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The Impact of Emotional and Material Social Support on Women's Drug Treatment Completion

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The Impact of Emotional and Material Social Support on Women's Drug Treatment Completion
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  Cleveland State University  EngagedScholarship@CSU  % #5 F%7< P%76 * % #5 8-2009 $e Impac of Emoional and Maerial SocialS!ppor on Women's Dr!g Treamen Compleion Cahleen A. Le"ando"ski Cleveland State University  , .%6@6. T"#la J. Hill Wichita State University How does access to this work benet you? Let us know!  Publisher's Statement  >6 6 % 5-<7, %75-5 PDF * % %57 %7 *5 %7  H%7 &% #5, *+ 5 5. > 56 * 55 > I%7 * E7% % M%75%% 57  #'6 D5+ !5%77 C7 6 %%%  %7?://6.;*55%6.5+/77/34/3/213.%675%7F 76 % %7% 56 %7:?://+%+6%56.6./6$*%P%57 * 7% #5 C6 >6 A57 6 5+7 7 < *5 *5 %  %66 < 7  * % #5 %7 E+%+%56@C. I7 %6  %7 *5 6 % #5 F%7< P%76 < % %75= %675%75 * E+%+%56@C. F5 5 *5%7, %6 7%75%5<.6@6.. R C7%7 L%6, C%7 A. % H, !<% J., "> I%7 * E7% % M%75% % 57  #'6 D5+ !5%77C7" (2009). Social Work Faculty Publications. P%5 24.?://+%+6%56.6./6$*%/24  The Impact of Emotional andMaterial Social Support on Women'sDrug Treatment Completion Cathleen  A. Lewandowski and  Twylaf.  Hill This study assessed how women's perceptions of emotional and material social support affecttheir completion of residential drug treatment. Although previous research has examinedhow social support affects recovery, few studies, if any, have examined both the types and thesources of social support.The study hypothesized that women's perceptions ofthe emotionaland material social support they receive from family, friends, partners, drug treatment, childwelfare, and welfare agencies will affect treatment completion. The sample consisted of 117women who were enrolled in a women's residential treatment program. Data were collectedin semistructured initial and follow-up interviews using a life history calendar; the Scale ofPerceived Social Support, which was adapted for this study; and women's treatment records.The results support the hypothesis. Social support can have both positive and negative effectson treatment completion, depending on the type and source of support provided.KEY WORDS:  drug  treatment;foster  care;  social  support;  TANF; women A ccording to social network theory, socialnetworks are important sources of socialsupport  Scott,  2000).  Individuals who per-ceive that others will provide appropriate assistanceare less likely to view  a  situation  as  stressful and tendto feel that they are able to meet the demands ofthe situation (Lazarus & Folkman,  1984).  Womenwho use drugs and have more social support mayresort to substance  abuse less  often than women withless social support because they may feel less needto turn to drugs in response to stressful life events(Tucker et al., 2005).This study examined the impact of women'sperceptions of the emotional and material socialsupport they receive from family and friends anddrug treatment, welfare, and child welfare agencieson their completion ofa residential drug treatmentprogram for women in  a  midwestern state.Women'sperceptions of the emotional and material supportthey received were examined, as research suggeststhat perceptions of  social  support are most closelyassociated with self-efficacy (Bandura, 1990). Itemsfrom the Scale of Perceived Social Support (Mac-Donald, 1998) were used to measure emotionalsupport. Cash assistance and providing a residencefor the women or their children were included astypes of material  support.  Women's perceptions ofemotional and material social support  were  measuredon their initial admission into  treatment.  Emotionalsocial support was also measured in a subset ofwomen at three months to assess whether women'sperceptions of emotional support remained stableduring the initial months following treatment. REVIEW OF THE LITER TURE Although there are many defmitions, experienc-ing some type of positive interaction or helpfulbehaviors when in need is a common elementin all the defmitions of  support  (Rook & Dooley, 1985).  Beyond this common element, there is noconsensus on how social support should be defmed,and researchers have used an array of definitions toexamine  social  support.  Although some defme socialsupport narrowly—for example, according to thetype of support received or the nature ofthe socialnetwork—others argue that the concept of socialsupport  is  multifaceted (Hupcey,  1998).  For example.Vaux (1988) argued that social support encompassessupport networks, supportive behaviors, and a sub-jective appraisal of support. Individuals'perceptionsof  social  support, or their subjective appraisal, maybe most related to their self-efficacy, or a belief intheir ability to accomplish a task (Bandura, 1990).On the basis of Bandura's defmition of self-efficacy.  