Women In Substance Abuse Treatment Research Articles

A brief measure assessing sexual risk behavior in women in substance abuse treatment

A brief measure assessing sexual risk behavior in women in substance abuse treatment

Relationship of Trauma Exposure and Substance Abuse to Self-Reported Violence Among Men and Women in Substance Abuse Treatment

Past research showed a relationship between substance abuse and aggression and past trauma and aggression. The nature of the relationships between substance use, trauma, and aggression is inconclusive. The current research hypothesized greater aggression among those with a history of substance abuse and trauma compared with those without such a history and an additive relationship between substance abuse and trauma on aggression. Participants were 615 individuals in a substance abuse treatment program for individuals under criminal justice supervision. Data were collected from face-to-face interviews and self-report measures. Univariate and multivariate analyses assessed the relationships among substance use, trauma, and aggression. Participants with a history of trauma and regular substance use reported the highest rates of homicidal ideation, problem behaviors, and person offenses. Participants in this group also reported greater desire for help managing their stress and tension, dealing with problems in their intimate relationships, developing healthier relationships in general, and learning prosocial approaches to express their feelings. Substance abusing participants who experienced trauma reported more externalizing behaviors and a greater desire for coping- and social-skills training than participants who abused substances but did not report a history of trauma. This suggests that participants in substance abuse treatment programs may have improved outcomes with the addition of components to address these issues.

Partner Violence and Substance Abuse Are Intertwined

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.

Characteristics of perinatal women seeking treatment for marijuana abuse in a community-based clinic.

In the US, marijuana continues to be the most frequently used illicit drug among women of childbearing age, including pregnant and postpartum women. Given the critical window for treatment during the perinatal period, more information is needed about the characteristics of women who abuse marijuana and about their unique needs with the goal of improving clinical services and outcomes for both women and their infants. To (1) identify a profile of perinatal women seeking treatment for primarily marijuana abuse and (2) report birth outcomes in a subset of pregnant women with marijuana abuse. This retrospective clinical chart review study examined 67 adult perinatal women patients (54 % ethnic minority) who attended an inner-city, hospital-affiliated outpatient program specializing in substance abuse treatment for women. Of all pregnant women, 26 % reported positive urine screens during the first trimester, 41 % during the second trimester, and 27 % during the third trimester. While the subset of pregnant women was small, exploratory results suggest that infants whose mothers continued to use marijuana during their pregnancies were born at a lower gestational age than mothers who abstained; t(29) = 2.04, p <0.05. Identifying potential barriers to treatment could help improve retention in community-based treatment programs during pregnancy and the postpartum period.

Impact of Dual Disorders, Trauma, and Social Support on Quality of Life Among Women in Treatment for Substance Dependence

Objective: Women with dual disorders report lower levels of social support than women with substance dependence alone, and lower levels of social support have been associated with lower quality of life among individuals with substance use disorders. However, little is known about the impact of trauma symptoms and violence exposure on quality of life for women with dual disorders. The purpose of this study was to examine the impact of dual disorders, trauma, and social support related to recovery on various domains of quality of life among women in substance abuse treatment. Methods: This study utilized multiple standardized measures and hierarchical ordinary least squares regression to examine quality of life, trauma, and social support in women with dual disorders. Four domains of quality of life were measured (physical, psychological, social, and environmental domains). Participants (N = 369) were recruited from three inner-city women-only addiction treatment programs. Institutional review board approval was obtained prior to sample recruitment. Results: Presence of dual disorders was significantly associated with lower quality of life in the physical and psychological domains. However, this difference was no longer significant when trauma symptoms were added to the model. Trauma symptoms and support for recovery significantly predicted quality of life across all four domains and friends’ support for abstinence across three domains. Conclusions: Findings suggest that the presence of dual disorders in women may indicate a history of trauma. They also support the importance of both friends’ support for abstinence and recovery support as predictors of quality of life in women with dual disorders. Interventions that focus on social support and quality of life in treatment with women with substance use disorders may potentially enhance treatment outcomes.

