METHODS: The Growing Together study is a 15-month, two-armed pragmatic randomized controlled trial for pregnant/parenting women with OUD/SUD and their infants. The two arms include: 1) BRIGHT, an attachment-based and trauma-informed parenting intervention; and 2) STAR, enhanced TAU. Participants are enrolled as early as the 24th week of pregnancy and assessment sessions (conducted at baseline [pregnancy], 6 weeks, 6 months and 9 months postpartum) consist of qualitative interviews and quantitative questionnaires. Relevant baseline measures used for this study include the Adult Attachment Scale (AAS), Addiction Severity Index (ASI), Life Stressor Checklist (LSC-R), PTSD Checklist (PCL) and Brief Symptom Inventory (BSI), among others. Bivariate analyses were computed to explore preliminary relationships among variables with a specific focus on SUDs, trauma, mental health, and attachment.
RESULTS: The sample of 39 pregnant women (M age=31 years, SD=4.4; M week of pregnancy= 31.6 weeks, SD=4.5) were predominantly White (87%) and unmarried (69%); approximately half (46%) had completed high school, 1/3 (33%) completed some college, and most had prior child welfare involvement (69%); 80% were unemployed and 69% had incomes under $20,000. All had histories of opioid/substance misuse, extensive life traumas (M=16), with 56% at-risk for PTSD, and 77% had insecure attachment styles. Preliminary results, controlling for participant age, showed that number of lifetime traumatic events was significantly correlated with mental health challenges (r=.42, p=.008**) and secure attachment style (r= -.43, p=.02*). Trauma symptoms were also significantly correlated with secure attachment style (-.56, p=.001**) and marginally correlated with years of heroin (r=.28, p=. 09t) and cannabis use (r=.31, p=.07t). Overall, mental health challenges were significantly correlated with secure attachment style (r= -.54, p=.002**) and with years of heroin (r=.38, p=.02*) and cannabis use (r=.36, p=.03*).
CONCLUSIONS AND IMPLICATIONS: Results demonstrated that trauma history and symptoms are directly but differentially associated with substance use, attachment and mental health challenges for pregnant women. Attachment style was not directly associated with years of substance use; severity of trauma may be underlying attachment difficulties. Further research with a larger sample should investigate these associations as they have important implications for social work interventions with pregnant and postpartum women and infants.