Substance-abusing Women Research Articles

Implementing Substance Abuse Screening and Brief Motivational Intervention With Women in Jail

This article presents a social work in-reach model for identifying women's substance abuse service needs while in jail and increasing their motivation and abilities to obtain services on reentry to the community. The authors describe important aspects of the Women and Jails Project and its development that can help inform social work practice in this area. Data are reported on the first 1,091 women participating in the project. Specific issues and practical suggestions for planning, conducting, and evaluating this type of in-reach intervention are examined. Implications for social work practice and future outcomes research are discussed.

Culturecology, Women, and African-Centered HIV Prevention

The Healer Women Fighting Disease Integrated Substance Abuse and HIV Prevention Program for African American women is based on a conceptual framework called “culturecology” and an African-Centered Behavioral Change Model (ACBCM). Culturecology poses that an understanding of African American culture is central to both behavior and behavioral transformation. The ACBCM model suggests that behavioral change occurs through a process of resocialization and culturalization. These processes minimize negative social conditions and maximize prosocial and life-affirming conditions. The participants were 149 women—105 in the intervention group and 44 in the comparison group. Findings show significant changes among participants from pretest to posttest in (1) increasing motivation and decreasing depression (cultural realignment ), (2) increasing HIV/AIDS knowledge and self-worth (cognitive restructuring ), and (3) adopting less risky sexual practices (character development ). The African-centered approach demonstrates promise as a critical component in reducing and/or eliminating health disparities in the African American community.

The adoption of wraparound services among substance abuse treatment organizations serving criminal offenders: The role of a women-specific program

Women's substance abuse treatment outcomes are improved when women-specific needs are addressed through wraparound services, such as the provision of child care, employment assistance, or mental health counseling. Despite a higher prevalence of pre-incarceration drug use, women in prison report receiving fewer services than their male counterparts, suggesting they likely have greater service needs upon release. It is unknown whether community-based treatment organizations with a women-specific program offer more wraparound services than programs without a focus on women. This study uses data from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative's National Criminal Justice Treatment Practices Survey (NCJTPS), a nationally representative sample of community-based treatment programs serving predominantly criminal offenders ( n = 217). First, bivariate analyses identified differences between organizations with and without a women-specific program on the number of wraparound services adopted as well as organizational-level characteristics (i.e., organizational structure, personnel characteristics, culture, sources of information, and systems integration) related to their adoption. Second, Poisson regression was used to identify the organizational characteristics associated with the number of adopted wraparound services, with having a women-specific program being the primary covariate of interest. Results indicate larger organizations that utilized a greater number of treatment approaches and believed that treatment could reduce crime were more likely to offer a greater assortment of wraparound services. In an effort to improve behavioral treatment outcomes, it is imperative to examine organizational-level contextual factors that shape the availability of wraparound services for female offenders in community-based substance abuse treatment settings.

Adapting HIV Interventions for Women Substance Abusers in International Settings: Lessons for the Future

Many substance abusers are at risk for HIV due to their drug using and sexual behaviors. HIV interventions developed early on for substance abusers did not account for gender differences. Women's risk for HIV around the world makes them more vulnerable than men, yet their circumstances are different and adaptations to interventions are needed. The Women's CoOp, considered a best-evidence intervention, has been adapted with several groups of noninjecting women in South Africa and with injecting drug-using women in Russia. To reach vulnerable women in diverse settings to test interventions to reduce their risk, researchers also need to mentor the next generation of scientists to help stem the feminization of HIV among substance abusers.

Treatment Outcomes and Perceived Benefits: A Qualitative and Quantitative Assessment of a Women's Substance Abuse Treatment Program

This study examines outcomes of a women's substance abuse treatment program based on empowerment, choice, and client/therapist collaboration. The program was assessed through qualitative and quantitative research methods. The article includes extensive quotes from six client interviews as well as data from pre-post surveys of 50 women in the treatment program. Results show that the women felt they benefited from the collaborative treatment approach. Benefits to the women included feeling more empowered and learning to take responsibility for their lives. The importance of taking a broad view of recovery that includes ongoing evaluation of positive changes in various areas of the clients' lives is discussed.

