorganized, F (1, 72) = 6.45, b = 0.39, t = 2.54, p < 0.01, R2 = 0.08, attachment patterns were positive and significant. Given this pattern of results, only the disorganized attachment variables were examined further in the overall model.

3.3.2. Mothers’ ACEs Predicting Substance Use Severity, Depression, and Trauma Symptoms

Contrary to our hypotheses, mothers’ ACEs did not predict significantly substance use severity (via the SUS), F (1, 72) = 7.5, b = 0.12, t = 0.87, p < 0.39, R2 = 01, or depression, F (1, 72) = 1.65, b = 0.52, t = 1.28, p < 0.20, R2 = 0.02. In support of the hypotheses, mothers’ ACEs positively and significantly predicted their trauma symptoms, F (1, 72) = 25.65, b = 4.17, t = 5.06, p < 0.001, R2 = 0.26, such that greater ACEs predicted mothers’ greater trauma symptoms.

3.3.3. Mothers’ Substance Use Severity, Depression, and Trauma Symptoms Predicting Frightened–Disorganized Attachment Patterns

Contrary to our hypotheses, mothers’ substance use severity, F (1, 72) = 0.69, b = −0.09, t = −0.83, p < 0.41, R2 = 0.009, and depression, F (1, 72) = 1.89, b = 0.05, t = 1.37, p < 0.17, R2 = 0.03, did not significantly predict frightened–disorganized attachment patterns. As hypothesized, mothers’ trauma symptoms positively and significantly predicted frightened–disorganized attachment patterns, F (1, 72) = 6.45, b = 0.39, t = 2.54, p < 0.01, R2 = 0.08.

3.3.4. Mothers’ ACEs, Substance Use Severity, Depression, and Trauma Symptoms Predicting Frightened–Disorganized Attachment Patterns

Collectively, when all predictor variables were entered into the regression equation to predict mother–child frightened–disorganized attachment patterns, the model was significant, F (4, 69) = 5.09, p < 0.001, R2 = 0.23. When mothers’ substance use severity, depression, and trauma symptoms were entered into the equation, mothers’ ACEs no longer significantly predicted frightened–disorganized attachment patterns, b = 0.10, t = 0.73, p < 0.47. Mothers’ substance use severity (b = −0.11, t = −1.07, p < 0.29) and depression (b = −0.01, t = −0.26, p < 0.79) continued not to be predictors, whereas mothers’ trauma symptoms emerged as a significant predictor of frightened–disorganized attachment patterns (b = 0.06, t = 3.16, p < 0.002). Indirect effects were computed for each of 5000 bootstrapped samples. A significant indirect effect of mothers’ ACEs on frightened–disorganized attachment patterns through trauma symptoms was found, b = 0.25, BCa CI [0.07, 0.48], representing a large indirect effect and explaining 23% of the variance in frightened–disorganized attachment patterns (i.e., a stark increase from the 9% variance explained by the direct path from mothers’ ACEs to frightened–disorganized attachment patterns). See Table 6 and Figure 1.

3.3.5. Mothers’ Substance Use Severity, Depression, and Trauma Symptoms Predicting Helpless–Disorganized Attachment Patterns

Contrary to our hypotheses, mothers’ substance use severity did not predict helpless–disorganized attachment patterns, F (1, 72) = 0.14, b = −0.05, t = −0.37, p < 0.71, R2 = 0.002. In support of the hypotheses, mothers’ depression, F (1, 72) = 14.87, b = 0.16, t = 3.86, p < 0.001, R2 = 0.17, and trauma symptoms, F (1, 72) = 5.88, b = 0.05, t = 2.43, p < 0.02, R2 = 0.08, positively and significantly predicted helpless–disorganized attachment patterns.

3.3.6. Mothers’ ACEs, Substance Use Severity, Depression, and Trauma Symptoms Predicting Helpless–Disorganized Attachment Patterns

Collectively, when all predictor variables were entered into the regression equation to predict mother–young child helpless–disorganized attachment patterns, the model was significant, F (4, 69) = 5.14, p < 0.001, R2 = 0.23. When mothers’ substance use severity, depression, and trauma symptoms were entered into the equation, mothers’ ACEs decreased in significance but continued to significantly predict helpless–disorganized attachment patterns, b = 0.17, t = 1.96, p < 0.05. Mothers’ substance use severity continued not to predict helpless–disorganized attachment patterns, b = −0.09, t = −0.76, p < 0.45. Mothers’ trauma symptoms also no longer significantly predicted helpless–disorganized attachment patterns, b = −0.002, t = −0.09, p < 0.93. Mothers’ depression emerged as a significant predictor of helpless–disorganized attachment patterns, b = 0.15, t = 3.28, p < 0.002. The significance of this indirect effect was tested using bootstrapping procedures, where indirect effects were computed for each of 5000 bootstrapped samples. Although mothers’ depression explained 23% of the variance in helpless–disorganized attachment patterns (i.e., a stark increase from the 8% variance explained by the direct path from mothers’ ACEs to helpless–disorganized attachment patterns), the indirect effect of depression was not significant, b = 0.08, BCa CI [−0.22, 0.19]. See Table 7 and Figure 2.

