Elsevier

Child Abuse & Neglect

Volume 28, Issue 11, November 2004, Pages 1229-1247
Child Abuse & Neglect

African–American women who use crack cocaine: a comparison of mothers who live with and have been separated from their children,☆☆,

https://doi.org/10.1016/j.chiabu.2004.06.009Get rights and content

Abstract

Objective:

This study examined factors that influenced caregiver status for African–American mothers who use crack cocaine but are not receiving drug treatment and participated in an HIV prevention study in North Carolina.

Method:

Caregiver mothers who were living with at least one of their children at intake (n = 257) were compared with non-Caregivers who were separated from all of their children (n = 378). Bivariate analyses and logistic regression were used to compare these mothers at intake on current drug use, risky sex practices, psychological symptoms, victimization, and aggression.

Results:

Compared with Caregiver mothers, non-Caregivers reported higher frequencies of drug use, risky sex practices, psychological distress, and victimization experiences. Caregiver mothers were more likely than non-Caregiver mothers to have health insurance, but were less likely to have received drug treatment. Logistic regression found that non-Caregiver mothers were significantly more likely than Caregiver mothers to be older, to have been physically abused as children, to trade sex more frequently, to be homeless, and to have no health insurance. Recent crack use, psychological symptoms, and victimization were not significantly related to caregiver status.

Conclusions:

Findings that socio-environmental factors were more strongly associated with caregiver status than crack use underscore the importance of contextual issues such as housing, victimization history, and resources in serving maternal crack users. Community outreach and interventions that engage mothers who use drugs and live with their children may be more effective strategies than formal office-based services to link mothers who use crack and their children to needed drug treatment and family and child services.

Résumé

Objectif:

Cette étude a recherché les facteurs qui caractérisent les mères afro-américaines ayant en charge leur enfant, qui utilisent du “crack”, mais ne suivent pas de traitement substitutif et qui ont participé à une étude de prévention du VIH en Caroline du Nord.

Méthode:

Les mères ayant la charge d’au moins un de leurs enfants en début d’étude (n = 257) ont été comparées à d’autres mères séparées de tous leurs enfants (n = 378).

Des analyses bivariées et une régression logistique ont été utilisées pour comparer ces mères en début d’étude sur leur utilisation habituelle de drogue, leurs pratiques sexuelles à risque, leur symptomes psychologiques, leur éventuel état de victime ou d’agression.

Résultats:

Comparées aux mères avec enfant, celles sans enfant ont montré des fréquences plus élevées de consommation de drogues, de pratiques sexuelles à risque, de détresse psychologique et d’expérience de victimisation. Les mères avec charge parentale étaient plus susceptibles que celles séparées de leur enfant d’avoir une couverture sociale, mais moins susceptibles d’avoir reçu un traitement de sevrage. L’étude anamnestique a trouvé que les mères sans enfant étaient significativement plus âgées, elles avaient étéplus souvent physiquement maltraitées dans l’enfance, se livraient plus fréquemment à la prostitution, avaient tendance à être sans domicile et sans couverture sociale. L’utilisation récente de crack, les symptomes psychologiques et la victimisation n’étaient pas significativement en relation avec le fait d’avoir ou non la charge de leur enfant.

Conclusions:

Les constatations que les facteurs socio-environementaux soient plus fortement associés au statut de charge parentale qu’à l’utilisation de crack, soulignent l’importance des problèmes contextuels tels que le logement, le passé de victime et les ressouces pour prendre en charge les mères utilisatrices de crack. Le travail social et les interventions communautaires visant à soutenir des mères utilisatrices de drogue à vivre avec leurs enfants peuvent être des stratégies plus efficaces que des prises en charge institutionnelles sensées offrir aux mères utilisatrices de drogue et à leurs enfants des traitements spécifiques et des services sociaux pour les familles et leurs enfants.Mujeres afro-americanas que usan crack: estudio comparativo con otras que viven con y han sido separadas de sus hijos.

Resumen

Objetivo:

Este estudio examinó los factores que influyeron para asignarle estatus de cuidadoras a otras africo-americanas que usan crack cocaína pero que no están recibiendo tratamiento contra las drogas y participaron en un estudio de prevención del VIH en Carolina del Norte.

