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Schiff DM, Li WZM, Work EC, Goullaud L, Vazquez J, Paulet T, Dorfman S, Selk S, Hoeppner BB, Wilens T, Bernstein JA, Diop H. Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209346. [PMID: 38789329 DOI: 10.1016/j.josat.2024.209346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Racial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. METHODS Peer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. RESULTS The study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. CONCLUSION Pregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America; Division of Newborn Medicine, MassGeneral for Children, Boston, MA, 02114, United States of America.
| | - William Z M Li
- Harvard Medical School, Boston, MA, United States of America
| | - Erin C Work
- University of California, Schools of Public Health and Social Welfare, Los Angeles, CA, United States of America
| | - Latisha Goullaud
- Institute for Health and Recovery, Watertown, MA, United States of America
| | | | - Tabhata Paulet
- Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Sarah Dorfman
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America
| | - Sabrina Selk
- National Network of Public Health Initiatives, Washington, DC, United States of America
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Timothy Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Judith A Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, MA, 02108, United States of America
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Haynes CJ, Beck AK, Wells M, Hatton EL, Kelly PJ, Tan WJ, Larance B. Women and opioid use disorder treatment: A scoping review of experiences, use of patient-reported experience measures, and integration of person-centred care principles. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104520. [PMID: 39003893 DOI: 10.1016/j.drugpo.2024.104520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Patient-reported experience measures (PREMs) are an important aspect of assessing and improving women's experiences of person-centred care during treatment for Opioid Use Disorder (OUD). This scoping review aimed to 1) examine the extent, type, and characteristics of evidence regarding women's OUD treatment experiences, and 2) describe the extent to which PREMs and person-centred care principles are incorporated within research methods. METHODS Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a scoping review to identify peer-reviewed articles on women's OUD treatment experiences. Data were extracted from 39 included studies and synthesised based on study design, method of assessment/analysis (including use of PREMs), key findings, and the integration of person-centred care principles. RESULTS Analysis of included studies revealed a predominance of qualitative research focused on women's experiences of pharmacological OUD treatment (methadone and/or buprenorphine) in Western countries. Women in these studies reported predominantly negative or mixed experiences of treatment. Few studies used validated PREMs and there was a lack of direct assessment or focus on recognised person-centred care principles. However, common categories of outcomes/findings identified in results across studies broadly aligned with person-centred care principles (e.g., fast access to reliable healthcare, effective treatment by trusted professionals), emphasising their applicability to women's experiences of treatment. CONCLUSIONS Although there has been an increased focus on women's experiences of treatment for OUD in recent years, results highlighted room for improvement regarding the systematic and comprehensive assessment of women's experiences across different contexts. Given the often negative or mixed experiences reported by women, an increased focus on assessing service provision through a person-centred care lens (including utilising PREMs) may allow for service improvements or adaptations targeted towards the needs and experiences of women.
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Affiliation(s)
- Chloe J Haynes
- School of Psychology, University of Wollongong, Australia.
| | - Alison K Beck
- School of Psychology, University of Wollongong, Australia
| | - Megan Wells
- School of Psychology, University of Wollongong, Australia
| | - Emma L Hatton
- School of Psychology, University of Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Australia
| | - Wan Jie Tan
- School of Psychology, University of Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Australia
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Chen CY, Hsieh TW, Rei W, Huang CH, Wang SC. Association between socioeconomic and motherhood characteristics with receiving community-based treatment services among justice-involved young female drug users: a retrospective cohort study in Taiwan. Harm Reduct J 2024; 21:109. [PMID: 38840179 PMCID: PMC11151603 DOI: 10.1186/s12954-024-01010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/23/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Drug-involved individuals who contact treatment services in Taiwan are mostly driven by criminal justice systems either as an alternative or adjunct to criminal sanctions for a drug offence. With a focus on justice-involved young female drug users, the present study examines the extent to which socioeconomic and motherhood characteristics are associated with receiving deferred prosecution, a scheme diverting drug offenders to community-based addiction treatment. METHODS We identified a cohort of 5869 women under the age of 30 arrested for using Schedule II drugs (primarily amphetamine-like stimulants) from the 2011-2017 National Police Criminal Records in Taiwan. Information concerning socioeconomic characteristics, pregnancy and live birth history, and deferred prosecution was obtained through linkage with the 2006-2019 National Health Insurance, birth registration, and deferred prosecution datasets. Multinomial logistic regression was used to evaluate the association with stratification by recidivism status. RESULTS Within six months of arrest, 21% of first-time offenders (n = 2645) received deferred prosecution and 23% received correction-based rehabilitation; the corresponding estimates for recidivists (n = 3224) were 6% and 15%, respectively. Among first-time offenders, low/unstable income was associated with lower odds of deferred prosecution (adjusted odds ratio [aOR] = 0.71; 95% CI: 0.58, 0.88). For recidivists, those with low/unstable income (aOR = 1.58) or unemployment (aOR = 1.58) had higher odds of correction-based rehabilitation; being pregnant at arrest was linked with reduced odds of deferred prosecution (aOR = 0.31, 95% CI: 0.13, 0.71) and correction-based rehabilitation (aOR = 0.50, 95% CI: 0.32, 0.77). CONCLUSIONS For the young women arrested for drug offences, disadvantaged socioeconomic conditions were generally unfavored by the diversion to treatment in the community. Childbearing upon arrest may lower not only the odds of receiving medical treatment but also correctional intervention. The criminal prosecution policy and process should be informed by female drug offenders' need for treatment and recovery.
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Affiliation(s)
- Chuan-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.
| | - Tan-Wen Hsieh
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Wenmay Rei
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
| | | | - Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
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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] [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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Long FC, Jepsen KS. Situating Stigma: An Ethnographic Exploration of How Stigma Arises in Interactions at Different Stages of People's Drug Use Journeys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6894. [PMID: 37835164 PMCID: PMC10572790 DOI: 10.3390/ijerph20196894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
The association between stigma and drug use has been widely researched. However, to fully understand the nuances of stigma, as experienced by people who use drugs (PWUD), it is argued that we must look at the situations within which stigma is encountered. To obtain an 'up close' look at situated stigma, data are drawn from two ethnographic studies-one set in a homeless hostel in the South of England and the other at a substance use service in South Wales. This article explores how PWUD experience and negotiate stigma at different stages of their drug use. We identify three notable themes across these settings. Firstly, 'othering' occurs in two distinct ways, by othering the past self or distancing from other PWUDs. Secondly, 'drug exceptionalism' is used to justify an individual's drug use and express frustration at the associations between legality, social harm, and stigma. Finally, in 'negotiating identities', individuals present alternate identity roles to either demonstrate clashes in identity or to promote a conventionally positive sense of self. This article contributes to the existing literature on stigma, firstly, by comparing the stigma management strategies of those in active drug use and recovery and, secondly, by using this to highlight the importance of ethnography and situated stigma within this field.
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Darlington CK, Clark R, Jacoby SF, Terplan M, Alexander K, Compton P. Outcomes and experiences after child custody loss among mothers who use drugs: A mixed studies systematic review. Drug Alcohol Depend 2023; 251:110944. [PMID: 37713979 DOI: 10.1016/j.drugalcdep.2023.110944] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Mothers who use drugs are more likely to experience child custody loss than mothers who do not use drugs. The negative impact of removal on children has been well characterized in current literature while less is known about the impact of custody loss on mothers. The purpose of this mixed studies systematic review is to describe the state of science on the maternal outcomes and experiences after child custody loss among mothers who use drugs. METHODS PubMed, PsycINFO, CINAHL, and Social Work Abstract databases were systematically searched between June 2022 to January 2023. Article eligibility criteria centered on the outcomes and experiences of mothers who use drugs after losing child custody. Studies were analyzed using results-based convergent synthesis methodology for mixed studies reviews. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A visual synthesis model was derived from combined results across all studies. RESULTS Of 2434 articles screened, 22 relevant scientific articles were selected for inclusion. Longitudinal, cohort studies (n=4) and a cross-sectional study (n=1) identified positive associations between custody loss and poorer mental health, increased drug use and overdose risk, less treatment engagement, and worsened social factors. Qualitative studies (n=17) identified themes that described re-traumatization after child custody loss and the development of coping mechanisms through identity negotiation. CONCLUSION Our findings indicate that child custody loss associated with drug use may exacerbate trauma and worsen maternal health. Immediate implications are provided for maternal health policy and practice in healthcare, child welfare, and legal professions.