3.3.7. Second Set of Mediation Analyses: Fathers’ ACEs Predicting Father–Young Child Attachment Patterns

First, the hypothesized path (i.e., direct effect) from fathers’ ACEs to father–young child attachment patterns was examined. In contrast to the hypotheses, fathers’ ACEs did not predict avoidant, F (1, 24) = 0.70, b = 0.07, t = 0.84, p < 0.41, R2 = 0.03; anxious, F (1, 24) = 1.12, b = 0.09, t = 1.06, p < 0.30, R2 = 0.04; frightened–disorganized, F (1, 24) = 2.02, b = −0.41, t = −1.42, p < 0.17, R2 = 0.08; or helpless–disorganized, F (1, 24) = 0.91, b = −0.29, t = −0.95, p < 0.35, R2 = 0.04, attachment patterns with their young children. Thus, the hypothesized direct path was not supported, and the mediational role of fathers’ substance use, depression, and trauma symptoms was not analyzed.

4. Conclusions

The objective of this study was to uncover pathways of risk that may perpetuate intergenerational cycles between ACEs and insecure/disorganized attachment patterns in mothers and fathers who are opioid-involved. Historically, much of the literature has considered sequelae stemming from early adversity, including, but not limited to, insecure attachment patterns, lifetime substance use, psychological sequela (e.g., depression and trauma symptoms), and negative parenting [6,12,15,18]. These various risk factors are likely to overlap [6,19,42] and, thus, may be best understood through examination of indirect predictive relationships [24] and collective models that bring these variables together. Given increased concern from the opioid epidemic [3] and evidence that parents who are opioid-involved may demonstrate heightened parenting difficulties [1], this study sought to expand on existing research while also filling gaps in the literature.
Of particular interest, research has focused overwhelmingly on mothers, with fathers seldom being included in empirical discussions of trauma, attachment, and/or parenting [1,25]. Cassidy and colleagues [43] posited that this discrepancy reflected likely challenges in recruiting fathers for research. The challenges of recruiting fathers were compounded in this study by fathers being more likely to be employed than mothers (thereby making them less likely to participate due to work obligations) and by unprecedented difficulties brought on by the COVID-19 pandemic. Nonetheless, this study was still successful in expanding efforts to examine mothers and fathers and to explain pathways of risk between parents’ ACEs and insecure/disorganized attachment patterns.
Mediational models examined predictive pathways from mothers and fathers’ ACEs to insecure/disorganized attachment patterns with their young children, with substance use severity, depression, and trauma symptoms as potential mediators. First, the hypothesized path from parents’ ACEs to insecure/disorganized attachment patterns (i.e., direct effect) was supported for mother–young child disorganized attachments only, such that mothers with higher ACEs perceived greater frightened–disorganized and helpless–disorganized attachment with their young children. In other words, mothers’ ACEs did not predict mother–young child insecure attachment patterns, only mother–young child disorganized attachment patterns. These findings demonstrated that mothers’ childhood adversity may be related to disorganized attachment patterns in particular, rather than to other insecure attachment patterns in general [44].
The hypothesized pathways (i.e., direct effects) from fathers’ ACEs to father–young child insecure/disorganized attachment patterns were unsupported for fathers’ perceptions of all four patterns of attachment. This lack of predictive relationships impeded the ability to learn more regarding the relationship between fathers’ ACEs and father–young child attachment patterns. Despite similarities in our mother and father samples on ACEs, the data highlighted that fathers endorsed higher levels of avoidant attachment patterns than did mothers. No other significant differences were noted in attachment patterns between mothers and fathers. Overall, these findings may imply that mothers and fathers’ perceptions of avoidant attachment patterns may represent different constructs, that mothers’ pathways may be different than those of fathers, and that attachment findings for mothers may not be generalizable to fathers [43]. The sample size for fathers also may have played a role, as more fathers could not be recruited due to their employment responsibilities and the implementation of COVID-19 quarantine protocols in the United States of America during the course of this study. The role of fathers’ attachment consequently necessitates further study [27,43], especially since further exploration of fathers’ indirect mediational pathways could not be completed theoretically in this study.
Contrary to the hypotheses and previous findings [6,7], mothers’ ACEs did not predict their substance use severity, suggesting that a mediational role of substance use severity was not supported. Several theories should be considered in explaining these findings. In this study’s sample, 38% of mothers described prescription opioids (alone or alongside heroin) as their ‘drug of choice’, whereas 50% of mothers described heroin alone as their ‘drug of choice.’ (Opposite percentages were noted for fathers, perhaps explaining some of the differences in findings between mothers and fathers.) Nonetheless, it should be considered that the parents in this sample were receiving medication-assisted treatment at study recruitment. Individuals’ journeys with substance use recovery often vacillate between periods of stability (i.e., sobriety and adherence to treatment) and relapse [27]. It is possible, therefore, that progress in substance treatment and stage of recovery may have buffering effects for mothers’ substance use severity on parent–young child attachment patterns.
In examining the mediational role of mothers’ depression, the hypothesis of this study was not supported. In contrast with this study’s expectations and with previous findings [19,45], mothers’ ACEs did not predict their depression. Interestingly, the majority of mothers (and fathers) in this study exhibited low levels of depression overall, with only 7% of mothers (and 11% of fathers) endorsing severe symptoms. Thus, it may be that this study’s sample was benefiting from the substance use and other treatments that they were receiving. In partial support of hypotheses, mothers’ depression predicted helpless–disorganized attachment. It may be that the helplessness associated with depression also presents itself in the mothering role and interferes with mothers’ abilities to identify young children’s emotional cues and to respond adaptively to them [46]. These data were salient given that disorganized attachment patterns have been associated with the most maladaptive outcomes for young children [47].
When examining the mediational role of mothers’ trauma symptoms, the hypotheses were found to be supported fully. Consistent with previous findings [42], mothers’ ACEs predicted their trauma symptoms, which predicted both frightened–disorganized and helpless–disorganized attachment patterns. When examined collectively, mothers’ ACEs no longer predicted frightened–disorganized attachment patterns. Mothers’ trauma, however, mediated and explained 23% of the variance in the relationship between mothers’ ACEs and frightened–disorganized attachment patterns, representing a large indirect effect as a mechanism of action.