Experiences of Drug Use and Parenting among Women in Substance Abuse Treatment: An Exploratory Study

The purpose of this exploratory study was to explore the multiple contexts of vulnerability, drug use and parenting for women in substance abuse treatment. Nineteen purposively sampled women provided qualitative data through semi-structured interviews. Findings revealed that adverse childhood experiences and intimate partners were important pathways into drug use initiation. Identities as mothers emerged as a key finding, intimately linked to women's motivation to seek and complete treatment. Understanding the challenges to recovery among mothers in treatment is an important priority for social workers. This study highlights the complexity of women's experiences and suggests implications for future practice and research.

Weight-related concerns related to drug use for women in substance abuse treatment: Prevalence and relationships with eating pathology

Women in substance abuse treatment increasingly report weight-related concerns as motivation for drug use. However, limited research has explored the nature of these concerns or examined whether women in substance abuse treatment with weight-related concerns related to drug use differ from those who do not on variables relevant to eating pathology. Using a sample of 297 women in substance abuse treatment, this study examined two intertwined issues: (1) the prevalence and nature of weight-related concerns related to drug use and (2) whether women who endorse weight-related concerns related to drug use differ from those without weight-related concerns on body dissatisfaction, eating pathology, perceived pressure and internalization of thin-ideal media, and appearance-related drug-use expectancies. Descriptive analyses indicated that the majority of participants were concerned about gaining weight during treatment and/or that weight gain could trigger drug relapse. Analyses of variance revealed that women who reported weight-based concerns (both with regards to weight gain during treatment and relapse potential) endorsed higher levels of body dissatisfaction, dieting, bulimic symptoms, and thin-ideal internalization than women who did not endorse weight-related concerns. Results suggest that substance abuse treatment programs should be aware of and address weight-related concerns around drug use for women.

Trauma Services for Women in Substance Abuse Treatment: An Integrated Approach by Denise Hien , Lisa Caren Litt , Lisa R. Cohen , Gloria M. Miele , Aimee Campbell (review)

Trauma Services for Women in Substance Abuse Treatment: An Integrated Approach by Denise Hien , Lisa Caren Litt , Lisa R. Cohen , Gloria M. Miele , Aimee Campbell (review)

Incremental Validity of Stressful Life Experiences in Predicting Psychiatric Comorbidity Among Women in Substance Abuse Treatment

ABSTRACT The dynamic contribution of stressful life experiences in predicting psychiatric comorbidity continues to challenge clinical practice and research. This study tested incremental validity of stressful life experiences related to psychiatric comorbidity among 128 young women in a Midwestern substance abuse treatment facility. Respondents reported low income, homelessness, and health and mental health issues. Using the Addiction Severity Index (ASI), Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision, and Stressful Life Experience (SLE) Screen as correlates, hierarchical linear regression demonstrated support for incremental validity of SLE uniquely accounting for 6.5% of variance in ASI psychiatric scores. Findings support future use of SLE in clinical settings for assessment and intervention purposes.

Opioid Dependency in Pregnancy and Length of Stay for Neonatal Abstinence Syndrome

