Self-change from addiction problems

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U N I V E R S I T Y O F A A R H U S Centre for Alcohol and Drug Res earch

Dorte Hecks her

Self-change from addiction

problems

Pregnancy and self-change from

addiction problems?

By Dorte Hecksher

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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?

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Dorte Hecks her

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 1300-1900 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

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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 %)

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Dorte Hecks her

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

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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

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Dorte Hecks her

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.

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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

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Dorte Hecks her

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.”

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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

drug-using life-styles

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Dorte Hecks her

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

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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

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Dorte Hecks her

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)

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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)

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Dorte Hecks her

Why do these women employ self-change

strategies?

(Dahl & Hecksher, 2007)



_{Because some of them are capable of changing}

behaviour on their own

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Barriers to treatment :

Among women in general:

Fear of embarrassment, stigmatization, uncomfortable of

self-disclosure, 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

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Dorte Hecks her

references

 Blomqvist, J. (1996). Paths to recovery from substance misuse: Change of lifestyle and the role of treatment. Substance Use & Misuse, 31(3), 1807-1852.

 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), 163-174.

 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), 119-158.

 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), 365-369.

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 Cunningham, F. G., Blomqvist, J., Koski-Jannes, A., & Cordingley, J. (2005). Maturing out of

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 Dahl, H., & Hecksher, D. (2007). Graviditet og misbrug. Belyst ud fra kvindernes perspektiv. Aarhus: Center for Rusmiddelforskning.

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 Granfield, R., & Cloud, W. (1999). Comming clean: Overcomming addiction without treatment. New York: New York University Press.

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references

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 Kesmodel, U., Kesmodel, P. S., Larsen, A., & Secher, N. J. (2003). Use of alcohol and illicit drugs among pregnant Danish women, 1998. Scandinavian Journal of Public Health, 31, 5 -11.

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