Next, variables were examined collectively in the prediction of helpless–disorganized attachment patterns. In contrast to results for frightened–disorganized attachment patterns, mothers’ ACEs and trauma symptoms no longer predicted helpless–disorganized attachment patterns. Mothers’ depression symptoms emerged as a significant predictor of helpless–disorganized attachment patterns (over and above mothers’ ACEs) and helped to explain 23% of the variance in helpless–disorganized attachment patterns. Bootstrapping procedures, however, were unable to conclude with 95% confidence that mothers’ depression represented a significant indirect effect. Thus, mothers’ depression predicted uniquely helpless–disorganized attachment patterns but did not significantly mediate the relationship between mothers’ ACEs and parent–young child helpless–disorganized attachment patterns.
These data suggested that, rather than mothers’ ACEs being directly harmful for mother–young child attachment patterns, the long-term psychological consequences of mothers’ ACEs may carry a greater risk of perceived attachment patterns with their young children. Specifically, mothers’ trauma symptoms acted as a mechanism of action in the relationship between mothers’ ACEs and frightened–disorganized attachment patterns, whereas mothers’ depression predicted uniquely helpless–disorganized attachment patterns above and beyond mothers’ ACEs. These findings corroborated prior research suggesting that mothers’ current psychological symptoms, rather than their histories of childhood adversity, posed the greatest risk to establishing secure bonds with their young children [42]. Disorganized attachment patterns may be exacerbated by the instability and inconsistency characteristic of the opioid recovery process [27]. These findings stressed how mothers’ trauma and depression symptoms, along with their substance involvement, are threats to their young children’s sense of safety and security [48].
The results of this study demonstrated the importance of interventions to be trauma-informed and family-focused when targeting difficulties with parents’ substance use, psychological sequelae, and parent–young child attachment patterns. To date, only one review seemed to comprehensively examine the literature on parenting and opioid use, and fathers who were opioid-involved had been studied seemingly only once empirically [1]. Unquestionably, it is vital that future work continues to investigate the specific difficulties and needs exhibited by mothers and fathers who have high ACEs and who are opioid-involved to inform evidence-based practice. Future work should utilize a family systems approach to best understand the development of insecure/disorganized attachment patterns between parents and their young children [49]. See Renk and colleagues [50] for a review of evidence-based treatments for parents who are substance-involved. Interventions such as Circle of Security [51], which promote reflection on parents’ own childhood adversity and their current parenting, as well as reflective relationship-based treatments, such as Child–Parent Psychotherapy [52], may also be helpful in mitigating risk for families with young children. Addressing parents’ psychological sequelae through evidence-based intervention approaches may provide further mitigation toward preserving the parenting capacities of mothers and fathers.
The results of this study should be interpreted in the context of its limitations. This study had a relatively homogenous sample, with demographic characteristics potentially compromising external validity. Although lacking in racial diversity, this mostly White/Caucasian sample reflected both the national demographic of opioid users [53] and the racial disparities in those who receive prescription opioids [54] in the United States of America. It should also be noted that this study examined mediations using a cross-sectional design, where ratings of all variables were collected within one time period. Although ACEs were likely to have occurred prior to the other variables of interest (given the nature of this construct), it cannot be determined with certainty whether parents’ depression or trauma symptoms preceded their development of insecure/disorganized attachment patterns with their young children. Further, cross-sectional data do not allow causal claims to be made.
Certainly, a greater sub-sample of fathers would have been optimal. Our efforts resulted in the recruitment of 26 fathers, an ostensibly small sample as compared to the sample of mothers. This sample size was complicated by the fact that fathers more often had to leave for work (relative to mothers) after receiving their medication-assisted treatment, as well as by restrictions put in place for COVID-19. This sample size of fathers was found to exceed that found in previous studies, however [55]. The problematic omission of fathers in attachment research has long been documented [49]. Even after a significant push for more research on father–child attachment, only 16 studies existed on this topic by 2019 [56]. Moreover, only one review could be identified as examining fathers’ opioid use to date [1]. Thus, this study still enhanced the literature on fathers.
This study utilized self-report measures to examine the variables of interest. Although several of the measures included validity scales, the possibility remains that parents may have exhibited positive or negative self-bias [57] in their responses. Nonetheless, there were significant relationships among the variables of interest in this study. Further, Cassidy and colleagues [43] stated the importance of conducting such intergenerational attachment research using self-report measures. It should be noted that, rather than the accuracy of attachment patterns (e.g., on the Strange Situation procedure), this study was interested in mothers and fathers’ perceptions of their attachment patterns with their young children. Nonetheless, future studies would benefit from including young children themselves, especially in conjunction with parent–young child observational paradigms.
In summary, this study uniquely added to the understanding of intergenerational risk pathways between parents’ ACEs and insecure/disorganized attachment patterns with parents who are opioid-involved. The results of this study suggested that mothers’ trauma and depression symptoms play a central role in perpetuating relationships between childhood adversity and disorganized attachment patterns with their young children. As such, these are essential targets for intervention with these mothers. Interestingly, fathers’ ACEs were not predictive of their attachment patterns with their young children. This study recognized that a low sample size of fathers relative to mothers may have impacted relationships among the variables investigated. Further inclusion of fathers in parenting, attachment, and trauma research is vital. Overall, these data highlighted that differences may exist in how mothers and fathers perceive parent–young child attachment patterns. These results have implications for tailoring trauma-informed and attachment-focused parenting interventions to help parents break perpetuating cycles of ACEs and insecure/disorganized attachment patterns.