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Affiliation(s)
- Caroline K Darlington
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States.
| | - Rebecca Clark
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States; Pennsylvania Hospital, Philadelphia, PA, United States
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | | | - Peggy Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
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West BS, Choi S, Terplan M. In our responses to the overdose epidemic, we cannot forget pregnant and postpartum people. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104153. [PMID: 37572587 DOI: 10.1016/j.drugpo.2023.104153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
In 2021, there were over 100,000 drug overdose deaths in the United States (US). Death rates have increased faster among women than men, particularly among Black and Indigenous people. Although drug overdose is a leading cause of pregnancy-associated deaths, birthing people are rarely emphasized in discussions of overdose and research and services remain limited. Data show increases in drug use and deaths among women of child-bearing age, with risks continuing in the postpartum period. Harms experienced by birthing people who use drugs occur in the context of broader inequities in maternal morbidity and mortality that lead to disparate reproductive health outcomes. Shared structural antecedents (e.g. intersecting sexism and racism, stigma, and punitive policies) underlie overlapping epidemics of overdose and maternal morbidity and mortality. Here we discuss the unique challenges placed on birthing people who use drugs and make recommendations on how to mitigate harms by improving access to and delivery of quality care and addressing unjust policies and practices. We highlight the need for integrated health services, clearer guidelines rooted in equity, and the need for changes to policy and practice that support rather than punish. To better serve individuals and families impacted by substance use, we need multilevel solutions that advance gender equity and racial justice to reshape and/or dismantle the systems that undergird oppression.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, United States.
| | - Sugy Choi
- Department of Population Health, New York University Langone Health, United States
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SCHERZ CHINA, BURRAWAY JOSHUA. Keeping it in the family. AMERICAN ETHNOLOGIST 2022. [DOI: 10.1111/amet.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- CHINA SCHERZ
- Department of Anthropology University of Virginia
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McGovern R, Newham J, Addison M, Hickman M, Kaner E. The effectiveness of psychosocial interventions at reducing the frequency of alcohol and drug use in parents: findings of a Cochrane Review and meta-analyses. Addiction 2022; 117:2571-2582. [PMID: 35188313 PMCID: PMC9543590 DOI: 10.1111/add.15846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Parental substance use is a major public health and safeguarding concern. There have been a number of trials examining interventions targeting this risk factor. We aimed to estimate the effectiveness of psychosocial interventions at reducing parental substance use. DESIGN We used systematic methods to identify trials; pooling data using a random-effects model. Moderator analyses examined influence of parent gender, presence of child in treatment and intervention type. SETTING No restrictions on setting. PARTICIPANTS Substance using parents of children below the age of 21 years. INTERVENTIONS Psychosocial interventions including those that targeted drug and alcohol use only, and drug and alcohol use in combination with associated issues. MEASUREMENTS Frequency of alcohol use and frequency of drug use. FINDINGS We included eight unique studies with a total of 703 participants. Psychosocial interventions were more effective at reducing the frequency of parental alcohol use than comparison conditions at 6-month [standardized mean difference (SMD) = - 0.32, 95% confidence interval (CI) = -0.51 to -0.13, P = 0.001] and 12-month follow-up (SMD = -0.25, 95% CI = -0.47 to -0.03, P = 0.02) and frequency of parental drug use at 12 months only (SMD = -0.21, 95% CI = -0.41 to -0.01, P = 0.04). Integrated interventions which combined both parenting and substance use targeted components were effective at reducing the frequency of alcohol use (6 months: SMD = -0.56, 95% CI = -0.96 to -0.016, P = 0.006; 12 months: SMD = -0.42, 95% CI = -0.82 to -0.03, P = 0.04) and drug use (6 months: SMD = -0.39, 95% CI = -0.75 to -0.03, P = 0.04; 12 months: SMD = -0.43, 95% CI = -0.80 to -0.07, P = 0.02). Interventions targeting only substance use or parenting skills were not effective at reducing frequency of alcohol or drug use at either time-point. CONCLUSION Psychosocial interventions should target both parenting and substance use in an integrated intervention.
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Affiliation(s)
- Ruth McGovern
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - James Newham
- Faculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
| | | | - Matt Hickman
- Population Health SciencesBristol UniversityBristolUK
| | - Eileen Kaner
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
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Gunn A. Stigma, surveillance, and wounded healing: Promoting a critical ethics of care in research with formerly incarcerated Black women. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3438-3454. [PMID: 35334119 PMCID: PMC9464655 DOI: 10.1002/jcop.22845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Black women experience myriad challenges post incarceration, from managing stigma within social relationships to navigating surveillance when interfacing with service systems. It is these challenges that also make them vulnerable participants in community-based research. With many of potential research harms not falling under the guidance of Institutional Review Boards, it is critical to explore how communities experiencing stigma and surveillance perceive their engagement in research. As such, this study explores how 28 justice-involved Black women experience the research process. Findings reveal that participants view the research context as spaces for reflecting on surveillance and stigma in ways that promote self-recovery. Moreover, they perceive the interview process to allow them to envision identities as wounded healers who use their pasts as mechanisms to help others. The study's implications for anti-oppressive inquiry underscore the need for researchers to employ ethical care and justice frameworks that center compassion, reflexivity, and equity throughout the process.
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Affiliation(s)
- Alana Gunn
- Department of Criminology, Law, and JusticeUniversity of Illinois at ChicagoChicagoIllinoisUSA
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Baumgart M, Chiarello E, Slay T. Reluctant Saviors: Professional ambivalence, cultural imaginaries, and deservingness construction in naloxone provision. Soc Sci Med 2022; 309:115230. [DOI: 10.1016/j.socscimed.2022.115230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022]
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Holeksa J. Dealing with low access to harm reduction: a qualitative study of the strategies and risk environments of people who use drugs in a small Swedish city. Harm Reduct J 2022; 19:23. [PMID: 35246162 PMCID: PMC8894830 DOI: 10.1186/s12954-022-00602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The development of harm reduction has been limited in many areas of Sweden. This study aims to understand the implications that this has for the life circumstances and risk management of people who use drugs in areas of low access. METHODS Eleven qualitative, semi-structured interviews were undertaken with people who use drugs in a small urban centre with no needle and syringe exchange program (NSP) or Housing First policy. RESULTS Participants reported many solutions to lack of NSP, including travel to an external NSP, creating bridging distribution networks, stealing, borrowing, reusing, ordering online, and smuggling injection equipment. They were at risk of having their equipment confiscated by police. Participants were mostly homeless, and to address exclusion from housing services, were forced to frequently find new temporary solutions, sheltering themselves in public places, with friends, in cars, among others. Participants felt the lack of services reflected stigmatized notions of drug use and heightened their exclusion from general society. For example, they avoided accessing other health care services for fear of discrimination. These issues caused high levels of stress and anxiety, in addition to serious risk for many somatic and psychological health conditions, including HIV and HCV transmission. CONCLUSION Lack of harm reduction services placed a great burden on study participants to develop strategies due to gaps in official programming. It also contributes to a vicious cycle of exclusion from services. The implementation of such evidence-based programs will reduce this burden, as well as provide the indirect, symbolic effect of inclusion.
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Affiliation(s)
- Julie Holeksa
- Department of Social Work, Faculty of Health and Society, Malmö University, Citadellsvägen 7, 211 18, Malmö, Sweden.