To examine opioid replacement therapy in pregnancy and effect on neonatal outcomes, including length of hospital stay for neonatal abstinence syndrome. Retrospective descriptive study. Labor and delivery unit and neonatal intensive care unit (NICU), Eastern Maine Medical Center, Bangor, Maine. One hundred fifty-two opioid-dependent pregnant women on methadone maintenance therapy (MMT) (n = 136) or buprenorphine maintenance therapy (BMT) (n = 16) during pregnancy and their neonates. The neonates were born between January 1, 2005 and December 31, 2007. A review of the electronic medical record (EMR) was conducted of all opioid-dependent women who were maintained on MMT or BMT at the time of admission for labor and delivery and their neonates. Maternal methadone dose and concomitant in-utero exposure to benzodiazepines prolonged the length of hospital stay for neonates. Length of stay was shorter in breastfed neonates than formula-fed neonates or neonates who received formula and breast milk. Neonates with prenatal exposure to MMT spent more days in the hospital (21 vs. 14 days) for treatment of neonatal abstinence syndrome (NAS) than infants with prenatal exposure to BMT. These findings are consistent with previous research on the simultaneous use of methadone and benzodiazepines during pregnancy and provide further direction for the treatment of opioid dependency during pregnancy. Harm reduction strategies for opioid-dependent pregnant women in substance abuse treatment with MMT may one day include guidance on daily treatment doses and recommendations to avoid the concomitant use of benzodiazepines to lessen NAS. Breastfeeding should be recommended to shorten length of stay. Understanding perinatal and neonatal outcomes of pregnant women on methadone or buprenorphine will help to identify optimal treatment for opioid dependency in pregnancy.

Prospective patterns and correlates of quality of life among women in substance abuse treatment

BackgroundQuality of life (QOL) is increasingly recognized as central to the broad construct of recovery in substance abuse services. QOL measures can supplement more objective symptom measures, identify specific service needs and document changes in functioning that are associated with substance use patterns. To date however, QOL remains an under investigated area in the addictions field, especially in the United States. MethodsThis study examines patterns and predictors of QOL at 1 and 6 months post treatment intake among 240 women enrolled in substance abuse treatment in Cleveland, Ohio. The World Health Organization Quality of Life (WHOQOL-BREF) measure was used to assess physical, psychological, social and environmental domains. Hierarchical multiple regressions were conducted to identify correlates of QOL at 6 months post treatment intake. ResultsAll QOL domains across the follow up time points improved significantly. However, QOL scores across domains remained below those of healthy population norms. Trauma symptoms significantly predicted Physical and Psychological QOL. Among treatment process variables, alcohol use was the sole significant factor associated with QOL and only for Environmental QOL. Recovery support and friends support for abstinence were consistently associated with QOL across all four domains.Implications: This study suggests the usefulness of the WHOQOL measure as an indicator of functioning in substance abusing populations. Findings underline the importance of helping women deal with trauma symptoms and develop support for recovery. Further research is needed on the longitudinal relationship between QOL and substance use patterns.

Long-term residential substance abuse treatment for women: lessons learned from Israel

BackgroundPolicymakers and treatment providers must consider the role of gender when designing effective treatment programs for female substance abusers. This study had two aims. First, to examine female substance abusers’ perceptions regarding factors that contribute to their retention (and therefore positive treatment outcomes) in a women-only therapeutic community in Northern Israel. Second, to explore pretreatment internal and external factors including demographic, personal and environmental factors, factors associated with substance use and with the treatment process, and networks of support that contribute to retention and abstinence.MethodsThe study was a conducted using a mixed methods approach. Semi-structured qualitative interviews examining perceptions towards treatment were conducted in five focus groups (n = 5 per group; total n = 25). Intake assessments and a battery of questionnaires examining pretreatment internal and external factors related to treatment retention and abstinence were collected from 42 women who were treated in the program during the 2 year study period. Twenty-three women who completed the 12 month program were compared to the 19 women who did not, using chi-square for categorical variables and t-tests for continuous variables. Nineteen of the 23 women who completed the questionnaires also completed a post-treatment follow-up questionnaire.ResultsA content analysis of the interviews revealed five central themes: factors associated with treatment entry; impact of treatment in a women-only setting; significant aspects of treatment; difficulties with the setting; prospects for the future. Analysis of the questionnaires revealed that compared to non-completers, completers had fewer psychiatric symptoms, higher levels of introverted behavior in stressful situations, a better sense of coherence, and less ability to share emotions. No significant differences were found with regard to demographic and substance use factors. All 19 women who completed treatment and the follow-up questionnaire remained abstinent from illicit drugs for 18 months following the end of treatment.ConclusionResults indicate that women see the women-only treatment setting as extremely significant. Also, there is a profile of psychiatric co-morbidity, extrapunitiveness, and fewer personal resources that predict a risk for attrition. Thus, women at risk for attrition may be identified early and treatment staff can utilize the results to assist clients in achieving their treatment goals. Results can inform policymakers in making decisions regarding the allocation of resources, by pointing to the importance of long-term women-only residential treatment in increasing positive treatment outcomes.

