Barriers to Treatment for Women With Substance Use Disorders

Substance-dependent women are facing tremendous barriers that impede them from entering into treatment programs. Such barriers include the lack of childcare, fear of stigma, lack of family or financial support, denial, and the co-occurring disorders. Strategies are paramount to the removal of these barriers, whereas treatment and relapse prevention aid in the rehabilitation process.     

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.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

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.     

Culturally Competent Substance Abuse Treatment for Asian/Pacific Islander Women

Summary

In response to the urgent need for substance abuse treatment among pregnant and postpartum Asian/Pacific Islander (A/PI) women, heath care and social service providers in a rural community of Hawaii established a culturally based, women-centered residential treatment program. The program was designed to address barriers that often prevent A/PI women from engaging and completing treatment. Treatment included Hawaiian healing practices or deep cultural therapy, provision for newborns to live with their mothers, infant health-care services, parent education, and infant-mother bonding guided by kupu-na (elders) of the community.

Analysis of twenty-one in-depth interviews revealed factors that A/ PI women participants found vital to their treatment process: having their children with them in a non-punitive, mutually respectful treatment milieu; working with consistent, competent residential staff and culturally-sensitive interdisciplinary professionals; and involvement in a range of substance abuse interventions, including cultural healing practices.

Findings underscore the importance of learning about and affirming women's lived-experiences and cultural contexts in the development of culturally competent practice models, interventions, research procedures, and policies that focus on the complex needs of chemically dependent pregnant and parenting women (Brindis & Theidon, 1997).     

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.     

The Role of Hawaiian Elders in Substance Abuse Treatment Among Asian/Pacific Islander Women

SUMMARY

The elders of a culture are often the designated transmitters of long-standing values and ways that define the unique essence of a people. Küpuna (elders) teachings are especially important to Native Hawaiians who have experienced the cumulative effects of cultural imperialism, which has taken their lands, discouraged use of their language and cultural ways, damaged their identity as a people and destroyed their sovereignty.

Modern day cultural imperialism, which universalizes the dominant group's experience and culture, renders minority groups as invisible while marginalizing them (Young, 1990). The chronic stress of this insidious form of oppression can translate into physical, mental health problems which lead to decreased life expectancy (McEwen, 1998; Schulkin, Gold & McEwen, 1998). Statistics on Hawaiians and other Asian/Pacific Islanders in Hawaiì indicate these groups have high rates of health problems and increasing rates of substance abuse (Office of Hawaiian Affairs, 1998).

This article describes the roles and Hawaiian practices of küpuna who acted as facilitators in the healing of Asian/Pacific Islander pregnant and postpartum women who participated in a culturally based substance abuse treatment program (CBSATP). The findings of a qualitative study, which examined the effectiveness of küpuna in these roles and their implications for practice are discussed.     

A Model Program for Increasing Treatment Access for African American Women Who Use Crack Cocaine and Are at Risk of Contracting HIV

ABSTRACT

In the United States, the threat of HIV/AIDS to African-American women's health has become the focus of much concern. This article describes a federally funded community-based program that provides services to African-American women at risk for HIV/AIDS in Nashville, TN. This program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important to the continued development of culturally relevant interventions that are vital to stemming the disproportionate rates of HIV/AIDS within the African-American community by ensuring treatment access to all populations.     

Alcohol Use and Prior Substance Abuse Treatment in Relation to Gambling Problem Severity and Gambling Treatment Outcome

Recent research has made it clear that problematic gambling is often accompanied by problematic alcohol use. Unfortunately, little is known about the nature of this association, especially as it relates to gambling treatment outcome. The purpose of this study is to explore the effect of current alcohol use level and previous substance abuse treatment on the symptoms of a large cohort of pathological gamblers as well as on their response to treatment for pathological gambling. The sample included 464 men and 301 women recruited at six gambling treatment programs in Minnesota. Gambling treatment patients were assessed on a number of gambling problem severity and related clinical variables using the Gambling Treatment Outcome Monitoring System (GAMTOMS). Patients with frequent alcohol use had greater gambling involvement at baseline than infrequent alcohol users. Patients with a previous history of substance abuse treatment had more severe psychosocial problems, ostensibly resulting from their gambling behavior, than patients without past substance abuse treatment. A MANOVA with repeated measures showed that neither pretreatment alcohol use, nor past substance abuse treatment exerted significant effects on gambling treatment outcome. While the level of pretreatment alcohol use and a history of substance abuse treatment are markers for greater gambling problem severity, treatment outcome for pathological gambling was not adversely impacted by these variables.     

The Role of Technology in Mediating Use of Outpatient Substance Abuse Treatment Services

ABSTRACT

This study examined the relationship between Connect, a telephone-based information and support system, and the use of outpatient substance abuse treatment services. Regression models were formulated to examine the relationship between use of substance abuse treatment services and Connect. The results indicate that Connect use was not significantly related to the likelihood of using treatment (N = 240). However, an inverse relationship was found between Connect and use of treatment services (n = 123). The findings raise the conceptual issue of whether one introduces technology as an “add-on” to or as a “substitute for” traditional substance abuse treatment services.     