Motivation Enhancement Therapy with pregnant substance-abusing women: Does baseline motivation moderate efficacy?

Some evidence suggests that motivational approaches are less efficacious – or even counter-productive – with persons who are relatively motivated at baseline. The present study was conducted to examine whether disordinal moderation by baseline motivation could partially explain negative findings in a previous study [Winhusen, T., Kropp, F., Babcock, D., Hague, D., Erickson, S.J., Renz, C., Rau, L., Lewis, D., Leimberger, J., Somoza, E., 2008. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. J. Subst. Abuse Treat. 35, 161–173]. Analyses also focused on the relative utility of the University of Rhode Island Change Assessment (URICA) scale, vs. a single goal question as potential moderators of Motivation Enhancement Therapy (MET). Participants were 200 pregnant women presenting for substance abuse treatment at one of four sites. Women were randomly assigned to either a three-session MET condition or treatment as usual (TAU). Generalized Estimating Equations (GEE) revealed no significant moderation effects on drug use at post-treatment. At follow-up, contrary to expectations, participants who had not set a clear quit goal at baseline were less likely to be drug-free if randomized to MET (OR = 0.48); participants who did set a clear quit goal were more likely to be drug-free if randomized to MET (OR = 2.53). No moderating effects were identified via the URICA. Disordinal moderation of MET efficacy by baseline motivation may have contributed somewhat to the negative results of the [Winhusen, T., Kropp, F., Babcock, D., Hague, D., Erickson, S.J., Renz, C., Rau, L., Lewis, D., Leimberger, J., Somoza, E., 2008. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. J. Subst. Abuse Treat. 35, 161–173] study, but in the opposite direction expected. A simple question regarding intent to quit may be useful in identifying persons who may differentially respond to motivational interventions. However, moderation effects are unstable, may be best identified with alternate methodologies, and may operate differently among pregnant women.

The Recovery Paradigm in Trauma Work: Approaches to Healing Psychiatric Disability and Substance Abuse in Women's Lives

This article addresses the importance of integrative treatment for women with psychiatric disabilities and substance issues, particularly those who have histories of abuse, violence, and trauma. Psychiatric rehabilitation, trauma, and cooccurring dimensions of treatment are discussed. Promising programs using consumer-oriented service models are highlighted.

Women's Past-Year Prostitution Status and Receipt of Substance Abuse Treatment Services

The study compared services received in substance abuse treatment programs by women who reported involvement in prostitution and by those who did not. Women (N=1,604) in a national study of substance abuse programs completed a structured interview assessing substance abuse, demographic characteristics, and past-year prostitution at program entry. At discharge, information was gathered on treatment modality (residential including inpatient, or outpatient), duration, and amounts of medical, mental health, and psychosocial services received during treatment. Analyses compared women involved in prostitution and those not involved. Women involved in prostitution were more likely to enter residential treatment. No differences between involvement groups were found in residential treatment duration, services received in residential treatment, or length of outpatient enrollment. In outpatient programs, women involved in prostitution received more psychosocial services. Substance abuse treatment programs appear responsive to the greater needs of women involved in prostitution. However, more research is needed on outcomes.

Influence of Personality Disorder Features on Social Functioning in Substance-Abusing Women Five Years after Compulsive Residential Treatment

Background: Personality disorders (PD) are related to negative outcome in substance abuse treatment, and in the general population, personality disorders are related to negative outcome in overall functioning. Little is known about the impact of PD on adjustment following substance abuse treatment. Methods: A cohort of 132 women was followed for 5 years after their index treatment episode in compulsory treatment. During treatment, patients were assessed with the SCID-II. At follow-up, patients were administered a timeline follow-back interview covering their functioning, including employment status over the years, and linked with hospital and criminal justice registers. Results: The impact of PD on functioning varied substantially between disorders and outcome domains. Conduct disorder alone was associated with criminal justice involvement, and conduct disorder and avoidant PD features were associated with unemployment. Dependent PD and obsessive-compulsive personality disorder features were positively associated with employment. Borderline PD features were associated with hospital admissions. Discussion: We discuss how strategies associated with various PDs may foster or hinder social adjustment in general and employment patterns in particular.

