Increased Family and Social Problems for Women with Alcohol and Cocaine or Opiate Dependence

Background: Previous research found that when substance dependent women also met criteria for Alcohol Abuse/Dependence, they presented for treatment with greater medical (Keyser-Marcus et al., 2006) and legal (Draper et al., 2006) problems and higher levels of psychopathology (Miles et al., 2001). The present study examined family conflicts and social functioning in a sample of substance dependent pregnant women with and without alcohol co-morbidity. Methods: Participants were N=387 pregnant women admitted to a comprehensive urban perinatal addiction treatment program. The majority of women were African American (87%) and all met criteria for polydrug abuse/dependence; predominantly cocaine and opiates. All women provided informed consent to one of several behavioral research studies and completed the Addiction Severity Index (ASI) as part of study participation. Women were then classified as either positive (Alc+; 16.8% of sample) or negative (Alc-; 83.2% of sample) for co-morbid alcohol use disorder (AUD). Chi-square analyses were used for group comparisons. Results: Alc+ women were more likely to report recent conflicts with their mothers (39% vs 25%), siblings (38% and 18%; p<.001), other family members (32% and 18%; p<.04) and their sexual partner(s) (40% and 24%; p<.016) than Alc- women. Alc+ women were also less likely to report ever having a close personal relationship with their mothers than Alc- women (45% vs 67%; p<.01). Finally, Alc+ women reported higher rates of emotional abuse both in past 30 days (40% vs 21%; p<.001) and in their lifetime (66% and 43%; p<.001). Conclusion: The results suggest that there may be additional psychosocial issues to explore in providing interventions for this population. Based on the reported difficulties in relationships, it may be that attachment disorders are also correlated with AUD. Study findings provide further support for the hypothesis that co-morbid AUDs in women with cocaine and opiate dependence are associated with greater impairment and more severe problems. Such women may benefit from more intensive treatment, with a particular focus on family/social functioning and communication.