Método:

Las madres cuidadoras que cuando ingresaron vivían por lo menos con uno de sus hijos (n = 257) fueron comparadas con las no cuidadoras que habían sido separadas de todos sus hijos (n = 378). Se utilizó el análisis bivariado y la regresión logística para comparar estas madres cuando ingresan sobre su uso actual de drogas, prácticas sexuales de riesgo, síntomas psicológicos, victimización y agresión.

Resultados:

Al comparar a las madres cuidadoras con las no cuidadoras, éstas últimas reportaron mayores frecuencias en el uso de drogas, practicas sexuales de riesgo, malestar psicológico y experiencias de victimización. Las madres cuidadoras tenían más probabilidad que las no cuidadoras de tener seguro de salud, pero menos probabilidad de haber recibido tratamiento por las drogas. La regresión logística encontró que las madres no cuidadoras tenían significativamente más probabilidad que las madres cuidadoras de ser mayores en edad, haber sido abusadas físicamente en la niñez, comercializar el sexo con mayor frecuencia, no tener donde vivir, y no tener seguro de salud. El uso reciente de crack, los síntomas psicológicos y la victimización, no estuvieron significativamente asociados con el estatus de cuidadora.

Conclusiones:

Los hallazgos de que los factores socio-ambientales estaban más fuertemente asociados con el uso de crack destacan la importancia de los aspectos ambientales como la vivienda, historia de victimización y los recursos para atender a las madres que usan crack. Para vincular a las madres que usan crack y a sus hijos con el tratamiento para las drogas que necesitan, el apoyo comunitario y las intervenciones que involucran a las madres que usan drogas y viven con sus hijos pueden ser estrategias más efectivas que los servicios formales desde una oficina.

Introduction

It is estimated that one in four children lives with a parent who regularly uses alcohol or other drugs (Child Welfare League, 2001). Children of substance abusers are at increased risk of experiencing health, behavioral, psychological, and academic problems, including becoming substance abusers themselves (Kumpfer, 1999). Parents challenged by addiction and associated drug-seeking behaviors and lifestyles are at increased risk of having their children being placed in out-of-home care (Johnson & Leff, 1999; Kumpfer, 1987; Wilens, Biederman, Kiely, Bredin, & Spencer, 1995). In fact, parental drug use contributes to as many as 90% of child placements in the welfare system (GAO, 1997). Child neglect secondary to substance use has been cited as the primary reason for out-of-home placements (GAO, 1994; Zlotnick, Kronstadt, & Klee, 1998).

Despite this strong link between parental substance use and child welfare, many parents who use drugs have their children living with them (Beckwith, Howard, Espinosa, & Tyler, 1999; Kearney, Murphy, & Rosenbaum, 1994; Nair et al., 1997, Pilowsky et al., 2001; Tyler, Howard, Espinosa, & Doakes, 1997). Among clinical samples, between 66% and 85% of parents who abuse substances have been found to retain care or custody of their children (Hohman, Shillington, & Baxter, 2003; Tyler et al., 1997), while among community samples of drug-using mothers and fathers, 37% to 57% have been found to retain care of their children (Nair et al., 1997, Pilowsky et al., 2001).

The multiple environmental risk factors present in many families with parental substance abuse may exacerbate poor parenting and increase poor child outcomes (Dunn et al., 2002; Kettinger, Nair, & Shuler, 2000). A recent study of fathers who were entering drug treatment, had spouses who did not abuse alcohol or other drugs, and whose children were not exposed to drugs prenatally identified a number of risk factors in the child-rearing context created by parental drug users that affected their children (Fals-Stewart, Kelley, Cooke, & Golden, 2002). The study found that paternal substance use, as well as socio-demographic factors, parental relations, and parents’ psychological adjustment each contributed independently to child adjustment.

