"The Whole Family Suffered, so the Whole Family Needs to Recover": Thematic Analysis of Substance-Abusing Mothers' Family Therapy Sessions

Residential substance use treatment outcomes for pregnant and postpartum women: Distinct patterns for women enrolled before versus during the COVID-19 pandemic

Introduction

Substance use among pregnant and postpartum women (PPW) is a serious public health concern. The COVID‐19 pandemic has exacerbated substance use among the general population including pregnant women, and disrupted operations for substance use treatment centers. Little is known about the outcomes of substance use treatment for PPW before and during the COVID‐19 pandemic.

Method

Data from a longitudinal program evaluation were analyzed to examine outcomes among 136 PPW participating in a residential SUD treatment program, and to explore differences in treatment outcomes for women who enrolled in services before versus during the COVID‐19 pandemic. Analyses were used to test the significance of change from treatment intake to 6‐month post‐intake on assessments of substance use, mental health symptoms, and functioning collected to evaluate the Healthy Families Program (HFP), a comprehensive program for PPW located within a gender‐specific SUD treatment facility in the United States.

Results

Results indicated that from treatment intake to follow‐up assessment, clients self‐reported statistically significant improvements in family functioning and daily functioning as well as reduced days of substance use. Notably, the rate of treatment intakes declined during the COVID‐19 pandemic. In separate analyses by subgroup, mental health indicators showed improvements only for clients engaged in treatment before the COVID‐19 pandemic and not for clients served during the COVID‐19 pandemic, but substance use decreased significantly for both pre‐pandemic and pandemic enrollees.

Conclusion

Specialized treatment considerations and implications for PPW are discussed, including a need for added emphasis on co‐occurring mental health symptoms and family system stress during a pandemic, and the role of nurses in identifying and addressing these concerns. Additionally, potential relapse prevention efforts during COVID‐19 for PPW with substance use disorders are examined.

Clinical Relevance

The present research continues to highlight the importance of specialized treatment programming for PPW with SUDs as well as the potential need for additional recovery support mechanisms to be utilized during the COVID‐19 pandemic.

An Exploration of Mothers' Successful Completion of Family-Centered Residential Substance Use Treatment

Behavioral health and substance use centers have started focusing efforts on creating, adopting, and implementing evidence-based practices and programs that effectively address the needs of women and, particularly, mothers entering treatment with children. However, women with substance use disorders (SUDs) remain an underserved and understudied population; even less studied are the complexities and unique SUD treatment needs of women who have children. Family therapists' systemic training is a valued approach in conceptualizing and implementing treatment for mothers with SUDs and their families. This study explored the construct of mothering children during family-centered substance use treatment using a transcendental phenomenological approach. Analysis revealed themes related to motherhood, parenting, and support for mothers and children. Two themes emerged from the data: (a) grappling with motherhood and addiction leading to the decision for treatment and (b) specific aspects of the treatment program conducive to motherhood. Results indicated the positive impact of mothers' experiences in family-centered substance use treatment, aligning with previous literature that suggests mothers are more engaged in treatment when their children remain in their care. The insights gleaned from the participants in this study provide suggestions for further improving programming that supports mothers and their children during the recovery process. Treatment considerations are offered for family therapists working with mothers with SUDs and their families.

Understanding ambivalence in help-seeking for suicidal people with comorbid depression and alcohol misuse

Help-seeking prior to a suicide attempt is poorly understood. Participants were recruited from a previous research trial who reported a history of suicidal behaviours upon follow-up. Qualitative interviews were conducted with six adults to understand their lived experience of a suicide attempt and the issues affecting help-seeking prior to that attempt. Participants described being aware of personal and professional supports available; however, were ambivalent about accessing them for multiple reasons. This paper employs an ecological systems framework to better understand the complex and multi-layered interpersonal, societal and cultural challenges to help-seeking that people with suicidal ideation can experience.

Puérperas dependientes de crack: dificultades y facilidades afrontadas en el cuidado al recién nacido

Introducción: los recién nacidos de dependientes de crack sufren los efectos de la dependencia ya en las primeras horas de vida y pueden presentar cuadro de irritabilidad, sudoración, hipertonía y dificultad en los ciclos de sueño y vigilia. Esta realidad requiere el auxilio profesional a la puérpera usuaria de crack para su instrumentalización al cuidado del recién nacido. Objetivo: conocer dificultades y facilidades de puérperas dependientes de crack en el cuidado al recién nacido. Método: se realizó investigación con enfoque cualitativo en una maternidad del sur de Brasil, por medio de entrevistas semiestructuradas con 18 puérperas. Resultados: desde el análisis de contenido, se identificaron como dificultades: abstinencia de la droga, no lactancia, falta de respaldo familiar, vigilancia de los profesionales del Consejo Tutelar (Similar al Bienestar Familiar en Colombia), falta de habilidad para la realización de cuidados directos al recién nacido, miedo a lastimarlo y falta de condiciones financieras. Como facilidades, se encontró que el recién nacido llore poco, sea tranquilo y quieto; respaldo de la familia, vecinos y amigos, y auxilio financiero del compañero y familiares. Conclusión: puérperas dependientes de crack necesitan de auxilio para que cumplan su rol de cuidadoras del recién nacido. Deben ser identificadas durante el embarazo y acompañadas de forma a que realicen el prenatal, orientadas acerca de los cuidados con el niño y recibidas en servicios de apoyo.