Background and overview of mental health and substance abuse treatment systems: meeting the needs of women who are pregnant or parenting

I am Lifted Above the World: utilizing VR for stress reduction among perinatal women of color

Background

Perinatal mental health conditions affect 800,000 individuals annually in the United States and are a leading cause of complications in pregnancy and childbirth. However, the impact of these conditions varies across racial and ethnic groups. Portable digital solutions, such as mobile apps, have been developed for maternal mental health, but they often do not adequately cater to the needs of women of color. To ensure the effectiveness and equity of these interventions, it is crucial to consider the unique experiences of perinatal women from diverse racial backgrounds. This qualitative study aims to explore the complex aspects of motherhood, maternal mental well-being, and resilience among perinatal women of color. It also investigates the factors that either hinder or facilitate the use of Virtual Reality (VR) for stress management in this specific demographic.

Methods

This research involves two focus groups comprising perinatal women, primarily identifying as Black or Latina, enrolled in the ongoing Nurturing Moms study at the University of Miami Miller School of Medicine. Additionally, feedback is collected from five different participants. The study assesses Nurture VR™, a VR-based program integrating mindfulness techniques, relaxation exercises, and guided imagery for pregnancy and postpartum.

Results

Qualitative analysis uncovers five primary themes and 19 sub-themes, addressing the complexities of motherhood, maternal mental health, attitudes towards VR therapy, postpartum care, and the perception of resilience. Participants share challenges related to household management, caregiving, financial stress, breastfeeding, relaxation, sleep, and the significance of social support. Their preferences and reservations regarding VR therapy are also expressed.

Conclusion

This study sheds light on the diverse struggles and obstacles faced by women of color during and after pregnancy, with potential repercussions for their mental and sleep health. It underscores the need for mental health screening and analysis of maternal stress-related sleep issues, in addition to the facilitation of social support in maternal health programs. Additionally, it highlights the promise of culturally responsive behavioral treatments, including VR interventions, in offering timely and tailored mental health support to perinatal women, taking into account their intersectional identities.

Maternal obesity and depression reported at the first antenatal visit

Background

Maternal obesity and depression are common and both have been associated with adverse pregnancy outcomes.

Aims

The aim of this observational study was to examine the relationship between maternal body mass index (BMI) category and self-reported depression at the first antenatal visit.

Methods

Women who delivered a baby weighing ≥ 500 g over nine years 2009–2017 were included. Self-reported sociodemographic and clinical details were computerised at the first antenatal visit by a trained midwife, and maternal BMI was calculated after standardised measurement of weight and height.

Results

Of 73,266 women, 12,304 (16.7%) had obesity, 1.6% (n = 1126) reported current depression and 7.5% (n = 3277) multiparas reported a history of postnatal depression. The prevalence of self-reported maternal depression was higher in women who had obesity, > 35 years old, were socially disadvantaged, smokers, had an unplanned pregnancy and used illicit drugs. After adjustment for confounding variables, obesity was associated with an increased odds ratio (aOR) for current depression in both nulliparas (aOR 1.7, 95% CI 1.3–2.3, p < 0.001) and multiparas (aOR 1.8, 95% CI 1.5–2.1, p < 0.001) and postnatal depression in multiparas (aOR 1.4, 95% CI 1.3–1.5, p < 0.001). The prevalence of current depression was higher in women with moderate/severe obesity than in women with mild obesity (both p < 0.001).

Conclusions

We found that self-reported maternal depression in early pregnancy was independently associated with obesity. The prevalence of depression increased with the severity of obesity. Our findings highlight the need for implementation of strategies and provision of services for the prevention and treatment of both obesity and depression.

Supplementary information

The online version contains supplementary material available at 10.1007/s11845-021-02665-5.

Prevalence of self-reported mental disorders in pregnancy and associations with adverse neonatal outcomes: a population-based cross-sectional study

BACKGROUND

Mental disorders in pregnancy are common causes of morbidity and mortality with associated risks of adverse neonatal outcomes. Our aims were to evaluate the prevalence of self-reported mental disorders in women presenting to maternity services and to determine the association between history of self-reported maternal mental disorder and adverse neonatal outcomes.

