Self-change from addiction problems

Transcription

1 Self-change from addiction problems Pregnancy and self-change from addiction problems? By Dorte Hecksher Stockholm november 2007

2 Three main questions: 1) Do women,when they become aware of their pregnancy, change their behaviour in relation to use of alcohol and illegal drugs? 2) Is the process of self-change from addictive behaviour reserved to a non-pregnant population only? 3) do we see any specific reasons, why some women choose to manage on their own being pregnant and misusing drugs or alcohol?

3 Why is it important to take interest in pregnancy and misuse of alcohol or drugs? Use of drugs and alcohol can cause considerable damage of the foetus In the US the use of alcohol is regarded as the leading cause of birth defects and mental retardation Denmark: every year infants are born by mothers with dependency on drugs, alcohol or addictive medicine The prevalence of drug and alcohol use and misuse during pregnancy is of major concern to treatment staff, politicians and researchers

4 Do pregnant women change behavior in relation to substance/alcohol use? Pregnant women use less illicit drugs and alcohol, less medication, and smoke fewer cigarettes than nonpregnant women Women change behaviour, when they become aware, they are pregnant, the majority cut down their use of alcohol and drugs Few women increase their use during pregnancy 2.8 % of pregnant women report use of illegal drugs (including marihuanna) 6,4 % of women of childbearing age in general report use of illegal drugs (US). According to Danish and Norwegeian studies there is a small group of pregnant women either using cannabis or narcotics (0,4 % - 1,2 %) (Ebrahim & Gfroerer, 2003;Ihlen et al, 1990, Kesmodel 2003, Kesmodel et al 2003; NSDUH Report 2005). Dorte Hecks her

5 Why do women generally change behaviour? Reasons for modifying drinking among pregnant women: Baby s health Awareness of Fetal Alcohol Syndrome (FAS) Social support to reduce drinking Family history of alcohol problems Current high risk pregnancy Subjects own health (Chang, Goetz, Wilkins-Haug, & Berman, 2000)

6 Being pregnant and misusing drugs or alcohol, is it possible to recover without treatment? Survey data on peoples reasons for changing behaviour show, that having children/becoming pregnant is a rather common reason (Cunningham, Blomqvist, Koski-Jannes, & Cordingley, 2005) Interview studies on women and self-change indicate having children and becoming pregnant can be a strong motivating factor (Copeland, 1998)

7 Pregnancy and becoming a parent as a turning point and source of motivation (N= 46) (Granfield & Cloud 1999; 2001) Having children/becoming pregnant is not interpreted as a predictor of recovery Rather, behaviour change is facilitated by responsibility for children.

8 Pregnancy and motherhood as a specific event, which can transform an already existing awareness into behaviour change. (Blomqvist, 1996, 1999, 2001a, 2002) half of the women in the drug sample related their decision to quit, partly or entirely, to feeling responsible for their children and some ( ) to actually becoming pregnant. (Blomqvist 2001a, p. 8) Motivation for self-change is an inner process, in which the individual becomes aware of the dominant position alcohol/drug has.

9 Pregnancy and motherhood as a specific event, which transform an already existent awareness into behaviour change. (Blomqvist, 1996, 1999, 2001a, 2002) Jag drack ju otroligt mycket ( )Så träffade jag min man jag blev med barn och drack inte en droppe under hele graviditeten ( ) Jag var helt enkelt så upptagen av att jag skulle bli mamma ( ) Och när hon var född, då på något sätt kom alkohol på en helt annan plats i mit liv ( )Det var ingenting som jag satt och planerade egentligen, utan mitt liv fylldes av nåt annat. Plus att man mognar när man får barn, man får ansvar för en annan person. Visst det har inte varit lätt alla gångar att vara morsa heller, men jag tror att där kom vändpunkten och jag började bli vuxen så att säga. (Blomqvist, 1999, p. 142)

10 Different (self-)change strategies pregnancy as mean for identity change (n = 120) (Murphy & Rosenbaum 1999) The women were aware of the risks associated with continued drug use All of them tried to reduce/change their intake Pregnant substance misusing women do employ a range of strategies: They switched drug They entered prenatal care They altered unhealthy routines related to their drugusing life-styles

11 Different (self-)change strategies pregnancy as mean for identity change (Murphy & Rosenbaum 1999) Pregnancy offered a chance at motherhood possibly one of the only conventional, socially sanctioned identities available to the women in our study (Murphy & Rosenbaum 1999, p. 65) Exchanging the spoiled identity as a women on heroin with the identity as a mother

12 Pregnancy/giving birth as a motivating factor for behaviour change (a danish study, n =26) (Dahl & Hecksher, 2007) All of the women employed strategies to change intake of alcohol or drugs They were all aware of the harmful effect of continous use of drugs/alcohol

13 How do they describe their motivation for change? (Dahl & Hecksher, 2007) 1. Avoid harm to the child It is just a bad combination being pregnant and doing drugs (woman, 27) 2. To avoid the interference by social workers questioning their capability as mothers. e.g: asking for control To make sure they don t come and say that I cant have my baby. (woman, 27) 3. To make a family

14 How do they describe their motivation for change? (Dahl & Hecksher, 2007) 4. To provide a better childhood (than their own). I knew this was not the kind of life I wanted, nor it was a life I would provide for a child. I know about pain, and what it feels like (woman 24) 5. To increase their chance of regaining custody of older children removed from home 6. To protect the relation to the child, a relationship they do not want to risk loosing by using drugs/alcohol. No child comes into this world to save anyone, I am aware of that. But he arrived, and he has really saved his mother ( ) I have come this far very quickly. I hadn t done it without him (woman, 31)

15 Why do these women employ self-change strategies? (Dahl & Hecksher, 2007) Because some of them are capable of changing behaviour on their own Some find treatment threatening and unattractive

16 Barriers to treatment : Among women in general: Fear of embarrassment, stigmatization, uncomfortable of selfdisclosure, believe they can change without therapy, have negative images of treatment etc Among pregnant substance and alcohol misusing women: Fear of losing custody of child Uncertainty about consequences of the mothers use of drugs Professional making decisions without involving the parents Having experiences from the past Professionals lack of belief in them as competent parents The woman or her partner misuse of drugs/alcohol

17 references Blomqvist, J. (1996). Paths to recovery from substance misuse: Change of lifestyle and the role of treatment. Substance Use & Misuse, 31(3), Blomqvist, J. (1999). Inte bara behandling - väger ut ur alkoholmisbruket. Stockholm: Bjurner och Bruno. Blomqvist, J. (2001a). Att lägga sitt missbruk bakom sig - om "spontanläkning" och betydelsen av behandling. Nordisk Alkohol & Narkotikatidsskrift, 18(2), Blomqvist, J. (2001b). Gender-specific issues in unassisted recoveries from addiction problems. Paper presented at the The 27th Annual Alcohol Epidemiological Symposium of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol, Toronto, Canada. Blomqvist, J. (2002). Recovery with and without treatment: A comparison of resolutions of alcohol and drug problems. Addiction Research & Theory, 10(2), Chang, G., Goetz, M. A., Wilkins-Haug, L., & Berman, S. (2000). A brief intervention for prenatal alcohol use. Journal of Substance Abuse Treatment, 18(4), Copeland, J. (1998). A qualitative study of self-managed change in substance dependence among women. Contemporary Drug problems, 25(2), Cunningham, F. G., Blomqvist, J., Koski-Jannes, A., & Cordingley, J. (2005). Maturing out of drinking problems: perceptions of natural history as a function of severity. Addiction Research & Theory, 13(1), Dahl, H., & Hecksher, D. (2007). Graviditet og misbrug. Belyst ud fra kvindernes perspektiv. Aarhus: Center for Rusmiddelforskning. Embedslægeinstitutionen. (2004). Graviditeter og fødsler blandt stofmisbrugere i Danmark København: Embedslægeinstitutionen for København og Fredriksberg Kommune. Granfield, R., & Cloud, W. (1999). Comming clean: Overcomming addiction without treatment. New York: New York University Press.

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