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Herriott AL. "I just want the best for him." Pregnancy in the context of substance use disorders: Perspectives of postpartum women. Birth 2024; 51:81-88. [PMID: 37635414 DOI: 10.1111/birt.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/29/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND In the United States, the incidence of substance misuse among pregnant women has been steadily increasing. While pregnant women with substance use disorder (SUD) are in critical need of support during the prenatal period, they enter prenatal care stigmatized and facing the possibility of punitive responses. Little research has been done about how women with SUDs themselves experience pregnancy and the transition to motherhood. The aim of this study was to examine women's internal experiences of pregnancy in the context of SUD. METHODS Semi-structured interviews were conducted with n = 19 postpartum women with SUD. Data were analyzed using a semantic, thematic approach. RESULTS Participants expressed their thoughts and experiences about their pregnancies in four main themes: (1) fear of harming the baby; (2) fear about child welfare involvement; (3) guilt informed by recovery stage; and (4) mixed feelings about pregnancy amidst complicated circumstances. The women expressed fear about their children's well-being, coupled with motivation to protect their child and the need for clear medical information. Their expressions of guilt depended on the severity of their SUD and their stage in recovery during their pregnancy. Women entered prenatal care with mixed emotions about their pregnancy, such as guilt and excitement, in the midst of complicated life circumstances. CONCLUSIONS These findings suggest a complexity of internal experiences for pregnant women with SUDs. Participants' feelings and experiences during pregnancy can inform practitioners' approaches to prenatal care in the context of SUDs.
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Affiliation(s)
- Anna L Herriott
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chapin Hall at the University of Chicago, University of Chicago, Chicago, Illinois, USA
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2
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May PA, Marais AS, Kalberg WO, de Vries MM, Buckley D, Hasken JM, Snell CL, Barnard Röhrs R, Hedrick DM, Bezuidenhout H, Anthonissen L, Bröcker E, Robinson LK, Manning MA, Hoyme HE, Seedat S, Parry CDH. Multifaceted case management during pregnancy is associated with better child outcomes and less fetal alcohol syndrome. Ann Med 2023; 55:926-945. [PMID: 36919586 PMCID: PMC10026770 DOI: 10.1080/07853890.2023.2185808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Pregnant women participated in multifaceted case management (MCM) to prevent Fetal Alcohol Spectrum Disorders (FASD). METHODS Women recruited from antenatal clinics for a longitudinal child development study were screened for alcohol use. Forty-four pregnant women were defined as high-risk drinkers on the Alcohol Use Disorder Identification Test (AUDIT) by an AUDIT score ≥8 and participated in 18 months of MCM to facilitate reduction or cessation of alcohol consumption. Forty-one women completed MCM. Fifty-five equally high-risk women who received standard antenatal care comprised the comparison/control group. Development in offspring was evaluated by a blinded interdisciplinary team of examiners through 5 years of age. RESULTS At five years of age, more children (34%) of MCM participating women did not meet the criteria for FASD vs. non-MCM offspring (22%). Furthermore, a statistically significant (p = .01) lower proportion of MCM offspring (24%) was diagnosed with fetal alcohol syndrome (FAS) compared to controls (49%). Children of MCM participants had significantly (p < .05) better physical outcomes: lower total dysmorphology scores, larger head circumferences, longer palpebral fissures, and higher midfacial measurements. Neurodevelopment results showed mixed outcomes. While Bayley developmental scores indicated that MCM offspring were performing significantly worse on most domains through 18 months, group scores equalized and were not significantly different on Kaufman Assessment Battery neurobehavioral measures by five years. Regression analyses indicated that offspring of women who received standard antenatal care were associated with significantly more negative outcomes than MCM offspring: a diagnosis of FAS (OR = 3.2; 95% CI: 1.093-9.081), microcephaly (OR = 5.3; 95% CI: 2.1-13.5), head circumference ≤10th centile (OR = 4.3; 95%CI: 1.8-10.4), and short palpebral fissures (OR = 2.5; 95% CI: 1.0-5.8). CONCLUSION At age five, proportionally fewer children of MCM participants qualified for a diagnosis of FAS, and proportionally more had physical outcomes indicating better prenatal brain development. Neurobehavioral indicators were not significantly different from controls by age five.KEY MESSAGESMultifaceted Case Management (MCM) was designed and employed for 18 months during the prenatal and immediate postpartum period to successfully meet multiple needs of women who had proven to be very high risk for birthing children with fetal alcohol spectrum disorders (FASD).Offspring of the women who participated in MCM were followed up through age five years and were found to have significantly better physical outcomes on multiple variables associated with fetal alcohol syndrome (FAS) and FASD, such as larger head circumferences and fewer minor anomalies, than those children born to equally at-risk women not receiving MCM.Fewer children of women receiving MCM were diagnosed with FASD than the offspring of equally-at-risk controls, and significantly (p = .01) fewer MCM offspring had FAS, the most severe FASD diagnosis.
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Affiliation(s)
- Philip A May
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Anna-Susan Marais
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Wendy O Kalberg
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Marlene M de Vries
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Buckley
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, NM, USA
| | - Julie M Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Cudore L Snell
- School of Social Work, Howard University, Washington, DC, USA
| | - Ronel Barnard Röhrs
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dixie M Hedrick
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Heidre Bezuidenhout
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lise Anthonissen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Erine Bröcker
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luther K Robinson
- Department of Pediatrics, State University of New York, Buffalo, NY, USA
| | - Melanie A Manning
- Department of Pathology and Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, Sioux Falls, SD, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Charles D H Parry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
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Falker CG, Stefanovics EA, Rhee TG, Rosenheck RA. Women's Use of Substance Use Disorder Treatment Services: Rates, Correlates, and Comparisons to Men. Psychiatr Q 2022; 93:737-752. [PMID: 35661318 DOI: 10.1007/s11126-022-09989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
In spite of evidence of increasing prevalence of substance use disorders (SUDs) among women, there is little information on gender differences in SUD treatment use. Nationally representative survey data were used to compare specialized SUD treatment among women and men with past-year DSM-5 SUD diagnoses (N = 5,789, 42.8% women). An estimated 10.7% of women and 9.9% of men (p = 0.45) received SUD treatment. Those who received treatment among both men and women had more problems than others. Five variables were independently associated with receipt of past-year treatment in both women and men and while five others were independently associated with receipt of treatment for only one gender. Interaction analysis, however, revealed no statistically significant gender differences in any correlate of treatment receipt. Although men were more likely to have SUDs than women, there were no significant differences by gender in rates or correlates of service use.
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Affiliation(s)
- Caroline G Falker
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Elina A Stefanovics
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA.,Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA.,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Taeho Greg Rhee
- Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA.,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Robert A Rosenheck
- U.S. Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA. .,Mental Illness Research, Education and Clinical Center, 950 Campbell Avenue, CT, West Haven, USA. .,Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA. .,Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.
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Johnson E, Fellowes R, Cant K, Hunt S. Self-Assured and Sober: The Relationship Between Maternal Parenting Sense of Competence, Stress, and Alcohol Use. Front Glob Womens Health 2022; 2:778183. [PMID: 35174356 PMCID: PMC8841786 DOI: 10.3389/fgwh.2021.778183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022] Open
Abstract
Alcohol misuse is widespread, creating serious health and parenting harms. It is important to explore the motivations behind why people drink and the modifiable factors determining severity of the behavior. While alcohol-related research has historically focused on men, the closing gender gap in alcohol consumption highlights a need for targeted research on women. Parenting stress is a commonly reported motivation for maternal drinking. Likewise, parenting stress is associated with parenting sense of competence. However, there is no research connecting parenting sense of competence with alcohol use directly, nor indirectly via moderation of the alcohol and parenting stress relationship. The current study explored these associations and investigated the potential moderation through a questionnaire completed by a sample of 406 mothers. There were significant correlations between all factors, however, parenting sense of competence was not a significant moderator of the parenting stress and alcohol use relationship. Specifically, as a mother's parenting stress increases, her confidence in the parenting role tends to decline and she is more likely to misuse alcohol. Despite this, variation in parenting sense of competence among women was not significantly correlated with one's likelihood to drink when coping with stress. Further exploration of these relationships is required, with replication of the current study following the COVID-19 pandemic.
