Suzanne Brown

Individuals with mental illness are disproportionately represented in the criminal legal system due to the criminalization of mental illness; however, one highly prevalent diagnosis among this population is posttraumatic stress disorder (PTSD). Experiences of incarceration in jail among individuals with PTSD are understudied, which is alarming as persons in jails have the highest rates of PTSD within the criminal legal system. Utilizing a phenomenological approach, this study aims to explore, describe, and understand the lived experiences of persons previously incarcerated in jails with PTSD. Findings from this study provide a firsthand account of the inhumane and traumatizing jail experiences persons with PTSD encounter and identify areas of the criminal legal system requiring intervention.

Family members of people who misuse opioids frequently experience stigma due to their association with non-medical opioid use (NMOU). Stigma may affect how family members communicate about NMOU and seek social support. Guided by communication privacy management theory, this study sought to understand how affected family members (AFMs) communicate about NMOU within and outside of the immediate family. In-depth interviews were conducted with 34 adults with an immediate relative with NMOU. Qualitative analyses utilized a common iterative approach. Findings identified complex dialectical tensions that families traverse in both wanting to conceal stigmatizing information while simultaneously wanting to disclose information to engage support for themselves during stressful experiences. Strategies to resolve this tension included focusing on the good, functional updates, and moving from closed to open communication boundaries. Treatment for individuals with NMOU should engage families and assist with the resolution of communication privacy management tensions.

Providing family members of individuals with opioid use disorders (OUD) naloxone is a cost-effective way to prevent overdose deaths. However, misconceptions and negative attitudes towards naloxone hinder family engagement with naloxone programs. This study examines factors associated with knowledge and attitudes toward naloxone among adults with close family members who misused opioids. Adults with family members (parent, step-parent, child, spouse, sibling, or step-sibling) who misused opioids (N = 299) completed a web-based survey. Participants were recruited through treatment providers, community groups, and social media. Surveys assessed naloxone knowledge, attitudes toward overdose response, demographics, completion of naloxone training, attitude toward medications for OUD, and family members’ overdose history. Multiple regression was used to identify factors associated with naloxone knowledge (Model 1) and attitudes toward overdose response (Model 2). A graduate degree (B = .35, p < .003) and a history of overdose (B = 0.21, p = .032) were associated with greater naloxone knowledge. Age (B = .11, p < .001), race/ethnicity (B = -1.39, p = .037), naloxone training (B = 2.70, p < .001), and more positive attitude toward medications for OUD (B = 1.50, p = .003) were associated with attitudes toward overdose response. Family members are potential allies in reducing drug overdose deaths, and families may need broader education about naloxone. Awareness of previous overdose was associated with greater naloxone knowledge. Findings related to race/ethnicity suggest the need to reach family members of minoritized racial groups to provide access to naloxone training. Findings point to where education and distribution efforts may focus on increasing knowledge and improving attitudes among those closest to people with OUD.

Background: Poor early relationship experiences during the first 16 years of life may negatively impact adults’ capacity to establish and utilize social support (Suchman et al. 2005 Suchman NE , McMahon TJ , Slade A , Luthar SS . 2005. How Early Bonding, Depression, Illicit Drug Use, and Perceived Support Work Together to Influence Drug‐Dependent Mothers' Caregiving. Am J Orthopsychiatry. 75:431–445. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] ). This is especially of concern for women with substance use disorders (SUD) for whom social support is associated with recovery maintenance and treatment retention (Gregoire and Snively 2001 Gregoire TK , Snively CA . 2001. The relationship of social support and economic self-sufficiency to substance abuse outcomes in a long-term recovery program for women. J Drug Educ. 31:221–237. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] ). The purpose of this study was to examine the influence of early relationship experiences, specifically paternal and maternal warmth, on recovery related social support and personal network characteristics among African American (AA) and non-AA women in treatment for SUD. Methods: Data were collected from 254 women in substance abuse treatment, 146 AA and 108 non-AA. Ordinal logistic, Poisson or multiple linear regressions were fitted to predict the impact of maternal and paternal warmth during childhood on adult social network composition and recovery support. Results: Greater maternal warmth was associated with greater recovery-specific social support for both AA (β = 0.12) and non-AA (β = 0.15) women. Paternal, but not maternal, warmth significantly predicted the number of social network members who supported recovery for non-AA women (AOR = 1.04), and number of network members who used drugs and alcohol for AA women (IRR = 0.99). Conclusion: Developmental experiences associated with fathers appear to affect different domains of adult functioning than those associated with mothers, and those effects are different for AA versus non-AA women. Attention to these differences may inform culturally relevant substance abuse prevention and treatment efforts.

