Miller, B. A., Smyth, N. J., & Mudar, P. J. (1999). Mothers' alcohol and other drug problems and their punitiveness toward their children. Journal of Studies on Alcohol, 60 (5), 632-642.
One hundred seventy women were interviewed and categorized according to past, present, or no alcohol or other drug (AOD) problems. Participants were assessed on AOD use, childhood sexual abuse history, and punitiveness, among other variables. The researchers found that mothers with AOD problems were more punitive in their parenting.
This article provides valuable insight to practitioners working with addicted mothers. Treatment considerations include the obvious parent skill-building, more specifically, disciplinary actions with children. The urgency for intervention is explained in the generational susceptibility of AOD problems.
Rittner, B., & Dozier, C. D. (2000). Effects of court-ordered substance abuse treatment in child protective services cases. Social Work, 45 (2), 131-140.
The cases of 447 CPS supervised children were reviewed. Almost half (48.6%) of attending caretakers could be classified as having a substance abuse problem at intake. Of the 242 mothers and fathers mandated to substance abuse treatment, 113 were deemed non-compliant at the end of the first six-month period.
The court system is an influential force in intervening with substance abuse problems. However, poor follow through with such services may reflect a gap in continuity of care with this population. Practitioners, when aware of relevant risk factors, are better able to provide services to not only their AOD clients, but consequently to the children of those clients as well.
Smyth, N. J. (1996). Motivating persons with dual disorders: A stage approach. Families in Society, 77 (10), 605-614.
Perhaps the most widely sought after entry in the faculty publications series, this article combines the conceptual models of Miller & Rollnick's motivational interviewing and Prochaska and DiClemente's stages of change for effective use with persons with dual disorders. The author provides the theoretical basis of each and their practical application to this population.
This integrative model addresses the traditionally dichotomous nature of mental health and addictions services. In addition, the implications of social workers as primary providers of both types of services makes this information particularly relevant to this profession. Case examples are provided.
Smyth, N. J. (1998). Alcohol abuse. In B. A. Thyer & J. S. Wodarski (Eds.), Handbook of empirical social work practice, Vol. I: Mental disorders (pp. 181-204). New York: John Wiley & Sons.
This chapter provides an overview of alcohol-related assessment guidelines and interventions available to the practitioner. Beginning with definitions of alcohol problem severity and disorders, the author includes prevalence and incidence rates as well as the social and financial costs of alcohol-related problems across North America.
The assessment methods discussed in the chapter cover the spectrum of standardized measures (e.g., the Structured Clinical Interview for the DSM), computer-aided assessments, and the more common self-report, observational, and physiological screening and assessment tools.
Intervention methods are presented in terms of individual, group, and marital and family therapies. Community-level interventions, as well as prevention strategies are also discussed. (The reader is referred to the chapter's substance abuse counterpart described next.)
Smyth, N. J. (1998). Substance abuse. In B. A. Thyer & J. S Wodarski (Eds.), Handbook of empirical social work practice, Vol. II: Social problems (pp. 123-153). New York: John Wiley & Sons.
Like its alcohol abuse counterpart (described above), this chapter provides an overview of substance-related assessment guidelines and interventions available to the practitioner. The author begins with operational definitions of substance use and its related problems and disorders, including dual disorders. Prevalence, incidence, and social and financial costs are also described, as well as the import of involvement by the social work profession.
Assessment among persons with substance use disorders may necessitate making a differential diagnosis, an area that is covered in the present chapter. Appropriate assessment measures are discussed, such as standardized measures (e.g., the Structured Clinical Interview For The DSM), computer-aided assessments, and the more common self-report, observational, and physiological screening and assessment tools.
Intervention methods are presented in terms of individual, group, and marital and family therapies. Community-level interventions, as well as prevention strategies are also discussed. Furthermore, consideration to intervention with persons with dual disorders is provided. (The reader is referred to the chapter's alcohol abuse counterpart described above.)
Smyth, N. J., & Kost, K. A. (1998). Exploring the nature of the relationship between poverty and substance abuse: Knowns and unknowns. Journal of Human Behavior and the Social Environment, 1 (1), 67-82.
This article explores the relationship between poverty and substance abuse across four possible explanations: causal, risk factor, exacerbation, and spurious. Approaching the topic from the two perspectives of theory and research, the authors provide background in the various models that exist, and also previous research on the subjects of poverty and substance abuse.
The article concludes with a summary of research findings and suggestions for model applicability. Based on these conclusions, practice, policy, and research implications are offered with regard to the relatedness of poverty and substance use and abuse.
Smyth, N. J., & Miller, B. A. (1997). Parenting issues for women with alcohol and other drug problems. IN S. L. A. Straussner & E. Zelvin (Eds.), Gender issues in addiction (pp. 123-150). New York: Jason Aronson.
This chapter provides background on parenting by mothers who have substance use problems. Topic areas include child maltreatment, family of origin substance abuse, mental health and self-esteem issues, stigmatization, family system issues, substance use during pregnancy, and social/economic resource deficits.
The authors address the practice implications with this population in terms of assessment (e.g., parental functioning, environmental resources, social supports), and treatment issues, examined in relation to psychosocial concerns (such as those topic areas listed above) and parenting intervention (i.e., providing parenting skill-building, support groups, and play groups). A case example is provided to illustrate the key issues for this population.
Downs, W. R., & Miller, B. A. (1996). Inter-generational links between childhood abuse and alcohol-related problems. In L. Harrison (Ed.), Alcohol problems in the community (pp. 15-51). London: Routledge.