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Tsuda-McCaie F, Kotera Y. A qualitative meta-synthesis of pregnant women's experiences of accessing and receiving treatment for opioid use disorder. Drug Alcohol Rev 2022; 41:851-862. [PMID: 35038366 DOI: 10.1111/dar.13421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
ISSUES Addressing opioid use disorder (OUD) among pregnant women is of growing importance, and substance use treatment positively impacts outcomes for mother and baby. Understanding substance use treatment experiences is important to improve access, and retention, and no review or synthesis of research addressing the treatment experiences of pregnant women exists. APPROACH Thus, a qualitative meta-synthesis was conducted, which investigated the psychological motivators and barriers of pregnant women with OUD trying to access treatment and their perceptions of treatment. KEY FINDINGS A total of 3844 articles were retrieved from the literature search. Nine articles met eligibility criteria, were appraised, then synthesised using a comparative thematic approach. Four themes: (i) Embodied Experiences; (ii) Institutional Pressures; (iii) Social Context; and (iv) Reconstructing Selves; indicate that women with OUD are motivated to engage in treatment to pursue the safety and custody of the unborn baby and to pursue and enact the changes necessary to claim 'normal' parenthood status. Pregnant women describe psychological and relational barriers to engaging in treatment, including anxieties about the baby's health, fears of authorities' involvement, stigma and experiencing relationships with treatment providers as constrictive or invalidating. IMPLICATIONS Identity theory's concepts of identity verification, closed environments and master status identities illuminate the findings. Implications include recognising the salience of bodily experiences, providing medication-assisted treatment support groups and promoting validating relationships in treatment using strengths-based approaches. CONCLUSIONS Pregnant women face unique psychological challenges in accessing and engaging in substance use treatment for OUD.
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Affiliation(s)
| | - Yasuhiro Kotera
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Pedruzzi RA, Hamilton O, Hodgson HHA, Connor E, Johnson E, Fitzpatrick J. ‘We do what we can as soon as we can’ Alcohol and Other Drug workforce perspectives on preventing and responding to prenatal alcohol exposure. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2020.1843600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rebecca A. Pedruzzi
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | | | | | - Elizabeth Connor
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | | | - James Fitzpatrick
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
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To SM, Yan MW, Lau CD. Meaning-Making of Motherhood Among Mothers With Substance Abuse Problems. Front Psychol 2021; 12:679586. [PMID: 34566761 PMCID: PMC8457144 DOI: 10.3389/fpsyg.2021.679586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
Previous literature has documented the unique challenges encountered by mothers with substance abuse problems, which may hinder the ability to fulfill parenting responsibilities. Since there is evidence suggesting the engagement in meaning-making processes can help individuals reinterpret their transitions into parenthood and cope with parental stress, this study examined the meaning-making processes of motherhood among mothers with substance abuse problems. Sixteen Hong Kong Chinese mothers with a history of substance abuse were purposively selected and invited to narrate their life and maternal experiences in individual interviews. Based on the meaning-making model in the context of stress and coping, whereby global meaning refers to orienting system of an individual and situational meaning refers to the meaning one attributes to a particular situation, the global and situational meanings of participants related to motherhood and substance use, and their reappraised meanings in response to the discrepancies between global and situational meanings were analyzed. Using thematic analysis, the results showed that when faced with an internal conflict between global and situational meanings induced by substance abuse, most participants engaged in the meaning-making process of assimilation. Rather than changing their inherent parental beliefs and values, most participants adjusted their appraisals toward the situation, and hence made changes in their cognitions or behaviors such as making efforts to quit substance use or reprioritizing their parenting responsibilities. The analysis further revealed that being a mother provided a significant source of meaning to the participants in confronting highly stressful mothering experiences induced by substance abuse. Altogether, the findings suggest that a meaning-making approach may have benefits and implications for helping this population reorganize their self-perceptions, gain a clearer sense of future direction in motherhood, and achieve more positive life and parenting outcomes.
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Affiliation(s)
- Siu-ming To
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR China
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Collinson B, Hall L. The role of social mechanisms of change in women’s addiction recovery trajectories. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1929077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Beth Collinson
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, England
| | - Lauren Hall
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, England
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Boeri M, Lamonica AK, Turner JM, Parker A, Murphy G, Boccone C. Barriers and Motivators to Opioid Treatment Among Suburban Women Who Are Pregnant and Mothers in Caregiver Roles. Front Psychol 2021; 12:688429. [PMID: 34276513 PMCID: PMC8280285 DOI: 10.3389/fpsyg.2021.688429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/02/2021] [Indexed: 12/29/2022] Open
Abstract
Women of childbearing age who misuse opioids are a particularly vulnerable population, and their barriers to treatment are unique because of their caregiver roles. Research on treatment for opioid use generally draws from urban and rural areas. This study fills a gap in research that focuses on barriers and motivators to opioid treatment in suburban areas. The aim of this study was to give voice to suburban pregnant women and mothers caring for children while using opioids. Ethnographic methods were used for recruitment, and 58 in-depth interviews were analyzed using a modified grounded theory approach. Barriers to medication-assisted treatment (MAT) included stigma, staff attitudes, and perceptions the women had about MAT treatment. Barriers associated with all types of treatment included structural factors and access difficulties. Relationships with partners, friends, family, and providers could be barriers as well as motivators, depending on the social context of the women’s situation. Our findings suggest increasing treatment-seeking motivators for mothers and pregnant women by identifying lack of resources, more empathetic consideration of social environments, and implementing structural changes to overcome barriers. Findings provide a contemporary understanding of how suburban landscapes affect mothers’ treatment-seeking for opioid dependence and suggest the need for more focus on emotional and structural resources rather than strict surveillance of women with opioid dependence who are pregnant or caring for children.
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Affiliation(s)
- Miriam Boeri
- Department of Sociology, Bentley University, Waltham, MA, United States
| | - Aukje K Lamonica
- Department of Public Health, Southern Connecticut State University, New Haven, CT, United States
| | - Jeffrey M Turner
- Department of Public Health, Southern Connecticut State University, New Haven, CT, United States
| | - Amanda Parker
- Department of Sociology, Bentley University, Waltham, MA, United States
| | - Grace Murphy
- Department of Sociology, Bentley University, Waltham, MA, United States
| | - Carly Boccone
- Department of Sociology, Bentley University, Waltham, MA, United States
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Attending to Aliveness: Self-Harm, Body and World in Contexts of Urban Homelessness. Cult Med Psychiatry 2021; 45:282-311. [PMID: 33030644 DOI: 10.1007/s11013-020-09687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The DSM-5 proposes that self-harm be recognized as a diagnostic category of mental disease, compared to its previous definition as a behavioral symptom. Based on fieldwork in London, I challenge this proposal by exploring the life-history of a homeless sex-worker and substance-user who practices self-cutting. By bringing phenomenological anthropology into conversation with psychoanalytic theory, this article provisionally re-conceptualizes self-harm as an ethics of self-reparation and existential affirmation in the face of extreme precarity. Approached as an agentive practice through which human beings reclaim "somethingness" by altering their bodily conditions, we can conceive self-harm in a way that is attentive to the situational conditions that shape existential pain, instead of reaching straight for the diagnostic toolkit. In taking self-harm as simultaneously a reaction to and a reflection on existential crisis-rather than a sui generis disorder-this paper situates such practices as a pluralized condition-of-world rather than a bounded pathology-of-mind.
