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Hamby S, Schultz K, Taylor E. Health-Related Quality of Life among American Indian and Alaska Native People: Exploring Associations with Adversities and Psychosocial Strengths. HEALTH & SOCIAL WORK 2023; 48:105-114. [PMID: 36928132 DOI: 10.1093/hsw/hlad007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/10/2022] [Accepted: 05/02/2022] [Indexed: 06/18/2023]
Abstract
Identifying psychosocial strengths that support physical health can lead to better pathways to prevention and intervention. Relying on the resilience portfolio model as a conceptual framework, this study explores strengths in three domains (regulation, meaning making, and interpersonal) to identify promising protective factors to support physical health-related quality of life (P-HRQOL), controlling for prior exposure to adversity, age, and gender. This study uses data from four resilience portfolio model studies collected in the southern United States, combined to increase the number of people who identified as American Indian/Alaska Native. The sample included 147 people (M age = 28.5 years; SD = 16.26), of which 57 percent are female. The surveys collected data on adversities (polyvictimization, other adversities, county poverty), psychosocial strengths (psychological endurance, sense of purpose, religious meaning making, compassion, and community support), and P-HRQOL. The full model accounted for 24 percent of the variance in P-HRQOL, with strengths explaining more than twice as much variance as adversities (13 percent versus 6 percent). A sense of purpose showed the most promise for supporting P-HRQOL. Regarding implications, authors recommend exploring a wider range of protective factors that might improve resilience in Native communities. Several evidence-based pathways to meaning making, such as narrative and mindfulness, may improve health outcomes for Native people.
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Affiliation(s)
- Sherry Hamby
- PhD, is distinguished research professor of psychology, Psychology Department, University of the South, 735 University Avenue, Sewanee, TN 37383, USA; and director, Life Paths Research Center, Sewanee, TN 37375, USA
| | - Katie Schultz
- PhD, MSW, is assistant professor of social work, School of Social Work, University of Michigan, Ann Arbor, MI, USA
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Herron JL, Venner KL. A Systematic Review of Trauma and Substance Use in American Indian and Alaska Native Individuals: Incorporating Cultural Considerations. J Racial Ethn Health Disparities 2023; 10:603-632. [PMID: 35089579 PMCID: PMC9329482 DOI: 10.1007/s40615-022-01250-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Disproportionate rates of psychiatric disorders, like substance use and posttraumatic stress disorders (SUD and PTSD), exist among American Indian and Alaska Native (AI/AN) individuals. This review examines substance use and trauma in existing AI/AN literature and utilizes an AI/AN-specific model to culturally inform the relationship between these factors and provide recommendations for future research. METHODS We searched three databases through April 2021 for peer-reviewed articles that examined substance use and trauma in AI/AN individuals. RESULTS The search identified 289 articles and of those, 42 were eligible for inclusion, including 36 quantitative and 6 qualitative studies. Rates of lifetime trauma exposure varied from 21 to 98% and were correlated with increased rates of SUDs. A dose response of traumatic events also increased the likelihood of an SUD among reservation-based AI populations. Factors from the Indigenist Stress Coping model included cultural buffers such as traditional healing and cultural identity, which aided in recovery from SUD and trauma, and social stressors like boarding school attendance, discrimination, and historical loss. CONCLUSIONS SUD and trauma are highly correlated among AI/AN individuals though rates of PTSD are lower than might be expected suggesting resilience. However, this pattern may not be consistent across all AI/AN groups and further research is needed to better explain the existing relationship of SUD and PTSD and relevant historical and cultural factors. Further research is needed to culturally tailor, implement, and validate PTSD and SUD assessments and treatments to ameliorate these health inequities.
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Affiliation(s)
- Jalene L Herron
- Psychology Department, University of New Mexico, MSC03-2220, Albuquerque, NM, 87131, USA.
- Center On Alcohol, Substance Use, & Addiction, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Kamilla L Venner
- Psychology Department, University of New Mexico, MSC03-2220, Albuquerque, NM, 87131, USA
- Center On Alcohol, Substance Use, & Addiction, University of New Mexico, Albuquerque, NM, 87131, USA
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Lan CW, Joshi S, Dankovchik J, Jimenez C, Needham Waddell E, Lutz T, Lapidus J. Racial Misclassification and Disparities in Neonatal Abstinence Syndrome Among American Indians and Alaska Natives. J Racial Ethn Health Disparities 2022; 9:1897-1904. [PMID: 34410606 PMCID: PMC8857293 DOI: 10.1007/s40615-021-01127-z] [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: 05/07/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Maternal substance misuse can result in neonatal abstinence syndrome (NAS), a drug withdrawal process in newborns exposed in utero to drugs. This study aimed to examine the effect of racial misclassification of American Indians and Alaska Natives (AI/AN) on rates of NAS in two hospital discharge datasets in the Pacific Northwest. METHODS We conducted probabilistic record linkages between the Northwest Tribal Registry and Oregon and Washington hospital discharge datasets to correct racial misclassification of AI/AN people. We assessed outcomes using International Classification of Disease, Ninth Revision/Tenth Revision, Clinical Modification (ICD-9-CM or ICD-10-CM) diagnosis codes. RESULTS Linkage increased ascertainment of NAS cases among AI/AN by 8.8% in Oregon and by 18.1% in Washington. AI/AN newborns were 1.5 and 3.9 times more likely to be diagnosed with NAS than NHW newborns in Oregon and Washington, respectively. The results showed that newborns residing in rural Washington were 1.4 times more likely to be diagnosed with NAS than those living in urban areas. CONCLUSIONS Correct racial classification is an important factor in improving data quality for AI/AN populations and establishing accurate surveillance to help address the disproportionate burden of neonatal abstinence syndrome among AI/AN. The results highlight the need for programing efforts tailored by insurance status and rurality for pregnant women using substances.