Downs and Miller present two separate literature reviews, "Parental alcohol problems and childhood maltreatment" and "Childhood maltreatment and the development of adulthood alcohol problems," as background for their research on the inter-generational links between parental alcohol problems and childhood violence. Their research findings indicate that parental alcohol problems are related to childhood maltreatment and also the childhood sexual abuse of their daughters. In turn, women's experiences of childhood maltreatment lead to alcohol problems in adulthood, thus sustaining the cycle of childhood maltreatment and adulthood alcohol problems.
The authors place the onus of interrupting this cycle on service providers and policymakers. Provided are preliminary guidelines for working with women, as well as men, in various treatment settings. These topics address alcohol and drug treatment facilities, assessing for childhood physical and sexual abuse, and group work among others.
Levine, M., Doueck, H. J., Anderson, E. M., Chavez, F. T., Deisz, R. L., George, N. A., Sharma, A., Steinberg, K. L., & Wallach, L. (1995). The impact of mandated reporting on the therapeutic process: picking up the pieces. Thousand Oaks, CA: SAGE Publications, Inc.
The authors interviewed therapists, primarily social workers (representing six nonprofit organizations) who had filed reports of child abuse and maltreatment, and child protection workers from two counties who investigated such reports. Presented are therapists' interpretations and implementations of the reporting laws and the subsequent impact of reporting on the therapeutic process.
Chapters in the book include "The reporting law and the child protection system" (ch. 2), "The decision to report" (ch. 4), "The effects of reporting on the therapy relationship" (ch. 6), and "Therapist strategies for maintaining the relationship once a report had been made" (ch. 7). The work concludes with therapeutic and policy implications covering cultural considerations, temporal limitations (i.e., "stale" reports), and clinical judgment and discretion.
Miller, B. A. (1998). Partner violence and women's drug use: Exploring the connections. In C. L. Wetherington & A. B. Roman (Eds.), Drug addiction research and the health of women (pp. 407-416). (NIH Publication No. 98-4290). Rockville, MD: U. S. Dept. of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse.
In this chapter, Miller presents her and her colleagues' research on women's drug use and the violent victimization they experience at the hands of their partners. The researchers analyzed data from 609 women representing outpatient drug treatment facilities, partner violence shelters, and the community. Among other specific evaluations, participants were polled on their drug use within the last six months and throughout their lifetime. Similarly, women were questioned about violence they had experienced within the last six months and over their lifetime.
Results indicate that women with alcohol and other drug (AOD) problems, whether they are in treatment or not, report a higher incidence of partner violence. Although it is unclear whether AOD use leads to victimization or vice versa, the implications that the two are linked are invaluable to the practitioner working with either the AOD user or victimized populations or both. Miller concludes with treatment considerations and suggestions for policy.
Parks, K. A., Nochajski, T. H., Wieczorek, W. F., & Miller, B. A. (1996). Assessing alcohol problems in female DWI offenders. Alcohol Clinical Experimental Research, 20 (3), 434-439.
Parks and her colleagues set out to explore the degree of alcohol problems among women driving while intoxicated/driving while ability impaired (DWI/DWAI) offenders, a population which the authors term "understudied." Survey responses were returned from 843 women who participated in a voluntary Drinking Driver Program for DWI/DWAI offenders. When assessed on multiple measures for their alcohol use as well as other non-alcohol -related variables, it was found that the majority of the women (67.6 percent) were diagnosable with alcohol abuse or dependence (as specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.).
The authors summarize that these data indicate the need for assessing women DWI/DWAI offenders for future alcohol use problems for which they are at risk. Included in the report are descriptions of the measures used and their subsequent outcome scores.
Shulman, L. (1999). The skills of helping individuals, families, groups, and communities (4th ed.). Itasca, IL: F. E. Peacock, Inc.
In his widely used text, "The skills of helping individuals, families, groups, and communities," Shulman includes a poignant case example of a mutual aid group targeting persons living with AIDS who are in early recovery from substance abuse. The group consists of Shulman and a substance abuse counselor as co-facilitators, and five members (three men and two women) ranging in age from late 20's to early 40's, each diagnosed with AIDS and recovering from a history of drinking and/or drug use.
Shulman recounts two sessions, the very first and the fifth, out of a total of eight sessions. The group is based on the 12-step model integrated with a mutual aid approach, thus utilizing the strengths of the members and the structure of the facilitators in the members' recovery process. Interspersed into the narrative are Shulman's thoughts and interventions as they are shaped by the dictates of the group process. This format of presentation allows the reader to understand the methods behind the treatment as they are applied in a real-life scenario.
Wiechelt, S. (2000, April). The role of shame in women's recovery from alcoholism. Paper presented at the Twelfth National Symposium of Doctoral Research in Social Work, Ohio State University, Columbus, OH.
In this brief review of her research findings, the author describes the proposed link between childhood sexual abuse, internalized shame and, difficulty in recovery among women alcoholics. Wiechelt suggests that shame, an effect resulting from childhood sexual abuse, re-emerges during the early recovery process causing alcoholic women to seek relief from unpleasant feelings and memories by returning to drinking.
Although it was not found that women who reported childhood sexual abuse would have higher levels of shame and more difficulty in recovery, a link was established between levels of internalized shame and difficulty in recovery. It has been shown previously that shame is an effect of childhood sexual abuse. Therefore, since there is at least an indirect association between the variables of childhood sexual abuse, shame, and difficulty in recovery, consideration should be given to the risk of relapse when treating alcoholic women.