Author Contributions

M.K. and K.R. conceptualized the idea behind the manuscript. M.K. wrote the original manuscript, which was used for her dissertation with guidance and editing from K.R. and K.R. then prepared the manuscript for publication and completed subsequent edits. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the University of Central Florida (STUDY00000397; 30 April 2019.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available upon request from the corresponding author due to the privacy of the data and the sensitivity of the sample recruited for this study.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References

  1. Peisch, V.; Sullivan, A.D.; Breslend, N.L.; Benoit, R.; Sigmon, S.C.; Forehand, G.L.; Strolin-Goltzman, J.; Forehand, R. Parental opioid abuse: A review of child outcomes, parenting, and parenting interventions. J. Child Fam. Stud. 2018, 27, 2082–2099. [Google Scholar] [CrossRef]
  2. Rebbe, R.; Sieger, M.L.; Reddy, J.; Prindle, J. US state rates of newborns reported to child protection at birth for prenatal substance exposure. Int. J. Drug Policy 2024, 130, 104527. [Google Scholar] [CrossRef] [PubMed]
  3. Substance Abuse and Mental Health Services Administration (SAMHSA). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068 2019, NSDUH Series H-54); Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration: Rockville, MD, USA. Available online: https://www.samhsa.gov/data/ (accessed on 30 April 2019).
  4. Kolodny, A.; Courtwright, D.T.; Hwang, C.S.; Kreiner, P.; Eadie, J.L.; Clark, T.W.; Alexander, G.C. The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annu. Rev. Public Health 2015, 36, 559–574. [Google Scholar] [CrossRef] [PubMed]
  5. U.S. Department of Health; Human Services (USDHHS). Opioid Crisis: Determination That a Public Health Emergency Exists; USDHHS: Washington, DC, USA, 2017. Available online: https://www.hhs.gov/sites/default/files/opioid%20PHE%20Declaration-no-sig.pdf (accessed on 30 April 2019).
  6. Felitti, V.J.; Anda, R.F.; Nordenberg, D.; Williamson, D.F.; Spitz, A.M.; Edwards, V.; Koss, M.P.; Marks, J.S. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am. J. Prev. Med. 1998, 14, 245–258. [Google Scholar] [CrossRef] [PubMed]
  7. Solis, J.M.; Shadur, J.M.; Burns, A.R.; Hussong, A.M. Understanding the diverse needs of children whose parents abuse substances. Curr. Drug Abus. Rev. 2012, 5, 135–147. [Google Scholar] [CrossRef]
  8. Ye, Y.; Dellor, E.; Freisthier, B. Trends in substance use among child welfare-involved parents during the COVID-19 pandemic. Child Abus. Negl. 2025, 166, 107487. [Google Scholar] [CrossRef]
  9. Kronenberg, M. Strategies in infant mental health: What is infant, toddler, & early childhood mental health? In Proceedings of the Cross-Sites Meeting, QIC-CT, Orlando, FL, USA, 20 October 2016. [Google Scholar]
  10. Bowlby, J. Attachment and Loss: Volume I, Attachment; Basic Books: New York, NY, USA, 1969. [Google Scholar]
  11. Sroufe, L.A. Emotional Development: The Organization of Emotional Life in the Early Years; Cambridge University Press: Cambridge, UK, 1996. [Google Scholar]
  12. Cyr, C.; Euser, E.M.; Bakermans-Kranenburg, M.J.; van IJzendoorn, M.H. Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Dev. Psychopathol. 2010, 22, 87–108. [Google Scholar] [CrossRef]
  13. Cassidy, J. The nature of the child’s ties. In Handbook of Attachment: Theory, Research and Clinical Applications, 2nd ed.; Cassidy, J., Shaver, P.R., Eds.; Guilford Publications: New York, NY, USA, 2008; pp. 3–22. [Google Scholar]
  14. Landers, M.S.; Sullivan, R.M. The development and neurobiology of infant attachment and fear. Dev. Neurosci. 2012, 34, 101–114. [Google Scholar] [CrossRef]
  15. Berthelot, N.; Ensink, K.; Bernazzani, O.; Normandin, L.; Luyten, P.; Fonagy, P. Intergenerational transmission of attachment in abused and neglected mothers: The role of trauma-specific reflective functioning. Infant Ment. Health J. 2015, 36, 200–212. [Google Scholar] [CrossRef]
  16. Sirparanta, A.E.; Danner Touati, C.; Cyr, C.; Miljkovitch, R. Parental history of childhood maltreatment and offspring attachment insecurity and disorganization: Two meta-analyses. Trauma Violence Abus. 2025, 26, 420–435. [Google Scholar] [CrossRef]
  17. Jayawardene, W.; Lohrmann, D.; Agley, J.; Jun, M.; Gassman, R. Adverse childhood experience-related conditions and substance use in adolescents: A secondary analysis of cross-sectional survey data. J. Sch. Health 2024, 94, 385–394. [Google Scholar] [CrossRef]
