Substance-abusing Women Research Articles

Schizophrenia — A predictor of suicide during the second half of life?

BackgroundLittle is known about the suicide risk of older adults diagnosed with schizophrenia. The purpose of the study is to examine whether older adults diagnosed with schizophrenia have an elevated risk of dying by suicide, examine trends by age, and identify predictors of death by suicide. MethodsIndividual-level register data on all older adults aged 50+ living in Denmark during 1990–2006 (N=2,899,411) were assessed using survival analysis. The impact of predictors was adjusted for a series of socio-demographic and health-related covariates. ResultsIn all, 248 suicides were identified among older adults diagnosed with schizophrenia. The suicide rate ratios of men and women aged 50–69years with a diagnosis of schizophrenia was 7.0 [95%CI: 5.8–8.4] and 13.7 [95%CI: 11.3–16.6], respectively, when compared to those with no diagnosis. With increasing age a lower rate ratio was found; for men and women aged 70+ it was 2.1 [95%CI: 1.1–3.9] and 3.4 [95%CI: 2.0–5.8], respectively. Adjusted analyses revealed an elevated risk of suicide for diagnoses of schizophrenia, greater number of hospitalizations, recent admission (for men), recent discharge, previous suicide attempt, recent suicide attempt, comorbidity of mood disorders, personality disorders, and substance abuse (for women). ConclusionsWe found an elevated mortality risk of suicide for both men and women aged 50years and over diagnosed with schizophrenia. Health care staff should be aware of elevated risk, particularly in older women diagnosed with schizophrenia, in relation to chronic disease courses, recent discharge, and suicide attempt.

From surviving to thriving: Understanding reunification among African American mothers with histories of addiction

Abstract Child maltreatment cases involving substance abuse have increased. Estimates reveal that between 40% and 80% of all families involved with child protection have substance-abuse issues. Only 12%–20% of substance-abusing families regain custody of their children. Little is known about the factors that contribute to substance-abusing women regaining or losing custody of their children. Using the Multiple Embedded Case Study method, this study illuminates the experiences and feelings of mothers struggling to overcome addiction and highlights the main differences between women who regained custody and those who permanently lost custody of their children. In this study, 50% of the women lost custody and 50% regained custody of their children. The women who lost custody of their children tended to be in survival mode, characterized as going through the motions, engaging in acting-out behaviors, and failing to follow treatment recommendations. The women who regained custody of their children tended to thrive, characterized as having internal motivation, taking responsibility, and engaging the material. This study advances our knowledge of the factors contributing to reunification. Understanding these factors can lead to the development of practices that increase the likelihood of reunification for families struggling to overcome addiction.

Self and peer perceptions of childhood aggression, social withdrawal and likeability predict adult substance abuse and dependence in men and women: A 30-year prospective longitudinal study

While childhood behaviors such as aggression, social withdrawal and likeability have been linked to substance abuse outcomes in adolescence and adulthood, the mechanisms by which these variables relate are not yet well established. Self and peer perceptions of childhood behaviors in men and women were compared to assess the role of context in the prediction of drug and alcohol abuse and dependence. Participants (N = 676) in an ongoing longitudinal project examining the relation between childhood behavior and adult mental health outcomes completed the Structured Clinical Interview for the DSM IV regarding their histories of substance abuse in mid-adulthood (mean age = 34, SD = 2). In women, higher levels of both self and peer reported aggression were associated with drug and alcohol abuse and dependence, and higher levels of peer reported aggression were associated with higher levels of alcohol abuse and dependence. As well, higher levels of self-perceived likeability were protective regarding substance abuse and dependence outcomes. In men, higher levels of peer perceived social withdrawal were protective regarding substance abuse and dependence outcomes. Findings support the comparison of self and peer perceptions of childhood behavior as a method of assessing the mechanisms by which childhood behaviors impact adult outcomes, and suggest the importance of gender in the relation between childhood behaviors and adult substance abuse and dependence.

