title: Substance, structure and stigma: parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods.
abstract: BACKGROUND
  Parenting and pregnancy in the context of drug use is a contentious topic, high on the policy agenda. Providing effective support to parents who are opioid dependent, through early intervention, access to drug treatment and parenting skills training, is a priority. However, little is known about opioid dependent parents' experiences and understanding of parenting support during the antenatal and postnatal periods. This paper focuses on the position and impact of opioid substitution therapy (OST) in the accounts of parents who were expecting, or who had recently had, a baby in the UK.
  
  
  METHODS
  Semi-structured qualitative interviews were held with a purposive sample of 19 opioid dependent service users (14 female, 5 male). Longitudinal data was collected across the antenatal and postnatal (up to 1 year) periods, with participants interviewed up to three times. Forty-five interviews were analysed thematically, using a constant comparison method, underpinned by a sociologically informed narrative approach.
  
  
  RESULTS
  Participants' accounts of drug treatment were clearly oriented towards demonstrating that they were doing 'the best thing' for their baby. For some, OST was framed as a route to what was seen as a 'normal' family life; for others, OST was a barrier to such normality. Challenges related to: the physiological effects of opioid dependence; structural constraints associated with treatment regimes; and the impact of negative societal views about drug-using parents.
  
  
  CONCLUSIONS
  Parents' accounts of OST can be seen as a response to socio-cultural ideals of a 'good', drug-free parent. Reflecting the liminal position parents engaged in OST found themselves in, their narratives entailed reconciling their status as a 'drug-using parent' with a view of an 'ideal parent' who was abstinent.
authors.affiliation: University of Edinburgh, Centre for Research on Families and Relationships, 23 Buccleuch Place, Edinburgh EH8 9LN, UK. Electronic address: a.chandler@ed.ac.uk.
authors.forename: Amy
authors.initials: A
authors.lastname: Chandler
authors.affiliation: Substance Misuse Directorate, NHS Lothian, 22 Spittal Street, Edinburgh EH3 9DU, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Whittaker
authors.affiliation: University of Edinburgh, Centre for Research on Families and Relationships, 23 Buccleuch Place, Edinburgh EH8 9LN, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cunningham-Burley
authors.affiliation: NHS Lothian, Waverley Gate, Waterloo Place, Edinburgh EH1 3EG, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Williams
authors.affiliation: Australian Primary Health Care Research Institute, Level 1, Ian Potter House, Acton ACT 2601, Australia.
authors.forename: Kelly
authors.initials: K
authors.lastname: McGorm
authors.affiliation: Edinburgh Napier University, Room 2.B.46 Sighthill Court, Sighthill Campus, Edinburgh EH11 4BN, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Mathews
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D055030:Drug Users / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D016487:Parenting / Q000523:psychology; D010290:Parents / Q000523:psychology*; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D011287:Prejudice; D011295:Prenatal Care / Q000379:methods*; D011639:Public Opinion; D036301:Qualitative Research; D012606:Scotland; D013240:Stereotyping; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Methadone maintenance treatment; Opioid substitution therapy; Parenting; Pregnancy