women's perceptions may be most closely related totheir sense of self-efficacy and contribute to theirdrug treatment completion.For women in recovery, social networks canprovide the social, emotional, and material re-sources they need to address the myriad concernsthat confront them, especially in the early stages ofrecovery (Becker  &  Gatz, 2005) .Women in recoverymay have less social support overall than womenwho are not chemically dependent (Curtis-Boles& Jenkins-Monroe,  2000),  and their support systemis different from that of recovering men (Dodge &Potocky-Tripodi,  2001;  Schilit & Gomberg, 1987).Early research suggests that both heroin-addictedand nonaddicted women of lower socioeconomicstatus tend to rely heavily on their informal helpers(Marsh,  1980),  and ethnicity,  age,  and primary drug have  little effect on women's social networks (O'DeU,Turner,  &  Weaver,  1998).  Women's social networkstend to be long-term, ethnically homogenous, andof high density (El-Bassel, Chen, & Cooper, 1998).Such long-term relationships can be a benefit or adrawback, depending on whether these networkssupport drug use (Trulsson & Hedin, 2004). Forhomeless women who use drugs and are not in treat-ment, negative social support directly predicts moredrug use, whereas positive social relationships donot encourage less drug  use.  For these women, theirsocial support networks may already be fragmentedand strained  Galaif,  Nyamathi, & Stein, 1999).Women who are heavily drug-involved generallyidentify parents and partners  as  their major providersof practical help and advice. In one study, women inoutpatient treatment indicated that they were satis-fied with the support they received from family andfriends (Salman,Joseph, Saylor,  &  Mann, 2000).Thefamily of origin, especially mothers, grandmoth- ers,  and sisters, can be the chief providers of bothemotional and material support (Trulsson & Hedin, 2004).  Close friends and family members may beable to provide child  care,  transportation, and othertypes of social support to help women make  a  func-tional recovery in the community (Metsch, McCoy,Miller, McAnany, & Pereyra, 1999). For women,mothers are often anxious to help their daughtersin any way. However, giving the daughter moneyor basic life necessities often enables her drug use.And although many daughters appreciate theirmother's help, there can be an element of distrustand control in these relationships (Strauss, 2001).Furthermore, when women are trauma survivors.they may view their family members as offeringless emotional support than their friends (Savage& RusseU, 2005).The support women receive from their intimatepartners is significantly associated with their mo-tivation to successfully complete drug treatment(Riehman, Hser, & Zeller, 2000). Receiving posi-tive support for recovery from their partner maybe especially helpful, though women's partnersseldom support their giving up drugs (Rosenbaum, 1981).  Living with a partner can be a protectivefactor for African American women who use drugs(Lam,Wechsberg,  &  Zule,  2004).  African Americanwomen look to their partners to provide a sympa-thetic ear and to their parents for affirmation ofself-worth (Strauss, 2001  ).  However, partners can alsoenable drug  use,  suggesting that treatment providersshould assess the quality of women's social support(Falkin  &  Strauss,2003).Because these relationshipscan often contain elements of power and control,many women choose to end their current relation-ship when they begin recovery (Trulsson & Hedin, 2004),  In addition to partners and parents, womenin treatment view children  as  providing support fortheir recovery, and this includes children living withthem and children who are in the custody of others(Tracy  &  Martin,  2007).  Having the responsibility forcaring for children and receiving public assistancecan also be protective factors for African Americanwomen who use drugs (Lam et al., 2004).In addition to family, partners, and friends,women in recovery may perceive drug treatmentprograms to be part of their support system (Salmanet  al.,  2000).  