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BA D, BA S, MD M. What the World Needs Now: Lifestyle Medicine for All Women. Am J Lifestyle Med 2021; 17:97-107. [PMID: 36636386 PMCID: PMC9830235 DOI: 10.1177/15598276211028101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Over the last several centuries, economic progress has allowed millions of women to move from rural subsistence agriculture to urban, more economically prosperous lifestyles. This trend is set to continue, even accelerate in the next century. Due to changes in diet, activity, and lifestyle, non-communicable diseases, such as cancer and heart disease, will continue to rise for women globally. At this time, we are uniquely positioned to anticipate this impact and empower women in both the developed and the developing world to learn from what has worked. Choosing the best approaches to nutrition, exercise, sleep, connectedness, substances, and stress can optimize women's health span across the globe.
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Affiliation(s)
| | | | - McHugh MD
- John McHugh, The Keck School of Medicine,
University of Southern California, 3334 E. Coast Highway #708 Corona del Mar, CA
92625, USA; e-mail:
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McCutcheon VV, Bucholz KK, Houston-Ludlam AN, Waldron M, Heath AC. Timing of mortality in mothers with recurrent convictions for driving under the influence of alcohol and their children, from childbirth to child age 17. Drug Alcohol Depend 2021; 221:108620. [PMID: 33639571 PMCID: PMC8772583 DOI: 10.1016/j.drugalcdep.2021.108620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We tested variation in the timing of child and maternal mortality associated with severe maternal AUD, as represented by recurrent arrests for driving under the influence of alcohol (rDUI). METHODS rDUI mothers (N = 1614) and Controls with no alcohol-related driving offenses (N = 109,928) who gave birth in Missouri from 2000 to 2004 were identified using vital records. Propensity score matching adjusted for birth record measures including delayed prenatal care, smoking during pregnancy, relationship with reproductive partner [married/unmarried, paternity acknowledged/unacknowledged], partner DUI status from driving records, and for socioeconomic characteristics of maternal residential census tract at birth derived from census data. Survival analysis was used to test months from childbirth to child or maternal death as a function of lifetime rDUI status. RESULTS Maternal rDUIs were associated with a consistently elevated probability of child mortality from birth through child age 17 after propensity score-adjustment (Hazard Ratio [HR] = 1.70, 95 % CI = 1.17-2.47). Maternal mortality was not elevated, relative to Controls, until child age 6-11 (HR = 1.58, 95 % CI = 1.05-2.35) and increased again from child age 12-17 (HR = 4.12, 95 % CI = 3.04-5.86). CONCLUSIONS Severe maternal AUD, as characterized by rDUI, increases the risk for child mortality over that of Controls through age 17. Delays in rDUI maternal mortality until child age 6 may indicate a period when maternal referral for intervention to reduce harm to child and mother is likely to be especially effective.
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Affiliation(s)
- Vivia V. McCutcheon
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Kathleen K. Bucholz
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Alexandra N. Houston-Ludlam
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110,Medical Scientist Training Program, Washington University School of Medicine in St. Louis, Missouri,Human and Statistical Genetics, Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, Missouri
| | - Mary Waldron
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110,Department of Counseling and Educational Psychology, School of Education, Bloomington, Indiana University, Indiana
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8134, St. Louis, MO 63110
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Reese SE, Riquino MR, Molloy J, Nguyen V, Smid MC, Tenort B, Gezinski LB. Experiences of Nursing Professionals Working With Women Diagnosed With Opioid Use Disorder and Their Newborns: Burnout and the Need for Support. Adv Neonatal Care 2021; 21:32-40. [PMID: 33055519 DOI: 10.1097/anc.0000000000000816] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the rate of opioid use in pregnancy escalates, there are a growing number of women diagnosed with opioid use disorder (OUD) and their newborns being cared for in inpatient settings. PURPOSE In this study, we sought to better understand the experiences of nurses and nursing assistants working with women diagnosed with OUD and their newborns. By identifying the needs of nurses and nursing assistants, the findings from this study may contribute to reductions in stigma and improved patient care. METHODS Nurses and nursing assistants were recruited from a postpartum unit at a large urban hospital in Utah. Participants (n = 30) attended up to 4 semistructured focus groups. We utilized Braun and Clarke's 6-phase approach to thematic analysis to analyze transcribed interviews. FINDINGS/RESULTS Themes identified during the data analysis process included negative feelings and reactions toward patients; preferential concern for the newborn over maternal well-being; and identification of organizational and training needs to overcome these challenges. IMPLICATIONS FOR PRACTICE These findings identify strategies for addressing challenges faced by nurses and nursing assistants in caring for women diagnosed with OUD and their newborns. IMPLICATIONS FOR RESEARCH Future research should examine the effectiveness of approaches to reduce behaviors influenced by stigma among nurses and nursing assistants working with women diagnosed with OUD and their newborns, as well as employee and patient satisfaction, and long-term health outcomes.
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Affiliation(s)
- Sarah E Reese
- School of Social Work, University of Montana, Missoula (Dr. Reese); School of Social Welfare, University of Kansas, Lawrence (Dr Riquino); School of Social Work, University of Montana, Missoula (Dr Molloy); independent researcher, Salt Lake City, UT (Dr. Nguyen); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City (Dr Smid); and Labor & Delivery and Obstetrical Emergency Services, University of Utah Hospital, Salt Lake City (Ms Tenort). Dr Gezinski is an independent researcher, Amsterdam, the Netherlands
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Abstract
Background: Little research has examined the needs of parents with opioid use disorder (OUD) who are receiving medications for OUD (MOUDs), which is striking given growing rates of OUD among parents. Objective: The current study expands the literature by examining psychiatric, psychosocial, and parenting-related functioning, as well as 12-month MOUD treatment retention among parents versus non-parents participating in a buprenorphine program at an academic family medicine residency clinic. Methods: Patients (N = 144; 61 parents) completed measures of psychiatric and psychosocial functioning at the first MOUD visit; parents also completed measures of parental functioning. Results: Parents endorsed less anxiety and loneliness, as well as greater social connection, life satisfaction, and life meaning. Parents were also older, more likely to be female, of a race other than white, married, employed, and had higher incomes. Although parents endorsed high levels of parental self-agency and strong bonds with children, many also reported elevated parental shame. Among parents, higher levels of shame were also associated with higher depression, anxiety, anger, stress, and loneliness. Over 25% of parents reported that a child lived with friends/relatives over 3 months, and 11% noted a child having been removed from the home by child protective services. Finally, parents were more likely to be retained in treatment at 12 months, although this finding was non-significant after controlling for covariates. Conclusions/Importance: These findings illustrate the needs experienced by parents engaged in MOUD treatment, which may prove valuable in informing policy, program development, and treatment approaches for parents with OUD.
