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Substance abusing women with children are a diverse group, but some of them are among the most disadvantaged individuals in the United States. These women are in dire need of effective treatment modalities in order to sustain sobriety. Using a quantitative research design, this study examines the perception of motivation in the recovery process among African American women with children. Through research surveys these women identify the motivating factors necessary for successful treatment outcomes. Scales were created to measure extrinsic motivators, intrinsic motivators, and barriers to treatment. Factors examined included attendance at twelve step meetings, church attendance, court mandates, family support, assistance from Children's Services Workers, participation in residential and outpatient treatment programs, training in life skills such as assertivenesss, stress management, effective communication, vocational skills, and parenting, and intrinsic spiritual beliefs. The study also examined barriers to treatment such as lack of transporation, child care, employment, housing and money.

Background: The current study examines the association of perceived racial and social class discrimination with cannabis involvement among Black youth and young adults. Methods: This secondary analysis used data from the Missouri Family Study (MOFAM), a high-risk longitudinal family study of alcohol use disorder, oversampled for Black families. Offspring (n = 806) and their mothers were interviewed by telephone. Cox proportional hazards regression analyzes were used to examine associations of racial and social class discrimination (experienced by offspring and their mothers) with offspring cannabis involvement. Two stages of cannabis involvement were analyzed: timing of 1) initiation and 2) transition from initiation to first cannabis use disorder (CUD) symptom. Results: The study found that offspring report of experiencing racial (HR: 1.28, CI: 1.01–1.62) and social class discrimination (HR: 1.45, CI: 1.14–1.84) were associated with cannabis initiation in our fully adjusted model. Mothers’ report of discrimination predicted a lower hazard of cannabis initiation among offspring (HR: 0.79, CI: 0.64–0.98). Offspring social class discrimination (HR: 2.45, CI: 1.71–3.51) predicted an increased hazard of transition from initiation to first CUD symptom, while offspring racial discrimination (HR: 0.57, CI: 0.39–0.85) was associated with lower hazard of transition in our fully adjusted model. Conclusions: As rates for cannabis use among Black youth are disproportionately rising, there is a critical need to identify pathways to its use among Black youth. These findings suggest racial and social class discrimination may be important targets in efforts to prevent cannabis involvement among Black youth and emerging adults.

This study examines the effects of gender and social bonds on the experience of prescription painkiller misuse for men and women. The theoretical framework for the project is Travis Hirschi's social control theory (1969), and the social bond elements of attachment, commitment, involvement, and belief, which emphasizes the importance of these bonds in creating a "stake in conformity" for the individual, leading to acceptance of social norms and desistence from deviance. This theory, however, is relatively silent with regard to gender differences and was developed to examine delinquency in an all male sample of adolescents. The elements of this theory were used to further test the effects of these social bonds and add to the literature gap on the gendered experience of the misuse of prescription painkillers. Data for this project comes from the 2011 National Survey on Drug Use and Health, an annual nationally representative, cross-sectional survey. Multivariate logistic regression analyses reveal that, being white, not being married, having less than a high school diploma, a having a job are all significant predictors of increased prescription painkiller misuse. Characteristics associated with a significant decrease in the odds of misusing prescription painkillers are being older, having a college degree, and placing importance on religious/spiritual beliefs. Multivariate logistic regression also reveals that female respondents are less likely to misuse prescription painkillers than are their male counterparts. Interaction effects are operationalized to measure the relationship between gender and the social bond elements of interest. Most of the interaction effects are not statistically significant, but some of the main effects remain significant, which indicates that the main effect has little impact on prescription painkiller misuse for women, but remains significant for men (marriage, education, work status). Significant interaction effects are found for gender (female) x income and gender (female) x religiosity, which indicates that for both men and women, increased income and higher levels of religiosity are significantly associated with decreased odds of prescription painkiller misuse, that the effect is stronger for women and that this difference between men and women is significant. These results provide further insight into the experiences of prescription painkiller misuse for men and women.

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Criminalization, and other forms of punishment, are at the core of the current policy response to prenatal drug use in the United States (U.S.). However, evidence has repeatedly shown that interventions founded on deterrence principles—the idea that punishments deter crimes—more commonly harm rather than advance public health goals. In three aims, this dissertation examines several consequences of prenatal drug use criminalization, first, through a review of the current policy and evidence base (Chapter 2), followed by two empirical studies testing for adverse effects of state-level prenatal drug use criminalization on pregnant people’s participation in drug treatment (Chapter 3) and pregnancy care (Chapter 4). First, in Chapter 2, the legal survey found that by 2022, nearly half of U.S. states had implemented one or more punitive policies, demonstrating that a significant number of pregnant people are vulnerable to the carceral and child custody-related implications of these laws. Moreover, the review of the corresponding literature found that while existing research consistently identified few benefits of punitive law adoption, evidence for potential negative repercussions, including on drug treatment utilization, pregnancy and birth-related outcomes, and family separation, was inconsistent, supporting the need for additional research. In Chapter 3, analyses of national drug treatment program data from 1992 to 2019, revealed that contrary to legislative intent, prenatal drug use criminalization was associated with a decrease in pregnancy-specific drug treatment admissions. Post-criminalization declines were limited to admissions for opioid and amphetamine use in criminalization states, rather than for non- criminalized substances like alcohol, supporting the validity of the primary finding. Further, while treatment reductions appeared to be concentrated among low-income pregnant people receiving public assistance, similar reductions were not observed among pregnant people of color, in contrast to expectations. Lastly, Chapter 4 used birth certificate information from 1989 to 2019, to investigate a potential unintended consequence of prenatal drug use criminalization—reductions in pregnancy care. Results indicated that criminalization was associated with a meaningful decrease in the prevalence of any prenatal care, and a likely, though imprecise, decrease in the prevalence of healthcare facility-based delivery. Results further suggested potential post-criminalization decreases in prenatal care timeliness, but not adequacy, measures defined in terms of the trimester of initiation and the completed number of recommended visits, respectively. The findings from this dissertation support the hypothesis that policies criminalizing prenatal drug use discourage pregnant people from participating in drug treatment and from some types of pregnancy care. Criminalization is therefore a public health strategy that appears to be not only ineffective, but also overtly counterproductive, to the goal of preventing potential harms associated with prenatal drug use.

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published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Service Management / Master / Master of Social Sciences