  18. Madigan, S.; Wade, M.; Plamondon, A.; Jenkins, J. Maternal abuse history, postpartum depression, and parenting: Links with preschoolers’ internalizing problems. Infant Ment. Health J. 2015, 36, 146–155. [Google Scholar] [CrossRef] [PubMed]
  19. Khan, M.; Renk, K. Understanding the pathways between mothers’ childhood maltreatment experiences and patterns of insecure attachment with young children via symptoms of depression. Child Psychiatry Hum. Dev. 2018, 49, 928–940. [Google Scholar] [CrossRef] [PubMed]
  20. Negriff, S.; Fritz, H.L.; Ji, J. Parental depression and adulthood adversities as mediators of direct versus indirect intergenerational experiences of child maltreatment. J. Fam. Violence 2025, 40, 503–513. [Google Scholar] [CrossRef]
  21. Kaufman, J.; Zigler, E. The intergenerational transmission of child abuse. In Child Maltreatment; Cicchetti, D., Carlson, V., Eds.; Cambridge University Press: Cambridge, UK, 1989; pp. 129–150. [Google Scholar]
  22. Madigan, S.; Cyr, C.; Eirich, R.; Fearon, R.P.; Ly, A.; Rash, C.; Poole, J.C.; Alink, L.R.A. Testing the cycle of maltreatment hypothesis: Meta-analytic evidence of the intergenerational transmission of child maltreatment. Dev. Psychopathol. 2019, 31, 23–51. [Google Scholar] [CrossRef]
  23. Knight, K.E.; Menard, S.; Simmons, S.B. Intergenerational continuity of substance use. Subst. Use Misuse 2014, 49, 221–233. [Google Scholar] [CrossRef]
  24. Vaillancourt, K.; Pawlby, S.; Fearon, R.M. History of childhood abuse and mother-infant interaction: A systematic review of observational studies. Infant Ment. Health J. 2017, 38, 226–248. [Google Scholar] [CrossRef]
  25. Deneault, A.A.; Laquerre, D.; Beaulieu, L.; Myre, G.; Racine, N.; Madigan, S. Prevalence and correlates of adverse childhood experiences in fathers: A systematic review and meta-analysis. Child Abus. Negl. 2025, 169 Pt 2, 107651. [Google Scholar] [CrossRef]
  26. Alink, L.R.A.; Cyr, C.; Madigan, S. The effect of maltreatment experiences on maltreating and dysfunctional parenting: A search for mechanisms. Dev. Psychopathol. 2019, 31, 1–7. [Google Scholar] [CrossRef]
  27. Scaife, V.H. Maternal and paternal drug misuse and outcomes for children: Identifying risk and protective factors. Child. Soc. 2008, 22, 53–62. [Google Scholar] [CrossRef]
  28. Centers for Disease Control and Prevention (CDC). Opioid Overdose; CDC: Atlanta, GA, USA, 2017. Available online: https://www.cdc.gov/drugoverdose/index.html (accessed on 30 April 2019).
  29. Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings; NSDUH Series H-41, HHS Publication No. (SMA) 11-4658; Substance Abuse and Mental Health Services Administration: Rockville, MD, USA, 2011. [Google Scholar]
  30. Hayes, A.F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach; Guilford Press: New York, NY, USA, 2013. [Google Scholar]
  31. Hall, M.T.; Wilfong, J.; Huebner, R.A.; Posze, L.; Willauer, T. Medication-assisted treatment improves child permanency outcomes for opioid-using families in the child welfare system. J. Subst. Abus. Treat. 2016, 71, 63–67. [Google Scholar] [CrossRef]
  32. Brennan, K.; Clark, C.; Shaver, P. Self-report measurement of adult attachment: An integrative overview. In Attachment Theory and Close Relationships; Simpson, J., Rholes, W.S., Eds.; Guilford Press: New York, NY, USA, 1998; pp. 46–76. [Google Scholar]
  33. George, C.; Solomon, J. Caregiving helplessness: The development of a screening measure for disorganized maternal caregiving. In Disorganized Attachment and Caregiving; Solomon, J., George, C., Eds.; Guilford Publications: New York, NY, USA, 2011; pp. 133–166. [Google Scholar]
  34. Solomon, J.; George, C. (Eds.) Disorganized Attachment and Caregiving; Guilford Press: New York, NY, USA, 2011. [Google Scholar]
  35. Tonigan, J.S.; Miller, W.R. The Inventory of Drug Use Consequences (InDUC): Test-retest stability and sensitivity to detect change. Psychol. Addict. Behav. 2002, 16, 165. [Google Scholar] [CrossRef]
  36. Asberg, K.; Renk, K. Substance use coping as a mediator of the relationship between trauma symptoms and substance use consequences among incarcerated females with childhood sexual abuse histories. Subst. Use Misuse 2012, 47, 799–808. [Google Scholar] [CrossRef]
  37. Westermeyer, J.; Crosby, R.; Nugent, S. The Minnesota Substance Abuse Problems Scale: Psychometric analysis and validation in a clinical population. Am. J. Addict. 1998, 7, 24–34. [Google Scholar] [CrossRef]
