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. Author manuscript; available in PMC: 2026 Apr 1.
Published in final edited form as: J Addict Dis. 2024 May 7;43(2):146–152. doi: 10.1080/10550887.2024.2344837

Perinatal women in substance use disorder treatment: Interest in partnering with family and friends to support recovery needs

Alexis Hammond 1, Denis Antoine 1, Michael Sklar 1, Michael Kidorf 1,*
PMCID: PMC11540869  NIHMSID: NIHMS1992900  PMID: 38712861

Abstract

Background.

Perinatal women treated for substance use disorder (SUD) face considerable barriers to recovery that might be ameliorated through activation of community support.

Objectives.

This descriptive study evaluated the presence of drug-free family and friends in the social networks of perinatal women treated for SUD. It also assessed the interest of these women to partner with network members to mobilize support across several recovery needs.

Methods.

Social network interviews were conducted with 40 pre- and post-partum women treated at the Center for Addiction and Pregnancy (CAP) in Baltimore MD. These interviews also prompted participants to consider which network members to invite to the program to support recovery efforts.

Results.

Study participants reported that their personal social networks included 4.4 drug-free adults. An overwhelming majority (80%) of participants reported a willingness to invite at least one person to the CAP program. Participants also endorsed several opportunities for collaboration between the program and community support.

Conclusions.

These findings suggest that treatment program guided activation of network support offers a testable strategy to help perinatal women reduce barriers to recovery and improve treatment outcomes.

Keywords: perinatal women, substance use disorder, social support, social network

1.0. Introduction

Perinatal substance use and misuse remains a serious health concern. Recent national data show that about 8% of women of childbearing age report using illicit drugs during pregnancy (SAMHSA, 2020). This finding dovetails with studies that show increases in the national prevalence of opioid use disorder and overdose deaths among perinatal women (Haight et al., 2018; Smid et al., 2019), and reinforces the importance of developing treatment strategies that are sensitive to the unique challenges faced by this vulnerable population (Meyer et al., 2019).

While various treatment modalities for SUD have demonstrated effectiveness, including agonist treatments for opioid use disorder and cognitive-behavioral therapies for other SUDs (Haug et al., 2014; Suarez et al., 2022), perinatal women routinely face multiple barriers to good treatment response and retention. Obstacles include treatment access, financial burdens, child care, and internalized or real stigma toward SUD and agonist treatments (Bright et al., 2022; Frazer et al., 2019; Mattocks et al., 2018), concerns that were exacerbated by the COVID-19 pandemic (Volkow, 2020).

At least some of these barriers might be ameliorated during a treatment episode by helping women activate social support from their personal networks. An important component of the larger construct of recovery capital (Sanchez et al., 2020), social support can be defined as the actual or perceived assistance that is available from other people and is often divided into three categories: emotional, practical, or informational (Cohen & Wills, 1985). Higher levels of social support are positively associated with a range of good mental and medical health outcomes (Hogan et al., 2002; Lakey & Orehek, 2011).

A recent review (Kumar et al., 2021) showed that network support for abstinence is associated with a more effective recovery from opioid use disorder, although these findings were not evaluated by gender. In fact, the benefits of social support for women with opioid use disorder and other SUDs appear to be complicated by personal networks that reinforce drug use and instigate violence (Devries et al., 2014; Park et al., 2019), creating repeated traumatic experiences that can further harm psychosocial functioning (Peirce et al., 2013).

Yet women with SUD appear to have family or friends in their personal networks who may be willing to actively support recovery efforts. Tracy et al. (2012), for example, showed that among 240 women enrolled in substance use disorder treatment, higher levels of network support were associated with a better quality of life. Min et al. (2013) demonstrated that women applying to residential and outpatient treatments for SUD reported a mix of network members who were drug using and drug free, and found that those in residential treatment had more success modifying their networks one year later.