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Affiliation(s)
- Adam F Sattler
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
| | - Stephanie A Hooker
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA.,HealthPartners Institute, Bloomington, Minnesota, USA
| | - Robert Levy
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
| | - Michelle D Sherman
- Broadway Family Medicine, University of Minnesota North Memorial Residency Program, Minneapolis, Minnesota, USA
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9
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Hildebrandt UC, Graham JC, Grant TM. Predictors and moderators of improved social-emotional functioning in mothers with substance use disorders and their young children enrolled in a relationship-based case management program. Infant Ment Health J 2020; 41:677-696. [PMID: 32578238 DOI: 10.1002/imhj.21872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mothers with substance use disorders (SUDs) typically have trauma histories and psychosocial difficulties that lead to poor social-emotional functioning and disrupted mother-child relationships. This 12-month study explored associations of family adverse circumstances and services (case management, therapeutic, and community-based) received by 57-mothers with SUDs and their infants (less than 24-months-old) with changes in social-emotional functioning. All mothers were enrolled in a relationship-based case management program (Parent-Child Assistance Program [PCAP]) that emphasized connecting mothers to appropriate community services. A subset of mothers was additionally provided a trauma-focused psychotherapeutic intervention (infant-parent psychotherapy [IPP]). Dyads in both treatment groups improved in overall social-emotional functioning as assessed by the Functional Emotional Assessment Scale (FEAS). A combined-sample regression analysis revealed that improved FEAS scores were significantly predicted by the number of community services received but not by PCAP case management hours (IPP was not included in this analysis). More adverse circumstances were associated with less improvement in social-emotional functioning in the children; but among the mothers trauma level did not predict FEAS scores. We also found a moderating effect of trauma: Dyads with relatively more adversity showed a significantly greater association of community services received with improvement in FEAS scores than did those with relatively less adversity.
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Affiliation(s)
| | - J Christopher Graham
- Alcohol and Drug Abuse Institute, University of Washington Health Sciences Administration, Seattle, Washington
| | - Therese M Grant
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Le TL, Kenaszchuk C, Milligan K, Urbanoski K. Levels and predictors of participation in integrated treatment programs for pregnant and parenting women with problematic substance use. BMC Public Health 2019; 19:154. [PMID: 30727978 PMCID: PMC6364426 DOI: 10.1186/s12889-019-6455-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 01/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background Women who are seeking services for problematic substance use are often also balancing responsibilities of motherhood. Integrated treatment programs were developed to address the diverse needs of women, by offering a holistic and comprehensive mix of services that are trauma- and violence-informed, and focus on maternal and child health promotion and the development of healthy relationships. Methods Using system-level administrative data from a suite of outpatient integrated programs in Ontario, Canada, we described the clients and rates and predictors of treatment participation over a 7-year period (2008–2014; N = 5162). Results All participants were either pregnant or parenting children under 6 years old at admission to treatment. Retention (length of time between the first and last visit) averaged 124.9 days (SD = 185.6), with episodes consisting of 14.6 visits (SD = 28.6). The vast majority of women attended more than one visit (87.2%), typically returning within 2 weeks (mean 12.3 days, SD = 11.1). In addition to being pregnant or new mothers experiencing problematic substance use, most were unemployed, on social assistance, and single. Conclusions Programs appeared to be able to successfully engage most women in treatment once they accessed the programs. Although rates of treatment participation did vary across subgroups defined by sociodemographic and admission characteristics, effect sizes tended to be small on average, providing little evidence in general of sociodemographic inequities in participation. Further work is needed to study the influence of program-level factors on participation, and how these link to maternal and child outcomes.
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Affiliation(s)
- Thao Lan Le
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Chris Kenaszchuk
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Karen Milligan
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Karen Urbanoski
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.,Canadian Institute for Substance Use Research, Public Health and Social Policy, University of Victoria, 2300 McKenzie Avenue, Victoria, BC, V8W 2Y2, Canada
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Latuskie KA, Andrews NC, Motz M, Leibson T, Austin Z, Ito S, Pepler DJ. Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study. Women Birth 2019; 32:e57-64. [DOI: 10.1016/j.wombi.2018.04.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/20/2018] [Accepted: 04/02/2018] [Indexed: 01/09/2023]
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Mellentin AI, Ellermann AE, Nielsen B, Mejldal A, Möller S, Nielsen AS. The prognosis of out-patient alcohol treatment among parents with childcare responsibility. BJPsych Open 2018; 4:471-477. [PMID: 30450227 PMCID: PMC6235993 DOI: 10.1192/bjo.2018.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite expansive knowledge on the detrimental effects of growing up with parents with alcohol use disorders (AUDs), little is known about the prognosis of alcohol treatment among parents with childcare responsibility. AIMS This observational cohort study aimed to examine the prognosis of patients with and without childcare responsibility, in a conventional out-patient alcohol treatment clinic. METHOD A consecutive AUD sample (N = 2201), based on ICD-10 Diagnostic Criteria for Research, was assessed with the European Addiction Severity Index during the clinical routine, at treatment entry and conclusion. Data on addiction severity, treatment course and drinking outcomes were derived, and adjusted odds ratios (AORs) were calculated with logistic-regression models. Drinking outcomes were compared in an intention-to-treat analysis, including all patients in a logistic regression with inverse probability weighting. RESULTS Patients with childcare responsibility (aged <18 years) had a less severe addiction profile and lower drop-out rate compared with patients without children or with children living out-of-home. They were also more likely to improve on all drinking-related outcomes, including abstinence (AOR 2.68, 95% CI 1.82-3.95), number of drinking days (AOR 2.45, 95% CI 1.50-4.03) and excessive drinking days (AOR 4.66, 95% CI 2.36-9.17); and those with children living out-of-home had better outcomes on abstinence (AOR 1.59, 95% CI 1.08-2.34) than patients without children. CONCLUSIONS Childcare responsibility among out-patients was associated with better treatment course and outcomes than those without or not living with their children. This knowledge can help guide clinical practice, effectuate interventions and inform social authorities.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark and Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark and Clinical Psychologist, Psychiatric Hospital, Odense University Hospital, Denmark
| | | | - Bent Nielsen
- Professor, Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark and Psychiatrist, Psychiatric Hospital, Odense University Hospital, Denmark
| | - Anna Mejldal
- Statistician, Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Sören Möller
- Statistician, Professor, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Anette Søgaard Nielsen
- Associate Professor, Research Director, Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Denmark
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Andrews NCZ, Motz M, Pepler DJ, Jeong JJ, Khoury J. Engaging mothers with substance use issues and their children in early intervention: Understanding use of service and outcomes. Child Abuse Negl 2018; 83:10-20. [PMID: 29958135 DOI: 10.1016/j.chiabu.2018.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/20/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
Mothers who use substances need integrated, multi-sectoral intervention services to support substance use discontinuation. We explored mothers' service use at Breaking the Cycle, an early intervention and prevention program for pregnant and parenting women and their young children in Toronto, Canada. We conducted retrospective analyses of families' service records and client charts (N = 160). Aims were to 1) describe women's use of service, 2) examine how early engagement of pregnant women related to postnatal service use, and 3) examine the circumstances in which women ended their service relationship with Breaking the Cycle. Specifically, we examined circumstances at service ending relating to women's service goals; custody status with children; and global substance-use, parent-child relationship, and child development outcomes. We found that these vulnerable women were actively engaged in many services and for a long duration, early engagement was associated with greater service use, and greater service use was associated with more positive circumstances upon ending service. Results provide support for a relational approach to service that promotes not only the relationship between mother and child, and mother and service provider, but also highlights relationships among staff, between staff and management, and between community partners as integral to effective service delivery. Integrating positive relationships at all levels is critical to support vulnerable families with complex needs.