Correlates of Sexual Self-Esteem in a Sample of Substance-Abusing Women

An exploratory study was conducted to investigate the construct of sexual self-esteem of women in substance abuse (SA) treatment. Demographical and abuse data were collected from 99 women in SA treatment centers in New York State in 2006 to explore relationships between demographic, addiction, abuse, and treatment variables and sexual self-esteem. Correlation of scores from the SSEI-W and its subscales and abuse variables were conducted to examine relationships between variables. T-tests showed significant differences between the mean scores of the physical abuse and physical/sexual abuse variables, relationship variables and sexual orientation. Regression analyses examined the effects of abuse, sexual orientation, relationship variables and treatment characteristics. Abuse and sexual orientation remained significant in all of the models and their affect is not influenced by controlling for the other variables. The results are discussed with regard to treatment implications. This study provides evidence of the reliability of this measure in a female substance-abusing population and contributes to the knowledge of sexual self-esteem as it relates to an adult female population of women in SA treatment. Limitations and future directions are discussed, along with proposed clinical use and assessment.

Long-term outcomes among drug-dependent mothers treated in women-only versus mixed-gender programs

This study examined the long-term outcomes of women who were pregnant or parenting at admission to women-only (WO; n = 500) versus mixed-gender (MG; a matched sample of 500) substance abuse treatment programs. Administrative records on arrests, incarcerations, mental health services utilization, and drug treatment participation were collected, covering 3 years preadmission and 8 years postadmission. Women treated in WO programs had lower levels of arrest, mental health services utilization rates, and drug treatment participation during the first year after drug treatment. No differences were found between the two groups in the long-term trajectories except that the WO program participants had lower incarceration rates during the third year after treatment. The study findings suggest a positive short-term impact of WO versus MG programs with regard to arrest and mental health services utilization. Limited long-term gain is shown in the reductions in posttreatment incarceration. The study findings suggest the added value of specialized WO programs and begin to address the gap in knowledge regarding long-term outcomes for substance-abusing women.

The relative effectiveness of women-only and mixed-gender treatment for substance-abusing women

Following research indicating that the treatment needs of women are different from those of men, researchers and clinicians have argued that drug treatment programs for women should be designed to take their needs into account. Such programs tend to admit only women and incorporate philosophies and activities that are based on a social, peer-based model that is responsive to women's needs. To assess the relative effectiveness of women-only (WO) outpatient programs compared with mixed-gender (MG) outpatient programs, 291 study volunteers were recruited (152 WO, 139 MG), and a 1-year follow-up was completed with 259 women (135 WO, 124 MG). Using bivariate, logistic regression, and generalized estimating equation analysis, the following four outcomes were examined: drug and alcohol use, criminal activity, arrests, and employment. In both groups, women showed improvement in the four outcome measures. Comparison of the groups on outcomes yielded mixed results; women who participated in the WO treatment reported significantly less substance use and criminal activity than women in the MG treatment, but there were no differences in arrest or employment status at follow-up compared with those in the MG treatment.

Substance-abusing women in a medium secure psychiatric setting: characteristics and psychometric test performance

Background: There have been few assessments of women with substance misuse problem in secure psychiatric settings.Aims: The aim is to describe the characteristics and psychometric test performance of women admitted to a medium secure hospital.Method: Consecutive admission was classified into risk-relevant categories using case note data. Responses to psychometric measures of dependence, substance-related problems, self-efficacy, motivation for change, craving and coping were assessed.Results: Forty-four out of 55 consecutive admissions had a risk-relevant pattern of substance use before admission. Analysis of psychometric test performance produced two groups of patients differentiated according to self-efficacy, craving and belief in the benefits of change.Conclusions: Although further work needs to be done in assessing the applicability of specific psychometrics to specialist populations, findings reinforce the importance of matching treatment interventions to stages of readiness to change.

