The blog of the Urban Institute
May 14, 2019

The Large Overlaps between Opioid Use Disorder, Mental Illness, and Parenting Young Children

As the nation grapples with one of the largest public health crises in a generation, the opioid epidemic continues to touch many families, communities, and service systems across the US.

In a new paper, we find that more than half a million (623,000) adults with opioid use disorder are parents living with children younger than 18. Nearly half (42 percent) of parents with opioid use disorder had one or more other substance use disorders, most commonly alcohol use disorder. Fewer than one-third (28 percent) of parents with an opioid use disorder have received any type of substance use treatment.

The co-occurrence of substance use disorders and mental illness among parents with opioid use disorder is especially worrying:

  • Almost two-thirds (62 percent) of parents with opioid use disorder have a mental illness.
  • More than one in five parents with opioid use disorder had suicidal thoughts and behaviors in the past 12 months.
  • Twenty-five percent of parents with opioid use disorder had a major depressive episode in the past 12 months.
  • Twenty-three percent of parents with opioid use disorder had a serious mental illness (e.g., schizophrenia, severe bipolar disorder, severe major depression) in the past 12 months.

These rates are higher for parents with opioid use disorder than for parents with other substance use disorders. We find that 42 percent of parents with an opioid use disorder reported receiving treatment for mental health in the past 12 months.

In 2016, nearly 45,000 Americans died by suicide, representing a steep increase (nearly 30 percent) from 1999. Despite the co-occurrence among parents of behaviors that signal substance use disorders and suicide risk, there has been little study of these trends or discussion about the unique mental health needs of parents—especially those who are struggling to manage addiction and care for their children.

Our analysis adds to the growing evidence that we must tackle addiction and poor mental health together, and doing so will benefit some of the youngest and most vulnerable in the US.

Primary care practices are hindered in addressing mental health and substance use issues among parents because of many constraints—including time, reimbursement, training, and discomfort or stigma. But these primary care practices could play a critical role in screening and diagnosing, motivating change, and facilitating initiation of treatment for both mental health and substance use problems. Some providers already screen postpartum mothers for maternal depression. If providers screened for substance use disorder at the same time, it could trigger critical follow-ups and further assessments to confirm diagnoses and start treatment.

Yet even when primary care physicians have appropriate screening tools for both mental health and substance use disorders, they may lack training and reimbursement to provide follow-up care (e.g., a brief intervention motivating behavior change) and initiate treatment, or if referring out, they may not know where to refer parents for appropriate care and treatment. And if a pediatrician screens the parent, will they be followed up by their own primary care physician (if they have one)? Oftentimes no. Or will the pediatrician follow up? Probably not. So the system lets far too many parents fall through the cracks. And the infrastructure to link parents with social services such as child care, housing, and nutrition assistance is also often lacking.

Children’s futures hang in the balance

Parental substance use and mental illness are major risk factors for children’s development and health—these children are more likely to face early traumatic and adverse experiences. Prenatal substance exposure is itself a form of trauma, and children of parents with substance use disorder may also experience family dysfunction and violence, parental incarceration, abuse or neglect, and may have more difficulties in academic and social functioning, a higher rate of mental and behavioral disorders, and a higher likelihood of developing substance use disorders in adolescence and young adulthood.

The fact that more than one in five parents with opioid use disorder say they have had suicidal thoughts and behaviors in the past 12 months should give us all pause. Losing a parent has disastrous consequences for children, families, and communities.

This evidence clearly shows parents need more support as the opioid crisis continues and that integrating treatment for mental health and substance use disorder for parents will be a key part of the solution.

Rachel holds her baby Isabella at the UCHealth Memorial Hospital on November 16, 2017. Isabella was born with a mild case of neonatal abstinence syndrome because of her mother's recovery from an opioid addiction. Rachel, 30, was taking a synthetic opioid prescription during her pregnancy as she recovered from an addition to heroin. (Photo by Andy Cross/The Denver Post via Getty Images).

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