The social networks of perinatal women have been evaluated through a number of qualitative studies that suggest the influence of both drug-using and abstinent members (Goodmen et al., 2020; Grub et al., 2020; Kuo et al., 2013). Using a cross-sectional design, Asta et al (2021) found that perinatal women (n = 50) with opioid use disorder reported a median of eight network members that included family and friends who did and did not report substance use, and that they received more emotional and material support from those who were abstinent. Taken together, these studies suggest that mobilization of drug-free social support across the social network offers a novel approach to help perinatal women with SUD address common barriers to recovery.

The present descriptive study provides additional data on the composition of social networks of treatment-seeking perinatal women. It also offers new information on the interest of these women to invite network members to treatment to help address common recovery needs. We expect that most women will identify broad drug-free support in their networks and demonstrate a willingness to partner with some of them to facilitate recovery efforts. Findings will be used to support program development for perinatal women.

2.0. Methods

2.1. Participants.

Participants (n = 40) were recruited from the Center for Addiction and Pregnancy (CAP) at Johns Hopkins Bayview Medical Center in Baltimore Maryland across two recruitment periods: 2/20/20 -- 3/9/20 and 12/11/20-- 1/21/21. These women met with research staff to learn about the study. The intention was to recruit all women treated at CAP during the recruitment periods (n = 57). However, 4 women left treatment before being interviewed, 6 women declined interest, and 7 women were not approached in time before the medical school restricted human research participation due to the COVID-19 pandemic, leaving a study sample of 40 participants. These women provided Oral Consent to participate, using a form approved by the Johns Hopkins University School of Medicine Institutional Review Board (IRB). They were not paid to complete the interview.

2.2. CAP.

CAP is a Johns Hopkins Bayview Medical Center substance use disorder program. CAP provides a comprehensive outpatient program for pre- and post-partum women, offering agonist-based treatment (methadone, buprenorphine), routine and intensive schedules of individual and group counseling, OB/GYN services, psychiatric and medical care, pediatric care, and family planning.

2.3. Demographics, substance use, and psychiatric characterisitcs.

These variables were collected based on participant self-report as part of the social network assessment.

2.4. Social network assessment.

The Local Family and Friends Worksheet used in this study was modeled closely on The Community Support Worksheet (Kidorf et al., 2016), an instrument that has been previously used to identify drug-free family or friends among patients receiving medications for opioid use disorder. These surveys were developed by the senior author (M.K.) based on clinical experience and a review of network measures reported in the literature (e.g., Zywiak et al, 2009). The development of these measures are ongoing and used clinically, but have not been evaluated for reliability or validity. The senior author trained three research staff to conduct the interviews; two had a master’s degree and one a bachelor’s degree.

The Local Family and Friends Worksheet is completed as an interview. Participants are asked to identify all people who are important to them in their social network, and then to report on their drug use (Zywiak et al., 2009). Network members were considered drug-free if participants reported that they have not used illicit drugs for the past 6-months and did not have current alcohol-related problems. For each network member, participants reported age, drug use or alcohol problems, current substance use disorder (SUD) treatment, and days of contact in the past 30 days. Participants also reported their relationship to each network member: 1) family of origin (parents, step-parents, siblings); 2) immediate family (partner, children ≥ 18 years old), 3) other relatives, and 4) friends, acquaintances, co-workers). Participants were also asked to consider their willingness to invite each of the drug-free members to CAP to: 1) learn about agonist treatment; 2) support SUD recovery needs; 3) support pre- and post-partum needs, 4) learn about overdose prevention; 5) help identify a primary care physician or psychiatrist. They were also asked to consider which network member could be asked to provide help with the following seven tasks outside of CAP: 1) attend SUD treatment; 2) attend self-help groups; 3) take or refill medications; 4) speak with treatment providers; 5) help with daily responsibiities; 6) help with child care; 7) help with a place to live. Finally, participants were asked if they have ever worked with a peer recovery specialist (PRS), and if they would be willing to work with a PRS to attend treatment or self-help groups.

2.5. Data Analysis.

The study uses descriptive statistics to report on the characteristics of social networks and interests on partnering with drug-free support in treatment and in the community.