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Affiliation(s)
- Naomi C Z Andrews
- Mothercraft, Early Intervention Department, 860 Richmond Street West, Toronto, Ontario, M6J 1C9, Canada; York University, Department of Psychology, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Mary Motz
- Mothercraft, Early Intervention Department, 860 Richmond Street West, Toronto, Ontario, M6J 1C9, Canada
| | - Debra J Pepler
- York University, Department of Psychology, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Jessica J Jeong
- York University, Department of Psychology, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Jennifer Khoury
- Ryerson University, Department of Psychology, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
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Dworkin ER, Zambrano-Vazquez L, Cunningham SR, Pittenger SL, Schumacher JA, Stasiewicz PR, Coffey SF. Treating PTSD in Pregnant and Postpartum Rural Women with Substance Use Disorders. ACTA ACUST UNITED AC 2017; 41:136-151. [PMID: 28983389 DOI: 10.1037/rmh0000057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The co-occurrence of posttraumatic stress disorder and substance use disorder (PTSD-SUD) can pose significant problems for rural pregnant and postpartum women (PPW) and the well-being of their children. Although effective treatments exist, PPW experience limitations in their ability to access and engage in treatment that may be compounded by various aspects of rural settings, so providers must be attentive to these barriers in order to address this pressing public health need. In addition, as part of increasing rural access to care, it is important to consider the costs and benefits to PPW of selecting exposure-based techniques (e.g., prolonged exposure) to disseminate. The current article discusses the treatment of PTSD-SUD in rural PPW in the context of the authors' experiences providing an exposure-based cognitive behavioral treatment for PTSD in this population. Barriers to treatment access and engagement are discussed and recommendations are provided.
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Affiliation(s)
- Emily R Dworkin
- University of Mississippi Medical Center, Jackson MS.,G.V. (Sonny) Montgomery Veteran Affairs Medical Center, Jackson MS
| | - Laura Zambrano-Vazquez
- University of Mississippi Medical Center, Jackson MS.,G.V. (Sonny) Montgomery Veteran Affairs Medical Center, Jackson MS
| | - Sarah R Cunningham
- University of Mississippi Medical Center, Jackson MS.,G.V. (Sonny) Montgomery Veteran Affairs Medical Center, Jackson MS
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Bohrman C, Tennille J, Levin K, Rodgers M, Rhodes K. Being Superwoman: Low income mothers surviving problem drinking and intimate partner violence. J Fam Violence 2017; 32:699-709. [PMID: 29200612 PMCID: PMC5708557 DOI: 10.1007/s10896-017-9932-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
| | | | | | | | - Karin Rhodes
- Office of Population Health Management, Hofstra Northwell Medical School
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Prevatt BS, Desmarais SL, Janssen PA. Lifetime substance use as a predictor of postpartum mental health. Arch Womens Ment Health 2017; 20:189-199. [PMID: 27915390 DOI: 10.1007/s00737-016-0694-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/22/2016] [Indexed: 01/26/2023]
Abstract
Postpartum mood disorders (PPMD) affect approximately 10-20% of women and have adverse consequences for both mom and baby. Lifetime substance use has received limited attention in relation to PPMD. The present study examined associations of lifetime alcohol and drug use with postpartum mental health problems. Women (n = 100) within approximately 3 months postpartum (M = 2.01, SD = 1.32) participated in semi-structured interviews querying lifetime substance use, mental health history, and postpartum symptoms of anxiety, stress, posttraumatic stress disorder (PTSD), depression, and obsessive compulsive disorder. The study was conducted in an urban Canadian city from 2009 to 2010. Analyses revealed that lifetime substance use increased the variability explained in postpartum PTSD (p = .011), above and beyond sociodemographic characteristics and mental health history. The same trend, though not significant, was observed for stress (p = .059) and anxiety (p = .070). Lifetime drug use, specifically, was associated with postpartum stress (p = .021) and anxiety (p = .041), whereas lifetime alcohol use was not (ps ≥ .128). Findings suggest that lifetime drug use is associated with PPMD. Future research should examine whether screening for lifetime drug use during antenatal and postpartum care improves identification of women experiencing PPMD.
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Affiliation(s)
- Betty-Shannon Prevatt
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC, 27695-7650, USA.
| | - Sarah L Desmarais
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC, 27695-7650, USA
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, Rm 103, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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17
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Abstract
Little is known about barriers to engaging and retaining African-American women in drug treatment. This descriptive study addressed three questions regarding barriers to substance abuse treatment for African-American women: What barriers made it difficult for women to participate in treatment? Did identified barriers differ by program modality? To what degree were barriers related to treatment retention? Findings revealed that barriers considered to be internal in nature, i.e., “drug severity,” “did not feel like going,” and “felt I could manage on my own,” were most frequently reported. Only a few program-related barriers were found to be related to length of time in treatment and both internal and programmatic barriers had an effect on treatment completion. Implications for policy decisions, future research, and clinical competence in addressing barriers to treatment for African-American women are discussed.
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Abstract
This study examined substance abuse treatment providers' perceptions of the gender-specific service needs of women in treatment as well as the obstacles that impede the delivery of services to meet those needs. Surveys were administered to more than 100 staff members of five treatment agencies that were participating in the Chicago Practice Improvement Collaborative. These surveys were followed up with focus group discussions. Most participants reported that their treatment agencies delivered gender-specific services but also described the numerous barriers to addressing women's specific needs, such as limited resources and the psychosocial challenges experienced by women in treatment (e.g., depression, child care, and family responsibilities). We discuss these findings in light of previous studies, the strengths and limitations of our research design, and the value of collaborations between researchers and practitioners.
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Abstract
BACKGROUND Few studies focus on gender differences among patients who utilize detoxification services; even fewer focus on detoxification for Alaska Native people. This analysis focused on gender differences at admission among a sample of Alaska Native patients seeking alcohol withdrawal treatment. METHODS The sample included 383 adult Alaska Native patients admitted to an inpatient alcohol detoxification unit during 2006 and 2007. Logistic regression was used to estimate unadjusted and adjusted associations with gender. RESULTS Women were 88% more likely to have stable housing than men (odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.15, 3.05, P = .01). Women were 87% less likely to be seasonal workers (OR = 0.13, 95% CI = 0.03, 0.48, P = .003) and 50% less likely than men to be seeking employment (OR = 0.50, 95% CI = 0.29, 0.84, P = .01) at admission. Women had more than 5 times the odds of having children in the home at admission (OR = 5.64, 95% CI = 3.03, 10.56, P < .001) and almost 3 times the odds of experiencing physical abuse than men (OR = 2.96, 95% CI = 1.31, 6.66, P = .01). Additionally, women were 50% less likely to accept a referral to substance abuse treatment following detoxification (OR = 0.50, 95% CI = 0.30, 0.83, P = .01). CONCLUSIONS The study found significant differences based upon gender. For instance, women are in need of services that accommodate women with children and services that address histories of physical abuse. Conversely, men are in need of housing and employment opportunities. Post detoxification follow-up, case management, and transition to care should include gender as a factor in treatment planning.
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Affiliation(s)
- Ursula Running Bear
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Janette Beals
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Douglas K. Novins
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Abstract
The prevalence of prescription opioid abuse has increased nationally in the last decade with increased incidence rates reported among pregnant women. This was a qualitative study designed to understand the role of pregnant women with an opioid use disorder participating in medical decision making regarding their prenatal care while addressing their addiction. Group interviews were conducted with postpartum women who self-identified as opioid dependent during their pregnancy, and the data were analyzed using Interpretative Phenomenological Analysis. Social workers in the health care setting are an integral part of the interdisciplinary team in caring for pregnant and postpartum opioid-dependent women. Social workers are ideal in creating stigma reduction strategies, peer and professional supports, and comprehensive coordinated care. A social justice-based practice may be a framework to utilize when caring for this unique population.