METHODS

Data on all singleton pregnancies known to maternity services in Northern Ireland over the period 2010 to 2015 were extracted from the Northern Ireland Maternity System (NIMATS), including frequency data for number of pregnancies where the mother reported a history of mental disorder. Odds ratios were derived from logistic regression analyses to determine the associations between self-reported maternal mental disorder and preterm birth, low infant birth weight and APGAR scores.

RESULTS

In total, 140,569 singleton pregnancies were registered using NIMATS over this period. In 18.9% of these pregnancies, the mother reported a history of at least one mental disorder. After adjustment for potential confounding factors, significant associations were demonstrated between self-reported maternal mental disorder and preterm birth (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.25-1.37), low infant birth weight (OR 1.29, 95% CI 1.21-1.38) and APGAR score < 7 at 1 min (OR 1.14, 95% CI 1.10-1.19) and 5 min (OR 1.23, 95% CI 1.12 to 1.34).

CONCLUSIONS

These findings emphasise the critical importance of routine enquiry regarding psychiatric history when women present to maternity services and the impact of maternal mental illnesses upon outcomes for their infants.

Consumer Perspectives on Co-Occurring Disorders Treatment

A series of four focus groups were conducted with 35 clients with a co-occurring diagnosis of mental illness and substance abuse to obtain their perspectives on treatment. Four content areas emerged. System barriers, such as poor therapeutic environment, difficulties navigating complex systems, and poor integration of services were most frequently mentioned. Factors facilitating recovery included consumer strengths, a positive therapeutic environment, and helpful recovery tools. Consumer challenges refer to obstacles in the client's life including the long-term chronic nature of their illness, self-medication of psychiatric symptoms, and limited personal resources and options. Specific treatment needs, such as treatment from “similar others,” one-on-one counseling, and time management were identified. The results demonstrate that a client-centered approach is preferred. Limited system resources continue to be a barrier. Improved coordination of services and cross-training on co-occurring diagnosis are needed. Consumers recognize the long-term nature of their problems and have strengths for dealing with them.

Meeting the Treatment Needs of Multiply Diagnosed Consumers

Recent research demonstrates that approximately 10 million people in the United States have been diagnosed with at least one co-occurring mental health disorder and substance abuse disorder in any given year (Substance Abuse & Mental Health Services Administration National Advisory Council, 1997). Emerging awareness by clinicians, substance abuse counselors, and researchers has subsequently awakened the treatment community to the needs of consumers who are afflicted with co-occurring problems. One panel of the Los Angeles County-wide conference “Common Ground, Common Language, Common Goals: Bringing Substance Abuse Research and Practice Together” (held in April 2001) focused on the prevalence and treatment of co-occurring disorders. This article outlines the discussion and findings of this panel on the numerous treatment needs of consumers with multiple diagnoses and the converging and conflicting treatment models that have been developed for them.

Experiences of opioid-dependent women in their prenatal and postpartum care: Implications for social workers in health care

The prevalence of prescription opioid abuse has increased nationally in the last decade with increased incidence rates reported among pregnant women. This was a qualitative study designed to understand the role of pregnant women with an opioid use disorder participating in medical decision making regarding their prenatal care while addressing their addiction. Group interviews were conducted with postpartum women who self-identified as opioid dependent during their pregnancy, and the data were analyzed using Interpretative Phenomenological Analysis. Social workers in the health care setting are an integral part of the interdisciplinary team in caring for pregnant and postpartum opioid-dependent women. Social workers are ideal in creating stigma reduction strategies, peer and professional supports, and comprehensive coordinated care. A social justice-based practice may be a framework to utilize when caring for this unique population.

Gender differences in sense of coherence, perceived social support, and negative emotions among drug-abstinent israeli inmates

This study examines gender differences in the sense of coherence, perceived social support, and negative emotions among drug-abstinent Israeli inmates. One hundred nineteen inmates have participated in this study (65 men and 54 women). The findings indicate that among female inmates, abstinence of more than a year is related to a decrease in sense of coherence and to an increase in their perceived friend support. In contrast, among male inmates, abstinence of more than a year is related to an increase in sense of coherence and no change at all in their perceived friend support. In addition, hostility level is lower and sense of coherence is higher when the length of abstinence exceeds a year among male inmates. In contrast, among female inmates hostility level is higher when the sense of coherence is lower, without any connection to the length of abstinence. The implications of these findings to treatment intervention are discussed.