3.0. Results

3.1. Demographic, substance use, and psychiatric characteristics.

Participants were 29.0 (SD = 4.3) years of age; they were predominantly Caucasian (n = 26; 65%), the remainder African-American (n = 12; 30%) or other (n = 2; 5%). They were split between those who were pre-partum (n = 24; 60%) and post-partum (n = 16; 40%). Most were treated for opioid use (n = 34; 85%), and reported at least one co-occurring mood or anxiety disorder (n = 30; 75%). Most participants did not have a primary care physician (n = 25; 62%), psychiatrist (n = 38; 95%), or child care assistance (n = 29; 72%) in the community.

3.2. Social network description.

Participants reported 5.6 (SD = 1.8) social network members, which included a 4.4 (SD = 1.8) drug-free adults. Participants reported contact with drug-free members on 18.0 (SD = 12.1) days of the month, and drug-using members on 15.9 (SD = 12.5) days of the month. About half of the network (n = 222 members) consisted of people from their family of origin (n = 111; 50.0%); immediate family (n = 36; 16.2%), friends (n = 39; 17.6%), and other relatives (n = 36; 16.2%) were also represented. Most participants (n = 28; 70%) reported that they had a current intimate partner who was drug-free.

3.3. Interest in inviting a drug-free network member to CAP.

Most participants (n = 32; 80%) reported an interest in inviting at least one drug-free person to CAP to support recovery efforts (Mean = 2.3 (SD = 2.0) members). Put another way, participants were willing to partner with 58% (n = 128) of the total number of network members (n= 222) to address recovery needs: family of origin (n = 55), immediate family (n = 27), other relatives (n = 24), and friends (n = 22). As shown in Table 1, participants were most interested in having the network member learn about ways to support recovery (n = 31; 77.5%), and least interested in having them learn about overdose prevention (n = 22; 55%).

Table 1:

Interest in engaging drug-free family or friends to support recovery

Variable Overall (n=40)
% Subjects Network
members
M (SD)
Support at program
Interest in inviting ≥1 network member to CAP 80.0% 2.3 (2.0)
Interest in inviting network member to CAP to provide support for:
Recovery needs 77.5% 1.6 (1.5)
Pre- and post-partum needs 72.5% 1.2 (1.9)
Participating in MOUD treatment 67.5% 1.3 (1.3)
Identifying a PCP or psychiatrist 60.0% 0.80 (0.79)
Overdose prevention 55.0% 1.2 (1.6)
Support in community
Interest in working with ≥1 network member in the community 95.0% 2.6 (1.5)
Interest in working with network member in the community to provide support for:
Child care 90.0% 1.9 (1.7)
A place to live 75.0% 1.2 (1.1)
Attending substance use disorder treatment 72.5% 1.2 (0.95)
Attending self-help groups 72.5% 0.87 (0.69)
Speak with treatment providers 70.0% 1.3 (1.1)
Help with daily responsibilities 60.0% 1.0 (1.1)
Taking or refilling medication 55.0% 0.80 (0.85)
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3.4. Interest in working with drug-free network member in the community.

Similarly, almost all participants (95%) expressed a willingness to work with at least one network member in the community to help with various recovery tasks (Mean = 2.6 (SD = 1.5) members). Helping with child care was endorsed by the highest percent of participants (n = 36; 90%), though over 70% acknowledged the importance of support in other activities: providing a place to live, attending substance abuse treatment or self-help groups, speaking with treatment providers (Table 1).

3.5. Peer recovery specialist (PRS).

Only about a third of the participants (n = 13) had experience working with a PRS; most (n = 38; 95%) thought that it would be helpful. A majority of participants believed that a PRS could help with problem-solving (n = 33; 82.5%), attending treatment (n = 29; 73%), or advocating for recovery needs (n = 29; 73%); fewer participants were interested in receiving PRS support to remind them about appointments (n = 22; 55%) or attend self-help groups (n = 20; 50%).