Children of Substance Abusing Women on Federal Welfare

SUMMARY

The present study sought to characterize well-being indicators for a sample of children of substance dependent TANF women. Participants were 372 mothers meeting DSM-IV criteria for substance dependence and 156 non-substance abusing women from two urban counties in New Jersey. Children of substance dependent TANF mothers experienced significant vulnerabilities, as demonstrated by higher levels of contextual risk factors and negative behavioral and emotional and school outcomes. Overall, these rates were about double those found in children of non-substance abusing mothers. Results highlight the need for multi-systemic services to address the problems experienced by substance abusing TANF women and their children.     

Rebirth of the Self: How Battered Women Experience Treatment

The study analyzes battered women's experiences of treatment processes and results. A qualitative methodology based on the phenomenological approach, including semi-structured deep interviews, was used in collecting and analyzing the data of 60 women who had undergone treatment in six different agencies. All the agencies were highly qualified in providing psychosocial intervention in cases involving domestic violence and were operated by the Israel Ministry of Labor and Social Affairs. The findings reveal that the most significant experience for the women was being held and contained by the social worker, an action that allowed their recognition of self. Concerning outcomes, objective results such as taking action toward changing the violent relationship or leaving it were much less significant in the women's experience. Various aspects of the experience are described and analyzed, emphasizing the treatment process as a rebirth of the women. Implications for treatment based on this significant perspective are given.     

When practice and policy collide: Child welfare workers' perceptions of investigation processes

This qualitative study examines variability in practices surrounding Child Protective Services (CPS) investigations regarding the allegations of child maltreatment. Working under the auspices of a community-research collaboration with Department of Human Services officials, university researchers conducted a series of focus groups with CPS caseworkers in a state that was under court-ordered consent decree to improve child welfare investigations. Focus groups with caseworkers sought to better understand caseworkers' common investigative practices and their perceptions of best practices in conducting child welfare investigations. Two main areas were noted for improvement: (1) the need for ongoing training of CPS workers, particularly at the stage of initial intake of the allegations of maltreatment, and cross-training of police and hospital staff who regularly work with CPS, and (2) implementation of an improved risk assessment tool. These recommendations are discussed in detail.     

Predictors and Protective Factors in the Prevention and Treatment of Adolescent Substance Use Disorders

Contemporary adolescents are at a higher risk for developing a substance use disorder. Risk factors serve as predictors for identifying youths at the greatest risk for developing these disorders. Protective factors serve to protect adolescents from developing the substance use disorders. First-time drug use can be prevented through the “model program” modalities implemented through prevention research. However, when youths fall through the cracks and develop a substance dependency on alcohol or other substances, treatment strategies promise hope for adolescents who are experiencing the onset of substance dependency.     

Post-Modern Ideas in Substance Abuse Treatment

ABSTRACT

This article describes the use of post-modern ideas in the treatment of substance abusers at a long term residential and day treatment center. It describes some of the changes that ensued as a result of a transformation from a “therapeutic community” (TC) model to a “solution-focused” model. The TC is a deficit model that focuses on a person's flaws and weaknesses. Solution-focused therapy, on the other hand, focuses on what a person has done and is doing right and his or her strengths, assets, and resources. This approach not only improves the quality and effectiveness of substance abuse treatment for clients, but also creates a better working environment for staff.     

Resilient Southern Women

ABSTRACT

Using stories from Southern women, fictional and real, this article explores early life experiences and maltreatment in birth families, placement in out-of-home care, and outcomes. The method is qualitative, using unstructured interviews with two sisters, the creation of stories, and identification of patterns throughout the women's lives. Their experiences are compared with the experiences of resilient Southern women as presented in popular fiction. Patterns include resiliency, multiple episodes and types of maltreatment, lack of protection, shame, repetition of relationship patterns and intergenerational transmission of trauma, abandonment, scars and ghosts from the past, and mixed success in adulthood. Recommendations for research and practice to improve child and family well being conclude the article.     

Social and Health Service Use and Treatment Outcomes for Sexual Minorities in a National Sample of Substance Abuse Treatment Programs

This study examines substance use severity, levels of social and health service utilization, and the impact of service utilization on treatment outcomes for sexual minorities versus non-minorities. The sample included 3,094 clients from the National Treatment Improvement Evaluation Study (NTIES). Substance use severity among sexual minorities and non-sexual minorities was similar at treatment entry and at 12 months post-discharge. Differences in social and health service utilization were significant for substance abuse counseling and health services. Significant interactions between sexuality and access services and sexuality and mental health services were also found. Practice and research implications are discussed.     

Focus Group Study to Examine Content of Family Meetings in Short-Term Substance Use Disorder Treatment

This study explores the content family members find helpful in family meetings that occur while patients are in short-term treatment for substance use disorders. Four focus groups were conducted: 3 with 23 family members and 1 with 10 patients who were asked to identify those topics that are helpful or unhelpful for families with and without prior treatment experiences. Families identified education about substance use disorders and an overview of treatment options as useful for family members new to treatment, and an emphasis on response to relapse and family supports as important for those with prior treatment experiences.