Use of Mental Health and Substance Abuse Treatment Services by Female Injection Drug Users

This article examines whether female injection drug users (IDUs) who have a history of using mental health services (i.e., one or more psychiatric hospitalizations or counseling) enter types of drug treatment different from those of female IDUs who do not have a history of using mental health services. Data used for this exploration originate from a statewide drug-treatment database covering all women who entered drug treatment in the state of Massachusetts from 1996 to 2001. A total of 7776 women were included in the study. Through the use of logistic regression analysis, the study determined that those female IDUs who had a mental health service history, compared with female IDUs who had no such history, were about two-thirds more likely to enter substance abuse treatment other than detoxification only. Specifically, women with a mental health service history were about 66% more likely to enter substance abuse treatment modalities such as drug-free outpatient counseling, methadone maintenance, and/or long-term residential services rather than detoxification alone. This is a positive result, indicating that female IDUs who have mental health problems and therefore have high needs for effective substance abuse treatment are entering the more intensive and/or longer term modalities likely to lead to better outcomes. Possible factors accounting for this, including the referral process within detoxification centers, the role of community referral agents, and the experience women gain as a consequence of receiving services in more than one service system, are discussed.

Residential treatment for parents and their children: the Village experience

The Village South, Inc., in Miami, Florida, offers comprehensive substance abuse treatment and prevention services to adults, adolescents, and children. The Village’s Families in Transition program, launched in the early 1990s as one of the Nation’s first 11 federally funded programs for women wth children, has provided services to nearly 800 parents and approximately 2,000 children. This article discusses the philosophy behind FIT’s family-focused residential treatment program, characterizes its participants, describes its challenges and successes, and points out research needs that have come to light through experience with mothers and children in treatment.

WHEN PARENTS WITH SEVERE MENTAL ILLNESS LOSE CONTACT WITH THEIR CHILDREN: ARE PSYCHIATRIC SYMPTOMS OR SUBSTANCE USE TO BLAME?

This study compared parental psychiatric symptom severity, and the absence or presence of severe substance abuse, as predictors of contact with minor children for a representative sample of adults with diagnoses of serious mental illness (N = 45). Child contact and psychiatric symptom severity were measured during regularly scheduled 6-month research interviews over a total 30-month period following each participant's entry into the project. Severe substance abuse was documented as present or absent for the 6-month interval preceding each interview. Results revealed that incidence of severe substance abuse was repeatedly associated with less frequent parent-child contact, even after controlling for psychiatric symptoms, diagnosis, gender, age, ethnicity, and socioeconomic status. Neither psychiatric diagnosis nor symptom severity predicted frequency of child contact when substance abuse was taken into account. Mental health agencies offering parenting classes for adults with serious mental illness should incorporate substance use interventions to reduce loss of child custody and strengthen parent-child relationships.

Consumer Perceptions of Integrated Trauma-Informed Services Among Women with Co-Occurring Disorders

As part of a national, multi-site treatment outcome study, an instrument was designed to assess consumers' perceptions of key services integrating trauma, mental health, and substance abuse issues, the Consumer Perceptions of Care (CPC). This study evaluates the psychometric properties of this instrument and analyzes consumers' perceptions of the services they received. The results suggest that the measure has four factors: services integration, choice in services, trauma-informed assessment, and respect for cultural identity. These factors demonstrated adequate reliability, and the overall results suggested that the measure is a reliable, sensitive, and valid reflection of consumers' perceptions of their services and their providers for diverse racial and ethnic groups. Women in the intervention programs perceived their services as more highly integrated for trauma, mental health, and substance use than women in the services as usual or comparison programs, supporting its utility as a measure of programs designed to provide integrated services.

Substance abuse treatment entry, retention, and outcome in women: a review of the literature

This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.

