Many women who are recovering from addiction face a stigma with regard to their children — be it their parenting skills, or whether drug/alcohol use caused birth defects. Based on research, “pregnant crack smokers ... were not only stigmatized in straight worlds, but were insulted and ostracized by other crack users and other pregnant crack users” (Irwin, 1995).

If addicted mothers are treated as if they are inept, guilty, and irresponsible, then they are likely to tend to feel, and possibly behave, that way. It is hard to be a good or even a “normal” or average mother when those around you doubt your competence (Colton, 1982).

Published information on fetal alcohol syndrome in 1973 had a powerful impact on society, in terms of blaming the mother for drug/alcohol related birth defects (Jones et al., 1973). “By the early 1990s, the link between [the mother’s] crack cocaine use and fetal morbidity and mortality had moved to the heart of anti-drug ideology” (Irwin, 1995).

“What about Dad?” Ads and posters warning women not to use drugs or alcohol during pregnancy are common, but it is difficult, if not impossible, to find similar warnings for fathers-to-be. The great majority of published research papers about drug/alcohol-related birth defects focus on the mother’s substance use, while ignoring the father which conveys the silent but powerful message: It’s all Mom’s fault.

Interesting paternal research
Despite the scarcity of research on paternal drug/alcohol-related birth defects, some material does exist. According to research, “a wise assumption is that male and female germ cells are equally susceptible to damage” from ingested substances (The Birth Research News Letter, 1998). Several researchers have reported damage to sperm from paternal alcohol use (Cicero, 1994). Other research by Little and Sing (1986) and Dobkin et al. (1994) suggests that human infants whose fathers were regular drinkers weighed less than infants whose fathers were non-drinkers. Abel (1994) and Tarter (1992) both observe that women who drink heavily or use drugs tend to consort with men who also use these substances. It is reported that “75 percent of children with fetal alcohol syndrome have fathers who are alcoholics” (Abel, 1994).

Bracken et al. (1990) report on the abnormalities caused in human sperm by males’ cocaine use, specifically low sperm count, low motility, and malformations. They recommend that history of male cocaine use should be taken as part of fertility assessments. Other researchers note that “cocaine binds with high affinity to human spermatozoa … [thus] sperm may act as a vector to transport cocaine into an ovum” (Cone et. al., 1996). They further warn that this could lead to abnormal development in the embryo.

A study by Ji et al. (1997) found that the more a man smokes prior to his child’s conception, the greater risk that child has for developing cancer by age five. Data from the Birth Research Unit shows that “paternal smoking is associated with a significantly detrimental effect on prematurity and birth weight, and with an increase in the need for post natal medical aid” (Birth Research Letter, 1997). Research by Wilson et al. (1998) shows that a certain cardiac birth defect is attributable to paternal use of marijuana.

Resistance to research
Thacker (2004) writes of “cultural resistance” to the idea of sperm producing birth defects, even on the scientific level. He reports a case of a solidly researched paper on sperm’s contribution to birth defects that was well reviewed, but rejected for publication by two medical journals. In 1989, Koren et al. reported that research that shows no connection between maternal cocaine use and damage in pregnancy is censored. This held true even controlling for those studies with poor research design. These unfortunate biases, even in what is supposed to be an arena of objective exploration, explain why science has joined the public in focusing more on the mother as responsible for birth defects, thus devoting less research to paternal involvement.

The cost of blame
There are some very real consequences to singling out the mother to blame. The current policy seems to equate the war on drugs with the war on women. Pregnant drug users are being singled out for criminal liability. Men are not arrested for child abuse after having used morphine, methadone or cocaine (Lieb and Sterk-Elifson, 1995).

Other research with pregnant crack users indicates that the stigmatization of these women leads to their reluctance to obtain crucial prenatal care. Although the subjects knew prenatal care was important, they feared “discovering drug-related fetal damage, being identified as a drug user and evaluated by custody authorities, and being stigmatized as a crack user” (Kearney, 1995).

Advocacy
We need to confront the negative counter-transference created by our ignorance and dislike of these women (Colten, 1982). Other researchers indicate the need to tread carefully around the low self-regard that these mothers may have about their parenting:

Because they tend to feel inadequate as parents, they often shy away from critical feedback and practical help ... Parents’ responsiveness may be somewhat greater if issues around child-rearing were discussed within the context of supportive psychotherapeutic experiences for the mothers (Luthar and Walsh, 1995).

Women should be given complete and accurate information about the risks of birth defects from either parent’s use of drugs and alcohol. It is inaccurate and unjust to expect the woman to bear the full burden of responsibility. This author is not arguing that maternal drug/alcohol use is harmless during pregnancy. However, instead of blaming one parent, the focus should instead be on reaching both parents to educate them about the effects of their behaviors on reproduction.