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Affiliation(s)
- Heather Howard
- a Department of Social Work , Wheelock College , Boston , Massachusetts , USA
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21
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Slaunwhite AK. The Role of Gender and Income in Predicting Barriers to Mental Health Care in Canada. Community Ment Health J 2015; 51:621-7. [PMID: 25563485 DOI: 10.1007/s10597-014-9814-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/08/2014] [Indexed: 11/24/2022]
Abstract
There have been traditionally low rates of health care utilization by persons with mental health issues in developed countries such as Canada due to barriers that discourage health care service use such as waitlists, long distances to health services, and stigma that can be associated with seeking help for mental health issues. This project examined barriers to mental health care using data from the Canadian Community Health Survey (N = 4,134) to understand gender and income-related disparities in access to mental health care services. Data were modeled using logistic regression to determine whether gender and household income predicted experiencing barriers to care. There were significant variations in the barriers to care reported by gender and income. Both men and women from low-income (<$29,999) households were significantly more likely to report all types of barriers to care. Men were much more likely to report 'acceptability' barriers to care that related to their perceptions of mental health issues and usefulness of health care services, whereas women were much more likely to report availability or accessibility issues such as a lack of transportation or childcare. The findings of this study demonstrate that despite universal health insurance, there are significant inequities in access to mental health care for low-income Canadians and differences in the types of barriers to care experienced by gender.
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Affiliation(s)
- Amanda K Slaunwhite
- Centre for Addictions Research of British Columbia, Department of Geography, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada,
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Crawford-Williams F, Steen M, Esterman A, Fielder A, Mikocka-Walus A. "My midwife said that having a glass of red wine was actually better for the baby": a focus group study of women and their partner's knowledge and experiences relating to alcohol consumption in pregnancy. BMC Pregnancy Childbirth 2015; 15:79. [PMID: 25881173 PMCID: PMC4389416 DOI: 10.1186/s12884-015-0506-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/17/2015] [Indexed: 11/13/2022] Open
Abstract
Background While it is well established that alcohol can cross the placenta to the foetus and can affect an infant’s development, many women continue to drink during pregnancy. For this reason it is important to determine what information is being provided, what information may be missing, and the preferred sources of information on this issue. In order to improve prevention strategies, we sought to understand the knowledge and experiences of pregnant women and their partners regarding the effects of alcohol consumption during pregnancy. Methods The current study utilised a qualitative study design in order to gain insight into the views and experiences of pregnant women, newly delivered mothers and their partners. Focus groups examined the participant’s knowledge about the effects of alcohol consumption during pregnancy, the sources of information on this issue, and the psycho-social influences on their drinking behaviour. Five focus groups were conducted involving a total of 21 participants (17 female). A six-stage thematic analysis framework was used to analyse all focus group discussions in a systematic way. Results Seven major themes were identified from the focus group data: 1) knowledge of Foetal Alcohol Spectrum Disorders; 2) message content and sources; 3) healthcare system; 4) society and culture; 5) partner role; 6) evaluation of risk; and 7) motivation. The findings indicated that although the majority of participants knew not to drink alcohol in pregnancy they had limited information on the specific harmful effects. In addition, routine enquiry and the provision of information by health care professionals were seen as lacking. Conclusions The findings of this research provide important insights in to the relationship between pregnant women, their partners, and their healthcare providers. Several recommendations can be made on the basis of these findings. Firstly, public health messages and educational materials need to provide clear and consistent information about the effects of alcohol consumption on the developing baby. Additionally, more thorough and consistent routine enquiry for alcohol consumption in pregnant women needs to occur. Finally, it is important to ensure ongoing education for health professionals on the issue of alcohol consumption during pregnancy.
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Affiliation(s)
- Fiona Crawford-Williams
- School of Nursing and Midwifery, University of South Australia, City East Campus, Frome Road, Adelaide, Australia.
| | - Mary Steen
- School of Nursing and Midwifery, University of South Australia, City East Campus, Frome Road, Adelaide, Australia.
| | - Adrian Esterman
- School of Nursing and Midwifery, University of South Australia, City East Campus, Frome Road, Adelaide, Australia.
| | - Andrea Fielder
- School of Nursing and Midwifery, University of South Australia, City East Campus, Frome Road, Adelaide, Australia.
| | - Antonina Mikocka-Walus
- School of Nursing and Midwifery, University of South Australia, City East Campus, Frome Road, Adelaide, Australia. .,Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, UK.
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Brakenhoff B, Slesnick N. "The Whole Family Suffered, so the Whole Family Needs to Recover": Thematic Analysis of Substance-Abusing Mothers' Family Therapy Sessions. J Soc Serv Res 2015; 41:216-232. [PMID: 25729116 PMCID: PMC4341992 DOI: 10.1080/01488376.2014.980962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Substance abusing mothers and their children are more likely to experience a range of social, behavioral, and psychological difficulties. Despite the significant challenges faced by these families, little is known about their experiences in treatment. The current study analyzed 12 sessions of family therapy using thematic analysis to identify common themes that arose during substance abusing mothers and their children's discussion during family therapy. Mothers' ages ranged from 28 to 35 years and the children's ages ranged from 12 to 14 years. Four therapy sessions from three families were coded for a total of 12 therapy sessions. An ecological framework was used to classify themes, in which themes related to each level of the families' ecological systems were identified. Thematic analysis of the therapy sessions indicated that mothers and their children primarily discussed topics related to their relational and emotional needs. The findings indicated that substance use disordered mothers and their children have unique treatment needs that should be addressed when the mother seeks treatment. More research is needed to further clarify and confirm the observations in this study. In particular, future research should include a larger sample and quantitative methodology.
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Abstract
Background Substance use during pregnancy and motherhood is both a public health and criminal justice concern. Negative health consequences associated with substance use impact both the mother and the developing fetus, and there are ongoing attempts to criminalize substance use during pregnancy that put pregnant substance-using women at risk of detection, arrest, and punishment. This study explored the experiences of substance-using mothers as they navigated health and criminal justice consequences and accessed needed resources in the community. Methods In-depth life history interviews were conducted with 30 recently-pregnant women who had used alcohol or other drugs during their pregnancies. The three-part interview schedule included questions about past and current substance use, life history, and experiences with criminal justice authorities, child protective services, and health professionals. Results Women’s stories highlighted their strategies for managing their risk of detection by health or criminal justice authorities, including isolating themselves from others, skipping treatment appointments, or avoiding treatment altogether. Women described multiple barriers to treatment and healthcare, including a lack of suitable treatment options and difficulty finding and enrolling in treatment. Conclusion The findings suggest that policies that substance-using women find threatening discourage them from seeking comprehensive medical treatment during their pregnancies. The implications of the findings are discussed, particularly the need for further expansion of treatment programs and social services to meet the needs of substance-using women.