  38. Beck, A.T.; Steer, R.A.; Brown, G.K. Beck Depression Inventory-II; Psychological Corporation: San Antonio, TX, USA, 1996. [Google Scholar]
  39. Weiss, D.S.; Marmar, C.R. The Impact of Event Scale-Revised. In Assessing Psychological Trauma and PTSD: A Practitioner’s Handbook; Wilson, J.P., Keane, T.M., Eds.; Guilford: New York, NY, USA, 1997; pp. 399–411. [Google Scholar]
  40. Stein, M.D.; Conti, M.T.; Kenney, S.; Anderson, B.J.; Flori, J.N.; Risi, M.M.; Bailey, G.L. Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder. Drug Alcohol Depend. 2017, 179, 325–329. [Google Scholar] [CrossRef] [PubMed]
  41. Westermeyer, J.; Thuras, P. Association of antisocial personality disorder and substance disorder morbidity in a clinical sample. Am. J. Drug Alcohol Abus. 2005, 31, 93–110. [Google Scholar] [CrossRef]
  42. Muzik, M.; Bocknek, E.L.; Broderick, A.; Richardson, P.; Rosenblum, K.L.; Thelen, K.; Seng, J.S. Mother–infant bonding impairment across the first 6 months postpartum: The primacy of psychopathology in women with childhood abuse and neglect histories. Arch. Women’s Ment. Health 2013, 16, 29–38. [Google Scholar] [CrossRef] [PubMed]
  43. Cassidy, J.; Jones, J.D.; Shaver, P.R. Contributions of attachment theory and research: A framework for future research, translation, and policy. Dev. Psychopathol. 2013, 25, 1415–1434. [Google Scholar] [CrossRef]
  44. Granqvist, P.; Sroufe, L.A.; Dozier, M.; Hesse, E.; Steele, M.; van Ijzendoorn, M.; Solomon, J.; Schuengel, C.; Fearon, P.; Bakermans-Kranenburg, M.; et al. Disorganized attachment in infancy: A review of the phenomenon and its implications for clinicians and policy makers. Attach. Hum. Dev. 2017, 19, 534–558. [Google Scholar] [CrossRef]
  45. Khan, M.; Renk, K. Mothers’ adverse childhood experiences, depressive symptoms, parenting, and attachment as predictors of young children’s problems. J. Child Custody 2019, 16, 268–290. [Google Scholar] [CrossRef]
  46. Seligman, M.E. Learned helplessness. Annu. Rev. Med. 1972, 23, 407–412. [Google Scholar] [CrossRef]
  47. Mash, E.J.; Wolfe, D.A. Abnormal Child Psychology, 7th ed.; Wadsworth: Belmont, CA, USA , 2018. [Google Scholar]
  48. Scheeringa, M.S.; Zeanah, C.H. Symptom expression and trauma variables in children under 48 months of age. Infant Ment. Health J. 1995, 16, 259–270. [Google Scholar] [CrossRef]
  49. Cowan, P.A. Beyond meta-analysis: A plea for a family systems view of attachment. Child Dev. 1997, 68, 601–603. [Google Scholar] [CrossRef] [PubMed]
  50. Renk, K.; Boris, N.W.; Kolomeyer, E.; Lowell, A.; Puff, J.; Cunningham, A.; Khan, M.; McSwiggan, M. The state of evidence-based parenting interventions for parents who are substance-involved. Pediatr. Res. 2016, 79, 177–183. [Google Scholar] [CrossRef] [PubMed]
  51. Powell, B.; Cooper, G.; Hoffman, K.; Marvin, B. The Circle of Security Intervention: Enhancing Attachment in Early Parent–Child Relationships; Guilford Press: New York, NY, USA, 2014. [Google Scholar]
  52. Lieberman, A.; Ghosh Ippen, C.; Van Horn, P. Don’t Hit My Mommy!: A Manual for Child-Parent Psychotherapy with Young Children Exposed to Violence and Other Trauma, 2nd ed.; Zero to Three: Washington, DC, USA, 2015. [Google Scholar]
  53. Cicero, T.J.; Ellis, M.S.; Surratt, H.L.; Kurtz, S.P. The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry 2014, 71, 821–826. [Google Scholar] [CrossRef]
  54. Dickason, R.M.; Chauhan, V.; Mor, A.; Ibler, E.; Kuehnle, S.; Mahoney, D.; Armbrecht, E.; Dalawari, P. Racial differences in opiate administration for pain relief at an academic emergency department. West. J. Emerg. Med. 2015, 16, 372–380. [Google Scholar] [CrossRef]
  55. Lamb, M.E. The development of mother-infant and father-infant attachments in the second year of life. Dev. Psychol. 1977, 13, 637–648. [Google Scholar] [CrossRef]
  56. Ahnert, L.; Schoppe-Sullivan, S.J. Fathers from an attachment perspective. Attach. Hum. Dev. 2020, 22, 1–3. [Google Scholar]
  57. John, O.P.; Robins, R.W. Accuracy and bias in self-perception: Individual differences in self-enhancement and the role of narcissism. J. Personal. Soc. Psychol. 1994, 66, 206–219. [Google Scholar] [CrossRef]
Children 12 01496 g001