Development of a comprehensive measure to assess clinical issues in dual diagnosis patients: The Substance Use Event Survey for Severe Mental Illness

This paper provides a description of The Substance Use Event Survey for Severe Mental Illness (SUESS), a brief (20-30 min) interview that assesses clinical issues and domains that are relevant patients with substance use disorders and severe mental illness. First, we discuss the need for a new clinical measure for dual diagnosis patients, as well as our process of creating domains and items and developing the content of the assessment. Second, we provide a first look at the performance of the SUESS in a large sample of dually diagnosed patients from several large scale studies, including how patients responded to the instrument and their ability to complete the items. Third, we present initial reliability data on the SUESS. Finally, we include some initial validity data, including comparison of the self-report of substance use questions to urinalysis results, and verification of the service use information from medical record review. The SUESS appears to be a useful assessment that is tolerated and understood by dual diagnosis patients, and shows good preliminary reliability and validity.

Brief screening for co-occurring disorders among women entering substance abuse treatment

Background

Despite the importance of identifying co-occurring psychiatric disorders in substance abuse treatment programs, there are few appropriate and validated instruments available to substance abuse treatment staff to conduct brief screen for these conditions. This paper describes the development, implementation and validation of a brief screening instrument for mental health diagnoses and trauma among a diverse sample of Black, Hispanic and White women in substance abuse treatment. With input from clinicians and consumers, we adapted longer existing validated instruments into a 14 question screen covering demographics, mental health symptoms and physical and sexual violence exposure. All women entering treatment (methadone, residential and out-patient) at five treatment sites were screened at intake (N = 374).

Results

Eighty nine percent reported a history of interpersonal violence, and 70% reported a history of sexual assault. Eighty-eight percent reported mental health symptoms in the last 30 days. The screening questions administered to 88 female clients were validated against in-depth psychiatric diagnostic assessments by trained mental health clinicians. We estimated measures of predictive validity, including sensitivity, specificity and predictive values positive and negative. Screening items were examined multiple ways to assess utility. The screen is a useful and valid proxy for PTSD but not for other mental illness.

Conclusion

Substance abuse treatment programs should incorporate violence exposure questions into clinical use as a matter of policy. More work is needed to develop brief screening tools measures for front-line treatment staff to accurately assess other mental health needs of women entering substance abuse treatment

Improving drug treatment services for Hispanics: research gaps and scientific opportunities

Delivery of services to Hispanic drug users remains a great challenge, as shown by low service access and retention, and disproportionate negative consequences of drug abuse in the Hispanic population. This paper provides a critical analysis of current services research on Hispanics with drug abuse problems, identifies gaps in the knowledge, and offers recommendations for scientific opportunities to address these gaps, focusing on four central needs: (1) the need to understand the circumstances of Hispanics in their own communities (i.e., community context); (2) the need to develop and test service delivery models tailored to Hispanics' circumstances and special needs; (3) the need to remove client, provider, and system barriers to utilization; and (4) the need to establish links between drug abuse services, social services, and other service sectors to optimize treatment outcomes. The authors suggest an approach that begins with a focus on the local Hispanic community and builds understanding of the cultural context, inclusion of indigenous resources, recognition of barriers to enrollment and retention, and coordination of related services.

A Comparison of Mothers with Co-occurring Disorders and Histories of Violence Living with or Separated from Minor Children

Data from the Women with Co-occurring Disorders and Histories of Violence Study are used to examine characteristics distinguishing mothers currently providing care for all their minor children (n = 558) from mothers separated from one or more minor children (n = 1396). Mothers are described and compared on background characteristics and experiences, well-being and current functioning, situational context, and services used. Analyses control for number of children, race, and years of education. Mothers separated from children have more children, less education, have more often been homeless, in juvenile detention or jail, and have lower incomes than mothers living with all their children. Mothers separated from children have more extensive experiences of traumatic and stressful life events, and the groups differ in current functioning and patterns of services used. While cross-sectional data do not allow causal inferences, challenges faced by mothers have significant implications for policy and programs.