Given the traditional role of women as caretakers, mothers, in particular, are significantly more likely than fathers to be primary caregivers of at least one child. In a study of parents who were injecting drug users (IDUs) and not in treatment, 69% of mothers cared for their children, compared with 24% of fathers (Pilowsky et al., 2001). Substance-abusing mothers face their own challenges and stressors in their lives that compromise their parenting. Compared with non-addicted mothers, studies have demonstrated poorer parenting attitudes and behaviors among drug-using women (Ammerman, Kolko, Kirisci, Blackson, & Dawes, 1999; Hien & Honeyman, 2000; Kelley, 1998, Tyler et al., 1997). Numerous environmental and psychosocial risk factors have been associated with maternal substance abuse that likely contribute to poor parenting and compromised child outcomes in this population, including poverty, family dysfunction, and violence (Amaro, Fried, Cabral, & Zuckerman, 1990; Burns & Burns, 1990; Chasnoff, 1988, Colten, 1980, Finnegan, 1982; Ladwig & Anderson, 1989; Regan, Erlich, & Finnegan, 1987; Stein, Newcomb, & Bentler, 1993; van Baar, 1990). Substance-abusing mothers are also more likely than non-substance-abusing mothers to experience psychological symptoms, such as depression, anxiety, and antisocial personality disorders (Kelleher, Chaffin, Hollenberg, & Fischer, 1994; Kelley, 1998).

Research suggests that psychosocial and environmental risk factors exert both direct and indirect influences on outcomes of substance-abusing mothers and their children. Children of substance-abusing mothers who were homeless were more likely to have been removed from maternal care than substance-abusing mothers with housing (Zlotnick, Robertson, & Tam, 2002). Within maternal drug-using populations, comorbid maternal psychopathology predicted whether children remained in maternal care (Nair et al., 1997) as well as children's perceptions of parenting status and developmental outcomes (Beckwith et al., 1999; Hans, Bernstein, & Henson, 1999). Studies also suggest that the cumulative effects of environmental risk related to substance abuse may moderate effects on parenting in the population. Among a sample of substance-abusing mothers, those with high levels of environmental risk were more likely than those with low levels of environmental risk to report poor parenting attitudes and skills (Kettinger, Nair, & Schuler, 2000). Although limited, these studies provide evidence that while maternal substance use places mothers at increased risk of losing care of their children, the psychosocial and environmental factors associated with maternal drug use may exert independent and unique influences on caregiver status and child outcomes above and beyond parental drug abuse alone. These findings suggest that it may be possible to mitigate the adverse effects of maternal drug use on parenting by addressing other psychosocial and environmental risks and protective factors.

Although crack use is present among all ethnic groups (Weinstein, Roberts, & Pflugh, 1992), it is most prevalent among African–Americans (Havassy, Wasserman, & Hall, 1993), particularly low-income inner-city African–Americans (Carlson & Siegal, 1991). Crack use often leads to unstable and chaotic lifestyles. Psychosocial and environmental risk factors of homelessness, unemployment, lack of social support, a difficult childhood, childhood and adult victimization, criminal involvement, and depression, anxiety, and traumatic stress symptoms are especially prevalent in the lives of African–American women who use crack cocaine (Roberts, Wechsberg, Zule, & Burroughs, 2003; Wechsberg et al., 2003).

Boyd (1993) examined the relationships between age of first sexual abuse, first depressive symptoms, family drug use and age of first drug use among African–American women. Overall, Boyd found that a history of sexual abuse, depression, and family drug use were common antecedents to crack use. Cohen (1999) similarly reported that a history of physical and sexual abuse and parental drug use are common antecedents to crack use among African–American women. African–American women (92% of whom were mothers) who used crack and had a history of sexual abuse reported addictions to more substances and negligent parenting because of their drug use than women without such a history (Young, Boyd, & Hubbell, 2001). The strong associations among women between histories of child sexual and/or physical abuse and substance abuse (Harrison, Fulkerson, & Beebe, 1997; Wolock & Magura, 1996; Young et al., 2001) and increased psychological difficulties (Medrano, Hatch, Zule, & Desmond, 2002) are particularly concerning for maternal substance users, who are at increased risk of subsequently abusing or neglecting their own offspring (Brown, Cohen, Johnson, & Salzinger, 1998; Dunn et al., 2002, Kelleher et al., 1994, Leventhal et al., 1997).