Figure 1. Standardized regression coefficients for the relationship between mothers’ adverse childhood experiences and frightened–disorganized attachment patterns. Note. The standardized regression coefficient between mothers’ ACEs and frightened–disorganized attachment patterns, controlling for substance use severity, depression, and trauma, is in parentheses. The bold line indicates a direct path, whereas the dotted lines indicate indirect paths. Significance indicated by ** p < 0.01 and *** p < 0.001.
Figure 1. Standardized regression coefficients for the relationship between mothers’ adverse childhood experiences and frightened–disorganized attachment patterns. Note. The standardized regression coefficient between mothers’ ACEs and frightened–disorganized attachment patterns, controlling for substance use severity, depression, and trauma, is in parentheses. The bold line indicates a direct path, whereas the dotted lines indicate indirect paths. Significance indicated by ** p < 0.01 and *** p < 0.001.
Children 12 01496 g001
Children 12 01496 g002
Figure 2. Standardized regression coefficients for the relationship between mothers’ adverse childhood experiences and helpless–disorganized attachment patterns. Note. The standardized regression coefficient between mothers’ adverse childhood experiences and helpless–disorganized attachment patterns, controlling for substance use severity and depression and trauma symptoms, is in parentheses. The bold line indicates a direct path, whereas the dotted lines indicate indirect paths. Significance indicated by ** p < 0.01 and *** p < 0.001.
Figure 2. Standardized regression coefficients for the relationship between mothers’ adverse childhood experiences and helpless–disorganized attachment patterns. Note. The standardized regression coefficient between mothers’ adverse childhood experiences and helpless–disorganized attachment patterns, controlling for substance use severity and depression and trauma symptoms, is in parentheses. The bold line indicates a direct path, whereas the dotted lines indicate indirect paths. Significance indicated by ** p < 0.01 and *** p < 0.001.
Children 12 01496 g002
Table 1. Participant demographic information.
Table 1. Participant demographic information.
VariablesMothers (N = 75)Fathers (N = 26)
Parent’s Age                            
M (SD)33.08 (7.79)34.62 (9.07)
Child’s Age (Years)  
M (SD)2.83 (1.79)3.14 (1.61)
Number of Children  
M (SD)2.16 (1.33)1.69 (1.09)
Race/Ethnicity  
White/Caucasian80.0%73.1%
Latino/Hispanic6.7%23.1%
Black/African American8.0%0%
Multiracial5.3%3.8%
Marital Status  
Single70.7%73.1%
Married9.3%15.4%
Divorced/Separated18.7%11.5%
Education Level  
<High School6.8%3.8%
Some High School15.1%11.5%
High School Diploma/GED26.0%42.3%
Vocational Training6.8%3.8%
Some College42.5%30.8%
Bachelor’s Degree or Higher2.8%7.7%
Number Living in Home  
M (SD)5.09 (11.15)3.35 (1.55)
Substance Use  
Number of Substances, M (SD)5.26 (2.49)6.46 (2.49)
Opioid Use37.8%60.0%
Heroin Use50.0%36.0%
Medication-Assisted Treatment  
Methadone82.4%61.5%
Suboxone 13.5%26.9%
Vivitrol4.1%11.5%
Religious Affiliation  
Christian72.0%69.2%
Employment Status  
Employed39.7%84.6%
Socioeconomic Status  
<USD 500025.0%3.8%
USD 5000–USD 10,0006.9%3.8%
USD 10,000–USD 20,00019.4%3.8%
USD 20,000–USD 30,00013.9%26.9%
USD 30,000–USD 40,00015.3%34.6%
USD 40,000–USD 50,0009.7%3.8%
USD 50,000–USD 60,0002.8%7.7%
>USD 60,0007.0%15.3%
Table 2. Descriptive statistics for variables of interest.
Table 2. Descriptive statistics for variables of interest.
MothersFathers
Variables (Available Range)M (SD) M (SD) Actual Range
ACEs Total Score (0–10)3.79 (2.98)3.00 (2.73)0–10
Attachment Patterns   
Avoidant Attachment (1.00–7.00)2.38 (0.98)3.04 (1.09)1.17–4.44
Anxious Attachment (1.00–7.00)2.87 (1.09)3.11 (1.09)1.00–5.72
Disorganized Attachment (Mother/Child Frightened; 0–30)9.59 (3.36)10.88 (4.00)6–18
Disorganized Attachment (Mother Helpless; 0–30)10.05 (4.04)10.65 (4.15)5–21
Substance Use   
InDUC Total (0–50)36.51 (9.23)39.58 (8.04)9–45
M-SAPS Total (0–61)40.65 (11.17)46.35 (11.56)5–60
Parental Substance Use Severity (0–18)14.16 (3.55)15.00 (3.83)2–18
Depression Symptoms (0–63)13.16 (10.33)14.31 (13.81)0–47
Trauma Symptoms (0–88)29.35 (24.30)34.81 (20.90)0–88
Table 3. Independent-samples t-tests for mothers’ and fathers’ variables.
Table 3. Independent-samples t-tests for mothers’ and fathers’ variables.
MothersFathers
MSDMSDtCohen’s d
Number of Substances Used5.262.496.462.492.12 *0.48
ACEs3.792.983.002.73−1.180.28
Avoidant Attachment2.380.983.041.092.89 **0.64
Anxious Attachment2.871.093.111.090.980.22
Frightened Attachment9.593.3610.884.001.600.35