Substance Abuse Treatment Stage and Personal Networks of Women in Substance Abuse Treatment

This study examines the relationship among 4 treatment stages (i.e., engagement, persuasion, active treatment, relapse prevention) and the composition, social support, and structural characteristics of personal networks. The study sample includes 242 women diagnosed with substance dependence who were interviewed within their first month of intensive outpatient treatment. Using EgoNet software, the women reported on their 25 alter personal networks and the characteristics of each alter. With one exception, few differences were found in the network compositions at different stages of substance abuse treatment. The exception was the network composition of women in the active treatment stage, which included more network members from treatment programs or 12-Step meetings. Although neither the type nor amount of social support differed across treatment stages, reciprocity differed between women in active treatment and those in the engagement stage. Networks of women in active treatment were less connected, as indicated by a higher number of components, whereas networks of women in the persuasion stage had a higher degree of centralization, as indicated by networks dominated by people with the most ties. Overall, we find social network structural variables to relate to the stage of treatment, whereas network composition, type of social support, and sociodemographic variables (with a few exceptions) do not relate to treatment stage. Results suggest that social context, particularly how social contacts are arranged around clients, should be incorporated into treatment programs, regardless of demographic background.

Inside-Out Health: An Integrative Health Education Program for Women in Substance Abuse Treatment

Background: Women in treatment for substance use disorders have been identified as at risk for developing co-occurring addictions (e.g., eating disorders) during and following treatment [1] as well as health-related concerns (e.g., inadequate nutrition, weight gain) [2]. Methods: Two evidence-based programs, Full of Ourselves [3] and Healthy Steps to Freedom [4], inspired the development of an integrative health education program (i.e., Inside-Out Health) designed to promote physical activity, healthy nutrition and positive body image. Forty-nine participants aged 18-59 (M=30.61, SD=6.90) came to the weekly program with 74% of participants attending 4 or more sessions out of 6 and 22% having perfect attendance. Nutrition, physical activity and body image were evaluated at pre- and post- and exploratory questions were included to assess program satisfaction. Results: While statistical analyses did not reveal significant changes in body esteem and physical activity, the Food Choice Questionnaire responses on two subscales (i.e., FCQ-weight control, FCQ-nutrition) approached significance. FCQ-weight control scores increased from pretest (M=.2.24, SD=1.0) to posttest (M=2.55, SD=.74) and FCQ-nutrition scores increased from pretest (M=2.70, SD=.67) to posttest (M=2.82, SD=.68). Discussion: This integrative health education program is an initial attempt to incorporate health education and eating disorder prevention efforts into an existing substance abuse treatment program. This study confirms the feasibility of promoting physical activity, nutrition and positive body image among female substance abuse clients.

A gender-specific approach to improving substance abuse treatment for women: The Healthy Steps to Freedom program

Given that women increasingly report using drugs to lose weight, substance abuse treatment programs must include body image, weight, eating pathology, and health knowledge as core intervention targets. This study tested the efficacy of a supplemental health and body image curriculum designed for women in substance abuse treatment who report weight concerns called Healthy Steps to Freedom (HSF). Data from 124 adult women recruited from substance abuse treatment facilities in southern Nevada completed measures of drug use, body dissatisfaction, eating pathology, thin-ideal internalization, and health knowledge/behaviors before and after participation in the 12-week HSF program. Results revealed that thin-ideal internalization, body dissatisfaction, and eating disorder symptoms significantly decreased after HSF program participation, whereas health-related behaviors (e.g., increased healthy food consumption) and knowledge (e.g., understanding of basic nutrition, exercise) increased. These results suggest that the inclusion of the HSF program in substance abuse treatment improves weight-related issues in substance-abusing women.