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Affiliation(s)
- Rebecca Stone
- School of Criminology and Justice Studies, University of Massachusetts Lowell, 113 Wilder St, Ste. 400 Lowell, MA, 01854 USA
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25
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Liebrenz M, Stohler R, Nordt C. Ethnic- and gender-specific differences in the prevalence of HIV among patients in opioid maintenance treatment-a case register analysis. Harm Reduct J 2014; 11:23. [PMID: 25130184 PMCID: PMC4178317 DOI: 10.1186/1477-7517-11-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We have sought to identify ethnic- and gender-specific differences in HIV prevalence among heroin users receiving opioid maintenance treatment in the canton of Zurich, Switzerland. METHODS We used a generalized linear model (GEE) to analyze data from the anonymized case register for all opioid maintenance treatments in the canton of Zurich. Patients who received either methadone or buprenorphine between 1991 and 2012 (n=11,422) were evaluated for gender (male vs. female), ethnic background (Swiss vs. non-Swiss), and lifetime method of drug use (ever injector vs. non-injector). We addressed missing data by multiple imputation. RESULTS The overall prevalence of HIV among patients declined substantially from 33.7% in 1991 to 10.6% in 2012 in the complete dataset. In the imputed datasets, the respective prevalence dropped from 32.8% in 1991 to 9.7% in 2012. Non-injectors had a four to five times lower risk ratio (RR) compared to the reference group, 'Swiss males who ever injected'. In addition, we found a significantly higher risk ratio of HIV prevalence among females who had ever injected; this was true both for the complete dataset and the imputed dataset (Swiss RR 1.18 CI 95% 1.04-1.34, non-Swiss RR 1.58 CI 95% 1.18-2.12). CONCLUSION In this population, gender, ethnic background, and lifetime method of drug use influenced the risk of being HIV positive. Different access to treatment and different characteristics of risk exposure among certain subgroups might explain these findings. In particular, the higher risk for women who inject drugs-especially for those with an immigrant background-warrants additional research. Further exploration should identify what factors deter women from using available HIV-prevention measures and whether and how these measures can be better adapted to high-risk groups.
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Affiliation(s)
- Michael Liebrenz
- Research Group on Substance Use Disorders, Psychiatric University Hospital, Selnaustrasse 9, 8001 Zurich, Switzerland.
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Rojmahamongkol P, Weitzman C, Senturias Y, Augustyn M. Attention deficit hyperactivity, fetal alcohol spectrum disorder, or something else: the broad differential of kindergarten suspension. J Dev Behav Pediatr 2014; 35:344-6. [PMID: 24906036 DOI: 10.1097/DBP.0000000000000066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thomas is a 5-year 6-month-old boy whose parents requested an urgent care appointment because he has recently been suspended from kindergarten stating "and his doctor must see him before he can come back." His suspension from kindergarten was due to kicking and biting his classmates, but he has also become increasingly aggressive at home. His teacher reported that he has always had a high activity level and difficulty shifting attention between tasks, as well as noncompliance with rules and directions. He is noted to have learning challenges and is showing difficulties in the concept of numbers and letter sounds. The practice has followed Thomas since his healthy birth. He has a history of delayed language development, and he received early intervention services from 2 years of age. He spoke his first word at 2 years 6 months. He started a half-day preschool program at 3 years of age. He had difficulty acclimating to preschool, interacting with peers, and was described as "hyperactive" by his teachers. His program was modified to decrease his time having to sit in a circle time, and he often required the support of the paraprofessional in the classroom. His parents have always described him as a "difficult child." He gets frustrated easily and can tantrum for up to 2 hours multiple times in a week when his immediate needs or requests are not met. He has difficulty falling asleep, has frequent night awakenings, and often has trouble getting back to sleep. His self-help skills are poor, and he has difficulty with activities such as brushing his teeth and dressing. His parents report that he does not seem to remember rules from day to day. He was evaluated at 5 years of age and diagnosed with Attention Deficit Hyperactivity Disorder, but his response to stimulants has been limited. Thomas is an only child. His parents are college educated and professionally employed. They deny drug use, domestic violence, and guns in the home. They reported that prior to the pregnancy, they enjoyed "partying" with friends on the weekends, but Thomas's mother reported that she stopped drinking as soon as she realized she was pregnant. All are wondering whether this child might have a fetal alcohol spectrum disorder, although he seems to have no clear facial dysmorphology. It is unsure what the next step might be and if there is value added in pursuing this diagnosis. What do you do next?
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Abstract
Research shows that co-occurring partner violence and substance abuse are problems for many women. However, less is known about women’s varied experiences with partner violence and substance abuse. This exploratory, qualitative study investigates these two issues among a sample of 15 women in substance abuse treatment who experienced partner violence. Overall, findings show participants’ experience of violence–substance connections varied in important ways; complicating factors exacerbate both problems; and domestic violence services and substance abuse treatments should account for these variations and complications. We discuss directions for providers, researchers, and policymakers concerned with partner violence or substance abuse.
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Affiliation(s)
| | - Connie Renz
- University of North Carolina at Chapel Hill, USA
| | - Emily Pelino
- KIPP Indianapolis College Preparatory School, IN, USA
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Khan SS, Secades-Villa R, Okuda M, Wang S, Pérez-Fuentes G, Kerridge BT, Blanco C. Gender differences in cannabis use disorders: results from the National Epidemiologic Survey of Alcohol and Related Conditions. Drug Alcohol Depend 2013; 130. [PMID: 23182839 PMCID: PMC3586748 DOI: 10.1016/j.drugalcdep.2012.10.015] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND To examine gender differences among individuals diagnosed with DSM-IV lifetime cannabis use disorder (CUD). METHODS A nationally representative sample of U.S. adults aged 18 years or older that were diagnosed with lifetime CUD (n=3297): Men (n=2080), Women (n=1217). Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n=43,093). The survey response rate was 81%. RESULTS Nearly all individuals with CUD had a psychiatric comorbidity (95.6% of men, 94.1% of women). Men with lifetime CUD were more likely than women to be diagnosed with any psychiatric disorder, any substance use disorder and antisocial personality disorder, whereas women with CUD had more mood and anxiety disorders. After adjusting for gender differences in sociodemographic correlates and the prevalence of psychiatric disorders in the general population, women with CUD were at greater risk for externalizing disorders. Men with CUD met more criteria for cannabis abuse, had longer episodes of CUD, smoked more joints, and were older at remission when compared to women with CUD. Women experienced telescoping to CUD. Treatment-seeking rates were very low for both genders, and there were no gender differences in types of services used or reasons for not seeking treatment. CONCLUSIONS There are important gender differences in the clinical characteristics and psychiatric comorbidities among individuals with CUD.
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Affiliation(s)
- Sharaf S. Khan
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA
| | - Roberto Secades-Villa
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA,Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Mayumi Okuda
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA
| | - Shuai Wang
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA
| | - Gabriela Pérez-Fuentes
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA
| | - Bradley T. Kerridge
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland 20742
| | - Carlos Blanco
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA
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Dodge K, Krantz B, Kenny PJ, Suciu GP. Substance Abuse Treatment Modalities and Outcomes in a Naturalistic Setting. Addictive Disorders & Their Treatment 2013; 12:76-90. [DOI: 10.1097/adt.0b013e31825a4006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.
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Affiliation(s)
- Afton Jackson
- Department of Sociology, Social Work, and Criminology, Morehead State University, 318 Radar Hall, Morehead, KY 40351, USA.
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Potter DA. Drawing the Line at Drinking For Two: Governmentality, Biopolitics, and Risk in State Legislation on Fetal Alcohol Spectrum Disorders. Critical Perspectives on Addiction 2012. [DOI: 10.1108/s1057-6290(2012)0000014010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Macy RJ, Goodbourn M. Promoting successful collaborations between domestic violence and substance abuse treatment service sectors: a review of the literature. Trauma Violence Abuse 2012; 13:234-251. [PMID: 22899704 DOI: 10.1177/1524838012455874] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Women who experience intimate partner violence (IPV) victimization are more likely to struggle with substance abuse problems than are women who do not experience IPV. Given the connection between IPV victimization and substance abuse, recommended practices urge collaboration between domestic violence service agencies and substance abuse treatment agencies to provide comprehensive services for women with these co-occurring problems. However, domestic violence and substance abuse services have unique histories of development that have led to distinct ways of service delivery. To promote successful collaborations, service providers and researchers are developing strategies to foster relationships across the two service sectors. The authors conducted a review of this emerging body of knowledge with the aim of assembling recommendations for strategies to foster collaboration between domestic violence and substance abuse services. The authors identified 15 documents for review inclusion and our analysis established 5 categories of documents. Findings yield key collaboration strategies and recommended service models. In addition, the review determined the existence of considerable challenges to promoting collaborative relationships between domestic violence and substance abuse treatment service sectors.
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Affiliation(s)
- Rebecca J Macy
- School of Social Work, University of North Carolina at Chapel Hill, NC 27599, USA.
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Park EM, Meltzer-Brody S, Suzuki J. Evaluation and management of opioid dependence in pregnancy. Psychosomatics 2012; 53:424-32. [PMID: 22902085 DOI: 10.1016/j.psym.2012.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Opioid use disorders are a growing public health problem in the United States. Most women who are opioid-dependent are of childbearing age, and management of opioid dependence during pregnancy poses unique challenges. Assessment includes evaluation for addiction, withdrawal syndromes, and comorbid psychiatric diagnoses. Consultation-liaison (C-L) psychiatrists may also be involved in acute pain management, perinatal medication management, buprenorphine induction, and stabilization. For the past four decades, the standard of care has included methadone maintenance, but the increasing use of buprenorphine creates new treatment issues and opportunities. OBJECTIVE To educate C-L psychiatrists in emergency and obstetrical settings about the appropriate approach toward the evaluation and basic management of women with opioid dependence in pregnancy. METHOD The authors reviewed the consensus literature and all new treatment options on opioid dependence during pregnancy. DISCUSSION In this review, the authors summarize known and emerging management strategies for opioid dependence in pregnancy pertinent to C-L psychiatrists.
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Affiliation(s)
- Eliza M Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27599, USA.
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Chong SA, Abdin E, Sherbourne C, Vaingankar J, Heng D, Yap M, Subramaniam M. Treatment gap in common mental disorders: the Singapore perspective. Epidemiol Psychiatr Sci 2012; 21:195-202. [PMID: 22789169 DOI: 10.1017/S2045796011000771] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS The problem of wide treatment gaps in mental disorders is endemic world wide. The study aims to establish the treatment gap of common mental disorders in Singapore. METHODS A national sample of 6616 persons aged 18 years and above was surveyed with the World Mental Health Composite International Diagnostic Interview in which for each diagnostic module, respondents were asked a series of questions regarding treatment contact. RESULTS Treatment gap varied considerably between disorders; alcohol abuse had the largest treatment gap (96.2%), followed by obsessive compulsive disorder (89.8%) and alcohol dependence (88.3%). The disorder for which people were most likely to seek help was major depressive disorder. Women with dysthmia were more likely than men to seek help but this help seeking behavior was reversed among those with alcohol abuse and dependence. Age of onset was significantly associated with treatment contact with those who had an earlier age of onset less likely to have treatment contact than those with late age of onset for all disorders except obsessive compulsive disorder. CONCLUSIONS Our findings suggest that treatment gaps are wide even in an economically developed country like Singapore and other than sociodemographic factors, cultural influences might play an important role in help seeking behavior.
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Affiliation(s)
- Richard Chenhall
- a Centre for Health and Society, Melbourne School of Population Health, The University of Melbourne , Melbourne , Australia
| | - Kate Senior
- b Menzies School of Health Research, Charles Darwin University , Casuaina , Northern Territory , Australia
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Davis KJ, Yonkers KA. Making lemonade out of lemons: a case report and literature review of external pressure as an intervention with pregnant and parenting substance-using women. J Clin Psychiatry 2012; 73:51-6. [PMID: 22316576 PMCID: PMC3286840 DOI: 10.4088/jcp.11cr07363] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Juhnke GA, Coker JK. A Solution-Focused Intervention With Recovering, Alcohol-Dependent, Single Parent Mothers and Their Children*. Journal of Addictions & Offender Counseling 2011. [DOI: 10.1002/j.2161-1874.1997.tb00116.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Manhal-Baugus M. The Self-in-Relation Theory and Women for Sobriety: Female-Specific Theory and Mutual Help Group for Chemically Dependent Women. Journal of Addictions & Offender Counseling 2011. [DOI: 10.1002/j.2161-1874.1998.tb00127.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kropp FB, Manhal-Baugus M, Kelly VA. The Association of Personal-Related Variables to Length of Sobriety: A Pilot Study of Chemically Dependent Women. Journal of Addictions & Offender Counseling 2011. [DOI: 10.1002/j.2161-1874.1996.tb00108.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Few interventions have been developed for substance-abusing homeless mothers. Among those interventions, high dropout rates (up to 85%) are consistently reported. Understanding homeless mothers' experiences with service providers may be an important first step to understanding ways to increase treatment engagement. Therefore, the current study used qualitative methods to gain a better understanding of homeless mothers' perceptions of service providers. A total of 28 mothers who were currently residing at a homeless shelter in a Midwestern city participated in three focus groups. Overall, mothers held negative perceptions of service providers related to understanding, support, and fear. Based upon this study's findings, recommendations are offered to improve service delivery and guide future research.
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Affiliation(s)
- Polly Radcliffe
- Polly Radcliffe Research Fellow, Institute for Criminal Policy Research, School of Law, Birkbeck, University of London
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Radcliffe P. Motherhood, pregnancy, and the negotiation of identity: The moral career of drug treatment. Soc Sci Med 2011; 72:984-91. [DOI: 10.1016/j.socscimed.2011.01.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 01/20/2011] [Accepted: 01/20/2011] [Indexed: 11/16/2022]
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Milligan K, Niccols A, Sword W, Thabane L, Henderson J, Smith A, Liu J. Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: a meta-analysis. Subst Abuse Treat Prev Policy 2010; 5:21. [PMID: 20809957 PMCID: PMC2942813 DOI: 10.1186/1747-597x-5-21] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 09/01/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of women with substance abuse issues is increasing. Women present with a unique constellation of risk factors and presenting needs, which may include specific needs in their role as mothers. Numerous integrated programs (those with substance use treatment and pregnancy, parenting, or child services) have been developed to specifically meet the needs of pregnant and parenting women with substance abuse issues. This synthesis and meta-analysis reviews research in this important and growing area of treatment. METHODS We searched PsycINFO, MedLine, PubMed, Web of Science, EMBASE, Proquest Dissertations, Sociological Abstracts, and CINAHL and compiled a database of 21 studies (2 randomized trials, 9 quasi-experimental studies, 10 cohort studies) of integrated programs published between 1990 and 2007 with outcome data on maternal substance use. Data were summarized and where possible, meta-analyses were performed, using standardized mean differences (d) effect size estimates. RESULTS In the two studies comparing integrated programs to no treatment, effect sizes for urine toxicology and percent using substances significantly favored integrated programs and ranged from 0.18 to 1.41. Studies examining changes in maternal substance use from beginning to end of treatment were statistically significant and medium sized. More specifically, in the five studies measuring severity of drug and alcohol use, the average effect sizes were 0.64 and 0.40, respectively. In the four cohort studies of days of use, the average effect size was 0.52. Of studies comparing integrated to non-integrated programs, four studies assessed urine toxicology and two assessed self-reported abstinence. Overall effect sizes for each measure were not statistically significant (d = -0.09 and 0.22, respectively). CONCLUSIONS Findings suggest that integrated programs are effective in reducing maternal substance use. However, integrated programs were not significantly more effective than non-integrated programs. Policy implications are discussed with specific attention to the need for funding of high quality randomized control trials and improved reporting practices.
