Early Bonding Experiences, Social Support, and Quality of Life Among Women in Substance Abuse Treatment

Purpose:  Previous research has identified poor early bonding experiences during the first 16 years of life among women with substance use disorders (SUD) (Suchman, 2006).  Relationships between early bonding experiences, adult social support and adult quality of life (QoL) have also been established (Belizaire & Fuertes, 2011; Martin, et. al., 2013).  This is especially of concern for women with SUDs, as QoL is associated with recovery related outcomes such as relapse prevention and program retention, and poor early bonding experiences may increase vulnerability to limited social supports, poor quality of life, and potential relapse. The purpose of this NIDA funded study was to examine the influence of early bonding experiences, adult social support, and personal network characteristics on adult QoL among women in treatment for SUDs and dual disorders (SUDs and mental disorders).    

Methods:  Data were collected from 369 women one week following intake to one of three substance abuse treatment programs.  Criteria for study eligibility included being at least 18 years old, and having a diagnosis of alcohol and /or drug dependence.  The World Health Organization Quality of Life Scale was utilized to assess overall QoL. The Parental Bonding Instrument assessed women’s early bonding experiences with their own parents during childhood.  Social support was examined using both the Interpersonal Support Evaluation List (ISEL) and EgoNet- a computerized assessment of personal network characteristics.  Hierarchical regression was performed to examine the unique contributions of early bonding experiences, social support, and personal network characteristics on QoL.

Results: Participant’s average age was 36.5 (SD=10.4).  Most identified as Black-African American (59.8%), and had less than a high school education (56.5%); 73.3% had a dual disorder, and 58.9% were dependent on more than one substance.  Over half (58.9%) were in outpatient treatment while 41.1% were in residential treatment.  Only 9.8% were currently employed, and 43% had been homeless at some time in their lives.  Women’s addiction histories averaged 6.41 years (SD= 7.76) and ranged from 0-38.  The multivariate regression model (F(6, 229)=34.054, p<.001) including demographic variables, trauma symptoms, Parental Bonding Instrument scores and social support (ISEL) accounted for 52.2% of the variance in QoL satisfaction.  Parental Bonding (β=.156, p<.01) and social support (β=.284, p<.001) each predicted quality of life.  Personal network characteristics also associated with QoL included sobriety support (β=.125, p<.05) with final model accounting for 41% of the variance in QoL, relationship closeness (β=.210, p<.001) with final model accounting for 42.1% of variance, and number of individuals in the network using alcohol/drugs ((β=-.145, p<.05) with final model accounting for 39% of variance.  

Implications:  Findings suggest the importance of early parental bonding, adult social support, and personal network characteristics as predictors of QoL for women with SUDs.  Practice implications include the importance of considering the relationships between early bonding experiences, social support, personal network characteristics, and QoL when planning interventions for women with SUD and when considering their possible vulnerability to relapse.  Future research will examine personal network characteristics as possible mediators in the relationship between early bonding and adult quality of life.