The relationship of social support and economic self-sufficiency to substance abuse outcomes in a long-term recovery program for women.

A growing literature suggests that women experience chemical dependency in a very different manner than men. Their needs in treatment may also vary. In particular, women with low incomes face greater economic hardship, and may be more subject to the influence of social support in maintaining recovery. Despite evidence for the relationship of both employment and social support in substance abuse treatment outcomes, many programs are reducing services and lengths of stay. The authors explored outcomes for fifty-nine women who attended long-term substance abuse treatment in a womens' facility that emphasized employment and economic self-sufficiency. Reductions in substance use were associated with an increase in economic autonomy. Improvement in other life domains was positively associated with measures of economic self-sufficiency. Women living in drug-free social environments had higher rates of abstinence and better overall functioning. At least among women who participated in our study, economic outcomes, substance use, and general functioning went hand-in-hand. Eliminating services such as employment assistance may, while reducing cost, also negatively impact outcomes among the most vulnerable clientele.     

Oxford house: a review of research and implications for substance abuse recovery and community research

After treatment for substance abuse, whether it is in hospital-based treatment programs, therapeutic communities, or recovery homes, many patients return to former high-risk environments or stressful family situations. Returning to these settings without a network of people to support abstinence increases chances of a relapse. As a consequence, substance abuse recidivism following treatment is high for both men and women. Alternative approaches need to be explored, and there are some promising types of recovery homes. From a public health perspective, a series of studies conducted at DePaul University suggests that one type of recovery home for alcohol abuse recovery has much potential. For example, within this self-help communal living setting, recovering alcoholics were able to maintain employment, thereby reducing their need for government subsidies. Maintaining employment for recovering alcoholics may promote increased personal responsibility, which may impact self-efficacy beliefs. These pilot studies, then, raised both theoretical and practical issues needing further evaluation.     

Predictors of Burden of Family Caregivers of Women with Substance Use Disorders or Co-Occurring Substance and Mental Disorders

ABSTRACT

This study examined the impact of having a female family member with a substance use or co-occurring disorders on family caregivers. Predictors of subjective burden (worry, stigma, and displeasure) and objective burden (family disruption) on caregivers and on types of burden were explored. Subjects were 82 women receiving substance abuse treatment and their family member providing most social support. Behavioral problems of the recipient and lack of social support for caregivers predicted higher levels of family member burden, with different types of social support predicting different types of burden. Having a dual disorder did not predict family member burden. Implications of findings for treatment are discussed.     

Personal Social Networks of Women with Co-Occurring Substance Use and Mental Disorders

ABSTRACT

There has been relatively little examination of the social network resources of women with substance use disorder, and even fewer explorations of women with co-occurring mental disorders, such as anxiety, depression, and posttraumatic stress disorder. This study explores the nature of co-occurring mental disorders, social network characteristics and perceived social support in 136 women with substance use disorders. Respondents reported small personal networks that contained both supportive and non-supportive people. Relatives did provide social support, but those who used alcohol/drugs were viewed as tending to interact negatively. Women with dual disorders perceived less concrete, emotional, and sobriety support from some network relationships than the women with substance use disorders only. Implications for research and practice are presented.     

Experiences of Drug Use and Parenting among Women in Substance Abuse Treatment: An Exploratory Study

The purpose of this exploratory study was to explore the multiple contexts of vulnerability, drug use and parenting for women in substance abuse treatment. Nineteen purposively sampled women provided qualitative data through semi-structured interviews. Findings revealed that adverse childhood experiences and intimate partners were important pathways into drug use initiation. Identities as mothers emerged as a key finding, intimately linked to women's motivation to seek and complete treatment. Understanding the challenges to recovery among mothers in treatment is an important priority for social workers. This study highlights the complexity of women's experiences and suggests implications for future practice and research.     

Substance Abuse,Homelessness, Developmental Decision-Making and Spirituality: A Women's Health Issue

ABSTRACT

A qualitative methodology was used to examine the relationship between homeless women's spirituality, substance abuse, moral reasoning and developmental decision-making. Findings indicated that a lack of development in spirituality and the ability to make decisions in childhood is related to homeless, addicted women's inability to maintain abstinence and achieve social independence. Spirituality impacted decisions to abstain from substance abuse and increased the women's social independence. Findings suggest that treatment needs to incorporate spirituality, family of origin, and the development of skills for independent decision-making. The authors propose that childhood maltreatment, homelessness and substance abuse impede spiritual development. Therefore, substance abuse treatment needs to include a focus on spirituality and moral reasoning in the recovery process.     