Women with substance use disorders (SUDs) experience high rates of violence exposure and posttraumatic stress disorder (PTSD), which are associated with parenting anxiety and lower parenting satisfaction among mothers. Although social support may buffer the impact of violence and PTSD on parenting, violence exposure and PTSD may impair mothers’ ability to create, perceive, and utilize social support. We examined the impact of violence exposure, trauma symptoms, and interpersonal support on parenting competence among 291 mothers with substance dependence, using ordinary least squares regression and path analysis. Greater violence exposure and trauma symptoms were associated with lower parenting competence. Greater interpersonal support was associated with greater parenting competence. Trauma symptoms and interpersonal support sequentially mediated the impact of violence exposure on parenting competence, suggesting one pathway through which violence exposure may affect parenting among substance-dependent mothers. Implications for practice include the need to utilize trauma-informed interventions that modify social support.

Historically, recovery from substance use disorders (SUD) has focused exclusively on the use or non-use of the addictive substance(s). More recently, SAMSHA [ 1 ] has defined recovery in a more holistic way, using quality of life (QoL) as a measure of recovery for individuals with substance use and mental health disorders. However, little is known about the myriad experiences that inform and affect QoL for individuals with substance use disorders. Using an attachment informed stress-buffering framework, the purpose of this study was to examine the contribution of parental warmth and recovery support to QoL among women in substance abuse treatment. Linear regression and bootstrapping were used to examine direct and mediated effects of parental warmth and recovery support on QoL among 318 women recruited from three inner-city women-only addiction treatment programs. Relationships were assessed across three domains of quality of life: physical, psychological, and social. Parental warmth and recovery support were directly associated with psychological and social QoL, when controlling for the influence of trauma symptoms. Recovery support mediated the relationship between parental warmth and QoL across psychological and social QoL domains. Findings suggest that interventions that focus on attachment-related constructs to enhance recovery support may improve quality of life among women with SUD.

Objective: Approximately 73% of women entering treatment for substance use disorders are mothers of children younger than 18, and the high rate of mental health disorders among mothers with substance use disorders increases their vulnerability to poor parenting practices. Parenting efficacy and social support for parenting have emerged as significant predictors of positive parenting practices among families at risk for child maltreatment. The purpose of the current study was to examine the impact of parenting support and parenting efficacy on the likelihood of out-of-home placement and custody status among the children of mothers with dual substance use and mental health disorders. Methods: This study examined the impact of parenting efficacy and assistance with childcare on the likelihood of child out-of-home placement and custody status among 175 mothers with diagnosed dual substance and mental health disorder and in treatment for substance dependence. Logistic regression was utilized to assess the contributions of parenting efficacy and the number of individuals in mothers’ social networks who assist with childcare to the likelihood of out-of-home placement and custody loss of children. Parenting efficacy was also examined as a mediator using bootstrapping in PROCESS for SPSS. Results: Greater parenting efficacy was associated with lower likelihood of having at least one child in out-of-home placement (B = −.064, SE = .029, p = .027) and lower likelihood of loss of child custody (B = −.094, SE = .034, p = .006). Greater number of children in the 6 to 18 age range predicted greater likelihood of having at least one child in the custody of someone else (B = .409, SE = .171, p = .017) and in out-of-home placement (B = .651, SE = .167, p < .001). In addition, mothers who identified as African American were less likely to have a child in out-of-home placement (B = .927, SE = .382, p = .015) or to have lost custody of a child (B = −1.31, SE = .456, p = .004). Finally, parenting efficacy mediated the relationship between parenting support and likelihood of out-of-home placement (effect = −.0604, SE = .0297, z = 2.035, p = .042) and between parenting support and likelihood of custody loss (effect = −.0332, SE = .0144, z = −2.298, p = .022). Conclusions: Implications for practice include the utilization of personal network interventions, such as increased assistance with childcare, and increased attention to efficacy among mothers with dual disorders.

Objective: Women with dual disorders report lower levels of social support than women with substance dependence alone, and lower levels of social support have been associated with lower quality of life among individuals with substance use disorders. However, little is known about the impact of trauma symptoms and violence exposure on quality of life for women with dual disorders. The purpose of this study was to examine the impact of dual disorders, trauma, and social support related to recovery on various domains of quality of life among women in substance abuse treatment. Methods: This study utilized multiple standardized measures and hierarchical ordinary least squares regression to examine quality of life, trauma, and social support in women with dual disorders. Four domains of quality of life were measured (physical, psychological, social, and environmental domains). Participants (N = 369) were recruited from three inner-city women-only addiction treatment programs. Institutional review board approval was obtained prior to sample recruitment. Results: Presence of dual disorders was significantly associated with lower quality of life in the physical and psychological domains. However, this difference was no longer significant when trauma symptoms were added to the model. Trauma symptoms and support for recovery significantly predicted quality of life across all four domains and friends’ support for abstinence across three domains. Conclusions: Findings suggest that the presence of dual disorders in women may indicate a history of trauma. They also support the importance of both friends’ support for abstinence and recovery support as predictors of quality of life in women with dual disorders. Interventions that focus on social support and quality of life in treatment with women with substance use disorders may potentially enhance treatment outcomes.