Integrated Group Treatment of Women's Substance Abuse and Trauma

ABSTRACT Substance abuse and trauma co-occur at very high rates among women in clinical settings. However, clinical programs that address both problems are rare, due in part to knowledge deficits and attitudinal barriers in both substance abuse and mental health treatment settings. We describe core competencies for clinicians who treat women with co-occurring substance abuse and trauma, and some of the challenges these patients pose to more traditional treatment models. We also outline an integrated approach to treating these women, which incorporates elements of the relational model, motivational interviewing, emotional regulation, and distress tolerance and seeking safety. Finally, we describe the application of this model to group treatment through a pair of clinical vignettes.

Drugs, alcohol and pregnant women—changing characteristics of women engaging with a specialist perinatal outreach addictions service

Pregnant substance misusers present an increased risk to themselves and the unborn child. The aim of this study was to investigate changes in the characteristics of women referred to a specialist perinatal addictions outreach service (1989-1991 versus 2002-2005). A cross-sectional audit of health records was conducted. Information was gathered for each woman who contacted the service (2002-2005). Data were compared to an earlier study in the same locality (1989-1991). A total of 167 pregnant substance-using women were referred between 2002 and 2005, of whom 126 made contact. The mean age was 30.2 years at 20.8 weeks' fetal gestation, with 76% not in addictions treatment, 32% from black or minority ethnic (BME) communities, 49% polysubstance users and 29% homeless. The primary substance used was illicit heroin (38%), followed by cocaine (24%). Compared to 1989-1991, there were significantly more pregnant women presenting at an older age, later gestation, with increased polysubstance use and a higher percentage of women from BME communities. This service was able to access vulnerable substance-abusing women with an altered pattern of substance use compared to over 10 years previously. However, improvements are needed for engaging all referred women and accessing women at an earlier gestation.

Trauma and psychosocial predictors of substance abuse in women impacted by HIV/AIDS.

The purpose of this study was to estimate the relative contributions of trauma, chronic stress burden, depression, anxiety, social support, and social undermining in predicting alcohol and drug abuse, and whether ethnicity moderated these relationships. A multi-ethnic sample of 288 HIV-positive and HIV-negative women was recruited. Multiple group path analysis indicated that greater drug dependence was associated with being HIV+, more depression, and higher chronic burden. Trauma was related only to anxiety. Also, greater alcohol dependence was associated with more depression and more social undermining, and these effects were moderated by ethnicity. African American and Latina women evidenced different relationships between depression, social support and social undermining. Depression, social support and social undermining served as intervening variables in influencing the relationships between the other psychosocial variables and drug and alcohol dependence. The implications of these findings for alcohol and drug abuse research and services are discussed.

Characteristics of Drug-Abusing Women With Children in Residential Treatment: A Preliminary Evaluation of Program Retention and Treatment Completion

ABSTRACT An ex post facto study was conducted to investigate treatment outcomes for 80 women and 168 children admitted into a residential substance-abuse treatment program. The results indicated childhood emotional neglect is a barrier for remaining in and completing treatment for African-American women with comorbid psychological disorders but not for those with crack cocaine dependent disorders. African-American women with comorbid psychological disorders were also three times more likely to dropout of treatment. In addition, there were relatively few differences for between drug-exposed and nonexposed children. However, the results indicated that children of substance-abusing women who completed treatment were more likely to have behavioral problems, to receive early intervention services, and to have mothers as legal guardians by the end of treatment. Implications for gender-specific interventions for African-American women and their children in residential treatment are discussed.

