Research That Matters (January 17 - 20, 2008)

Purpose: Substance abuse is a problem with great societal, familial, and individual consequences. The primary policy approach to substance abuse in the U.S. has relied on punishment, stigma, and withholding access to participate fully in society. Current policy theorists argue that these punitive approaches are ineffective and that to be effective policies should promote reintegration rather than estrangement from society. This study explores the predictors of relapse and the facilitators of recovery among women with recent histories of drug dependence examining the role of societal participation in reducing risk for relapse. Methods: A mixed methods, cross-sectional study design was used to explore the facilitators of recovery and risk factors for relapse among a sample of 325 women with histories of drug dependence. Analysis of secondary data, collected as part of a national cross-site study funded by the Substance Abuse and Mental Health Services Administration, combined logistic regression and qualitative analysis of responses from two open-ended items. A sequential, logistic regression explored predictors of relapse while an inductive approach was used to explore women's perceptions of the factors that positively and negatively influenced their recovery. Due to the limitations of the original data set, verification techniques of check-coding and peer consultation were used in the analysis of the qualitative data. Results: The results revealed that the combination of lower levels of support and participation in normal social roles predicted women's likelihood to relapse. Additionally, ten themes, perceived by participating women to be critical to recovery, were identified. The themes identified were instrumental support, affective support, participation in family and community, twelve-step programs, treatment providers, coercion, psychological characteristics, reliving painful experiences, acknowledging the past, and relationships with children. Implications: The findings support the contention that effective policies regarding women with histories of substance abuse should rely more on providing avenues for reintegration with society. They call into question policies that punish and estrange women from important social roles. Furthermore, the results suggest that children are often a motivating factor for women to seek recovery and that coercion associated with removal of children may be very differently perceived by women than loss of personal freedom. In addition, psychological characteristics such as hopefulness and vision for the future are factors that may not be adequately recognized in the treatment program design and policy development. Finally, this study demonstrates that including a small number of open-ended items in a larger quantitative measure can provide a richness and “voice” to the findings that would not otherwise be available.