Editor’s note: Today’s review is part of our month-long Special Series on Addiction and Social Support. Throughout March, the BASIS is highlighting the role of social support in addiction-related experiences.
Family and friends can greatly influence the likelihood that people use drugs or recover from drug misuse. For example, on one hand, women with a parent or grandparent who used drugs have higher chances of using drugs themselves. On the other hand, social networks can influence people to enter treatment. However, those with problems involving the criminal justice system are more likely to experience barriers to getting social support from family and friends. This week, as part of our Special Series on Addiction and Social Support, STASH reviews a study by Abenaa A. Jones and colleagues. Through interviews with women in recovery from opioid use disorder (OUD), substance use disorder treatment professionals, and criminal justice professionals, they explored how social structures, family dynamics, and peer networks influence opioid abuse recovery among women with histories of criminal justice system involvement.
What was the research question?
Among women involved in the U.S. criminal justice system, how do their social networks affect their path to recovery from opioid abuse?
What did the researchers do?
In 2022, the researchers conducted in-depth interviews with 20 women with past or current opioid use disorder, 12 substance use disorder treatment professionals (e.g., recovery coaches, counselors), and ten criminal justice professionals (e.g., prosecutors, law enforcement officers) in Pennsylvania. Each participant was asked questions about what promoted or inhibited opioid use disorder treatment, any experiences that might be unique to women, and the impact of criminal justice in the lives of women who use drugs. The researchers explored similarities and differences across the three expert groups.
What did they find?
The researchers observed multiple common factors, some of which worked towards recovery, some of which worked against it. Intergenerational substance use was a common theme as a pathway that led women to start using substances and as a barrier to treatment. Family support and dynamics were another theme. Some women felt guilt from relationships, including mother-child relationships, that were broken by their substance misuse, and acknowledging that guilt and loss can add stress to the recovery process. Intimate partner influence was another noted barrier to recovery, especially if said partner was using drugs themselves. Peers and coworkers can also be less than helpful, either by tempting people out of abstinence or just being users themselves. More specific to criminal justice, incarceration presented unique challenges and factors. Incarceration could mean an interruption of addiction treatment. It could also mean being away for a time and losing contact with friend groups that could have served as social or emotional support.
Sometimes the factors that served as barriers could be turned around and used as facilitators or motivators for treatment. Intergenerational substance use can serve as a target for “breaking the cycle” and reducing substance misuse across multiple generations at the same time. Family members, peers, and coworkers, instead of being sources of guilt, can be supportive influences encouraging those in recovery to persevere and stay sober.
Figure. Barriers and facilitators to treatment for opioid use disorder, for women involved in the criminal justice system. Barriers included intergenerational drug use, intimate partner influence, and peer pressure. Treatment facilitators included familial and peer support. Representative quotes are provided. Click image to enlarge.
Why do these findings matter?
Those who are involved with the criminal justice system can have extra barriers to recovery and more dire consequences for returning to active use. Knowing the ways that peer and family networks and environments can affect recovery efforts — for better or worse — will help counselors guide those trying to overcome addiction toward putting themselves in the best positions to succeed. Understanding these factors will ultimately lead to better health and social outcomes for women struggling with addiction.
Every study has limitations. What are the limitations in this study?
Out of the 20 women with past or current opioid use disorder, 14 were non-Hispanic white and another 4 did not disclose their race or ethnicity. Thus, the results might not generalize to other ethnicities or racial groups. Participants were all from a single state in the U.S., so the results might not generalize to the rest of the country or other parts of the world. Only one staff member coded the interview transcripts to look for common themes. Ideally, studies using interviews involve two coders who meet after examining the transcripts and compare notes.
For more information:
The CDC has a web page dedicated to treatment for opioid addiction. It includes information on drugs that can be prescribed and links to other government resources. Additional resources can be found at the BASIS Addiction Resources page.
— Matthew A. Tom, Ph.D.
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