Closing the Need-Service Gap: Gender Differences in Matching Services to Client Needs in Comprehensive Substance Abuse Treatment

Despite the broad recognition in social work that services are more effective when they are tailored to individual client needs, we have only limited evidence of the impact that services matched to client needs have on treatment outcomes. This study examines gender differences in the impact of matched services, access services, and outcome-targeted services on substance abuse treatment outcomes by using data collected from 1992 through 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and clients. The analytic sample consists of 3,027 clients (1,105 women and 1,922 men) who reported needed services from 59 treatment facilities. Findings from the study indicate that overall programs have only limited success in targeting services to client needs, but when they do, receipt of substance abuse counseling and matched services predicts both remaining in treatment and reduced posttreatment substance use for both women and men, but especially for women.     

SUBSTANCE ABUSE TRAINING AND PERCEIVED KNOWLEDGE: PREDICTORS OF PERCEIVED PREPAREDNESS TO WORK IN SUBSTANCE ABUSE

As frontline mental health care providers, social workers need to be prepared to confront and properly manage substance abuse issues in practice. This study examined predictors of recent master of social work (MSW) graduates' perceptions of preparedness to practice in the area of substance abuse. A cross-sectional design was used, and 232 recent MSW graduates completed a mail-in survey (65.7% response rate). Respondents were more likely to perceive themselves as prepared to work with substance abuse issues if they received more formal academic training in substance abuse and had higher knowledge of substance abuse concepts and models. The findings support the need to include substance abuse education in social work curricula.     

Couples therapy for women survivors of child sexual abuse who are in addictions recovery: a comparative case study of treatment process and outcome

Treatment for women who are survivors of child sexual abuse and who have a history of substance abuse has largely involved gender-specific interventions. This study examines the use of conjoint couple therapy with a cohort of women who were survivors of child sexual abuse and who are in addiction recovery and with their partners. A comparative case study analysis incorporated standardized clinical measures with client and therapist interviews. Brief conjoint therapy was found to assist couples in the specific relationship skill areas of communication and mutual problem solving. Further, substantive gains were found in the realm of affective relations. The women reported an increase in support from their male partners, and the men reported a decrease in negative emotional atmosphere in the relationship.     

Enhancing Drug Treatment Program Staff's Self-Efficacy to Support Patients' HCV Needs

To increase HCV-related support for patients in substance abuse treatment programs, we implemented an on-site staff training in 16 programs throughout the United States. It aimed to increase participants' self-efficacy in assisting patients with their HCV-related needs. Findings indicate that participants' self-efficacy increased both 1- and 3-months post-training, resulting in providers' perceptions that they were better able to support patients regarding HCV. Implementing an engaging and interactive HCV training for social workers and other substance abuse treatment program staff has the potential to increase their HCV knowledge, self-efficacy, and the HCV-related assistance provided to patients both in the short- and longer-term.     

Evaluation of a Training to Reduce Provider Bias Toward Pregnant Patients With Substance Abuse

The objective of this article is not to present a scientific or systematic study, but to provide an initial framework for designing a training workshop to enhance health practitioners’ (nurses, social workers, physicians, etc.) knowledge regarding substance abuse treatment and to decrease their bias toward substance-abusing women, particularly pregnant women in rural communities. We incorporated the 4 Transdisciplinary Foundations from the Substance Abuse and Mental Health Services Administration Competencies Model, with specific competencies targeted that related to provider bias. After the conference, 52 of the 70 participants completed a questionnaire to self-assess knowledge level and confidence in skill related to substance abuse management. Participant mean scores were statistically significantly higher following the conference than 1 week prior (p < .001) in the area of “gender difference with substance abuse,” moving from an average of 2.6 to 4.5 on a 5-point Likert scale. Our conference was successful in increasing attendees’ knowledge about gender difference and substance abuse among pregnant patients.     

Appalachian Women’s Use of Substance Abuse Treatment: Examining the Behavioral Model for Vulnerable Populations

The Gelberg–Andersen Behavioral Model for Vulnerable Populations was applied to understand vulnerable Appalachian women’s (N = 400) utilization of addiction treatment. A secondary data analysis included multiple multivariate analyses. The strongest correlates of treatment utilization included ever injecting drugs (OR = 2.77), limited availability of substance abuse treatment facilities (OR = 2.03), and invalidated violence abuse claims (OR = 2.12). This study contributes theory-driven research to the greater social work addiction literature by confirming that vulnerable domains related to substance abuse treatment utilization warrant unique considerations compared to nonvulnerable domains. Findings also highlight the importance of understanding the unique role that cultural factors play in treatment utilization among Appalachian women. Inferences relevant to clinicians and policymakers are discussed.     

