Not all mothers who struggle with drug addiction have difficulties parenting, but many of them do. Moreover, evidence-based parenting programs that have proven efficacious with other parent populations often fail with mothers who are fighting chronic substance addiction, perhaps because of the neurobiological changes in neural reward circuitry that they face. This article describes an intervention for mothers called Mothering From the Inside Out (MIO) that was designed to support the mother's capacity to manage emotional distress in the parenting role while recovering from addiction. In two randomized clinical trials, MIO has demonstrated efficacy for improving the mother's capacity for mentalizing (making sense of her own and her young child's affective experiences) in order to counteract the psychological deficits that are commonly associated with drug addiction.