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Affiliation(s)
- Karen Milligan
- Integra, (25 Imperial Street.), Toronto, ON, (M5P 1B9), Canada
| | - Alison Niccols
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, McMaster Children's Hospital - Chedoke site, (565 Sanatorium Road.), Hamilton ON, (L8N 3Z5), Canada
| | - Wendy Sword
- School of Nursing, McMaster University (1200 Main Street West), Hamilton ON, (L8N 3Z5), Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, St. Joseph's Healthcare, (50 Charleton Avenue East), Hamilton ON, (L8N 4A6), Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, University of Toronto, (33 Russell Street), Toronto, ON, (M5 S 2S1), Canada
| | - Ainsley Smith
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, McMaster Children's Hospital - Chedoke site (565 Sanatorium Road), Hamilton, ON, (L8N 3Z5), Canada
| | - Jennifer Liu
- Department of Mathematics and Statistics, McMaster University (1200 Main Street West), Hamilton ON, (L8N 3Z5), Canada
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Rajendran K, Chemtob CM. Factors associated with service use among immigrants in the child welfare system. Eval Program Plann 2010; 33:317-323. [PMID: 19651442 DOI: 10.1016/j.evalprogplan.2009.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 06/01/2009] [Accepted: 06/01/2009] [Indexed: 05/28/2023]
Abstract
This study investigated child, caregiver, and caseworker factors associated with greater use of family support services by immigrant families in the U.S. child welfare system. Among child factors, higher levels of internalizing behavior problems (Odds Ratio (O.R.)=3.60), externalizing behavior problems (O.R.=2.62) and a history of neglect (O.R.=4.23) were associated with greater family support service use. Among caregiver factors, prior reports of maltreatment (O.R.=6.77), a serious mental health problem of the caregiver (O.R.=6.86), cognitive impairments (O.R.=10.46) in the primary caregiver, the primary caregivers' history of arrests (O.R.=6.47) and domestic violence (O.R.=2.87), were associated with heavy service use. Caseworkers' training on cultural issues (O.R.=61.35), their concerns over bureaucracy (O.R.=25.38) and concern over rules and regulations (O.R.=6.08) were also associated with greater service use among immigrant families. This research suggests that use of family support services may be determined not only by the family's demographic factors and risk level but also by caseworkers' training in cultural competence and their perception of organizational problems.
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Affiliation(s)
- Khushmand Rajendran
- Child and Family Resilience Program, Department of Psychiatry, Mount Sinai School of Medicine, One Gustave Levy Place, New York City, NY 10029, USA.
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France K, Henley N, Payne J, D'Antoine H, Bartu A, O'Leary C, Elliott E, Bower C. Health professionals addressing alcohol use with pregnant women in Western Australia: barriers and strategies for communication. Subst Use Misuse 2010; 45:1474-90. [PMID: 20590371 DOI: 10.3109/10826081003682172] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Health professionals have an important role to play in preventing prenatal alcohol exposure. In 2006 qualitative data were collected from 53 health professionals working in primary care in metropolitan and regional Western Australia. Thematic analysis was used to elucidate barriers in addressing prenatal alcohol use and the strategies used to overcome them. Health professionals identified strategies for obtaining alcohol use information from pregnant women but they are not recognizing moderate alcohol intake in pregnant women. Study limitations are noted and the implications of the results are discussed. This research was funded by the Health Promotion Foundation of Western Australia.
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Affiliation(s)
- Kathryn France
- Centre for Child Health Research, Telethon Institute for Child Health Research, The University of Western Australia, West Perth, WA, Australia.
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Bromberg SR, Backman TL, Krow J, Frankel KA. The Haven Mother's House Modified Therapeutic Community: Meeting the gap in infant mental health services for pregnant and parenting mothers with drug addiction. Infant Ment Health J 2010; 31:255-276. [PMID: 28543223 DOI: 10.1002/imhj.20255] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The specialized needs of pregnant and parenting women in the treatment of drug addiction must not be underestimated. The impact of substance abuse on developmental outcomes for young infants and children supports the notion that attention to the parent-child relationship is a critical aspect of addiction treatment for this population. As such, the standard of care appears to be shifting from separating mothers and young children while the mother completes addiction treatment to women residing with their children while in treatment and receiving concurrent addiction treatment and parenting education. While parenting education is important, it may not provide the needed relationship intervention to address the myriad of issues often present for female recovering addicts and their children. This article describes the evolution and workings of a program for integrating infant mental health practice into a long-term residential treatment community for pregnant and parenting women with addiction. The principles and structure of the modified therapeutic community are described, as are the ways in which infant mental health practice have been effectively integrated and incorporated into the addiction treatment philosophy. A case example is provided, and clinical implications are discussed.
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Small J, Curran GM, Booth B. Barriers and facilitators for alcohol treatment for women: are there more or less for rural women? J Subst Abuse Treat 2010; 39:1-13. [PMID: 20381284 DOI: 10.1016/j.jsat.2010.03.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 02/11/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
Among women at-risk for problems drinking, treatment seeking can be hindered by a complex array of issues such as a lack of transportation, social stigma, denial, fear of losing children, and reluctance of primary care physicians to refer women. This study describes the barriers/facilitators and need for treatment among a community sample of rural and urban women at-risk drinkers. Data for this study were assembled from the baseline sample of individuals who participated in a large probability sample of rural and urban at-risk drinkers (N = 733) from six Southern states: Alabama, Arkansas, Georgia, Louisiana, Mississippi, and Tennessee. Men and women differed on perceived barriers/facilitators and need for alcohol treatment. Women differed from men on measures of treatment affordability, accessibility, acceptability and report of social support, illness severity, comorbidities, and demographic characteristics. Rural women differed from urban women on measures of treatment affordability and accessibility and report of illness severity and comorbidities.
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Affiliation(s)
- Jeon Small
- University of Arkansas for Medical Sciences Psychiatric Research Institute-Division of Health Services Research, Little Rock, AR 72205-7199, USA.
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Abstract
In many cultures, approximately one third of people with drug dependence are women of child-bearing age. Substance use among pregnant and parenting women is a major public health concern. Aboriginal people have some of the highest rates of substance abuse in Canada, increasing concern for detrimental health impacts, including those for women and their children. For many women, substance abuse offers a means of coping with trauma, such as childhood abuse, partner violence, and, for Aboriginal women, the intergenerational effects of colonization. In this paper, we review treatment issues for Aboriginal mothers with substance use problems and their children. We discuss gender-specific issues in substance abuse, the need for women-specific treatment, the impact of substance abuse on children and parenting, the additional risks for Aboriginal women and children, and the need for integrated programs (those that integrate pregnancy-, parenting-, and child-related services with women-specific addiction treatment). We describe New Choices as an example of an integrated program, review research on existing treatment for Aboriginal mothers with substance use issues, and describe Sheway as a promising integrated program for Aboriginal women with substance abuse issues and their young children. There are few treatment programs specifically for Aboriginal mothers with substance use issues and their children and very little research on their effectiveness. Based on our review of existing evidence, we offer recommendations for future research and practice.
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Niccols A, Dobbins M, Sword W, Smith A, Henderson J, Milligan K. A National Survey of Services for Women with Substance Use Issues and Their Children in Canada: Challenges for Knowledge Translation. Int J Ment Health Addict 2010; 8:310-9. [DOI: 10.1007/s11469-009-9267-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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