Lived Experience of Mothers with Substance Use Disorder (from Pregnancy to Infancy): A Phenomenological Study in Social Work

IntroductionSubstance Use Disorder (SUD) among pregnant women and mothers of young children has emerged as a significant public health and social concern globally. Its importance stems not only from the health impacts on both mother and child, but also from its intergenerational effects. International studies indicate that women's experiences with SUD during pregnancy frequently co-occur with domestic violence, mental health issues, unstable housing, and fears of stigma and child removal. In Iran, although research on women's substance use is increasing, most studies have focused on general addiction experiences with limited attention given to pregnant women or mothers raising young children. There is a notable lack of understanding regarding mothers who manage pregnancy or infant care while coping with SUD, particularly within the complex urban environment of Tehran. From a social work perspective, theoretical frameworks—including Bronfenbrenner's ecological model, the Person-In-Environment (PIE) perspective, the biopsychosocial model, and the strengths-based approach—underscore that SUD in these mothers cannot be fully understood without considering micro-systems (family), mezzo-systems (health services), and macro-systems (custody laws and structural inequalities). Furthermore, Iran's legal system, particularly Article 1173 of the Civil Code—which considers parental addiction as grounds for removing child custody—may intensify fears of seeking treatment. This study aimed to explore the lived experiences of pregnant women or mothers of infants and toddlers who were dealing with SUD. Materials & MethodsThis research employed a qualitative method grounded in descriptive phenomenology, drawing on Husserl's philosophy. Data analysis was conducted using Colaizzi's 7-step approach, emphasizing the concept of the lifeworld and the principle of epoché (bracketing). Participants included pregnant women or mothers of infants and toddlers with SUD residing in Tehran during 2020–2021. A targeted snowball sampling strategy was used, resulting in a sample of 25 participants. Inclusion criteria were: providing informed consent, possessing the cognitive capacity to articulate personal experiences, receiving a DSM-5 diagnosis of SUD, and being either pregnant or having a child under two years of age. Initial participants were identified through social workers at organizations assisting women with SUD, including the MehrAfarín Center and the National Addiction Line. Data collection continued until theoretical saturation, which was reached at the 23rd interview; two additional interviews were subsequently conducted for validation. Data were gathered through in-depth semi-structured interviews, each lasting an average of 90–120 minutes. Primary themes explored included the experience of motherhood in relation to SUD, self-care during pregnancy, support networks, factors contributing to substance use, and coping strategies. All interviews were audio-recorded with participants' consent, transcribed verbatim, and organized for analysis. Trustworthiness was established following Lincoln and Guba's criteria: credibility was ensured through 6 months of engagement, member checking, and external auditor review; transferability was achieved through thick description; dependability was maintained via thorough documentation; and confirmability was supported by researcher self-reflection. Ethical considerations included voluntary participation, confidentiality, trauma-informed interviewing, and referral to specialized services whenever crisis indicators emerged. Discussion of Results & ConclusionThe results were organized into 4 primary themes. First, participants exhibited a distinct socio-cultural profile characterized by a transition from traditional lifeways to urban marginalization. This shift led to social disconnection, fatalism as a mode of meaning-making, cultural resource deficits, emotional instability, and economic and social isolation. Second, substance use was embedded within intergenerational cycles accompanied by ongoing violence, significant sexual trauma, psychological distress resulting from accumulated trauma, and self-medication driven by restricted access to formal healthcare. Third, "substance use slums" emerged as alternative living environments, in which intra-group solidarity functioned as a form of contradictory social capital—simultaneously aiding survival while perpetuating substance use. Inequality in access to formal services highlighted a structural gap in the healthcare and social support systems. Fourth, complex layers of exclusion contributed to the breakdown of essential support systems, perpetuation of intergenerational violence, restricted reproductive decision-making, misconceptions about the effects of substance use on unborn children, and estrangement from children—signifying a loss of maternal identity. In addition, a phenomenon of "self-governed morality" emerged, in which individuals distanced themselves from societal norms even after having internalized them.Theoretical integration revealed that Goffman's stigma theory illuminates how the label of "substance-using mother" becomes internalized. The strengths-based perspective recognized resilience and group solidarity as capabilities that could be further enhanced. The PIE and ecological frameworks emphasized that mothers cannot be understood in isolation from violent micro-systems, marginalized mezzo-systems, and punitive macro-systems. Implications for social work included the development of harm-reduction services, design of multi-level ecological interventions, revision of custody policies (Article 1173), investment in sexual and reproductive health education in underserved communities, and strengthening of NGO-based, strengths-oriented services. Tensions, contradictions, and layered suffering characterized the experiences of mothers with SUD. These women should not be reduced to negative labels. They are individuals who, within unequal systems marked by ongoing violence and exclusion, struggle with scarce resources to survive and find meaning. A phenomenological approach, in dialogue with social work theories, is essential for uncovering the processes that perpetuate deprivation and creating more effective and equitable interventions that promote social justice while safeguarding the rights and well-being of both mothers and children. Limitations included difficulties in accessing resources due to stigma, scheduling changes, crowded interview locations, power dynamics, and findings confined to the social context of Tehran.