Outcomes for women with co-occurring disorders and trauma: program and person-level effects

Six-month outcomes are evaluated from a 9-site quasi-experimental study of women with mental health and substance use disorders who have experienced physical or sexual abuse who enrolled in either comprehensive, integrated, trauma-informed, and consumer/survivor/recovering person-involved services (N = 1023) or usual care (N = 983). Mental health, post-traumatic stress symptoms, and substance use outcomes are assessed with multilevel regression models, controlling for program and personal characteristics. Person-level variables predict outcomes independent of intervention condition and, to a small extent, moderate intervention and program effects. In sites where the intervention condition provided more integrated counseling than the comparison condition, there are increased effects on mental health and substance use outcomes; these effects are partially mediated by person-level variables. These results encourage further research to identify the longer-term effects of integrated counseling for women with co-occurring disorders and trauma histories.

Relationship of depressive symptoms and mental health functioning to repeat detoxification

To better understand residential detoxification use, we assessed the roles of depressive symptoms (DS) and mental health functioning (MHF) on repeat detoxification. A prospective cohort of residential detoxification patients (N=400) without primary medical care was followed over 2 years at 6-month intervals. Subsequent detoxification admissions were examined using a statewide administrative database and DS (Center for Epidemiologic Studies Depression Scale) and MHF (SF-36 mental component summary subscale) measurements at follow-up. Incidence rate ratios of return to detoxification were estimated using multivariable longitudinal Poisson regression. In separate analyses, greater DS and worse MHF predicted higher detoxification use rates. Clinically significant worsening (10 points) of DS and MHF on objective scales predicted a 20% increased rate of detoxification readmission. Male sex, heroin as a problem substance, and race/ethnicity each predicted detoxification use. These data suggest that identifying individuals with DS or worse MHF after detoxification may provide opportunities for clinical intervention to reduce recurrent residential detoxification.

Building resilience in children of mothers who have Co-occurring Disorders and histories of Violence

Historically, children of parents with co-occurring substance abuse and mental health disorders and histories of violence/trauma have been overlooked in behavioral health treatment systems. The Women, Co-occurring Disorders and Violence Study (WCDVS) was a 5-year initiative funded by the United States Substance Abuse and Mental Health Services Administration (SAMHSA) that included a Children's Study that explored the treatment needs of children of women with these multiple disorders. This article describes the development of the Children's Study intervention that included clinical assessment, group intervention, and resource coordination/advocacy for children aged 5-10 to build resilience through increasing coping skills, improving interpersonal relationships, and helping coalesce positive identity and self-esteem. Innovative procedures, including the participation of consumer/survivor/recovering women and mothers, in the planning, implementation, and administrative applications of this intervention and study are also highlighted. It is recommended that programs begin to implement family-focused integrated treatment approaches that can potentially increase protective factors for children affected by parental mental illness, substance abuse, and violence.

Women, Co-occurring Disorders, and Violence Study: Evaluation design and study population

The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a multi-site cooperative study to evaluate new service models for women with co-occurring mental health and substance use disorders and a history of physical and/or sexual abuse. Despite common features in the service interventions and evaluation procedures, diversity across the nine sites plus differences introduced by non-random assignment led to numerous methodological challenges. This article describes the design, measurement, and analysis decisions behind the WCDVS and lays the foundation for understanding participant-level outcomes and service costs. This article also describes the study population, as recruited and following attrition at the 6-month follow-up, in order to address the threat of selection bias to inferences drawn from this multi-site study.

Drug treatment, health, and social service utilization by substance abusing women from a community-based sample

BACKGROUND

Substance abuse is an escalating problem among poor urban Latina women; little is known about their access to drug treatment and to needed social and health services.

OBJECTIVE

Our objectives were to (1) examine the need and use of substance abuse treatment, health services, government entitlement programs, and social service programs among cocaine and heroin using Puerto Rican women and (2) identify whether service use predicts their prospective entry into drug treatment.

RESEARCH DESIGN

This was a 3-wave longitudinal study of community substance abusing women evaluated on substance abuse and dependence using diagnostic measures, and hair and urine toxicological screens. Information was collected on self-reported need and receipt of substance abuse treatment, social services, general health services, and government entitlement programs.

SUBJECTS

A community sample of cocaine-, crack-, and/or heroin-using women from copping areas in low-income urban centers of Puerto Rico were interviewed in 1997-1998 with 2 follow-up periods.