Using the Tidal Model of Mental Health Recovery to Plan Primary Health Care for Women in Residential Substance Abuse Recovery

Women currently are 30% of the substance abuse recovery population in North America and have gender specific treatment needs as they enter the difficult work of recovery. Important among women's specific needs as they enter recovery is the need for a focus on primary health care. Few models designed to guide the provision of health care for this population are available in the literature. The Tidal Model of Mental Health Recovery and Reclamation is based on the concept of nursing as “caring with” persons in the experience of distress. Given the emphasis in this model on developing a partnership between caregiver and client, it is especially appropriate for women in recovery for substance abuse. The Tidal Model, integrated with the United States Substance Abuse and Mental Health Services’ CSAT model for comprehensive alcohol and other drug (AOD) abuse treatment, is used to guide planning for delivery of primary health care in a residential women's substance abuse recovery center in the Midwest. This article describes the Tidal Model, and identifies how the model can improve the delivery of primary care to women in residential substance abuse treatment. Strategies for implementation of the model are proposed. Evaluation and outcome criteria are identified.

Neuropsychological screening of children of substance-abusing women attending a Special Child Welfare Clinic in Norway

BackgroundExposure to alcohol and illicit substances during pregnancy can have an impact on the child for the rest of his/her life. A Special Child Welfare Clinic (SCWC) in Norway provides care for pregnant women with substance abuse problems. Treatment and support are provided without replacement therapy.MethodsWe performed a neuropsychological screening of 40 children aged four to 11 years whose mothers had attended the SCWC during pregnancy, and of a comparison group of 80 children of women without substance abuse problems. The children were presented with tests chosen from Wechsler Intelligence Scale for Children, third version (WISC-III), Nepsy, Halstead-Reitan and Raven's Progressive Matrices, Coloured Version. The tests were grouped into five main domains; (1) learning and memory, (2) visual scanning, planning and attention, (3) executive function, (4) visuo-motor speed and dexterity and (5) general intellectual abilityResultsNo children in the study had test results in the clinical range in any domain. Bivariate analyses revealed that children of short-term substance-abusing mothers (who stopped substance abuse within the first trimester) had significantly lower test scores than the comparison group in three out of five domains (domain 2,3,4). Children of long-term substance abusers (who maintained moderate substance abuse throughout pregnancy) had significantly lower test results than the comparison group in one domain of the test results (domain 1). All but one child in the long-term group were or had been in foster homes. Most children in the short-term group stayed with their mothers. Multivariate regression analyses revealed that foster care minimum 50% of life time was associated with better scores on domains (1) learning and memory, (2) visual scanning, planning and attention, and (3) executive functions, while no significant associations with test scores was found for substance abuse and birth before 38 weeks of gestation.ConclusionChildren raised by former substance abusing mothers scored worse on the neuropsychological screening than children who had substance abusing mothers and mostly were raised in foster homes. This indicates that it is important to focus on the environment in cases where help and support are provided to presently or formerly addicted women raising children.

Substance Use and Women's Health

ABSTRACT Scientific findings show that substance abuse in women yields a higher risk of a variety of health problems than substance abuse in men. Research suggests that women experience addiction telescoping when they abuse alcohol, tobacco, specific stimulants, and possibly opioids. Medical side effects also develop more rapidly in women than men when they abuse many substances. Cancer and cardiac complications, specifically, pose a significant threat for women who abuse almost all types of substances. However, the physical consequences are not the only ones women suffer when they engage in substance abuse. Research on substance abuse in women ties opioids to mood and anxiety disorders, heroin to neurological deficiencies, cocaine to immune system suppression, and alcohol to intimate partner abuse. Additionally, female substance abusers, on average, have a lower level of education and lower rates of employment. In light of these gender-specific concerns, physicians should give particular consideration to detecting substance abuse in women.

Helping substance-abusing women of vulnerable populations: effective treatment principles and strategies

PrefaceAcknowledgmentsPart I. Helping Substance-Abusing Women in General1. Introduction: History, Epidemiology, and Consequences2. Etiologies and Risk Factors3. Factors in Successful Treatment Programs for Women4. Treatment MethodsPart II. Helping the Six Specific Vulnerable Populations5. Pregnant Women6. Adolescent Girls7. Older Women8. Homeless Women9. Street Prostitutes10. LesbiansAppendixesAppendix A. Screening ToolsAppendix B. Relapse Among Substance-Abusing WomenAppendix C. Turning the Child Welfare System's Involvement from Crisis Into OpportunityReferencesIndex

Treating Women Right

It has been estimated that 20—30% of all women will be sexually and/or physically abused at some time in their lives, and women who come for treatment of substance abuse report an even higher incidence of sexual and/or physical abuse. Using case vignettes, this article presents an integrated model of group treatment for substance-abusing women who have also experienced some form of interpersonal trauma.