4. Discussion

The present study replicates and extends the findings of Asta et al. (2021) to show that perinatal women with SUD have considerable drug-free support within their personal social networks, and that most were willing to partner with these network members to support recovery efforts across a range of recovery needs. These results dovetail with studies of other populations of people with SUD who also report an interest in network participation during treatment (Hammond et al., 2022; Kidorf et al., 2016). Mobilization of family and friends provides a treatment-based strategy to help patients increase overall recovery capital (Sanchez et al., 2000). This work also supports the recommendations of the International Women’s and Children’s Health and Gender Group tasked to promote an agenda of evidence-based research that focuses on the intersection of women and their community networks (Meyer et al., 2019).

The present study showed that the networks of women with SUD consist of far more people who are drug-free than drug using, a finding that is also consistent with a recent report on perinatal women with SUD (Asta et al., 2021). These findings diverge somewhat from earlier studies of people not in treatment that show a relatively even split of network members with or without current drug use (Buchanan & Latkin, 2008; Latkin et al., 1995). While women in this study may have underreported network members engaged in drug use, simply enrolling in treatment can impact social network change (Lloyd et al., 2008). It is also possible that pregnancy and childbirth further motivates social network change. Asta et al. (2021) showed that women during pregnancy reported seeking more support from drug-free members of their personal network.

Women in this study endorsed many recovery needs that might be addressed with the help of network support. A majority of participants were open to having a network member come to the treatment facility to learn about SUD and other recovery issues, educational topics with potential to improve treatment retention and reduce real or perceived stigma (Bright et al., 2022; Ellis et al., 2019; Smith et al., 2016). They also expressed interest in having network members help with childcare, filling prescriptions, and other recovery needs, thereby addressing obstacles that interfere with sustained treatment participation (Frazer et al., 2019; Mattocks et al. 2018). Interest in using network members to identify a PCP or psychiatrist is also important based on the high rates of co-occurring medical and psychiatric concerns in this population (Arnaudo et al., 2017; McHugh et al., 2018), and the fact that most women in this study lacked professional care in the community. Finally, women endorsed an interest in expanding existing support through having network members connect them to other treatment providers or self-help groups, a function that might also be accomplished through PRS participation (Rowe et al., 2007).

The optimal strategy to focus this support within a treatment episode is an empirical question that requires further research (Kumar et al., 2021). The present study showed that perinatal women were willing to partner with both family and friends during the treatment episode, and that members from their family of origin were most preferred. A number of models are available for working with network members, including partner therapy and community reinforcement approaches (Kidorf et al., 2023; O’Farrell & Clements, 2012; Roozen et al., 2004), though we are not aware of studies evaluating these approaches with perinatal women. Because social support is closely tied to both mental health and SUD treatment outcomes, activating community support would almost certainly assist rehabilitation and recovery efforts (Lakey & Orehek, 2011; Longabaugh et al., 2010; Stout et al., 2012). For perinatal women who continue to use substances, community support could offer assistance by connecting them to harm reducation services (e.g., syringe exchange) or by providing more direct assistance toward the welfare of the children or other family members (Kidorf et al., 2021).

The primary study limitation is generalizability of the findings. This study was conducted at one speciality program in Baltimore MD, and employed a relatively small sample of a majority of Caucasion women. While participant demographics and sample size are similar to other studies addressing faciltators and obstacles to SUD treatment in this population (e.g., Asta et al., 2021; Frazer et al., 2019; Mattocks et al., 2018), a larger and more diverse sample would provide more statistical power to evaluate individual and network-level differences among participants (Meyer et al., 2019). The survey used in this study is based on other assessments (Zywiak et al., 2009) and tailored toward a perinatal population, though its psychometrics have not been evaluated. Perhaps most importantly, it is not known if women who expressed interest in partnering with network support would actually do so, or if network members would attend co-joint sessions or provide assistance in the community.

Taken together, this descriptive study demonstrates that perinatal women report considerable social network support and express interest in working together with family and friends to address recovery needs. These data will be used for program development at CAP to prioritize inclusion of drug-free network members. The widespread endorsement of the potential benefits of network treatment involvement is encouraging, and provides a possible pathway to address common obstacles to care that routinely plague perinatal women participating in SUD treatment.