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Affiliation(s)
- Chiao-Wen Lan
- Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA.
- Northwest Tribal Epidemiology Center, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA.
| | - Sujata Joshi
- Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
- Northwest Tribal Epidemiology Center, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
| | - Jenine Dankovchik
- Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
- Northwest Tribal Epidemiology Center, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
| | - Candice Jimenez
- Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
- Northwest Tribal Epidemiology Center, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
| | | | - Tam Lutz
- Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
- Northwest Tribal Epidemiology Center, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
| | - Jodi Lapidus
- OHSU-PSU School of Public Health, 1805 SW 4th Ave - Mailcode VPT, Portland, OR, 97201, USA
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Shadowen C, Jallo N, Parlier-Ahmad AB, Brown L, Kinser P, Svikis D, Martin CE. What Recovery Means to Postpartum Women in Treatment for Opioid Use Disorder. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:93-103. [PMID: 35136881 PMCID: PMC8812494 DOI: 10.1089/whr.2021.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/12/2022]
Abstract
Introduction: Opioid overdose has become a leading cause of pregnancy-associated deaths, particularly in the 1st year postpartum, highlighting the need to better understand how to promote recovery for postpartum women. This mixed-methods study aims to investigate how postpartum women receiving medication for opioid use disorder (MOUD) define recovery and factors associated with recovery progression or inhibition. Methods: Women receiving MOUD 2-6 months postpartum were recruited from an outpatient perinatal addiction clinic. Participants completed electronic measures including the Brief Assessment of Recovery Capital (BARC-10, total score range: 6-60) and semistructured individual interviews. Substance Abuse and Mental Health Services Administration (SAMHSA)'s recovery framework served as the conceptual model for interview guide development. Descriptive statistics were generated for survey responses. A qualitative descriptive approach was used to analyze and report the interview data. Results: On average, participants (n = 8) were 28.6 years old and taking 19.5 mg/day buprenorphine (range 8-24). Fifty percent identified as white and 37.5% as black. All participants identified as currently in recovery, with mean BARC-10 score 52.5 (standard deviation 4.8). Recovery goals included no use of drugs or alcohol (62.5%), being a better partner/spouse (87.5%), and improving finances (87.5%). Interviews generated themes including recovery as transformative, building resilience, and transforming one's health, relationships, and environment through recovery. Conclusions: Participants defined recovery as a dynamic transformative process, including nonabstinence-based goals consistent with SAMHSA domains coupled with reduced substance use. Central to recovery for our postpartum participants was the sense of self reinforced throughout their recovery journey. Women highlighted the key role of MOUD in their recovery process. Findings underscore the need for individualized treatment for postpartum women with opioid use disorder based on their personal goals and will inform development of a validated, gender-informed measure of patient-reported recovery outcomes tailored for this population.
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Affiliation(s)
- Caroline Shadowen
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nancy Jallo
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anna Beth Parlier-Ahmad
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lisa Brown
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia Kinser
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace Svikis
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caitlin E Martin
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Deutsch AR, Lustfield R, Hanson JD. Where there's a will, there's a way? Strategies to reduce or abstain from alcohol use developed by Northern Plains American Indian women participating in a brief, alcohol-exposed pregnancy preconceptual intervention. Alcohol Clin Exp Res 2021; 45:2383-2395. [PMID: 34585745 DOI: 10.1111/acer.14721] [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: 05/17/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief, preconceptual AEP-reduction interventions are popular in such areas but have a small impact on alcohol use. Developing a strategic alcohol change plan is a key program component; however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen to reduce alcohol use by AIAN women participating in a culturally tailored, brief, preconceptual AEP-reduction intervention. METHODS One hundred-sixty Northern Plains AIAN women who were participating in a brief AEP-reduction program developed a plan to accomplish an alcohol reduction/abstention goal at the first and last program sessions. The plan included choosing 1 or more strategies to (1) achieve the goal, (2) mitigate barriers, and (3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all 3 strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component. RESULTS Most participants reported only 1 strategy (theme) for each of the 3 components. Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural resource strategy. CONCLUSION Programs aimed at reducing AEPs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with high levels of trauma and contextual barriers that can impact strategy selection. Such support could include ways to improve health on both interpersonal and community levels.