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McGovern R, Newham JJ, Addison MT, Hickman M, Kaner EF. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database Syst Rev 2021; 3:CD012823. [PMID: 33723860 PMCID: PMC8094759 DOI: 10.1002/14651858.cd012823.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Parental substance use is a substantial public health and safeguarding concern. There have been a number of trials of interventions relating to substance-using parents that have sought to address this risk factor, with potential outcomes for parent and child. OBJECTIVES To assess the effectiveness of psychosocial interventions in reducing parental substance use (alcohol and/or illicit drugs, excluding tobacco). SEARCH METHODS We searched the following databases from their inception to July 2020: the Cochrane Drugs and Alcohol Group Specialised Register; CENTRAL; MEDLINE; Embase; PsycINFO; CINAHL; Applied Social Science (ASSIA); Sociological Abstracts; Social Science Citation Index (SSCI), Scopus, ClinicalTrials.gov, WHO ICTRP, and TRoPHI. We also searched key journals and the reference lists of included papers and contacted authors publishing in the field. SELECTION CRITERIA We included data from trials of complex psychosocial interventions targeting substance use in parents of children under the age of 21 years. Studies were only included if they had a minimum follow-up period of six months from the start of the intervention and compared psychosocial interventions to comparison conditions. The primary outcome of this review was a reduction in the frequency of parental substance use. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%). Half of the studies (n = 11; 50%) compared the experimental intervention to usual treatment. Other comparison groups were minimal intervention, attention controls, and alternative intervention. Eight of the included studies reported data relating to our primary outcome at 6- and/or 12-month follow-up and were included in a meta-analysis. We investigated intervention effectiveness separately for alcohol and drugs. Studies were found to be mostly at low or unclear risk for all 'Risk of bias' domains except blinding of participants and personnel and outcome assessment. We found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) -0.32, 95% confidence interval (CI) -0.51 to -0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) -0.25, 95% CI -0.47 to -0.03; 4 studies, 366 participants). We found a significant reduction in frequency of use at 12 months only (SMD -0.21, 95% CI -0.41 to -0.01; 6 studies, 514 participants, moderate-quality evidence). We examined the effect of the intervention type. We found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD -0.35, 95% CI -0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD -0.09, 95% CI -0.86 to 0.61; 1 study, 34 participants) or drug use (6 months: SMD 0.01, 95% CI -0.42 to 0.44; 2 studies; 87 participants and 12 months: SMD -0.08, 95% CI -0.81 to 0.65; 1 study, 32 participants). A parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD -0.21, 95% CI -0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD -0.11, 95% CI -0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence) or frequency of drug use (6 months: SMD 0.10, 95% CI -0.11 to 0.30; 4 studies; 407 participants, moderate-quality evidence and 12 months: SMD -0.13, 95% CI -0.52 to 0.26; 3 studies; 351 participants, very low-quality evidence). Parents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD -0.56, 95% CI -0.96 to -0.16 and 12 months: SMD -0.42, 95% CI -0.82 to -0.03; 2 studies, 113 participants) and drug use (6 months: SMD -0.39, 95% CI -0.75 to -0.03 and 12 months: SMD -0.43, 95% CI -0.80 to -0.07; 2 studies, 131 participants). However, this evidence was of low quality. Psychosocial interventions in which the child was present in the sessions were not effective in reducing the frequency of parental alcohol or drug use, whilst interventions that did not involve children in any of the sessions were found to reduce frequency of alcohol misuse (6 months: SMD -0.47, 95% CI -0.76 to -0.18; 3 studies, 202 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.00; 2 studies, 147 participants) and drug use at 12-month follow-up (SMD -0.34, 95% CI -0.69 to 0.01; 2 studies, 141 participants). The quality of this evidence was low. Interventions appeared to be more often beneficial for fathers than for mothers. We found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD -0.27, 95% CI -0.50 to -0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD -0.43, 95% CI -0.78 to -0.09; 2 studies, 147 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.00; 2 studies, 147 participants) and drug use (6 months: SMD -0.31, 95% CI -0.66 to 0.04; 2 studies, 141 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.01; 2 studies, 141 participants). AUTHORS' CONCLUSIONS We found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol and drugs. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. Whilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. We found low-quality evidence from few studies that interventions involving children are not beneficial.
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Affiliation(s)
- Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James J Newham
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Michelle T Addison
- Faculty of Arts, Design and Social Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eileen Fs Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Andersson C, Wincup E, Best D, Irving J. Gender and recovery pathways in the UK. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1852180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Catrin Andersson
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, UK
| | | | - David Best
- College of Business, Law and Social Science, University of Derby, One Friar Gate Square, Derby, UK
| | - Jamie Irving
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, UK
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21
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Owczarzak J, Kazi AK, Mazhnaya A, Alpatova P, Zub T, Filippova O, Phillips SD. "You're nobody without a piece of paper:" visibility, the state, and access to services among women who use drugs in Ukraine. Soc Sci Med 2020; 269:113563. [PMID: 33309442 DOI: 10.1016/j.socscimed.2020.113563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023]
Abstract
In Ukraine, women constitute a third of all new HIV infections, and injection drug use accounts for nearly half of HIV infections among women. Women who use drugs (WWUD) often have diminished access to drug use treatment, HIV care, and other health and social services or underutilize women-specific services such as maternal health services. While interpersonal and contextual factors diminish access to and utilization of services among WWUD, rules, processes, and bureaucratic structures also systematically exclude women from accessing services and resources. Institutions, bureaucratic processes, and instruments of legibility such as documents regulate who can and cannot access services and raise questions about "deservingness." In this paper, we use the lens of bureaucracy to explore paperwork as a form of structural violence through its production of "legible" citizens, often through reinforcement of gender stereotypes and moral narratives of deservingness. Between December 2017 and October 2018, we interviewed 41 medical and social service providers and 37 WWUD in two Ukrainian cities. Our analysis revealed that requirements for internal passports and residency permits-the primary state apparatus through which rights to services are granted in Ukraine-compelled participants to continually render themselves visible to the state in order to receive services, despite financial, logistical and other challenges that undermined women's ability to obtain documents. These requirements exposed them to new forms of stigma and exclusion, such as reduced opportunities for employment and losing custody of children. Nongovernmental organizations, due to funding cuts, curtailed direct services such as support groups but became liaisons between clients and the state. They enforced new narratives of deservingness, such as the ability to define "good" behavior or reward social relationships with agency staff. Ukraine's current reforms to social safety net institutions present an opportunity to interrogate underlying assumptions about spheres of responsibility for the country's most marginalized and stigmatized groups.
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Affiliation(s)
- Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House Room 739, Baltimore, Maryland, USA.
| | - Asiya K Kazi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, Maryland, 21205-1996, USA.
| | - Alyona Mazhnaya
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health,; 624 N. Broadway, Baltimore, MD, 21205-1996, USA.
| | - Polina Alpatova
- Institute of Social-Humanitarian Research, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, 61022, Ukraine.
| | - Tatyana Zub
- Department of Sociology, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, 61022, Ukraine.
| | - Olga Filippova
- Department of Sociology, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, 61022, Ukraine.
| | - Sarah D Phillips
- Department of Anthropology, Indiana University, Student Building 130, 701 E. Kirkwood Ave, Bloomington, IN 47405, USA.
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Heimdahl Vepsä K. Parents' experiences of substance use problems, parenthood, and recovery within the 12-step movement. NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 37:576-591. [PMID: 35308645 PMCID: PMC8899279 DOI: 10.1177/1455072520941992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/04/2020] [Indexed: 11/25/2022] Open
Abstract
Aim: The aim of this study was to explore how people with earlier substance use problems narrated their experiences of becoming and being parents. The literature in this area is limited. Method: The study participants, all active members of the 12-step movement, were interviewed about their experiences of substance use problems, recovery, and parenthood. The data were analysed using a narrative theoretical framework seeking to answer the questions of how the parents narrate their experiences of parenthood within the frame of a classic 12-step storyline and how they present themselves as parents through these narratives. Results: The results show that, on the whole, the narratives conformed to a classic 12-step storyline. For example, the narratives’ turning points were often built up around experiences of “hitting rock bottom”, when the negative consequences of substance use culminated in dramatic events forcing the narrators to see the seriousness of their problems. At the same time the motivational potential of having or expecting (or wishing for future) children was downplayed by several study participants, who instead said that positive driving forces such as human relationships were not enough to break through their denial of their substance use problems. Finally, all study participants described how the process of working towards sobriety had been a transformative experience through which they had come in better contact with their feelings and emotions, and they defined this as an important resource in their everyday lives as parents. Conclusion: The results showed that the parents, when narrating their experiences within the frames of a classic 12-step storyline, were also able to present themselves as competent parents, empowered rather than stigmatised by their earlier experiences.