Given that their current networks maynot support recovery, women may look to drugtreatment, child welfare, and welfare agencies andother professionals as important sources of socialsupport (Trulsson & Hedin, 2004).Social networks and social support are associatedwith a variety of positive outcomes among womenaddicts who are in and out of drug treatment. Socialsupport has been shown to be predictive of drugtreatment completion (Knight, Logan, & Simpson, 2001),  abstinence (Kaskutas, Bond, & Humphreys, 2002;  Loudenburg & Leonardson, 2003), less fre-quent marijuana use and drinking to intoxication(Tucker et al., 2005), and better drug treatmentoutcomes for women in both outpatient (Comfort, Sockloff,  Loverro,  &  Kaltenbach,  2003 and residen-tial treatment (Alemi et al, 2003). Social supporthas also been associated with women using more  positive coping strategies in their recovery process(Roberts, 2001), with increased self-esteem, andit has been shown to be a key factor in moderat-ing depression (Dodge & Potocky, 2000). Amongwomen in temporary shelters, higher levels of socialsupport have been shown to predict less frequentmarijuana use (Tucker et al., 2005).Interventions designed to strengthen women'ssocial networks have been shown to improve drugrecovery outcomes (El-Bassel et al., 1995). Familymembers should  be  engaged in the treatment process,and women have expressed a desire for treatmentprograms that include family and friends and ac-commodate their young children (Riehman et al., 2000;  Roberts,  2001).  If social support is importantfor women's recovery, strengthening their  social  net-works should be viewed as critical to the recoveryprocess. At least one study has shown that both thesize and amount of social support can increase frompretreatment to posttreatment for women who  are  incontinuous recovery for a minimum of six months(Tucker et al., 2005).Although social support has been shown to af-fect women's recovery, further research  is  needed tounderstand its role in women's drug recovery overtime, including the impact of different sources andtypes of support. For example, little is known aboutthe relative benefits of receiving emotional supportfrom family and  friends as  opposed to receiving emo-tional support from staff in drug treatment agenciesand social service agencies. Similarly, litde is knownabout whether women who receive agency-basedmaterial support, such as cash benefits throughTemporary Assistance for Needy Families (TANF),are as likely to complete treatment as are womenwho receive material support from family, friends, orpartners.The current study examined the impact ofemotional and material social support provided byfamily, partners, friends, and agencies on women'streatment completion rate. METHOD This study  is  part ofa larger, federally funded researchproject that examined the impact of a multipleagency service environment on women's drug re-covery outcomes over time. The study's hypothesiswas that the emotional and material support womenreceived would influence treatment completion.The private nonprofit agency where the study tookplace provides comprehensive drug  abuse  treatmentin programs designed specifically for women. Thedrug treatment program offers inpatient or residen-tial treatment, intensive outpatient treatment, andoutpatient treatment in a sequential manner. Thisstudy examined women's completion of the 30-day residential treatment program. The residentialprogram provides comprehensive services, includingdrug treatment, nursing services, housing, on-siteday  care,  and education on HIV and other sexuallytransmitted diseases.These comprehensive servicesare the service components found to have positiveassociations with treatment completion and otherdesirable treatment outcomes for women (Ashley,Marsden, & Brady, 2003). Data Collection Project data were gathered using a panel-based,longitudinal survey research design assessing ser-vices and drug treatment outcomes for women inrecovery, using both retrospective data collectedwhen women first entered residential treatment anddata collected on events occurring during the studyperiod.The analysis reported here includes data col-lected when women entered residential treatmentand three-month follow-up data.The primary datacollection instruments were a life history calendardeveloped for the study and the Scale of PerceivedSocial Support (SPSS) (MacDonald, 1998).Primarydata were collected in a semistructured interviewon admission into treatment and at three months.Women's case records were used  as a  secondary datasource to coUect demographic data. The agency'sintake form, case closure form, and the AddictionSeverity Index (Leonhard, Mulvey, Gastfriend, &Schwartz, 2000), completed by agency  staff,  werethe key data sources in women's records. Women'sethnicity, whether they had children, and whetherthey completed treatment were obtained from theintake and closure forms. The Addiction SeverityIndex was used to collect data on women's maritalstatus, education, drug treatment history, and druguse in the past 30 days. Participants' case recordswere  also  used to compare women's responses duringinterviews with  case  record data.Women were askedto clarify any identified discrepancies.The life history calendar was used to collect dataon women's sources of material support, and theSPSS was used to collect data on women's percep-tions of emotional forms of social support. Using  a life history calendar can improve participants' recallby increasing the respondents' ability to place dif-ferent activities within the