Book Review: An-Pyng Sun Helping Substance-Abusing Women of Vulnerable Populations: Effective Treatment Principles and Strategies New York: Columbia University Press, 2009. $65 (hardbound)

Book Review: An-Pyng Sun Helping Substance-Abusing Women of Vulnerable Populations: Effective Treatment Principles and Strategies New York: Columbia University Press, 2009. $65 (hardbound)

Inner-City African-American Women’s Adolescence as Stressful Life Events: Understanding Substance Abusing Behavior

Lula Beatty (2003:59) asks, "What makes a black woman, voluntarily take a substance into her body which alters her perceptions and feelings of well-being?" This research examines African American women's substance abuse as a response to stressful life events grounded in adolescence, drawing in part on the cognitive-transactional approach and distal stressor model to discuss the effects of stressors on mental health and substance abusing behavior. Most respondents viewed their adolescent experiences and the associated stress as tribulations or lessons to be lived through, rather than a signal of needed change in their social, cultural, and ecological life circumstances. The effect of exposure to constant stressors early in the life course coupled with proximal stressors often resulted in negative active responses to stress (i.e. substance abuse) and continued stunted emotional growth. Thus, our findings indicate that the experience of African American women as adolescents contributes to understanding substance abuse amongst this population. These findings further help develop the cognitive-transactional model, while adding to the distal stressors and life process model as a way of considering gender, race, and structural forces.

Birth & Development Outcome Among Children Of Substance Abuse Women Attending a Special Child Welfare Clinic in Norway

Birth & Development Outcome Among Children Of Substance Abuse Women Attending a Special Child Welfare Clinic in Norway

Factor Analyses of the Allen Barriers to Treatment Instrument in a Sample of Women Seeking Outpatient Treatment for Substance Abuse

Abstract Objective: Women are less likely than their male counterpartsto seek treatment for substance abuse. The AllenBarriers to Treatment Instrument (ABTI) was devel-oped in 1994 to measure barriers to treatment fromthe perspective of substance-abusing women. Thefactor structure of the ABTI has not been adequatelyvalidated, and the instrument has therefore beenunderused as a clinical and research tool. The pur-pose of this study was to replicate and validate thefactor structure of the ABTI in a sample of womenseeking outpatient substance abuse treatment. Methods: Confirmatory and exploratory factor analyses of theABTI were conducted in a sample of 77 womencompleting intake for substance abuse treatment. Results: The originally proposed factors could not be repli-cated in this sample. Item-level analyses revealed3 distinct factors that seemed to be clinically inter-pretable and descriptive of ‘‘barriers to treatment.’’The new factors were labeled ‘‘Functional Barriers,’’‘‘Relational Barriers,’’ and ‘‘Affective Barriers.’’

Sex-Specific Dissociations in Autonomic and HPA Responses to Stress and Cues in Alcohol-Dependent Patients with Cocaine Abuse