Understanding and Utilizing Parallel Processes of Social Interaction for Attachment-based Parenting Interventions

In an effort to meet both the parenting and treatment needs of substance-abusing women who are parents, residential drug treatment programs have been struggling to find the best approach. A qualitative-quantitative study of the parenting experience of mothers in residential drug treatment programs housing both mothers and their children found that relational processes characterized how these mothers perceived parenting as well as treatment. The findings presented the interplay and mutuality between a mother’s interactions (natural or facilitated) with the external social world that includes her child and those connected to the treatment facility and the internal formation of her sense of herself, her child, and others, along with the changes in both areas that took place in the facility. These findings lend important support to the use of attachment-based parenting interventions in residential drug treatment programs by drawing on these relational processes.

Substance Abuse Interventions for Parents Involved in the Child Welfare System

Summary As child welfare systems across the country face the problem of parental substance abuse, there is an increasing need to understand the types of treatment approaches that are most effective for substance-abusing parents in the child welfare system-the majority of whom are mothers. This structured review of the literature focuses on evidence related to two areas: (1) individual-level interventions designed to assist mothers and women in addressing their substance abuse problems, and (2) system-level interventions designed to improve collaboration and coordination between the child welfare system and the alcohol and other drug system. Overall, research suggests the following program components may be effective with substance-abusing women with children: (1) Women-centered treatment that involves children, (2) Specialized health and mental health services, (3) Home visitation services, (4) Concrete assistance, (5) Short-term targeted interventions, and (6) Comprehensive programs that integrate many of these components. Research also suggests that promising collaborative models between the child welfare system (CWS) and the alcohol and other drug (AOD) system typically include the following core elements: (1) Out-stationing AOD workers in child welfare offices, (2) Joint case planning, (3) Using official committees to guide collaborative efforts, (4) Training and cross-training, (5) Using protocols for sharing confidential information, and (6) Using dependency drug courts. Although more rigorous research is needed on both individual-level and system-level substance abuse interventions for parents involved in the child welfare system, the integration of individual-level interventions and system-level approaches is a potentially useful practice approach with this vulnerable population.

Substance Abuse Treatment, Anticipated Maternal Roles, and Reentry Success of Drug-Involved Women Prisoners

This article reports analyses of recidivism and relapse experiences of substance-abusing women inmates as they reenter the community. Outcomes are compared for women who completed a work-release therapeutic community program, women who entered but did not complete the program, and those who did not receive work-release therapeutic community treatment. Additionally, this article compares women who anticipated living with their children following release to those who did not have children with whom they expected to live. Women who completed the treatment program were more likely to remain arrest-free during the first 18 months following prison, and they used drugs less frequently. Women who expected to live with their minor children were significantly more likely to enter the treatment program, but maternal role expectations had no direct effect on reentry outcomes once treatment experience and background factors were controlled.

Organizational Change in a Perinatal Treatment Setting: Integration of Clinical Practice and Policies on Tobacco and Smoking Cessation

Perinatal smoking presents serious health risks to the fetus, mother, and child. Despite extensive evidence of risk and high rates of smoking among in-treatment perinatal women substance abusers, tobacco-related practice and policy change has not been widely transferred for application in drug abuse treatment programs for pregnant and parenting women. This qualitative study investigated the process of change and the resultant adoption of clinical policy and treatment innovation in a residential drug abuse treatment program that converted from tobacco-tolerant to tobacco-free with provision of smoking cessation services. Informed by the Organizational Readiness for Change Model, staff interviews and data analysis were conducted to examine program characteristics affecting adoption. An organizational climate of openness to change and the program's clarity of mission, expressed in perinatal-specific motivators for change, influenced the adoption of tobacco-related clinical practice and policy. Re-allocation of time, previously occupied by smoking behaviors, allowed for added promotion of maternal-child interaction and positive role-model ing for children.