same time frame. Final  development  of  the life history calendar followedprocedures described by Freeman,Thornton, Cam-burn, andYoung-DeMarco (1988).Initial interviews took place  at the  residentialtreatment center  in a  private office. The follow-upinterviews were conducted in locations convenientto the women, such as their homes, halfway houses,or where they received outpatient counseling.Women were paid seven dollars as  an  incentive  for completion  of  the initial interview  and 10  dollarsfor completion  of  the follow-up interview. Sample The sampling frame was all women entering  a  resi-dential substance abuse treatment program  in the Midwest  for  women during a 13-month period  in 2003  and  2004. Systematic random sampling  was used  to  identify  a  pool  of  women  to be  consid-ered  as  potential participants. Every other womanentering residential treatment entered  the  pool.This methodology ensured that women enteringthroughout the month had  an  equal chance ofbe-ing included. Some women dechned  to  participate,and others  who  were admitted left before theycould  be  included  as  part  of  the pool  of  potentialparticipants. Some left within hours  of  admission.Twenty to 30 women entered residential treatmenteach month; the sample included 10  to  15 womenentering treatment each month  for 13  months. Atotal of 117 women, approximately one-third of thewomen entering  the  program during this period,participated  in the  study. Although results  may be generalizable only  to  women receiving residentialtreatment from this program and, more specifically,those  who  remained  in  residential treatment  for at least three days, systematic random samplingcontributes  to the  study's ability  to  generalize  to a wider population.The 117 women in the sample ranged in  age  from19 to 64 years, with  a  mean age of 32.5  {SD  =  9.19).Few of the women  (20  percent) were currently mar-ried, and 42 women (37 percent) had been marriedin  the  past. Although most women  had  children (108,  or 90  percent), only  65  women (56 percent)had children  in  their home.  In  terms  of  ethnicity,82  70  percent) were European American,  15 13 percent) were African American, eight  7  percent)were Hispanic,four  (3  percent) wereAsianAmerican,and eight  7  percent) were Native American. Withregard to educational levels, most of the women hada high school degree or  a GED,  and  a  few had somecollege. Approximately  47  percent,  or 55  women,had either  a  high school degree  or its  equivalent,and 21 percent  23  women)  had  some college  or a college degree, usually  a  two-year degree. Mostwomen (75 percent, or 88) had at least one previousdrug treatment episode,  and  44 percent  (51  women)had two or more previous treatment episodes. Only25 percent (29 women) had no previous drug treat-ment history. Slightly under half  (42  percent,  or 49 women) reported being multiple drug users whenthey first entered treatment. Marijuana, crack/co-caine, and methamphetamine were the illegal drugswomen most often reported  using  prior  to  treatment.DemographicaUy, the  38  women  who  participatedin  the  three-month follow-up were very similar  to the sample as a whole.  Thus,  results from analysis  of three-month follow-ups are probably applicable  to the whole sample.In terms  of  treatment completion,  71  women(61 percent) completed  the  30-day residentialtreatment program. The most common reason  for not completing treatment was self-discharge, as  24 women  21  percent)  in the  study self-discharged.Being administratively discharged  or  being  dis- charged  for  inappropriate behavior  was  second,as  11  women  9  percent) were discharged  by the treatment program.The reasons for not completingthe program  for  the remaining women were eithernot known  by the  agency  or not  indicated  in  theircase records.Women who were willing to completefoüow-up interviews were  a  little more likely  to have completed treatment  68  percent, comparedwith  61  percent  for the  whole sample), which  is not surprising. Variables The dependent variable  is a  dummy variable indi-cating whether women completed the 30-day resi-dential treatment program.Women who completedthe residential treatment program, moved to anothertreatment facility, or were continuing with  a  secondphase of residential treatment were coded  as  havingcompleted treatment; women who self-discharged orwere discharged for inappropriate behavior or otheradministrative reasons were coded  as  not completingtreatment.The independent variables were materialand emotional support. The following categoricaldemographic variables were included  as  controlvariables: marital status, education, drug treatmenthistory, drug use  in the  past  30  days, ethnicity, andhaving children.
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