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Henriques CMDG, Botelho MAR, Catarino HDCP. Phenomenology as a method applied to nursing science: research study. CIENCIA & SAUDE COLETIVA 2020; 26:511-519. [PMID: 33605329 DOI: 10.1590/1413-81232021262.41042020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/02/2020] [Indexed: 11/22/2022] Open
Abstract
In a more inductive or deductive way, several theorists have problematized about nursing care in which they seek to clarify nursing science focus of attention. The phenomenological perspective allows us to perceive the human lived experience and unveil their meaningful understanding as a person. Stemming from the question 'What is the lived transition experience of the maternal role of women with problems of addiction to psychoactive substances, from pregnancy to the first year of the child's life?' This research distills the core principles of a qualitative research, with a phenomenological and interpretative design, with the objective of understanding the lived experience transition process of the maternal role of women with problems psychoactive substances addition. The research does not only reveal the contribution of phenomenological studies in the development of nursing science, but also enhances the living experience of women with addiction problems to psychoactive substances, during pregnancy, childbirth, postpartum and the first year of their children's life, enabling nurses to develop specific interventions to dealt with this problematic issue under study.
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Affiliation(s)
- Carolina Miguel da Graça Henriques
- Escola Superior de Saúde, Center for Innovative Care and Health Technology (ciTechCare), Instituto, Politécnico de Leiria. R. Gen. Norton de Matos Apartado 4133. 2411-901 Leiria Portugal. carolina.henriques@ ipleiria.pt
| | | | - Helena da Conceição Pereira Catarino
- Escola Superior de Saúde, Center for Innovative Care and Health Technology (ciTechCare), Instituto, Politécnico de Leiria. R. Gen. Norton de Matos Apartado 4133. 2411-901 Leiria Portugal. carolina.henriques@ ipleiria.pt
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Gunn A, Miranda Samuels G. Promoting Recovery Identities Among Mothers with Histories of Addiction: Strategies of Family Engagement. FAMILY PROCESS 2020; 59:94-110. [PMID: 30556171 DOI: 10.1111/famp.12413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Changes in identity are critical to managing transitions to recovery from substance and alcohol addictions. Identity change is particularly important for mothers, whose recovery processes are often in the context of critical but complex family relationships and societal expectations. But research and practice often underestimate the relational dimensions that promote or inhibit changes in one's identity during recovery. Here we analyze data from a study that involved interviews with 30 formerly incarcerated women participating in a community-based substance use treatment program in the Midwest. Drawing from Constructivist Grounded Theory Methods, our analysis identified three factors shaping levels of engagement with family members: (1) the relational consequences of a shared past; (2) ascribing permanence to the old identity of "addict" versus the ability to see women's capacity to change; and (3) the current provision of caregiving support to participants' children. Our analysis supports and extends existing research by highlighting how family can both promote and inhibit a recovery identity process. We discuss potential implications for theorizing "recovery" and "identity" as relational and identify key elements to support practices more attuned to the hidden complexity of family support.
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Affiliation(s)
- Alana Gunn
- Department of Criminology, Law, and Justice, University of Illinois at Chicago, Chicago, IL
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Helme DW, Egan KL, Lukacena KM, Roberson L, Zelaya CM, McCleary MS, Wolfson M. Encouraging Disposal of Unused Opioid Analgesics in Appalachia. DRUGS (ABINGDON, ENGLAND) 2020; 27:407-415. [PMID: 35233152 DOI: 10.1080/09687637.2020.1711871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The Appalachian region has been disproportionately impacted by the opioid epidemic. This study, informed by the Health Belief Model (HBM), explored Appalachian community members' perspectives on prescription opioid misuse and community-based programs to dispose of unused opioid analgesics. In 2018, we conducted ten focus groups (n=94 participants) in 5 Appalachian counties. Thirteen themes across 5 of the HBM constructs emerged from our analysis. Participants perceived that their communities are susceptible to the harms associated with opioid misuse, these harms are serious, suggesting they could be motivated to change disposal behaviors. Many participants recognized the benefit to disposing of unused prescription opioids including protecting household members from misusing and protecting the home from robbery. Nevertheless, participants identified barriers to proper disposal, including keeping the medications "just in case" for future ailments and the location of drop boxes near law enforcement (due to deep-seated mistrust of law enforcement agencies). Self-efficacy was difficult to assess as many participants were completely unaware of the presence of dropboxes in the community and also expressed concerns about the inconvenience of proper disposal using dropboxes These findings have implications for developing community-based campaign messages promoting proper disposal of unused opioids.
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Affiliation(s)
| | - Kathleen L Egan
- Department of Health Education and Promotion, East Carolina University
| | | | | | | | | | - Mark Wolfson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine
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26
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Wincup E. Women as vulnerable subjects: A gendered reading of the English and Irish drug strategies. Addict Behav 2019; 98:105995. [PMID: 31288126 DOI: 10.1016/j.addbeh.2019.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/30/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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Beaton B, Copes H, Webb M, Hochstetler A, Hendricks PS. Accounting for Microdosing Classic Psychedelics. JOURNAL OF DRUG ISSUES 2019. [DOI: 10.1177/0022042619871008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Microdosing classic psychedelics (e.g., LSD [lysergic acid diethylamide] and psilocybin) is the practice of taking small amounts of these substances to bring about various positive life changes. Little is known about the subjective experiences and perceptions of those who engage in the practice. Accordingly, we use the sociology of accounts as a theoretical framework to explore the ways that those who microdose excuse or justify their practice. Using data from semistructured interviews with 30 people who had microdosed, we find that none provided excuses for their microdosing, but all offered one or more justifications. When discussing their microdosing, participants emphasized six key justifications: denial of injury, self-sustaining, self-fulfillment, appeal to normality, appeal to loyalties, and knowledgeableness. Findings provide insights into the subjective experiences of those who microdose, including the ways that they attempt to align their actions with societal expectations.
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Affiliation(s)
| | - Heith Copes
- The University of Alabama at Birmingham, USA
| | - Megan Webb
- University of California, Riverside, USA
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Radcliffe P, Chandler A, Martin F, Whittaker A. Parents and substance use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:97-100. [DOI: 10.1016/j.drugpo.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/23/2019] [Accepted: 02/25/2019] [Indexed: 01/08/2023]
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Martin FS. Engaging with motherhood and parenthood: A commentary on the social science drugs literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:147-153. [PMID: 30630710 DOI: 10.1016/j.drugpo.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/01/2022]
Abstract
The majority of qualitative social scientific research on the topic of parenthood and substance use focuses on mothers who use illicit drugs and their experiences of social marginalization and stigmatization. This commentary argues that new and important insights might be gained about parenting in the context of substance use by engaging more closely with everyday experiences of mothering and with contemporary theorising around motherhood and parenthood. Drawing on recent sociological studies of family life influenced by late-modern individualism and by new expert attention on the quality of parent-child relationships, the commentary proposes directions for future social research on the identities and experiences of mothers and fathers who use alcohol and other drugs.
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Affiliation(s)
- Fiona S Martin
- Department of Sociology and Social Anthropology, Dalhousie University, Canada.
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30
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Problematisation and regulation: Bodies, risk, and recovery within the context of Neonatal Abstinence Syndrome. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 68:139-146. [PMID: 30025899 DOI: 10.1016/j.drugpo.2018.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/01/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Neonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these. METHODS Qualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland. All the mothers were prescribed opioid replacement therapy and parents were interviewed after their baby was born. Data collection explored understandings about the causes and consequences of NAS and experiences of preparing for, and caring for, a baby with NAS. Data were analysed using a narrative and discursive approach. RESULTS Parent and professional accounts simultaneously upheld and subverted logics of care which govern maternal drug use and the assessment and care of mother and baby. Despite acknowledging the unpredictability of NAS symptoms and the inability of the women who are opioid-dependent to prevent NAS, logics of care centred on 'proving' risk and recovery. Strategies appealed to the need for caution, intervening and control, and obscured alternative logics of care that focus on improving support for mother-infant dyads and the family as a whole. CONCLUSION Differing notions of risk and recovery that govern maternal drug use, child welfare and family life both compel and trouble all logics of care. The contentious nature of NAS reflects wider socio-political and moral agendas that ultimately have little to do with meeting the needs of mothers and babies. Fundamental changes in the principles, quality and delivery of care could improve outcomes for families affected by NAS.
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Harp KLH, Oser CB. A longitudinal analysis of the impact of child custody loss on drug use and crime among a sample of African American mothers. CHILD ABUSE & NEGLECT 2018; 77:1-12. [PMID: 29287167 PMCID: PMC5857224 DOI: 10.1016/j.chiabu.2017.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 05/22/2023]
Abstract
UNLABELLED This study examines the influence of child custody loss on drug use and crime among a sample of African American mothers. Two types of custody loss are examined: informal custody loss (child living apart from mother but courts not involved), and official loss (child removed from mother's care by authorities). METHODS Using data from 339 African American women, longitudinal random coefficient models analyzed the effects of each type of custody loss on subsequent drug use and crime. RESULTS indicated that both informal and official custody loss predicted increased drug use, and informal loss predicted increased criminal involvement. Findings demonstrate that child custody loss has negative health implications for African American mothers, potentially reducing their likelihood of regaining or retaining custody of their children. CONCLUSIONS This study highlights the need to integrate drug treatment and other types of assistance into family case plans to improve reunification rates and outcomes among mothers, children, and families. Additionally, the finding that informal loss predicts increased drug use suggests that community-based efforts within the mother's social network could be implemented to intervene before child welfare system involvement becomes necessary.
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Affiliation(s)
- Kathi L H Harp
- University of Kentucky College of Public Health, Department of Health Management and Policy, 111 Washington Avenue, College of Public Health Building, Lexington, KY 40536, United States.
| | - Carrie B Oser
- University of Kentucky, Department of Sociology, Center on Drug and Alcohol Research, Patterson Office Tower, Lexington, KY 40506, United States.
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Myra SM, Ravndal E, Torsteinsson VW, Øfsti AK. Pregnant substance abusers in voluntary and coercive treatment in Norway: Therapists' reflections on change processes and attachment experiences. J Clin Nurs 2017; 27:e959-e970. [PMID: 28880415 DOI: 10.1111/jocn.14067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To explore therapists' discourses on treatment processes, when working with pregnant substance abusers in voluntary and coercive treatment, and looking for the clinical implications of these discourses. BACKGROUND Treatment of substance use disorder faces many challenges. One is pregnancy and motherhood, which are vulnerable and complex processes. The literature emphasises lack of optimal and knowledge-based treatment for this group. DESIGN The study follows a Foucauldian inspired discourse analysis. METHOD Forty therapists from four different residential units in Norway, offering both voluntary and coercive treatment of pregnant women with substance use disorders, were interviewed in focus groups. The semi-structured interview schedule focused on exploring how therapists' discourses on change processes and relationship experiences informed their clinical practice. RESULTS How to start "healthy" attachment processes between the pregnant woman and the unborn child was the dominant discourse among the therapists. Another important theme was coercion, and whether that as a contextual frame was negative or positive in creating attachment between mother and child. Other discourses were varieties of understanding attachment when the mothers had difficulties with substance abuse, the mothers' own attachment histories, and social and cultural challenges. CONCLUSION Systematic work with attachment issues between the pregnant woman and her unborn child was the dominant perspective of nearly all the therapists. The contextual factors in the lives of the women were less prioritised, even though they are of decisive importance for the relationship between mother and child. RELEVANCE TO CLINICAL PRACTICE Treatment professionals need to focus more on the discursive dilemmas encountered in the relation between substance use disorders and the unborn child.
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Affiliation(s)
- Siv M Myra
- Faculty of Social Work, VID Specialized University, Oslo, Norway.,UiO: Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Edle Ravndal
- UiO: Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Vigdis W Torsteinsson
- Regional Centre for Child and Adolescent Mental Health, Southern and Eastern Norway, Oslo, Norway
| | - Anne Ks Øfsti
- Faculty of Social Work, VID Specialized University, Oslo, Norway
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Edland-Gryt M, Sandberg S, Pedersen W. From ecstasy to MDMA: Recreational drug use, symbolic boundaries, and drug trends. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 50:1-8. [PMID: 28869878 DOI: 10.1016/j.drugpo.2017.07.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ecstasy pills with MDMA as the main ingredient were introduced in many European countries in the 1980s, and were often linked to the rave and club scenes. However, use gradually levelled off, in part as a response to increased concerns about possible mental health consequences and fatalities. Extensive use of MDMA now seems to be re-emerging in many countries. In this study, we investigated the cultural and social meaning associated with MDMA use in Oslo, Norway, with an emphasis on how users distinguish MDMA crystals and powder from "old ecstasy pills". METHODS Qualitative in-depth interviews (n=31, 61,3% males) were conducted with young adult party-goers and recreational MDMA/ecstasy users (20-34 years old, mean age 26.2 years). RESULTS Research participants emphasised three important perceived differences between the MDMA crystals and ecstasy pills: (i) The effects of MDMA were described as better than ecstasy; (ii) MDMA was regarded as a safer drug; (iii) Users of MDMA crystals were described as more distinct from and less anchored in out-of-fashion rave culture than those using ecstasy. These differences were an important part of the symbolic boundary work MDMA users engaged in when justifying their drug use. CONCLUSION MDMA has re-emerged as an important psychoactive substance in Oslo's club scene. One important reason for this re-emergence seems to be its perceived differentiation from ecstasy pills, even though the active ingredient in both drugs is MDMA. This perceived distinction between MDMA and ecstasy reveals the importance of social and symbolic meanings in relation to psychoactive substance use. Insights from this study can be important in terms of understanding how trends in drug use develop and how certain drugs gain or lose popularity.
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Affiliation(s)
- Marit Edland-Gryt
- Department of Substance Use, Norwegian Institute of Public Health, Norway.
| | - Sveinung Sandberg
- Department of Substance Use, Norwegian Institute of Public Health, Norway; Department of Criminology and Sociology of Law, University of Oslo, Norway
| | - Willy Pedersen
- Department of Sociology and Human Geography, University of Oslo, Norway; Norwegian Social Research, Oslo and Akershus University College of Applied Sciences, Norway
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Marcellus L. A Grounded Theory of Mothering in the Early Years for Women Recovering From Substance Use. JOURNAL OF FAMILY NURSING 2017; 23:341-365. [PMID: 28795852 DOI: 10.1177/1074840717709366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Women in recovery from addiction experience significant sociostructural barriers to reestablishing self, family, and home after having a baby. The aim of this grounded theory study was to describe pathways that women and their families followed and how transitions were experienced in the early years after receiving services through an integrated community-based maternity program. Eighteen women completed questionnaires and participated in a series of semistructured interviews over 2 years. The overall process women experienced was that of holding it together, which women did by restoring their sense of self during recovery, becoming a strong center for their family, and creating a sense of home no matter what the circumstances. Key elements supporting women in their transition to recovery and parenthood included longer term health, social, and recovery programs and services that addressed determinants of health (in particular, gender, housing, and income), and receiving support provided from strengths-based perspectives.
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Interpellating recovery: The politics of ‘identity’ in recovery-focused treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 44:174-182. [DOI: 10.1016/j.drugpo.2017.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/29/2017] [Accepted: 04/04/2017] [Indexed: 01/08/2023]
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Nordenfors M, Höjer I. Mothers with substance and alcohol abuse-support through pregnancy and early infancy. SOCIAL WORK IN HEALTH CARE 2017; 56:381-399. [PMID: 28332947 DOI: 10.1080/00981389.2017.1299072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article is about the support given to pregnant women and mothers, at an antenatal and child welfare team in Gothenburg (Sweden), specialised on working with mothers who abuse alcohol and/or other substances. The study consists of interviews with 17 women. The aim of the article is to account for how the women experienced the support they got and how they perceived the impact. The results show the importance for the staff of finding the balance between control and support and of creating a non-judgmental attitude in order to build trusting relationships with the women. The organization of the MBHV-team is a prerequisite for the staff to be able to design support based on an assessment of the mother's whole situation.
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Affiliation(s)
- Monica Nordenfors
- a Department of Social Work , University of Gothenburg , Gothenburg , Sweden
| | - Ingrid Höjer
- a Department of Social Work , University of Gothenburg , Gothenburg , Sweden
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MELO MC, CORRADI-WEBSTER CM. Meanings about mothering by women in treatment for drug use. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2016. [DOI: 10.1590/1982-02752016000400013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract There is a growing number of women who use drugs. Furthermore, the responsibility for family care is still attributed solely to women. This study aimed to describe the meanings constructed regarding mothering by women in treatment for drug use. This qualitative and descriptive study, with a social constructionist intelligibility, was developed with women in treatment at the Centro de Atenção Psicosocial - Álcool e Drogas of Ribeirão Preto, Brazil. Eight life story thematic interviews were carried out. The analysis resulted in four themes: 1) Mothering as the woman's choice; 2) Learning with drug consumption experiences and using this to warn and educate children; 3) Drug consumption interfering in mothering and 4) Drug consumption understood in different ways throughout the treatment. The meanings attributed to mothering consist of moral and gender discourses regarding the responsibilities attributed to women and the difficulties solely attributed to their drug use.
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Mawson E, Best D, Lubman D. Associations between social identity diversity, compatibility, and recovery capital amongst young people in substance use treatment. Addict Behav Rep 2016; 4:70-77. [PMID: 29511727 PMCID: PMC5836523 DOI: 10.1016/j.abrep.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 12/26/2022] Open
Abstract
This study explored associations between group memberships and recovery capital amongst 20 young adults aged 18 to 21 years in residential alcohol and drug treatment. METHOD Participants completed an interviewer administered research interview based on measures of recovery capital and a social networks assessment mapping group memberships, group substance use, and relationships between groups. RESULTS Higher personal and social recovery capital was associated with lower diversity of group memberships, a higher number of positive links between groups, and greater compatibility of lower substance-using groups with other groups in the network. Higher compatibility of heavier-using groups was also associated with having a higher number of negative, antagonistic ties between groups. CONCLUSIONS These findings indicate that it is higher compatibility of a lower substance-using social identity and lower-using group memberships that contributes to recovery capital. Further, positive ties between groups and lower diversity of group memberships appear to be key aspects in how multiple social identities that are held by young adults relate to personal and social recovery capital.
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Affiliation(s)
- E. Mawson
- The University of Melbourne, Melbourne, Australia
| | - D. Best
- Department of Law and Criminology, Sheffield Hallam University, Sheffield S10 2BP, United Kingdom
- Turning Point, 54-62 Gertrude St, Fitzroy, Victoria, Australia
| | - D.I. Lubman
- Turning Point, 54-62 Gertrude St, Fitzroy, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
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Buer LM, Leukefeld CG, Havens JR. "I'm Stuck": Women's Navigations of Social Networks and Prescription Drug Misuse in Central Appalachia. NORTH AMERICAN DIALOGUE : NEWSLETTER OF THE SOCIETY FOR THE ANTHROPOLOGY OF NORTH AMERICA 2016; 19:70-84. [PMID: 28736509 PMCID: PMC5519294 DOI: 10.1111/nad.12044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study utilizes anthropological analyses of kinship, care, gendered inequalities, and the state to examine how social networks affect women's substance use in a rural Appalachian county where the primary drug of choice is prescription opioids. Of 503 participants from a larger study of social networks among rural drug users, 16 women who reported using drugs with four or more other study participants (drug network members) were interviewed from November 2011 to February 2012. The purpose of interviews is to analyze the substance use patterns among participants who are highly connected in their networks. Female participants say they feel "stuck" in cycles of prescription drug misuse because of entrenchment in moral economies, intensive caretaking responsibilities, and violence from those in their networks. Although women demonstrate agency in their navigations of drug use, relationships, and economic and health inequalities, the factors that constrain women's actions culminate to create barriers for women accessing substance abuse treatment or decreasing substance use outside of treatment. This study adds to understandings of the relational and situational aspects of women's drug use and efforts to decrease use. Recognizing these aspects of women's lives will aid policies and programs in becoming more relevant to substance abusing women. (substance use; kinship; care; gendered inequalities; Appalachia).
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Affiliation(s)
- Lesly-Marie Buer
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, Medical Behavioral Science Building, Lexington, KY 40536
- Department of Anthropology, University of Kentucky, Lafferty Hall, Lexington, KY 40506
| | - Carl G. Leukefeld
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, Medical Behavioral Science Building, Lexington, KY 40536
| | - Jennifer R. Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, Medical Behavioral Science Building, Lexington, KY 40536
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Haritavorn N. I am just a 'maae' (mother): experiences of mothers injecting drugs in Thailand. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:1167-1179. [PMID: 27417684 DOI: 10.1111/1467-9566.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mothers who use drugs face much discriminatory action as society in general finds female drug users' modes of caring for their children unacceptable. In this article, I explore the ways in which Thai women's injecting practices revolve around the role of mother 'maae' and the ways they employ tactics to challenge the motherhood discourse. This article draws on in-depth interviews with 30 Thai mothers injecting drugs. Thai mothers injecting drugs struggled with stigma and self-blame. They internalise the values of the mother 'maae', that is, what the mother is supposed to be; attempting to combine their drug use with their parental responsibilities. Having a child is treated as a means for many women to manage the hostile social impacts of being an addict mother as well as anxieties about the future of their children. To maintain identity as a mother, as gender norms dictates, the mothers employ several tactics to defend that identity from the threats. In conclusion, the findings have implications for harm reduction and reproductive services for women using drugs in Thailand; health care providers need to appreciate the ramifications of the lived experiences of the women who take drugs.
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Lafferty L, Treloar C, Butler T, Guthrie J, Chambers GM. Unlocking dimensions of social capital in the prison setting. HEALTH & JUSTICE 2016; 4:9. [PMID: 27617184 PMCID: PMC4993805 DOI: 10.1186/s40352-016-0040-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Social capital has been shown to be a valuable resource for improving health outcomes. However, it has received little attention in the prison setting. Dimensions of social capital in mainstream society are likely to function differently among inmates in prison. This study seeks to identify and understand social capital dimensions among incarcerated men living with hepatitis C. METHODS In-depth interviews were conducted across three correctional centres in New South Wales with 30 male inmates living with hepatitis C. Interviews were transcribed then thematically coded and analysed. RESULTS There were differences in the access and utility of social capital dimensions in prison focusing specifically on trust and safety, informal and formal networks, agency, and civic engagement. CONCLUSIONS Dimensions of social capital do not necessarily translate into prison. An inmate's social capital may foster greater treatment uptake relating to health and rehabilitative programs during their incarceration.
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Affiliation(s)
- Lise Lafferty
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth, Sydney, NSW 2052 Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Tony Butler
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth, Sydney, NSW 2052 Australia
| | - Jill Guthrie
- National Centre for Epidemiology and Population Health, The Australian National University, Sydney, Australia
| | - Georgina M. Chambers
- National Perinatal Epidemiology and Statistics Unit, UNSW Australia, Sydney, Australia
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Abstract
The rising prevalence of women with opioid addiction in pregnancy necessitates understanding of medical, ethical, and legal considerations on the part of obstetricians. In addition to briefly reviewing the medical care of opioid abuse in pregnancy, we offer a careful consideration of the stigmatization of addiction and resultant medicolegal sequelae. We advocate for improved access to opioid maintenance therapy and social services as a means of improving healthful pregnancy outcomes and decry recent trends in the criminalization of addiction nationwide.
