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Motherhood can spur positive change in women struggling with substance use or violent relationships. Yet, intense stress that often accompanies motherhood can paradoxically compel women to remain in such relationships and even increase their risk of abusing alcohol. Research indicates a high correlation between problem drinking and intimate partner violence (IPV), however, research has yet to examine how these co-occurring problems may be exacerbated or mitigated by the role of motherhood.
This paper sheds light on these complex relational interactions by examining audiotaped narratives of mothers making sense of their drinking patterns and relationships with abusive partners during brief Motivational Interviewing (MI) sessions. MI has shown some promise in addressing problem drinking and IPV and is an evidence-based practice requiring a provider utilize directive, reflective listening aimed at eliciting individuals’ highly unique relationship to specific behaviors.
Methods: 600 women were participants in a randomized controlled trial of the use of brief MI in an urban emergency room setting to address problem drinking and IPV. From participants randomized to the treatment group, we selected those who were mothers with severe problem drinking behaviors (as indicated by the AUDIT instrument) who also had high levels of intimate partner violence (measured by the CTS2S). The sample was composed of 32 women who were predominantly black, middle to low income (25% making less than 10,000 and only 3% making over 50,000), with extremely high rates of depression (97% meeting criteria for depression) and a mean age of 30. We transcribed and inductively coded the sessions using feminist standpoint theory, which views knowledge as being situated within a context, privileging voices of persons with a particular experience.
Findings: Our analysis revealed that the relationship between motherhood, drinking and IPV could only be understood within the context of a social support system that lacked resources. With few people they could depend on, participants were challenged to balance their own needs with competing needs of others, including children. Constant struggles and self-criticism often contributed to depression, which detracted from ability to manage multiple tasks and roles. Women sought to be good mothers and role models for their children which generally resulted in the desire to reduce drinking. However, the pressure to remain in contact with abusive partners for the sake of the children prevented exit from abusive relationships and the women used alcohol to manage the stress of having no one but themselves to rely on.
Conclusions and Implications:
The MI session afforded a unique space for women to reflect on their experiences with drinking and intimate partnerships. Though women spoke of their drinking habits and relationships, much of their narratives related to being alone in a struggle for survival within social networks that offered little respite. Finding time to get treatment for problem drinking, paying for child care, or moving to another neighborhood would simply not have been options available to many of these women. This mezzo level deficit becomes particularly salient in environments that lack services and resources.