Friday, 14 January 2005 - 8:00 AM

This presentation is part of: Subtance Abuse Treatment

Assessing Psychological and Social Functioning of Pregnant Women in Substance Abuse Treatment

Purpose: Pregnant women who abuse substances are a particularly vulnerable group in need of sensitive and efficacious biopsychosocial services. Although gender-specific programs that combine substance abuse treatment with prenatal medical care are the recommended mode of treatment for pregnant women with substance abuse problems, little is know about how these services relate to improvements in women's psychosocial functioning. Using service data from a gender-specific program that combined substance abuse treatment with prenatal care for pregnant women, this investigation aimed to determine the relationship of these services to women's psychosocial functioning over time.

Methods: The study analyzed longitudinal service-delivery data among 159 pregnant women. Growth curve modeling, a powerful tool for analyzing longitudinal time varying data, was used to determine if these comprehensive, gender-specific services were related to women's psychosocial functioning as measured by the DSM IV-TR GAF score. Growth curve modeling allowed for the determination of 1) the participants' mean GAF score at the beginning of treatment; 2) the effect of service duration on the changes to GAF scores; and 3) the effect of specific types of services on the GAF scores by treating the number of services (i.e., group, individual, family, and case management) as time-varying covariates. The analyses also controlled for participants' education, prior mental health and substance abuse treatment, and severity of alcohol and cocaine use at the beginning of treatment.

Results: Using grand mean centering, the final model (BIC=2961.82) showed that the initial adjusted GAF score for the sample was 40.29, representing serious impairment in social and psychological functioning at the beginning of treatment. However, participants' GAF scores increased at a rate of .009 a day (p<.001), and the number of attended group sessions (p<.001) and individual sessions (p<.001) were positively related to this increase. However, the use of case management services was negatively related to the GAF scores (p<.001). A subsequent examination of service-use patterns helped to interpret this negative finding. Interestingly, there was no interaction effect between changes in the GAF scores with severe alcohol and cocaine use (p>.05) in the overall model.

Implications for practice: Findings show that the participants had significant psychosocial impairment at the beginning of treatment. However, in the context of comprehensive gender-specific substance abuse treatment, group and individual sessions significantly related to improved social and psychological functioning regardless of the severity of participant substance use at entry into the program. These results show the promise of comprehensive, gender specific substance abuse treatment programs for pregnant women, even with severe substance abuse problems. The examination of participants' service use patterns and needs suggests that women who used case management services had more difficulty with basic survival needs, which likely impacted GAF scores. Practice implications for the development and implementation of comprehensive, gender-specific services will be discussed, with attention to the delivery of services to women with severe socioeconomic needs.

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