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Benoit C, Magnus S, Phillips R, Marcellus L, Charbonneau S. Complicating the dominant morality discourse: mothers and fathers' constructions of substance use during pregnancy and early parenthood. Int J Equity Health 2015; 14:72. [PMID: 26303942 PMCID: PMC4548907 DOI: 10.1186/s12939-015-0206-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Consumption of substances is a highly controversial behaviour, with those who do so commonly viewed as deviants, even criminals, or else as out of control addicts. In other work we showed that the use of substances by women who are pregnant or have recently become parents was mainly viewed by health and social care providers as morally wrong. Problematic substance use was framed through the narrow lens of gendered responsibilisation, resulting in women being seen primarily as foetal incubators and primary caregivers of infants. Methods In this follow-up paper we examine descriptive and qualitative data from a convenience sample of biological mothers and fathers (N = 34) recruited as part of a larger mixed methods study of the development and early implementation of an integrated primary maternity care program. We present a description of the participants’ backgrounds, family circumstances, health status, and perception of drug-related stigma. This is succeeded by a thematic analysis of their personal views on substance use during both pregnancy and the transition to parenthood. Results Our results show that while many mothers and fathers hold abstinence as the ideal during pregnancy and early parenting, they simultaneously recognize the autonomy of women to judge substance use risk for themselves. Participants also call attention to social structural factors that increase/decrease harms associated with such substance use, and present an embodied knowledge of substance use based on their tacit knowledge of wellness and what causes harm. Conclusions While these two main discourses brought forward by parents concerning the ideal of abstinence and the autonomy of women are not always reconcilable and are partially a reflection of the dissonance between dominant moral codes regarding motherhood and the lived experiences of people who use substances, service providers who are attuned to these competing discourses are likely to be more effective in their delivery of health and social services for vulnerable families. More holistic and nuanced perspectives of health, substance use, and parenting may generate ethical decision-making practice frameworks that guide providers in meeting and supporting the efforts of mothers and fathers to achieve well-being within their own definitions of problematic substance use.
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Affiliation(s)
- Cecilia Benoit
- Centre for Addictions Research of BC and Department of Sociology, University of Victoria, PO Box 3050, Victoria, V8W3P5, BC, Canada.
| | - Samantha Magnus
- School of Public Health and Social Policy, University of Victoria, PO Box 1700, Victoria, V8W2Y2, BC, Canada.
| | - Rachel Phillips
- Centre for Addictions Research of BC, Centre for Addictions Research of BC, Victoria, Canada.
| | - Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700, Victoria, V8W-2Y2, BC, Canada.
| | - Sinéad Charbonneau
- Faculty of Law, University of Toronto, #1- 328 Arlington Ave, Toronto, M6C2Z9, ON, Canada.
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Abstract
Introduction Many patients in maintenance treatment programs for opioid dependence are parents to underage children. Objective The aim of this study was to explore how parents who are regular patients in maintenance treatment perceive their parenthood. Methods The study used a qualitative approach. The informants were recruited by staff at a substance abuse clinic in Sweden. Criteria for inclusion were participation in the local maintenance treatment program, having a child or children younger than 18 years, and being in contact with the child or children. Data were collected in 2012–2013 by in-depth interviews of seven fathers and five mothers and analyzed using concepts and procedures of qualitative content analysis. Results The central findings of the study were: 1) the parents’ concerns about possible future discrimination against their children, ie, stigma by association; and 2) the patients’ own parents’ role as the most important support in parenthood. Conclusion The issue of anticipated discrimination against the children of parents undergoing maintenance treatment might be an aspect to consider in the development of interventions and support. Considering the role of the patients’ own parents also seems important.
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Affiliation(s)
- Heljä Pihkala
- Institution of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Mikael Sandlund
- Institution of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
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Azim T, Bontell I, Strathdee SA. Women, drugs and HIV. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26 Suppl 1:S16-21. [PMID: 25277726 PMCID: PMC4498573 DOI: 10.1016/j.drugpo.2014.09.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Women who use drugs, irrespective of whether these are injected or not, are faced with multiple issues which enhance their vulnerability to HIV. METHODS In this commentary, we explore the HIV risks and vulnerabilities of women who use drugs as well as the interventions that have been shown to reduce their susceptibility to HIV infection. RESULTS Women who inject drugs are among the most vulnerable to HIV through both unsafe injections and unprotected sex. They are also among the most hidden affected populations, as they are more stigmatized than their male counterparts. Many sell sex to finance their own and their partner's drug habit and often their partner exerts a significant amount of control over their sex work, condom use and injection practices. Women who use drugs all over the world face many different barriers to HIV service access including police harassment, judgmental health personnel and a fear of losing their children. CONCLUSION In order to enable these women to access life-saving services including needle-syringe and condom programs, opioid substitution therapy and HIV testing and treatment, it is essential to create a conducive environment and provide tailor-made services that are adapted to their specific needs.
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Affiliation(s)
- Tasnim Azim
- Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
| | - Irene Bontell
- Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh; Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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Wolf JP, Chávez R. "Just make sure you can get up and parent the next day": Understanding the contexts, risks, and rewards of alcohol consumption for parents. FAMILIES IN SOCIETY : THE JOURNAL OF CONTEMPORARY HUMAN SERVICES 2015; 96:219-228. [PMID: 26457048 PMCID: PMC4595850 DOI: 10.1606/1044-3894.2015.96.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Little is known about how parents make drinking decisions and weigh the risks and rewards of alcohol consumption in specific contexts. This qualitative study examined two questions: 1. What factors influence parental drinking decisions in different drinking contexts? 2. What do parents perceive as the risks and rewards of alcohol consumption in different drinking contexts? Purposive sampling was used to select sixty parents of children aged 10 or younger living in four mid-sized California cities. Data were collected via in-depth, semi-structured interviews. Many parents viewed drinking at family get-togethers or parties as protective of children, since the presence of multiple adults and children provide buffers when parents become intoxicated. In contrast, parents noted that drinking at home, and particularly drinking alone, transmitted potentially negative messages. Social pressures and contexts influence alcohol consumption among parents and could provide potential avenues for intervention against alcohol-related harms.
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Affiliation(s)
| | - Raúl Chávez
- University of California, Berkeley School of Social Welfare, Berkeley, CA
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Chandler A, Whittaker A, Williams N, McGorm K, Cunningham-Burley S, Mathews G. Mother's little helper? Contrasting accounts of benzodiazepine and methadone use among drug-dependent parents in the UK. DRUGS-EDUCATION PREVENTION AND POLICY 2014; 21:470-475. [PMID: 25552821 PMCID: PMC4266080 DOI: 10.3109/09687637.2014.930814] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/29/2014] [Accepted: 05/29/2014] [Indexed: 11/21/2022]
Abstract
Aims To explore the ways in which opioid-dependent parents accounted for their use of opioids and benzodiazepines during and after pregnancy. Methods Longitudinal qualitative interviews [n = 45] with 19 opioid-dependent adults recruited in Scotland, UK, were held during the antenatal and post-natal period. Interviews focused on parenting and parenting support within the context of problem drug use and were analysed using a narrative informed, thematic analysis. Findings The majority of participants described using benzodiazepines in addition to opioids. Almost all indicated a desire to stop or reduce opioid use, whereas cessation or reduction of benzodiazepines was rarely prioritised. In stark contrast to opioid dependence, benzodiazepine dependence was portrayed as unproblematic, therapeutic and acceptable in the context of family life. Whereas opioid dependence was framed as stigmatising, benzodiazepine use and dependence was normalised. An exception was benzodiazepine use by men which was occasionally associated with aggression and domestic abuse. Conclusions Drug-dependent parents attach different meanings to opioid and benzodiazepine use and dependence in the context of parenthood. Divergent meanings, and stigma, may impact on stated commitment to stability or recovery from dependent drug-use. Attention should be paid to the way in which policy and practice regarding OST and benzodiazepines reflects this divergence.
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Affiliation(s)
- Amy Chandler
- Centre for Research on Families and Relationships, University of Edinburgh Edinburgh UK
| | - Anne Whittaker
- Substance Misuse Directorate, NHS Lothian, Astley Ainslie Hospital Grange Loan, Edinburgh UK
| | | | - Kelly McGorm
- Australian Primary Health Care Research Institute Acton Australia
| | | | - Gillian Mathews
- School of Molecular, Genetic and Population Health Sciences, University of Edinburgh Edinburgh UK
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Clinical Needs of In-treatment Pregnant Women with Co-occurring Disorders: Implications for Primary Care. Matern Child Health J 2014; 19:180-7. [DOI: 10.1007/s10995-014-1508-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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49
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Opioid pharmacotherapy: Treatment, regimes, constructions and control. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:e1-5. [DOI: 10.1016/j.drugpo.2013.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/24/2013] [Accepted: 08/10/2013] [Indexed: 11/19/2022]
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50
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Substance, structure and stigma: Parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:e35-42. [DOI: 10.1016/j.drugpo.2013.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/18/2013] [Accepted: 04/10/2013] [Indexed: 11/23/2022]
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