RESULTS

Drug treatment, health, and social service utilization were low relative to need for services throughout all data waves. Social service utilization predicted prospective entry into drug treatment but not contacts with general health services or government entitlement programs.

CONCLUSION

Drug-abusing women in low-income urban areas in Puerto Rico have substantial unmet substance abuse treatment, health, and social service needs. Mandated treatment by social service agencies may explain their clients' higher likelihood of entering drug treatment. Building linkages between service sectors to augment entry into drug treatment is essential for meeting the complex needs of this underserved population.

A voice for traumatized women: inclusion and mutual support

This paper reports experiences related to including women in recovery and peer support, in a project that developed integrated services for women with co-occurring mental health and substance use disabilities who have also survived violence. We describe strategies to include women in recovery and a unique peer-run group, which integrates trauma, mental health, and substance abuse recovery. Both research and perspectives of women in recovery are used to discuss the emerging themes of mutuality, bonding, and a focus on strengths.

Effects of gender and diagnosis on addiction history, treatment utilization, and psychosocial functioning among a dually-diagnosed sample in drug treatment

There has been increased recognition of the clinical treatment needs of patients with co-occurring mental and substance use disorders and the heterogeneity of this group with regard to types of substances used and mental disorders. This article examines differences between men and women diagnosed with mood or psychotic disorders at admission to residential drug treatment, specifically regarding their addiction history, treatment history, perceived service needs, and psychosocial functioning. Males initiated drug use at a younger age and had higher levels of dependence on alcohol, cannabis, and opioids. There were no differences among groups in treatment history, motivation, or initiation. Males had higher rates of being under legal supervision and engaging in property crime, whereas females had higher rates of prostitution. Females had greater needs for family- and trauma-related services, and females with psychotic disorders had the highest needs for basic services. There were no differences among groups in barriers to treatment, quality of life, self-efficacy, or family support. Individuals with psychotic disorders had more symptoms of psychological distress; females had higher rates of posttraumatic stress disorder. Differences among dually-diagnosed individuals related to gender and diagnosis need to be considered in treatment planning and in matching services to patient needs.

Effects of gender and level of parental involvement among parents in drug treatment

Most studies of parents in drug treatment have focused exclusively on mothers, and few studies have examined the effects of parents' level of involvement with their children on the parents' drug use and psychological functioning, either before or after treatment. This study examined mothers and fathers (n = 331) who were parents of children under the age of 18; participants were sampled from 19 drug treatment programs across four types of treatment modalities in Los Angeles County. A majority of each group (57% of 214 mothers and 51% of 117 fathers) were classified as being highly involved with their children. At the baseline assessment, higher parental involvement was related to lower levels of addiction severity, psychological severity, and symptoms of psychological distress, and to higher levels of self-esteem and perception of parenting skills. In general, fathers had higher levels of alcohol and drug-use severity than did mothers, but fathers who were more involved with their children showed lower levels of addiction severity than fathers who were less involved. Parental involvement at baseline was unrelated to drug use at the 12-month follow-up, although parents who were less involved with their children reported experiencing more stressors. Given the association of parental involvement with lower levels of addiction severity and psychological distress at baseline, treatment protocols should build upon the positive relationships of parents with their children, and seek to improve those of less-involved parents.

Towards the integration of treatment systems for substance abusers: report on the second International Symposium on Substance Abuse Treatment and Special Target Groups

The central ideas of this article are the result of intensive discussions during a symposium that was organized following structural changes in European substance abuse treatment. Therapeutic communities were concerned about their approach being replaced by other treatment modalities. Participants focused on the question of whether the emerging harm reduction paradigm could be combined with the principle of recovery and how its integration in a comprehensive treatment system could be beneficial or detrimental to therapeutic communities. This article defines integrated treatment systems for substance abusers from a conceptual, etymological, ethical and ideological point of view. In addition, it focuses on old but ongoing contradictions and discussions between drug-free, methadone-maintenance and harm reduction approaches. Several prerequisites for the integration of treatment systems are discussed, and parallels and discrepancies between the American and European situation are explored. An integrated and comprehensive system of treatment services is put forward as an alternative to the present-day gap between conventional abstinence-oriented programs and harm reduction initiatives. Participants maintain that collaboration between these apparently incompatible treatment paradigms will depend on mutual respect, the introduction of a common language and a thorough analysis of clients' treatment demands.

