Purpose: This study examined differences in coping strategies between women who were cocaine users vs. non-users during pregnancy. Although substance use has been conceptualized as a way of coping with life stressors, there is limited empirical evidence regarding the coping patterns of female cocaine/polydrug abusers. Further, certain coping strategies are more effective than others in reducing or increasing psychological distress. Thus, this study examined the impact of various coping strategies on psychological distress controlling for socioeconomic variables and social support.

Methods: Data from 376 women (193 cocaine using and 183 non-cocaine using), primarily poor, urban, African American, were collected during a face to face interview as part of a longitudinal research study that examines the effects of cocaine on fetal exposure. Women who were considered to be at high risk for drug use due to lack of prenatal care, behavior suggesting intoxication, a history of involvement with the Department of Human Services in previous pregnancies, or self-admitted drug use were given drug toxicology screening. Cocaine-using women were identified from positive results on infant meconium or urine, maternal urine, and/or maternal self-report to hospital staff or during a clinical interview. Coping was measured with the COPE (Carver et al., 1989), a 60-item self-report inventory designed to assess 15 conceptually different, theoretically derived coping responses. Psychological distress was measured using the Global Severity Index (GSI), a summary index of psychological distress on the Brief Symptom Inventory (BSI; Derogatis, 1992). Social support was measured with the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, 1990). Cocaine using versus non-cocaine using women were compared on socioeconomic, social support, coping strategies, and GSI. Pearson correlations were used to evaluate the relationship of covariates to GSI. A hierarchical regression analysis was used to examine the total contribution of coping to psychological distress, over and above the contributions of socioeconomic variables, cocaine use during pregnancy, and social support.

Results: There are significant mean differences on social support, coping strategies, and GSI by cocaine status. Cocaine using women reported lower level of social support, greater use of denial, behavioral disengagement, and mental disengagement coping strategies, and less use of positive reinterpretation, and higher psychological distress, compared to non-cocaine using women. Socioeconomic variables, age and education, were related to psychological distress, explaining 4.3% (p < .001) of the variance. Cocaine use during pregnancy was found to be a significant predictor, explaining another 5.2% (p < .001) of the variance. Social support was also significantly related to psychological distress, explaining additional 9.1% (p < .001) of the variance. Coping strategies jointly were found to explain 12.9% (p < .001) of the variance, and thus was the strongest predictor. Greater use of denial, mental disengagement, and focus on ventilation predicted greater distress. This model explained 31.6% of the variance of psychological distress.

Implications for practice: This study shows that certain coping strategies, namely avoidant, emotion-focused, predicted greater psychological distress. Treatment interventions to address use of avoidant, emotion-focused coping strategies would reduce psychological distress among cocaine using women.