Substance Abuse Treatment for Women who are Under Correctional Supervision in the Community: A Systematic Review of Qualitative Findings

This systematic review was conducted to more fully analyze qualitative research findings relating to community-based court-supervised substance abuse treatment for women and to make recommendations regarding treatment enhancement. Five reports of qualitative research met the inclusion criteria. Findings from these reports were extracted and analyzed using constant comparative methods. Women who are referred to court-sanctioned substance abuse treatment programs may initially be reluctant to participate. Once engaged, however, they advocate for a full complement of well-financed comprehensive services. To optimize treatment effectiveness, women recommend gender-specific programs in which ambivalence is diminished, hope is instilled, and care is individualized.

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.

The Impact of Comprehensive Services in Substance Abuse Treatment for Women With a History of Intimate Partner Violence

This study examines the impact of comprehensive services on posttreatment substance use among women with a history of intimate partner violence. The sample includes 1,123 women from 50 treatment facilities derived from the National Treatment Improvement Evaluation Study (NTIES). Generalized linear mixed modeling was used to determine whether a history of intimate partner violence moderates the association between service receipt and posttreatment substance use. Significant interactions were found between history of intimate partner violence and concrete ( p = .016) and family services (p = .023) in predicting substance use.

Adapting an evidence-based HIV prevention intervention for pregnant African-American women in substance abuse treatment

An adaptation of an evidence-based, woman-focused intervention designed to reduce HIV risk behaviors was conducted for pregnant, African-American women in substance abuse treatment in North Carolina. The intervention adaptation process included focus groups, expert panels, and the filming of women who spoke about their experiences with pregnancy, drug use, sex risk behaviors, HIV testing and treatment, need for substance abuse treatment, violence, and victimization. The assessment instrument was adapted for pregnant women and the intervention was organized into a 4-session PowerPoint presentation, with an additional session if a woman tested positive for HIV. All sessions and assessment instrument were installed on laptop computers for portability in treatment programs. We pilot tested our adaptation with 59 pregnant African-American women who had used an illicit drug within the past year and were enrolled in substance abuse treatment. At baseline, 41% were currently homeless, 76% were unemployed, 90% had not planned their current pregnancy, and approximately 70% reported drug use since finding out about the pregnancy. This sample of participants rated the intervention sessions and were highly satisfied with their experience, resulting in a mean satisfaction score of 6.5 out of 7. Pregnant African-American women who use drugs need substance abuse treatment that they do not currently access. Woman-focused HIV interventions help to address intersecting risk behaviors and need for treatment prevalent among this vulnerable group.

Detecting Ongoing Intimate Partner Victimization in the Lives of Trauma Survivors With Substance Use Disorders: The Need for Supplemental Assessment

Individuals seeking substance abuse treatment are at increased risk for posttraumatic stress disorder (PTSD) and recent/ongoing victimization by their intimate partners. To create a safe context for trauma treatment, it may be important to address ongoing intimate partner violence (IPV). Given that most diagnostic interviews for PTSD include an assessment of potentially traumatic events across the life span, including IPV, many clinicians may assume that IPV items included in such interviews are sufficient to assess recent/ongoing IPV. This study examined whether participants reported past-year IPV experiences on a well-established self-report questionnaire of IPV, The Conflict Tactics Scale–Revised, which were not reported during a modified version of a well-established interview of trauma history, “The National Women’s Study of PTSD Module.” Participants were men and women in substance abuse treatment with clinically significant trauma histories. As hypothesized, participants reported recent IPV on the self-report questionnaire that was not reported during the interview. Although clinicians may assume they have adequately assessed recent/ongoing IPV during interview-based trauma assessments, findings of this study indicate that supplemental self-report assessment may enhance its detection and facilitate intervention.