Toxicomanie et maternité

La plupart des études traitant de la toxicomanie des mères ont jusqu’à maintenant été axées sur les effets des produits, ou de l’environnement autour de la consommation, sur les enfants. Peu ont traité de la situation des mères elles-mêmes, de leurs trajectoires de vie, de leur désir d’enfant, de leurs besoins dans le développement des compétences parentales. L’article présente les résultats d’une recherche menée auprès d’un échantillon de mères toxicomanes ayant récemment accouché, en faisant ressortir plus particulièrement les divers événements qui ont ponctué leurs trajectoires de consommation et comment la maternité s’inscrit dans ces parcours. Trois principaux types de facteurs associés à l’initiation, au maintien, à la progression mais aussi à l’arrêt de la consommation ont été relevés : facteurs contextuels (consommation familiale, facilité d’accès aux produits, contacts dans le milieu de la drogue, conformité au groupe de pairs) ; facteurs relationnels (partenaire amoureux consommateur) et facteurs intrinsèques (automédication, besoin d’oublier et fuite de la réalité). L’arrivée de l’enfant, rarement planifiée, constitue un moment privilégié pour inverser la trajectoire et un facteur important dans la diminution de la consommation ou son abandon. Mais, elle peut également devenir une source de stress conduisant à des rechutes surtout dans le contexte où les conditions environnantes sont difficiles et où elles ont peu de contrôle sur leur avenir. L’étude des trajectoires permet de mieux comprendre la toxicomanie maternelle et de proposer des pistes pour l’intervention.

Treatment concerns of women with co-occurring serious mental illness and substance abuse disorders

The treatment needs of persons with co-occurring mental illness and substance abuse disorders is a relatively new area of inquiry. Even less information is available concerning the treatment concerns of women with dual diagnosis. A focus group was conducted with seven women as part of a larger study of effective treatments for adults with co-occurring disorders. Women responded to questions about what worked and what did not work in their past treatment experiences and what needs to be added for effective treatment. Five primary themes emerged: negative treatment experiences, negative system experiences, desirable treatment characteristics, therapeutic client characteristics, and life issues affecting treatment engagement. Two of the main treatment recommendations that emerged were the need for advocacy assistance with child protective service agencies and the need for providers to use client-centered treatment methods.

Nurse practitioners and parent education: a partnership for health

PURPOSE

To present the findings from a pilot-test of an innovative curriculum for parent education classes that included information about well child care and the care of sick children presented to substance abusing women at a residential drug treatment facility.

DATA SOURCES

Selected literature and the results of a comparison of pre- and post-tests from the 37 women who received the classes over a 6 week period.

CONCLUSIONS

The Healthy Children, Happy Children parent education program was successful overall in increasing the knowledge of the mothers about common skin disorders, care of infants, toddlers, and preschoolers, and basic first aid.

IMPLICATIONS FOR PRACTICE

Nurse practitioners (NPs) are well suited to teach parent education classes that contain information on growth and development, well child care and diagnosis and management of acute minor conditions. The Healthy Children, Happy Children curriculum can be adapted to a variety of settings and populations.

Antenatal depression, substance dependency and social support

BACKGROUND

The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women.

METHOD

391 women who were 14-37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2).

RESULTS

7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression.

LIMITATION

The caseness was defined with a self-report instrument.

CONCLUSION

Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.

I Didn't Know: Discoveries and Identity Transformation of Women Addicts in Treatment

The purpose of this research was to study the efficacy of gender-sensitive substance abuse treatment programs with a focus on the perceptions of women addicts. Based on semi-structured in-depth interviews and observation of treatment groups, an analysis of the women's stories about their lives revealed transformations in their identities. These identity transformations were based on self-discoveries made during treatment that included realizations about their addiction, emotional well-being, and parenting. An analysis of their discoveries shows compliance and resistance to institutional socialization. Just as surely as the women addicts accepted the institutional socialization, they also resisted, pushed, and pulled at it, reminding us that they are not automatons of social and institutional forces.