The Development of Theory and Treatment with Substance Abusing Female Juvenile Offenders

Little is known regarding the specific treatment needs of those female juvenile offenders with a history of substance abuse. While social scientists have advanced distinct theories regarding adolescent substance use and juvenile delinquency, minimal work has been conducted to integrate or link these two. In attempting to further explore their interrelationships, this article will review and incorporate the relevant theoretical and practice milestones in three areas: (1) substance abuse and women, (2) substance abuse and adolescents, and (3) substance abuse and juvenile delinquency, leading to the development of new theory and practice relevant to the female substance abusing juvenile offender population. The authors propose some practice considerations for current interventions with this population and discuss implications for future research and exploration.     

From social workers to socio-therapists: the transformative journey of substance abuse therapists

ABSTRACT

The efficiency of interventions in addiction is associated with the processes of practitioners’ professional development. Identity formation is studied extensively for clinical professions but little research focuses on social workers working in addiction settings. This study examined the experience of social workers working in a community treatment network in Greece. Fifteen interviews were conducted with 11 women and 4 men, ranging between 29 and 47 years οf age, who worked in different centers within the network. Data were analyzed following the guidelines of Interpretative Phenomenological Analysis, offering in-depth examinations of people’s lived experience. The results delineate a series of transformations in professional identity comprising a process of biographization. The participants highlighted intrapersonal and relational factors that influence this process which leads to self-understanding and engagement with the therapeutic community. The results contribute to deciphering the factors that influence social workers’ experience in their professional identity formation in substance abuse treatment contexts.     

Attitudes about addiction: a national study of addiction educators

The following study, funded by the National Institute of Drug Abuse (NIDA), utilized the Addiction Belief Inventory (ABI; Luke, Ribisl, Walton, & Davidson, 2002) to examine addiction attitudes in a national sample of U.S. college/university faculty teaching addiction-specific courses (n=215). Results suggest that addiction educators view substance abuse as a coping mechanism rather than a moral failure, and are ambivalent about calling substance abuse or addiction a disease. Most do not support individual efficacy toward recovery, the ability to control use, or social use after treatment. Modifiers of addiction educator attitudes include level of college education; teaching experience; licensure/certification, and whether the educator is an addiction researcher. Study implications, limitations, and directions for future research are discussed.     

Judges', caseworkers', and substance abuse counselors' indicators of family reunification with substance-affected parents

The decision to reunify children with their substance-affected parent is highly complex and requires a tremendous amount of work and change on the part of the affected parent. This exploratory study identified indicators for safe reunification of children placed in foster care due to parental substance abuse. Judges who hear juvenile cases, private agency child welfare caseworkers, and substance abuse counselors from a large midwestern state were surveyed using an instrument composed of a preliminary list of indicators identified through focus groups with these professional groups. Responses from 196 professionals who rated the importance of each item and subsequent factor analysis resulted in identification of 97 indicators. These indicators were grouped into the categories of motivation, recovery, competency, and reliability; social support; parenting skills; and legal issues. Implications of the findings for practice are discussed.     

Acute Stress Disorder Symptoms Among Female Sexual Abuse Survivors Seeking Treatment

ABSTRACT

This exploratory study examined relationships between acute stress disorder (ASD) symptoms and sexual abuse history, distress, and social support among sexual abuse survivors seeking treatment. Participants were 32 women recruited for a pilot study of group treatment for sexual abuse survivors who completed self-report and interview measures. Many participants (37.5%) met criteria for all ASD symptoms. Also, ASD symptoms were significantly related to seeing the self as the causal locus of the abuse, forgetting the abuse for a period of time, and the number of abusers, the distress of a recent life event, other forms of distress, and poor social support, Acute stress disorder may occur among many sexual abuse survivors seeking treatment, requiring special intervention to help these patients to manage their reactions to ongoing stresses.     

Networks,Neighborhoods, and Depression: Negative Interactions by Social Support Members as a Mediator of Neighborhood Characteristics and Depressive Symptoms in a Sample of Recovering Substance Abusing Women

Abstract

Although social networks and substance abuse have been extensively studied, less is known about the role social networks play in the context of neighborhood disorder and depression. Sixty-five women were recruited from CASAWORKS for Families, a national demonstration project for substance abusing women. Average participant age was 31; half of the sample was European American, 40% African American, and 10% was other ethnicities. The average length of time in the program was about three months. We found that negative interactions partially mediated the relationship between neighborhood disorder and depression. Specifically, higher levels of neighborhood disorder predicted increased negative social exchange that in turn predicted higher levels of depressive symptoms. However, mediation analysis indicated that the strength of the relationship between neighborhood disorder and depression was attenuated when negative interactions were considered. These results support the importance of community endeavors that seek to improve basic living conditions in disadvantaged communities.