Chronic alcohol and drug dependence leads to neuroadaptations in hypothalamic-pituitary-adrenal (HPA) and sympathetic adrenal medullary (SAM) stress systems, which impact response sensitivity to stress and alcohol cue and facilitates risk of relapse. To date, gender variations in these systems have not been fully assessed in abstinent alcohol-dependent individuals who also met criteria for cocaine abuse. Forty-two (21 M/21 F) early abstinent treatment-seeking substance-abusing (SA) men and women and 42 (21 M/21 F) healthy control (HC) volunteers were exposed to three 5-min guided imagery conditions (stress, alcohol/drug cue, neutral relaxing), presented randomly, one per day across three consecutive days. Alcohol craving and anxiety ratings were obtained as well as measures of heart rate (HR), blood pressure, plasma ACTH, cortisol, norepinephrine (NE) and epinephrine (EPI). SA males showed increased ACTH and EPI basal tone compared with HC males and SA females. However, they demonstrated no increase in ACTH and cortisol levels following stress and alcohol cue imagery exposure compared to the neutral condition. SA females demonstrated a typically increased stress response in both measures. In addition, SA males showed no increase in cardiovascular response to either stress or cue, and no increase in catecholamine response to cue compared with their response to neutral imagery. Again, this dampening was not observed in HC males who produced significantly higher levels of cue-related HR and EPI, and significantly higher stress-related DBP. In contrast, SA females showed an enhanced ACTH and cortisol response to stress and cue compared with neutral imagery and this was not observed in the HC females. They also demonstrated a reduced increase in NE and EPI compared with both SA males and HC females as well as reduced HR compared with HC females. While SA males showed a generalized suppression of HPA, SAM system and cardiovascular markers following both stress and cue, SA women demonstrated a selective sympatho-adrenal suppression to stress only and an enhanced HPA response to both stress and cue. These gender variations are discussed in terms of their potential impact on relapse vulnerability and treatment outcome.

Women and Substance Abuse: Gender, Age, and Cultural Considerations

Historically, data has shown that a smaller percentage of women use alcohol and illicit substances compared to men, and that frequency of use has been lower among women compared to use among men. Although this data on usage may be true, researchers also acknowledge that substance use among women has been a hidden issue, one not realistically acknowledged by society, especially prior to the mid-1960s. Along with this, more recent data indicates that rates of substance use among women are increasing. Factors contributing to this increase in substance abuse have begun to receive considerable attention, and recent research suggests that many issues exist that are unique to substance use among women. The purpose of this article is to discuss gender specific considerations in women's substance abuse by examining the history of substance use among women; analyzing gender-specific factors, including physiological factors, trauma-related factors, mental health issues, and cultural considerations that impact on women's substance use; articulating treatment approaches for working with substance abusing women and girls; and providing recommendations for further research in this area.

Neonatal findings among children of substance-abusing women attending a special child welfare clinic in Norway

A special child welfare clinic (SCWC) in Norway provides care for pregnant women with substance abuse problems to prevent the adverse effects of substances. The SCWC aims to give treatment without replacements. This article describes neonatal findings among children of substance-abusing women at the clinic. This was a retrospective cohort study including 62 children whose mothers had attended the SCWC during pregnancy. A comparison group with children of women with no substance abuse was included. Data were collected from medical records and by means of a questionnaire concerning neonatal data, health, and living conditions. SCWC mothers were divided into short-term users (substance use stopped within first trimester) and long-term users (continued moderate substance use throughout pregnancy). Average birthweight and head circumference were significantly lower in the substance-abusing groups: 3084 g and 34.0 cm in the short-term group, 3048 g and 33.9 cm in the long-term group, and 3496 g and 34.8 cm in the comparison group. There was no difference in Apgar score. Substance abuse and psychiatric illness were associated with low birthweight. Long-term users were more likely than comparisons to experience premature birth and have low-birthweight children. This difference was not found among short-term users. We found no difference in Caesarean sections and vacuum extractions. Substance abusers who stop their drug use early in pregnancy tend to have birth outcomes that are similar to those of mothers with no substance abuse. The study indicates that attendance at a voluntary, low-threshold initiative for pregnant substance abusers, with a focus on prenatal care and substance abuse treatment without replacements, may reduce the harmful effect of the abuse on the newborn.

Psychotherapies for Trauma and Substance Abuse in Women

Women are subject to high rates of interpersonal violence. One frequent co-occurring issue is substance abuse, which may arise posttrauma as a way to cope. In this article, psychosocial therapies for co-occurring trauma and substance abuse are reviewed. Description of empirically studied models is provided, as well as results of the empirical studies. Overall, this area of work suggests positive growth in the availability of new models but very limited empirical work thus far for all but one model. Directions for the future include the need for greater study of treatments in this area, as well as the need to address issues beyond specific models (e.g., workforce issues, access to care, and changing the culture of treatment systems). Policy implications are also offered.