Program variation in treatment outcomes among women in residential drug treatment

Multilevel modeling was used to assess the program characteristics associated with treatment retention among 637 women in 16 residential drug treatment programs in the Drug Abuse Treatment Outcome Study. Women who were pregnant or had dependent children had higher rates of retention in programs in which there were higher percentages of other such women. Longer retention was associated with higher rates of posttreatment abstinence. Bivariate analyses showed that programs with higher proportions of pregnant and parenting women provided more services related to women's needs. The findings support the provision of specialized services and programs for women in order to improve outcomes of drug abuse treatment.

At-risk behaviors with regard to HIV and addiction among women in prison

The bulk of studies pertaining to addiction among delinquents have been conducted on male subjects. However, the few studies examining female inmates show that a significant proportion of them present an addictive disorder. Furthermore, the HIV infection rate is higher among these women than among incarcerated men. This study attempts to verify if women presenting a combination of criminal and addictive behaviors are at a higher risk of developing an earlier and a more severe delinquency than other delinquent women. Another goal is to determine whether women showing this comorbidity present a higher incidence of HIV-related risk behaviors. The study was conducted on a sample of 210 women from the Montreal detention center. It shows that addicted inmates present earlier onsets of both drug use and criminal behaviors compared to other female inmates. Addicted women also exhibit significantly more HIV-related risky behaviors, both in their drug use and in their sexual practices.

Evaluation of the effects of outreach to women with multiple vulnerabilities on entry into substance abuse treatment

This paper examines ways in which the level of participation in intensive outreach contributes to entry into substance abuse treatment. It was hypothesized that the number of outreach contacts to substance abusing women predicts the likelihood of their entry into drug abuse treatment. As such women often have multiple vulnerabilities that impact upon their needs and readiness for seeking treatment, we also examine the relationships among readiness to seek assistance, the women's level of involvement with the outreach project, and admission to treatment. A sample of 665 women who participated in an enhanced outreach and treatment readiness preparation program was tracked to examine patterns of referral and entry into substance abuse treatment. The number of outreach contacts was inversely related to receiving referrals to substance abuse treatment, as well as to the completion of those referrals (for a subsample of 551 women who had received referrals). In addition, victims of domestic violence were 50% more likely to receive a referral to drug abuse treatment, but of the women who received such a referral, the lack of involvement in a violent relationship predicted entry into treatment. Findings are discussed in terms of their implications for designing and implementing outreach and treatment programs for women with multiple therapeutic issues, particularly substance abuse and domestic violence.

Women in a prenatal care/substance abuse treatment program: links between domestic violence and mental health

OBJECTIVES

This study examines the prevalence of violence experienced by patients enrolled in the Step by Step program, a combined prenatal care/substance abuse treatment program at the Wake County Health Department in North Carolina. In addition, potential associations between violence and sociodemographic characteristics, substance use, and mental health are investigated.

METHOD

All prenatal care/substance abuse treatment patients who met study eligibility criteria (N = 84) were assessed by health care providers. Descriptive statistics and bivariate analyses were used to compare victims of violence and nonvictims on a wide range of variables. Multiple linear regression analysis estimated the impact of the women's experiences of violence on their levels of mental health symptoms while controlling for confounding factors.

RESULTS

Forty-two percent of patients had been victims of both sexual and physical violence, and 30% had been victims of physical violence alone. The combination of sexual and physical violence was significantly less common among African-American women compared with other women. No other significant differences were found between victims and nonvictims in terms of sociodemographics or substance use. Compared with nonvictims, victims of the combination of sexual and physical violence had significantly elevated levels of general psychological distress as well as elevated levels of hostility, depression, anxiety, interpersonal sensitivity, and somatization. However, no significant differences in levels of mental health symptoms were observed among women who had experienced physical violence in the absence of sexual violence.

CONCLUSIONS

Questions concerning experiences of violence, including sexual victimization, should be incorporated into the clinical history-taking procedures of professionals working within prenatal care/substance abuse treatment programs so that effective interventions that take experiences of violence into account can be put into place for these high-risk women.