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Affiliation(s)
- Arielle R Deutsch
- Avera Research Institute, Sioux Falls, South Dakota, USA.,School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Rebecca Lustfield
- Avera Research Institute, Sioux Falls, South Dakota, USA.,School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Jessica D Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, Minnesota, USA
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Ritland L, Thomas V, Jongbloed K, Zamar DS, Teegee MP, Christian WK, Richardson CG, Guhn M, Schechter MT, Spittal PM. The Cedar Project: Relationship between child apprehension and attempted suicide among young Indigenous mothers impacted by substance use in two Canadian cities. PLoS One 2021; 16:e0252993. [PMID: 34111186 PMCID: PMC8191959 DOI: 10.1371/journal.pone.0252993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada's child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008-2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25-8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94-5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00-3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63-10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04-7.99), violence (HR: 2.54, 95%CI: 1.52-4.27) or overdose (HR: 4.97, 95%CI: 2.96-8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23-1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations.
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Affiliation(s)
- Lisa Ritland
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Victoria Thomas
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Wuikinuxv Nation
| | - Kate Jongbloed
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David S. Zamar
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Mary P. Teegee
- Takla Lake First Nation, Carrier Sekani Family Services, Prince George, BC, Canada
| | - Wenecwtsin-Kukpi Christian
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- Splatsin te Secwepemc
| | - Chris G. Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Patricia M. Spittal
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Barnett ER, Knight E, Herman RJ, Amarakaran K, Jankowski MK. Difficult binds: A systematic review of facilitators and barriers to treatment among mothers with substance use disorders. J Subst Abuse Treat 2021; 126:108341. [PMID: 34116826 DOI: 10.1016/j.jsat.2021.108341] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/30/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The United States and Canada have observed sharp increases in substance use disorder among women of child-bearing or child-rearing age. Substance use disorder can have deleterious effects on children, families, and communities. Many evidence-based treatments exist, but engaging mothers in treatment is difficult. No recent review is available to help systems and providers understand the facilitators of and barriers to treatment for mothers. OBJECTIVE To systematically identify facilitators and barriers to substance use and mental health treatment for mothers with substance use disorder who are pregnant or parenting young children in the United States and Canada. METHODS We systematically searched the literature using five online databases and performed a gray literature search. We included studies published in the past two decades focused on parent or provider perspectives. RESULTS Our search identified 23 high-quality papers. The majority of papers qualitatively examined the perspectives of treatment-seeking pregnant women and mothers diverse in race/ethnicity, region, and treatment settings. Our synthesis of findings revealed the compelling and complex centrality of motherhood, which served as both a facilitator and barrier. Motherhood often interacted with relational (e.g., perceiving stigma vs. support from providers, family, friends, partners) and structural (e.g., time commitments, childcare) factors to both hinder and help engagement in treatment. CONCLUSIONS Our findings can help policy-makers and practitioners make tangible improvements to the financing and delivery of substance use treatment for mothers. Our review points to specific areas for future research, including an examination of the relationships between various structural factors and treatment outcomes.
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Affiliation(s)
- Erin R Barnett
- Department of Psychiatry, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, USA.
| | - Erin Knight
- Geisel School of Medicine at Dartmouth, Center for Program Design & Evaluation, USA.
| | - Rachel J Herman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, USA.
| | - Kieshan Amarakaran
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, USA.
| | - Mary Kay Jankowski
- Department of Psychiatry, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, USA.
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Culturally Safe, Strengths-Based Parenting Programs Supporting Indigenous Families Impacted by Substance Use—a Scoping Review. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00237-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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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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Hamby S, Schultz K, Elm J. Understanding the burden of trauma and victimization among American Indian and Alaska native elders: historical trauma as an element of poly-victimization. J Trauma Dissociation 2020; 21:172-186. [PMID: 31752627 DOI: 10.1080/15299732.2020.1692408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Research on recognition of adverse childhood experiences (ACEs) and poly-victimization has transformed our understanding of violence and trauma exposure. Both concepts point to the importance of understanding the cumulative burden of trauma and the interconnections among forms of violence and abuse. However, there has been little conceptualization about what these two constructs mean for American Indian and Alaska Native (AI/AN) individuals, families, and communities, and even less attention to the experiences of AI/AN elders. This paper summarizes prior work on adverse childhood experiences and poly-victimization, addresses the limitations of past research on these issues, and expands these constructs to include concepts of historical trauma in order to better understand victimization and trauma among AI/AN elders. We call for the integration of historical trauma into the poly-victimization framework for AI/AN communities in order to more accurately capture the true burden of victimization among AI/AN peoples. Future research, prevention, and intervention can better incorporate historical trauma and we provide suggestions for doing so, including adding items on historical trauma to poly-victimization surveys and creating programs to promote cultural connectedness.
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Affiliation(s)
- Sherry Hamby
- Department of Psychology, Life Paths Research Center & University of the South, Sewanee, Tennessee, USA
| | - Katie Schultz
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Elm
- Center for American Indian Health, Great Lakes Hub, Johns Hopkins University, Duluth, Minnesota, USA
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