Personality pathology and substance abuse in eating disorders: A longitudinal study

Substance abuse has been shown to predict poor outcome in eating disorder (ED) samples, and prior cross-sectional data on personality subtypes of EDs suggest that substance abuse is associated with dysregulated and possibly avoidant-insecure subtypes. This study investigates longitudinal associations between personality and substance use. Personality pathology and substance use were assessed in 213 individuals with anorexia nervosa and bulimia nervosa at baseline; substance use was assessed at regular follow-up intervals over a 9-year period. Of the five personality factors identified, the obsessional-sensitive and high-functioning types were negatively associated with substance abuse at baseline, while the behaviorally dysregulated type was positively associated with substance abuse at baseline. Longitudinal associations were observed, suggesting that obsessional-sensitive personality type was protective against the development of substance abuse. Longitudinal associations between the other personality types and substance abuse were nonsignificant after baseline substance abuse history was included as a covariate in the model. Substance use demonstrates cross-sectional associations with personality style, but substance abuse history appears to be the most important predictor of future substance abuse in women with eating disorders.

Substance abuse in pregnant women. Experiences from a special child welfare clinic in Norway

BackgroundSubstance abuse during pregnancy may harm the foetus and can cause neonatal abstinence syndrome. Exposure to alcohol and other substances can influence the child for the rest of its life. A special child welfare clinic was set up in 1994 in Kristiansand, Norway, targeting pregnant women with substance abuse problems in the county of Vest-Agder. Pregnancy is not an indication for opioid replacement therapy in Norway, and one of the clinic's aims was to support the drug dependent women through their pregnancy without any replacements. The object of this paper is to describe concurrent health and social problems, as well as the predictors for stopping drug abuse, in the clinic's user group.MethodsRetrospective cohort study. Data was gathered from the medical records of all 102 women seen in the clinic in the period between 1992 and 2002. The study includes 59 out of 60 women that were followed until their children were two years old or placed in alternative care, and a comparison group of twice the size. Both groups were presented with a questionnaire concerning both the pregnancy and health and socio-economic issues.ResultsFour (4.5 percent) of the women that completed their pregnancies did not manage to reduce their substance abuse. All the others reduced their substance abuse considerably. The odds ratio for stopping substance abuse within the first trimester was significantly associated with stopping smoking (O.R. 9.7) or being victims of rape (O.R. 5.3).ConclusionA low cost and low threshold initiative organised as a child welfare clinic may support women with substance abuse problems in their efforts to stop or reduce their substance abuse during pregnancy.

Mother – infant group psychotherapy as an intensive treatment in early interaction among mothers with substance abuse problems

In this article we present a novel method of outpatient care: brief, dynamic mother – infant group psychotherapy with mothers who have substance use problems. In this therapy, substance abuse treatment is part of mental health and parenting interventions. The focus is on preventing disturbance in the mother – infant relationship in this high-risk group. The clinical material is taken from 16 mother – infant dyads from six psychotherapy groups, which met weekly over six months from pregnancy to post-partum. The therapy process consists of 20 – 24 three-hour sessions. The basis of the therapy is to offer mothers experience of care, which they, in turn, can give to their infants. In this paper we analyse the core therapeutic elements that may contribute to better mothering and child development. They involve: the group providing a symbolic maternal lap, and the meeting of the mothers' and the infants' needs. It is hoped that this may offer the mothers a new experience within which to reappraise their early memories. This may help prevent them from projecting traumatic past experiences onto their infants. Our analyses show that in the therapy, mothers, feeling safe within the group, gradually experienced pleasure with their infants and their peers. These effects, according to the mothers, were the most noticeable. Brief dynamic mother – infant group psychotherapy seems to be a promising form of treatment for those substance-abusing women able to commit to outpatient care and examine the causes of their drug dependence. The groups may also be used as a diagnostic tool to detect problems in early mother-baby interaction.