Acknowledgements

We are thankful for the patients who supported this work and participated in the study. We are also thankful for the outstanding commitment, skill, and integrity of the CAP clinical staff and our clinical research team, including Kori A. Kindbom, M.S., Michael Sklar, M.A., Jennifer Mucha, M.A., and Rachel Burns, B.A.

Funding

This work was supported through NIH-NIDA funding to R34 DA042320 (M. Kidorf, PI). The sponsoring agency had no role in the design and analysis of the study, or review or writing of the report. The opinions expressed in this paper are those of the authors and do not represent the official position of the U.S. government.

References

  1. Arnaudo CL, Andraka,-Christau B, & Allgood K (2017). Psychiatric co-morbidities in pregnant women with opioid use disorder: Prevalence, impact, and implications for treatment. Current Addiction Reports, 4, 1–13. Doi:10.10071sto429-017-0132-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Asta D, Davis A, Krishnamurt T, Klocke L, Abdullah W, & Krans EE (2021). The influence of social relationships on substance use behaviors among pregnant women with opioid use disorder. Drug and Alcohol Dependence, 222. Doi: 10.1016/j.drugalcdep.2021.108665 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bright V, Riddle J, & Kerver J (2022). Stigma experienced by rural pregnant women with substance use disoder: A scoping review and qualitative synthesis. International Journal of Environmental Research and Public Health, 19. Doi: 10.3390/ijerph192215065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Buchanan AS, & Latkin CA (2008). Drug use in the social networks of heroin and cocaine users before and after drug cessation. Drug and Alcohol Dependence, 96, 286–289. 10.1016/j.drugalcdep.2008.03.008 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cohen S, & Wills TA (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357. 10.1037/0033-2909.98.2.310 [DOI] [PubMed] [Google Scholar]
  6. Devries KM, Child JC, Bacchus LJ, Mak J, Falder G, Graham K et al. (2014). Intimate partner violence victimization and alcohol consumption in women: A systematic review and meta-analysis. Addiction, 109, 379–391. [DOI] [PubMed] [Google Scholar]
  7. Ellis JD, Cairncorss MA, Struble CA, Carr MM, Ledgerwood DM, & Lundahl LH (2019). Correlates of treatment retneion and opioid misuse among postpartum women in methadone treatment. Journal of Addiction Medicine, 13, 153–158. Doi: 10.1097/ADM.0000000000000467. [DOI] [PubMed] [Google Scholar]
  8. Frazer Z, McConnell K, & Jansson LM (2019). Treatment of substance use disorder in pregnant women: Motivators and barriers. Drug and Alcohol Dependence, 205, 1–6. 107652. Doi 10.1016.drugalcdep2019.107642. [DOI] [PubMed] [Google Scholar]
  9. Goodman DJ, Saunders EC, & Wolff KB (2020). In their own words: a qualitative study of factors promoting resilience and recovery among postpartum women with opiod use disorders. BMC Pregnancy and Childbirth, 20. 178. 10.1186/s12884-020-02872-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Grub I, Firemark A, & Davidson A (2021). Motherhood, substance use and peer support: Benefits of an integrated group program for pregnant and postpartum women. Journal of Substance Abuse Treatment, 131. 108450. [DOI] [PubMed] [Google Scholar]
  11. Haight SC, Ko JY, Tong VT, Bohm MK, & Callaghan WM (2018). Opioid use disorder documented at delivery hospitalization – United States, 1999-2014. Morbidity and Mortality Weekly Report, 67, 845–849. https://www.ncbi.nim.bih.gov/pmc/articles/ [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hammond A, Batkis M, Rostov P, Yan H, Kidorf M (2022). Drug-free community support in inpatients with co-occurring psychiatric disorders and substance use. Journal of Dual Diagnosis, 2022, 18, 177–184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Haug NA, Dufy M & McCaul ME (2014). Substance abuse treament services for pregnant women: psychosocial and behavioral approaches. Obstetrics and Gynecological Clinics of North America, 41, 267–296. Doi: 10.1016/j.ogc2014.03.001 [DOI] [PubMed] [Google Scholar]