Helpless Attachment10.054.0410.654.150.650.15
InDUC Total36.519.2339.588.041.510.35
M-SAPS Total40.6511.1746.3511.562.22 *0.50
SUS Total14.163.5515.003.831.020.23
Depression Symptoms13.1610.3314.3113.810.450.09
Trauma Symptoms29.3524.3034.8120.901.020.24
Note. ACEs = adverse childhood experiences; InDUC = Inventory of Drug Use Consequences; M-SAPS = Minnesota Substance Abuse Problems Scale; SUS = parental substance use severity scale. Significance indicated by * p < 0.05 and ** p < 0.01.
Table 4. Correlations among mothers’ ACEs, attachment patterns, substance use severity, depression, and trauma symptoms.
Table 4. Correlations among mothers’ ACEs, attachment patterns, substance use severity, depression, and trauma symptoms.
Variables12345678910
1. ACEs-         
2. Avoidant Attachment0.01-        
3. Anxious Attachment0.180.40 ***-       
4. Frightened Attachment0.29 **0.25 *0.52 ***-      
5. Helpless Attachment0.29 **0.26 *0.37 ***0.46 ***-     
6. InDUC Total0.19−0.10−0.15−0.12−0.12-    
7. M-SAPS Total0.10−0.18−0.08−0.060.040.73 ***-   
8. SUS Total0.09−0.13−0.05−0.10−0.040.83 ***0.83 ***-  
9. Depression Symptoms0.150.150.220.160.41 ***−0.010.020.03- 
10. Trauma Symptoms0.52 ***0.150.220.46***0.28 *0.070.090.010.42 ***-
Note. Significance indicated by * p < 0.05, ** p < 0.01, and *** p < 0.001. Items in bold are significant after Bonferroni correction.
Table 5. Correlations among fathers’ ACEs, attachment patterns, substance use severity, depression, and trauma symptoms.
Table 5. Correlations among fathers’ ACEs, attachment patterns, substance use severity, depression, and trauma symptoms.
Variables12345678910
1. ACEs-         
2. Avoidant Attachment0.17-        
3. Anxious Attachment0.210.29-       
4. Frightened Attachment−0.290.40 *0.40 *-      
5. Helpless Attachment−0.190.41 *0.52 **0.68 ***-     
6. InDUC Total0.21−0.060.13−0.130.03-    
7. M-SAPS Total0.240.080.270.020.190.83 ***-   
8. SUS Total0.230.040.18−0.090.070.97 ***0.83 ***-  
9. Depression Symptoms0.070.370.250.120.190.010.060.05- 
10. Trauma Symptoms0.230.150.310.020.220.060.210.120.50 **-
Note. Significance indicated by * p < 0.05, ** p < 0.01, and *** p < 0.001. Items in bold are significant after Bonferroni correction.
Table 6. Mediation effects of mothers’ substance use, depression, and trauma symptoms predicting frightened–disorganized attachment patterns.
Table 6. Mediation effects of mothers’ substance use, depression, and trauma symptoms predicting frightened–disorganized attachment patterns.
95% BCa CI
EffectbLowerUpper
Total (ACEs; No Mediator)0.33 **0.080.58
Direct (ACEs)0.10−0.180.38
Indirect (Substance Use)−0.01−0.080.03
Indirect (Depression Symptoms)−0.01−0.050.05
Indirect (Trauma Symptoms)0.25 **0.070.48
Note. BCa CI = bias-corrected confidence intervals. Items in bold represent significant indirect effects following bootstrapping. Significance indicated by ** p < 0.01.
Table 7. Mediation effects of mothers’ substance use, depression, and trauma symptoms predicting helpless–disorganized attachment patterns.
Table 7. Mediation effects of mothers’ substance use, depression, and trauma symptoms predicting helpless–disorganized attachment patterns.
95% BCa CI
EffectbLowerUpper
Total (ACEs; No Mediator)0.39 **0.080.69
Direct (ACEs)0.33−0.010.67
Indirect (Substance Use)−0.01−0.080.04
Indirect (Depression Symptoms)0.08 **−0.020.24
Indirect (Trauma Symptoms)−0.01−0.220.19
Note. BCa CI = bias-corrected confidence intervals. Significance indicated by ** p < 0.01.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Khan, M.; Renk, K. When Mothers and Fathers Are ‘Gone’: Predicting Intergenerational Cycles of Risk in Opioid-Involved Parents. Children 2025, 12, 1496. https://doi.org/10.3390/children12111496

AMA Style

Khan M, Renk K. When Mothers and Fathers Are ‘Gone’: Predicting Intergenerational Cycles of Risk in Opioid-Involved Parents. Children. 2025; 12(11):1496. https://doi.org/10.3390/children12111496

Chicago/Turabian Style

Khan, Maria, and Kimberly Renk. 2025. "When Mothers and Fathers Are ‘Gone’: Predicting Intergenerational Cycles of Risk in Opioid-Involved Parents" Children 12, no. 11: 1496. https://doi.org/10.3390/children12111496

APA Style

Khan, M., & Renk, K. (2025). When Mothers and Fathers Are ‘Gone’: Predicting Intergenerational Cycles of Risk in Opioid-Involved Parents. Children, 12(11), 1496. https://doi.org/10.3390/children12111496

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop