Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: a meta-analysis

Karen Milligan, Alison Niccols, Wendy Sword, Lehana Thabane, Joanna Henderson, Ainsley Smith, Jennifer Liu, Karen Milligan, Alison Niccols, Wendy Sword, Lehana Thabane, Joanna Henderson, Ainsley Smith, Jennifer Liu

Abstract

Background: The rate of women with substance abuse issues is increasing. Women present with a unique constellation of risk factors and presenting needs, which may include specific needs in their role as mothers. Numerous integrated programs (those with substance use treatment and pregnancy, parenting, or child services) have been developed to specifically meet the needs of pregnant and parenting women with substance abuse issues. This synthesis and meta-analysis reviews research in this important and growing area of treatment.

Methods: We searched PsycINFO, MedLine, PubMed, Web of Science, EMBASE, Proquest Dissertations, Sociological Abstracts, and CINAHL and compiled a database of 21 studies (2 randomized trials, 9 quasi-experimental studies, 10 cohort studies) of integrated programs published between 1990 and 2007 with outcome data on maternal substance use. Data were summarized and where possible, meta-analyses were performed, using standardized mean differences (d) effect size estimates.

Results: In the two studies comparing integrated programs to no treatment, effect sizes for urine toxicology and percent using substances significantly favored integrated programs and ranged from 0.18 to 1.41. Studies examining changes in maternal substance use from beginning to end of treatment were statistically significant and medium sized. More specifically, in the five studies measuring severity of drug and alcohol use, the average effect sizes were 0.64 and 0.40, respectively. In the four cohort studies of days of use, the average effect size was 0.52. Of studies comparing integrated to non-integrated programs, four studies assessed urine toxicology and two assessed self-reported abstinence. Overall effect sizes for each measure were not statistically significant (d = -0.09 and 0.22, respectively).

Conclusions: Findings suggest that integrated programs are effective in reducing maternal substance use. However, integrated programs were not significantly more effective than non-integrated programs. Policy implications are discussed with specific attention to the need for funding of high quality randomized control trials and improved reporting practices.

Figures

Figure 1
Figure 1
Study Eligibility Flowchart.
Figure 2
Figure 2
Forest Plot for ASI Alcohol Composite.
Figure 3
Figure 3
Forest Plot for ASI Drug Composite.
Figure 4
Figure 4
Forest Plot for Days of Use.

References

    1. Ahmad N, Poole N, Dell C. In: Highs & Lows: Canadian Perspectives on Women and Substance Use. Poole N, Greaves L, editor. Toronto, ON, Canada: Centre for Addiction and Mental Health; 2007. Women's substance use in Canada. Findings from the 2004 Canadian Addiction Survey; pp. 5–19.
    1. Ashley OS, Marsden ME, Brady TM. Effectiveness of substance abuse treatment programming for women: A review. Am J Drug Alcohol A. 2003;29:19–53. doi: 10.1081/ADA-120018838.
    1. Brienza R, Stein M. Alcohol use disorders in primary care: Do gender specific differences exist? J Gen Intern Med. 2002;17:387–397.
    1. Greenfield S. Women and alcohol use disorders. Harvard Rev Psychiat. 2002;10:76–85. doi: 10.1080/10673220216212.
    1. Hernandez-Avila CA, Rounsaville BJ, Kranzler HR. Opioid, cannabis, and alcohol-dependent women show more rapid progression to substance abuse treatment. Drug Alcohol Depend. 2004;74:265–272. doi: 10.1016/j.drugalcdep.2004.02.001.
    1. Brown L, Tucker C, Domokos T. Evaluating the impact of integrated health and social care teams on older people living in the community. Health Soc Care Comm. 2003;11:85–94. doi: 10.1046/j.1365-2524.2003.00409.x.
    1. Brownson RC, Gurney JG, Land GH. Evidence-based decision making in public health. J Public Health Manag Pract. 1999;5:86–97.
    1. Brunette M, Mueser K, Drake R. A review of research on residential programs for people with severe mental illness and co-occurring substance use disorders. Drug Alcohol Rev. 2004;23:471–481. doi: 10.1080/09595230412331324590.
    1. Byszewski AM, Graham ID, Amos S, Man-Son-Hing M, Dalziel WB, Marshall S, Hunt L, Bush C, Guzman D. A continuing medical education initiative for Canadian primary care physicians: The Driving and Dementia Toolkit: A pre- and postevaluation of knowledge, confidence gained, and satisfaction. J Am Geriatr Soc. 2003;51(10):1484–1489. doi: 10.1046/j.1532-5415.2003.51483.x.
    1. World Health Organization. Principles of Drug Dependence Treatment. Geneva, Switzerland: World Health Organization; 2008.
    1. Anderson Tammy L, Rosay Andre B, Christine Saum. The Impact of Drug Use and Crime Involvement on Health Problems Among Female Drug Offenders. Prison J. 2002;82(1):50–68. doi: 10.1177/003288550208200104.
    1. Mayes L, Truman S. In: Handbook of Parenting: Social Conditions and Applied Parenting. 2. Bornstein M, editor. Vol. 4. Mahwah, NJ: Erlbaum; 2002. Substance abuse and parenting; pp. 329–359.
    1. Coalescing on Women and Substance Use. Mothers and the substance use treatment system. Information Sheet No. 3. In Mothering and Substance Use Information Sheets. 2007. Retrieved May 24, 2009.
    1. Howell EM, Chasnoff IJ. Perinatal substance abuse treatment: findings from focus groups with clients and providers. J Subst Abuse Treat. 1999;17:139–148. doi: 10.1016/S0740-5472(98)00069-5.
    1. Women's Service Strategy Work Group. Best Practices in Action: Guidelines and Criteria for Women's Substance Abuse Services in Ontario. Toronto: Ministry of Health and Long Term Care; 2005.
    1. Finkelstein N. Treatment issues for alcohol- and drug-dependent pregnant and parenting women. Health Soc Work. 1994;19:7–14.
    1. Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series 51. HHS Publication No. (SMA) 09-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2009.
    1. Orwin R, Francisco L, Bernichon T. Effectiveness of women's substance abuse treatment programs: A meta-analysis. Fairfax, VA: Center for Substance Abuse Treatment. 2001.
    1. Cooper H, Hedges LV. In: The Handbook of Research Synthesis and Meta-Analyses. Second. Cooper H, Hedges LV, Valentine JC, editor. New York, NY: Russell Sage Foundation; 2009. Research synthesis as a scientific process; pp. 3–16.
    1. Dennis ML, Huebner RB, McLellan AT. Methodological issues in treatment services research. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 1996.
    1. Edwards ME, Steinglass P. Family therapy treatment outcomes for alcoholism. J Marital Fam Ther. 1995;21:475–509. doi: 10.1111/j.1752-0606.1995.tb00176.x.
    1. Niccols A, Sword W. "New Choices" for substance-using mothers and their children: Preliminary evaluation. J Subst Use. 2005;10:239–251. doi: 10.1080/146598904123313416.
    1. Rosenthal R. Meta-Analytic Procedures for Social Research. Newbury Park, CA: Sage; 1991.
    1. Nurius PS, Yeaton WH. Research synthesis reviews: An illustrated critique of "hidden" judgments, choices, and compromises. Clinical Psychology Review. 1987;7:695–714. doi: 10.1016/0272-7358(87)90014-6.
    1. Wilson DB. Meta-analyses in alcohol and other drug abuse treatment research. Addiction. 2000;95(Supplement 3):S419–S438.
    1. Hedges LV, Waddington T. From evidence to knowledge to policy: Research synthesis for policy formation. Rev Educ Res. 1993;63:345–352.
    1. Mullen B. Advanced Basic Meta-Analysis. Hillsdale, NJ: Lawrence Erlbaum Assoc Inc; 1989.
    1. Bennett C, Latham N, Stretton C, Anderson C. Capture-recapture is a potentially useful method for assessing publication bias. J Clin Epidemiol. 2004;57:349–357. doi: 10.1016/j.jclinepi.2003.09.015.
    1. Goldsmith CH, Haynes RB, Garg AX, McKibbon KA, Wilczynski NL, Kastner M. Horizon estimation - what is the horizon for a nephrology journal subset? Presentation at the 5th Canadian Cochrane Symposium, Ottawa, ON, Canada. 2007. Accessed October 2008.
    1. Kastner M, Straus SE, McKibbon KA, Goldsmith CH. The capture-mark-recapture technique can be used as a stopping rule when searching in systematic reviews. J Clin Epidemiol. 2009;62:149–157. doi: 10.1016/j.jclinepi.2008.06.001.
    1. Moher D, Jadad AR, Tugwell P. Assessing the quality of randomized controlled trials. Int J Technol Assess Health Car. 1996;12:195–208. doi: 10.1017/S0266462300009570.
    1. Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ. Scales to assess the quality of randomized controlled trials: A systematic review. Phys Ther. 2008;88:1–20.
    1. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P, (n.d.) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Retrieved May 25, 2009.
    1. Borenstein M, Hedges L, Higgins J, Rothstein H. Comprehensive meta-analysis version II [Computer program] Englewood, NJ, USA: Biostat; 2005.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control clin trials. 1986;7:177–188. doi: 10.1016/0197-2456(86)90046-2.
    1. Hunter JE, Schmidt FL. Fixed effects vs. random effects meta-analysis models: Implications for cumulative research knowledge. Int J Select Assess. 2000;8:275–292. doi: 10.1111/1468-2389.00156.
    1. Brewer DD, Catalano RF, Haggerty K, Gainey RR, Fleming CB. A meta-analysis of predictors of continued drug use during and after treatment for opiate addiction. Addiction. 1998;93(1):73–92. doi: 10.1046/j.1360-0443.1998.931738.x.
    1. Prendergast ML, Podus D, Chang E, Urada D. The effectiveness of drug abuse treatment: a meta-analysis of comparison group studies. Drug Alcohol Depend. 2002;67:53–72. doi: 10.1016/S0376-8716(02)00014-5.
    1. Carroll KM, Chang G, Behr HM, Clinton B, Kosten TR. Improving treatment outcome in pregnant, methadone-maintained women. Am J Addict. 1995;4:56–59.
    1. Gwadz MV, Leonard NR, Cleland CM, Riedel M, Arredondo GN, Wolfe H, Hardcastle E, Morris J. Behavioral interventions for HIV infected and uninfected mothers with problem drinking. Addict Res Theory. 2008;16:47–65. doi: 10.1080/16066350701651214.
    1. Luthar SS, Suchman NE, Altomare M. Relational Psychotherapy Mothers Group: A randomized clinical trial for substance abusing mothers. Dev Psychopathol. 2007;19:243–261.
    1. Armstrong MA, Osejo VG, Lieberman L, Carpenter DM, Pantoja PM, Escobar GJ. Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes. J Perinatol. 2003;23:3–9. doi: 10.1038/sj.jp.7210847.
    1. Whiteside-Mansell L, Crone CC, Conners NA. The development and evaluation of an alcohol and drug prevention and treatment program for women and children. J Subst Abuse Treat. 1999;16:265–275. doi: 10.1016/S0740-5472(98)00049-X.
    1. Barkauskas VH, Low LK, Pimlott S. Health outcomes of incarcerated pregnant women and thier infants in a community-based program. J Midwifery Womens Health. 2002;47:371–379. doi: 10.1016/S1526-9523(02)00279-9.
    1. Chang G, Carroll K, Behr HM, Kosten TR. Improving treatment outcome in pregnant opiate-dependent women. J Subst Abuse Treat. 1992;9:327–330. doi: 10.1016/0740-5472(92)90026-K.
    1. Harshman WL. A comparison of the effects of a gender-specific and traditional model of substance abuse treatment within the therapeutic community on treatment success (Doctoral Dissertation, Wayne State University) Diss Abstr Int. 1999;61(01):97.
    1. Sacks S, Sacks JY, McKendrick K, Pearson FS, Banks S, Harle M. Outcomes from a Therapeutic Community for Homeless Addicted Mothers and Their Children. Adm Policy Ment Hlth. 2004;31:313–338. doi: 10.1023/B:APIH.0000028895.78151.88.
    1. Sowers KM, Ellis RA, Washington TA, Currant M. Optimizing treatment effects for substance-abusing women with children: An evaluation of the Susan B. Anthony Center. Res Social Work Prac. 2002;12:143–158. doi: 10.1177/104973150201200110.
    1. Suchman N, Mayes L, Conti J, Slade A, Rounsaville B. Rethinking parenting interventions for drug-dependent mothers: From behavior management to fostering emotional bonds. J Subst Abuse Treat. 2004;27:179–185. doi: 10.1016/j.jsat.2004.06.008.
    1. Toussaint DW, VanDeMark NR, Bornemann A, Graeber C. Modifications to the trauma recovery and empowerment model (TREM) for substance-abusing women with histories of violence: Outcomes and lessons learned at a Colorado substance abuse treatment center. J Community Psychol. 2007;35:879. doi: 10.1002/jcop.20187.
    1. Conners NA, Bradley RH, Whiteside-Mansell L, Crone CC. A comprehensive substance abuse treatment program for women and their children: An initial evaluation. J Subst Abuse Treat. 2001;21:67–75. doi: 10.1016/S0740-5472(01)00186-6.
    1. Elk R, Schmitz J, Spiga R, Rhoades H, Andres R, Grabowski J. Behavioral treatment of cocaine-dependent pregnant women and TB-exposed patients. Addict Behav. 1995;20:533–542. doi: 10.1016/0306-4603(94)00076-B.
    1. Evenson RC, Binner PR, Cho DW, Schicht WW, Topolski JM. An outcome study of Missouri's CSTAR alcohol and drug abuse programs. J Subst Abuse Treat. 1998;15:143–150. doi: 10.1016/S0740-5472(97)00009-3.
    1. Ingersoll KS, Knisely JS, Dawson KS, Schnoll SH. Psychopathology and treatment outcome of drug dependent women in a perinatal program. Addict Behav. 2004;29:731–741. doi: 10.1016/j.addbeh.2004.02.002.
    1. McLellan TA, Gutman M, Lynch K, McKay JR, Ketterlinus R, Morgenstern J, Woolis D. One-year outcomes from the casaworks for families intervention for substance-abusing women on welfare. Evaluation Rev. 2003;27:656–680. doi: 10.1177/0193841X03259029.
    1. Volpicelli JR, Markman I, Monterosso J, Filing J, O'Brien CP. Psychosocially enhanced treatment for cocain-dependent mothers: Evidence of efficacy. J Subst Abuse Treat. 2000;18:41–49. doi: 10.1016/S0740-5472(99)00024-0.
    1. Wexler HK, Cuadrado M, Stevens SJ. Residential treatment for women: Behavioral and psychological outcomes. Drugs Soc. 1998;13:213–233. doi: 10.1300/J023v13n01_13.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ, USA: Lawrence Erlbaum Assoc Inc; 1988.
    1. Hubbard RL, Craddock SG, Flynn PM, Anderson J, Etheridge RM. Overview of 1-year follow-up outcomes in the drug abuse treatment outcome study (DATOS) Psychol Addict Behav. 1997;11(4):261–278. doi: 10.1037/0893-164X.11.4.261.
    1. McKay JR, McLellan AT, Alterman AI, Cacciola JS, Rutherford MJ, O'Brien CP. Predictors of participation in aftercare sessions and self-help groups following completion of intensive outpatient treatment for substance abuse. J Stud Alcohol. 1998;59:152–162.
    1. Merrill J. Evaluating treatment effectiveness: Changing our expectations. J Subst Abuse Treat. 1998;15:175–176. doi: 10.1016/S0740-5472(97)00305-X.
    1. Day N, Robles N. Methodological Issues in the Measurement of Substance Use. Ann NY Acad Sci. 1989;562:8–13. doi: 10.1111/j.1749-6632.1989.tb21002.x.
    1. Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud Alcohol. 1997;58:7–29.
    1. Harrison L. The validity of self-reported data on drug use. J Drug Issues. 1995;25:91–111.
    1. Messina N, Wish E, Nemes S. Predictors of treatment outcomes in men and women admitted to a therapeutic community. Amer J Drug Alc Abuse. 2000;26:207–227. doi: 10.1081/ADA-100100601.
    1. Farabee D, Fredlund E. Self reported drug use among recently admitted jail inmates: Estimating prevalence and treatment needs. Subst Use Misuse. 1996;31:423–435. doi: 10.3109/10826089609045819.
    1. Magura S, Kang S, Shapiro M, O'Day M. Evaluation of an AIDS education model for women users in jail. Int J Addict. 1995;30:259–273.
    1. Wish E, Hoffman J, Nemes S. In: The Validity of Self Reported Drug Use: Improving the Accuracy of Survey Estimates. Harrison L, Hughes A, editor. (DHHS Publication No. 97-4147, NIDA Research Monograph 167). Rockville, MD: National Institute of Drug Abuse; 1995. The validity of self reports of drug use at treatment admission and at followup: Comparisons with hair analysis and urine assays; pp. 200–226.
    1. Arndt S. Stereotyping and the treatment of missing data for drug and alcohol clinical trials. Substance Abuse Treatment, Prevention, and Policy. 2009;4(1):2. doi: 10.1186/1747-597X-4-2.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere