Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Cocaine using women have increased psychological distress, especially depression, low self esteem, anxiety, and paranoia. Women with substance abuse disorders and mental health treatment needs pose complex practice and service delivery issues. Such women are also at risk for domestic violence, polydrug use and child abuse and neglect. Providing appropriate services from multiple service systems is both a need and a challenge for these women.

Methods:

Using a cross sectional survey design, data were collected from 159 women identified as using cocaine during pregnancy as part of a NIDA funded longitudinal study. Current substance use and mental disorders were assessed using the Computerized Diagnostic Interview Schedule. Perceived service barriers were measured with the Allen Barriers to Treatment Inventory (ABTI). As adapted in this study, the ABTI consisted of 46 alcohol and drug and 39 mental health treatment barriers. Chronbach's alpha for both scales were .96. Self reported use of substance abuse and mental health services over the past six months was collected.

Results:

The mean age was 36.7 years. 88.7% identified as African American. The mean number of children was 4.4. 43.4% had a high school diploma or GED. 56% (89) had a lifetime diagnosis of cocaine dependence, 40.9% (65) lifetime alcohol dependence, and 24.5 % (39) lifetime marijuana dependence. Lifetime mental disorders were prevalent and were as follows: 39.6 % (63) major depressive episode, 32.1% (51) PTSD, 12.6% (20) generalized anxiety. 60.4 %( 96) had a lifetime substance use disorder only and 39.6% (63) had a lifetime co-occurring substance use and mental disorder. 19.5% (31) had used, 44% (70) had attempted and 36.5% (58) had not used substance abuse treatment services. 17% (27) of the women had used and 25.8% (41) attempted to access mental health services; 91 (57.2%) of the women had not used mental health treatment services.

Among those women who had used services, the most frequently reported barriers to alcohol and drug services were: “need alcohol/drugs for stress relief” (35.5%), “unable to stay clean in the past” (32.3%), “fear of losing children” (32.2%) “feeling ashamed” (29%) and “no one to take care of children” (29%). Most frequently reported barriers to mental health services were: “fear of losing children” (37%), “No one to take care of children” (29.6%) “dealing with the problems of family members (29.6%), “no transportation” (22.2%) and “not knowing the location” (22.2%). T-test showed that the lifetime dual disorders group (63) reported significantly more barriers to substance abuse and mental health treatment services.

Implications for Practice:

Mental health disorders were common among this sample of substance using women. “Fear of losing children” was the number one barrier to mental health services but not for substance abuse services. Barriers for alcohol and drug services tended to be interpersonal and psychological in nature. Barriers for mental health services tended to relate to family issues and the logistics of accessing services. Comprehensive treatment programs for women with substance use disorders could help women address these barriers, especially those related to child care and family issues.