The “education of men [is] integral to the problem of drug addiction and pregnancy” (Harrison, 1991). The Greater New York March of Dimes began a campaign in the early 1990s to educate men about the consequences of their health habits on their developing children (March of Dimes, 1993). Unless both parents are informed about the dangers of substance use, the toll of children with drug/alcohol related birth defects will continue. Educating only the mother is dangerously inadequate.

Try it
Explain to the addicted mothers you are counseling the fact that fathers, as well as mothers, can contribute to drug/alcohol-related birth defects. See how they react.

Research you can do
Take a count of how many women are unaware that the father could cause birth defects. Of those who did know, find out where they obtained the information.

References
Abel, E.L. (1994). Effects of physostigmine on male offspring sired by alcohol-treated fathers. Alcoholism: Clinical and Experimental Research 18(3), 648-52.
Beckett, K. (1995). Fetal rights and “crack moms”: Pregnant women in the war on drugs. Contemporary Drug Problems 22(4): 587-612.
Birth Research News Letter. (1998). Preconception counseling. National Science Foundation, Sri Lanka, at http://www.naresa.ac.lk/other/birth/b111998.htm.
Birth Research News Letter. (1997). Birth defects Research Unit. National Science Foundation, Sri Lanka, at http://www.naresa.ac.lk/other/birth/brn1197.htm.
Bracken, M.B., Eskenazi, B., Sachse, K., McSharry, J.E., Hellenbrand, K. & Leo-Summers, L. (1990). Association of cocaine use with sperm concentration, motility, and morphology. Fertility and Sterility, 53 (2), 315-22.
Cicero, T.J. (1994). Effects of paternal exposure to alcohol on offspring development. Alcohol Health & Research World 8(1), 37-41.
Colten, M.E. (1982). Attitudes, experiences, and self-perceptions of heroin addicted mothers. The Journal of Social Issues 38(2), 77-92.
Cone, E.J., Kato, K. & Hillsgrove, M. (1996). Cocaine excretion in the semen of drug users. Journal of Analytical Toxicology, 20 (2), 139-140.
Dobkin, P.L., Tremblay, R.E., Desmarais-Gervais, L. & Depelteau, L. (1994). Is having an alcoholic father hazardous for children’s physical health? Addiction 89(12), 1619-28.
Harrison, M. (1991). Drug addiction in pregnancy: The interface of science, emotion, and social policy. Journal of Substance Abuse Treatment 8(4), 261-68.
Irwin, K. (1995). Ideology, pregnancy and drugs: differences between crack-cocaine, heroin and methamphetamine users. Contemporary Drug Problems 22(4), 613-38.
Ji, B-T., Shu, X-O., Linet, M.S., Zheng, W., Wacholder, S., Goa, Y-T., Ying, D-M. & Jin, F. (1997). Paternal cigarette smoking and the risk of childhood cancer among offspring of nonsmoking mothers. Journal of the National Cancer Institute 89(3), 238-243.
Jones. K.L., Smith, D.W., Ulleland, C.H.,& Streissguth, A.P. (1973). Pattern of malformation in offspring of chronic alcohol mothers. Lancet 1(1) 267-1271.
Kearney, M.H. (1995). Damned if you do, damned if you don’t: crack cocaine users and prenatal care. Contemporary Drug Problems 22(4), 639-62.
Koren, G., Graham, K., Shear, H. & Einarson, T. (1989). Bias against the null hypothesis: The reproductive hazards of cocaine. Lancet 2(8671), 1440-42.
Lieb, J.J. & Sterk-Elifson, C. (1995). Crack in the cradle: social policy and reproductive rights among crack-using females. Contemporary Drug Problems 22(4), 687-705.
Little, R.E. & Sing, C.F. (1986). Association of father’s drinking and infant’s birth weight. New England Journal of Medicine 314(23), 1640-45.
Luthar, S.S. & Walsh, K.G. (1995). Treatment needs of drug-addicted mothers: Integrating parenting psychotherapy interventions. Journal of Substance Abuse Treatment 12(5), 341-48.
March of Dimes (1993). Men have babies too: A guide for fathers-to-be (pamphlet). New York: Greater New York March of Dimes.
Tarter, R.E. (1992). Prevention of drug abuse: Theory and application. The American Journal on Addictions 1(1),
2-20.
Thacker, P.D. (2004, April 14). Biological clock ticks for men, too. Journal of the American Medical Association, 291 (14). 1683-84.
Wilson, P.D., Loffredo, C.A., Correi-Villasenor, A. & Ferencz, C. (1998). Attributable fraction for cardiac malformation. American Journal of Epidemiology 148(5),
414-423.

Michael Taleff, PhD, CSAS, MAC, is an instructor at the University of Hawai’i, West Oahu, and National University – Hawai’i Branch campuses. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Marguerite Babcock, MEd, LPC, MAC, has worked in the addiction treatment field for over 25 years, and has written and taught on issues of women and addictions.

This article is published in Counselor,The Magazine for Addiction Professionals, June 2006, v.7, n.3, pp.72-73.

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