  14. Hogan BE, Linden W, & Najarian B (2002). Social support interventions: do they work? Clinical Psychology Review, 22, 383–442. 10.1016/s0272-7358(01)00102-7 [DOI] [PubMed] [Google Scholar]
  15. Kidorf M, Latkin C, & Brooner RK (2016). Presence of drug-free family and friends in the personal social networks of people receiving treatment for opioid use disorder. Journal of Substance Abuse Treatment, 70, 87–92. 10.1016/j.jsat.2016.08.013 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kidorf M, Latkin C, Brooner RK, Yan H, & Peirce JM (2021). Developing a community supported risk reduction intervention ro syringe exchange residents and their drug-free family and friends: A pilot study. Journal of Addictive Diseases, 39, 248–256. [DOI] [PubMed] [Google Scholar]
  17. Kidorf MS, Peirce JM, Brooner RK, Yan H, & Latkin C (2023). Feasibility and preliminary efficacy of a community support intervention for people with opioid use disorder. American Journal on Addictions, 32, 554–562. Doi: 10.1111/ajad.13457 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kumar N, Oles W, Howell BA, Janmohamed K, Lee ST, Funaro MC, O’Connor PG, & Alexander M (2021). The role of social network support in treatment outcomes for medication for opioid use disorder: A systematic review. Journal of Substance Abuse Treatment, 127. 108367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kuo C, Schonbrun YC, Zlotnick C, Bates N, Todorova R, Kao JC, & Johnson J (2013). A qualitative study of treatment needs among pregnant and postpartum women with substance use and depression. Substance Use and Misuse, 48. Doi: 10.3109/10826084.2013.800116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lakey B, & Orehek E (2011). Relational regulation theory: A new approach to explain the link between perceived social support and mental health. Psychological Review, 118, 82–495. 10.1037/a0023477 [DOI] [PubMed] [Google Scholar]
  21. Latkin C, Mandell W, Oziemkowska M, Celentano D, Vlahov D, Ensminger M, & Knowlton A (1995). Using social network analysis to study patterns of drug use among urban drug users at high risk for HIV/AIDS. Drug and Alcohol Dependence, 38, 1–9. 10.1016/0376-8716(94)01082-V [DOI] [PubMed] [Google Scholar]
  22. Lloyd JJ, Strathdee SA, Pu M, Havens JR, Cornelius LJ, Huettner S, Latkin CA. (2008). The impact of opiate agonist maintenance therapy on drug use within social networks of injecting drug users. American Journal on Addiction, 17, 414–21. doi: 10.1080/10550490802268165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Longabaugh R, Wirtz PW, Zywiak WH, & O’Malley SS (2010). Network support as a prognostic indicator of drinking outcomes: the COMBINE Study. Journal of Studies on Alcohol and Drugs, 71, 837–846. 10.15288/jsad.2010.71.837 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Mattocks KM, Clark R, & Weinreb L (2017). Initiation and engagement with methadone treatment among pregnant and postpartum women. Women’s Health Issues, 27, 646–651. [DOI] [PubMed] [Google Scholar]
  25. McHugh RK Votaw VR Sugarman DE & Greenfield SF (2018). Sex and gender differences in substance use disorders. Clinical Psychology Review, 66, 12–23. Doi: 10.10.1016/j.cpr.22017.10.012 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Meyer JP, Isaacs K, El-Shahawy O, Burlew K, & Wechsberg W (2019). Research on women and substance use disorders: Reviewing progress and developing a research and implementation roadmap. Drug and Alcohol Dependence, 197, 158–163. Doi: 10.1016/j.drugalcdep.2019.01.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Min MO, Tracy EM, Kim H, Park H, Jun M, Brown S, McCarty C & Laudet A (2013). Changes in personal networks of women in residential and outpatient substance abuse treatment. Journal of Substance Abuse Treatment, 45, 325–334. Doi: 10.1016/j.jsat.2013.04.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. O’Farrell TJ, & Clements K (2012). Review of outcome research on marital and family therapy in treatment for alcoholism. Journal of Marital & Family Therapy, 38, 122–144. 10.1111/j.1752-0606.2011.00242.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Park JN Foster KH Decker MR Tomko C Allen SJ Galai N et al. (2019). Integrative and structural factors associated with receptive syringe sharing amoung a prospective cohort of female sex workers who inject drugs. Addiction, 114, 1204–1213. Doi: 10.1111/add.14567 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Peirce J, Brooner RK, Kolodner K, & Kidorf M (2013). Prospective effects of traumatic event re-exposure and PTSD in syringe exchange participants. Addiction, 108, 146–153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Roozen HG, Boulogne JJ, van Tulder MW, van den Brink W, De Jong CA, & Kerkhof AJ (2004). A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine, and opioid addiction. Drug and Alcohol Dependence, 74, 1–13. DOI: 10.1016/j.drugalcdep.2003.12.006 [DOI] [PubMed] [Google Scholar]
  32. Rowe M, Bellamy C, Baranoski M, Wieland M, O'Connell MJ, Benedict P, Davidson L, Buchanan J, & Sells D (2007). A peer-support group intervention to reduce substance use and criminality among persons with severe mental illness. Psychiatric Services, 58, 955–961. DOI: 10.1176/ps.2007.58.7.955 [DOI] [PubMed] [Google Scholar]
  33. Sanchez J, Sahker E, & Arndt S (2020). The Assessment of Recovery Capital (ARC) predicts substance abuse treatment completion. Addictive Behavior, 102, 106189. Doi: 10.1016/j.addbeh.2019.106189. [DOI] [PubMed] [Google Scholar]
  34. Smid MC, Stone NM, Baksh L, Beffink MP, Emerson BD, Varner MN et al. (2019). Pregnancy-assisted deaths in Utah: Contribution of drug-induced deaths. Obstetrics and Gynecology, 133, 1131–1140. Doi: 10.1097/AOC.00000000000003279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Smith LR, Earnshaw VA, Copenhaver MM, & Cunningham CO (2016). Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations. Drug & Alcohol Dependence, 162, 34–43. 10.1016/j.drugalcdep.2016.02.019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Stout RL, Kelly JF, Magill M, & Pagano ME (2012). Association between social influences and drinking outcomes across three years. Journal of Studies on Alcohol and Drugs, 73, 489–497. 10.15288/jsad.2012.73.489 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Suarez EA, Huybrechts KF, Straub L, Hernandez-Diaz S, Jones HE., Connerty HS et al. (2022). Burpenorphine versus methadone for opioid use disorder in pregnancy. New England Journal of Medicine, 387. Doi: 10.1056/NEJMoa2203318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Substance Abuse and Mental Health Services Adminstration. (2020). 2020 national survey on drug use and health: Women. United States Department of Health and Human Services. [Google Scholar]
  39. Tracy EM, Laudet AB, Min MO, Kim H, Brown S, Jun MK, & Singer L (2012). Prospective patterns and correlates of quality of life among women in substance abuse treatment. Drug and Alcohol Dependence, 124, 242–249. Doi: 10.1016/j.drugalcdep.2012.01.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Volkow ND (2020). Collison of the COVID-19 and addiction epidemics. Annals of Internal Medicine, 173, 61–62. Doi: 10.7326/M20-1212 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Warren JI, Stein JA, & Grella CE (2007). Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders. Drug and Alcohol Dependence, 89, 267–274. 10.1016/j.drugalcdep.2007.01.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Zywiak WH, Neighbors CJ, Martin RA, Johnson JE, Eaton CA, & Rohsenow DJ (2009). The Important People Drug and Alcohol interview: Psychometric properties, predictive validity, and implications for treatment. Journal of Substance Abuse Treatment, 36, 321–330. 10.1016/j.jsat.2008.08.001 [DOI] [PMC free article] [PubMed] [Google Scholar]

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