Most research on drug-abusing parents targets clinical samples receiving treatment or identified through the courts (Hogan, 1998). A limited number of studies have begun to focus on drug-abusing parents who are not in treatment, examining factors that may affect the likelihood that they retain care of their children. A recent study of a community sample of parents who were IDUs found that 69% of mothers had their children living with them. Those living with children under 14 years of age were more likely to be female, have health insurance, engage in no- or low-risk drug practices, and be in better physical health than parents who were separated from their children (Pilowsky et al., 2001). In a comparison of mothers who remained primary caregivers of their child after 18 months (57%) and those who did not, Nair et al. (1997) identified maternal factors assessed within 2 weeks of the postpartum hospital stay that predicted disruptions in primary care of their infants at 18 months of age. These authors found that mothers who experienced disruptions in primary care of their infants by 18 months had tested positive for heroin use at their first child's birth, had two or more children, were younger, and reported more depressive symptoms than mothers who retained primary care of their child. Few studies, however, have identified the independent and unique effects of postnatal drug use and risk behaviors and associated environmental and psychosocial risks on caregiving status.

Given that over half of mothers who use illicit drugs may retain care of their children, understanding the contexts in which these children and mothers live is important for advancing research and practice in the fields of substance use and child welfare. The purpose of the present study is to describe characteristics of African–American mothers who use crack cocaine, comparing women who have their children living with them with those mothers who have been separated from their children on measures of socio-economic characteristics, drug use, risky sex practices, psychological symptoms, and victimization and aggressive experiences, and to determine whether current risk behaviors, psychosocial, and environmental factors influence caregiver status. This study fills an important gap in the literature by examining factors that affect whether mothers retain care of their children among a rarely studied sample of African–American women who actively abuse crack cocaine but are not connected to formal service or welfare systems.

Section snippets

Study population and recruitment

The sample was drawn from an intervention research study funded by the National Institute on Drug Abuse that was conducted in the Raleigh-Durham area of North Carolina. This study, the NC Women's CoOp, targeted African–American women who used crack but were not in drug treatment and were at risk of HIV. The program provided an HIV risk-reduction intervention that was tailored more closely to culturally- and gender-based needs than previous HIV prevention interventions. Study and data collection

Demographic characteristics

Table 2 presents the background characteristics of the mothers in the study. Caregiver mothers were somewhat younger (33.7 years, SD = 5.6) than those who were separated from their children (34.5 years, SD = 5.9) (p = .072). On average, women in each group had between two and three children, and were comparable regarding marital status, education levels, and employment status. Mothers living with and without their children were equally likely to be involved with the child welfare system. Mothers who

Discussion

In this study, 40% of African–American mothers who used crack cocaine had at least one of their children living with them, a lower proportion than the 46% to 69% found in other studies of non-clinical samples of mothers who use illicit drugs (Beckwith et al., 1999, Nair et al., 1997, Pilowsky et al., 2001). Findings suggest that the challenging and risky contextual environments in which African–American mothers who use crack cocaine may live have stronger influences on caregiver status than

Acknowledgments

We wish to thank all the women participants, field staff and RTI staff for their dedication to the study.

References (68)

  • P. Nair et al.

    Risk factors for disruption in primary caregiving among infants of substance abusing women

    Child Abuse & Neglect

    (1997)
  • D.J. Pilowsky et al.

    Characteristics of injection drug using parents who retain their children

    Drug and Alcohol Dependence

    (2001)
  • K.P. Richter et al.

    A hierarchy of strategies heroin-using mothers employ to reduce harm to their children

    Journal of Substance Abuse and Treatment

    (2000)
  • A.C. Roberts et al.

    Contextual factors and other correlates of sexual risk of HIV among African-American crack-abusing women

    Addictive Behaviors

    (2003)
  • R. Tyler et al.

    Placement with substance-abusing mothers vs. placement with other relatives: Infant outcomes

    Child Abuse & Neglect

    (1997)
  • N.L. Weatherby et al.

    Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach

    Evaluation and Program Planning

    (1994)
  • T.E. Wilens et al.

    Pilot study of behavioral and emotional disturbances in the high-risk children of parents with opioid dependence

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1995)
  • I. Wolock et al.

    Parental substance abuse as a predictor of child maltreatment re-reports

    Child Abuse & Neglect

    (1996)
  • H. Amaro et al.

    Violence during pregnancy and substance use

    American Journal of Public Health

    (1990)
  • L. Beckwith et al.

    Psychopathology, mother-child interaction, and infant development: Substance-abusing mothers and their offspring

    Development and Psychopathology

    (1999)
  • W.J. Burns et al.

    Parenting dysfunction in chemically dependent women

  • R.G. Carlson et al.

    The crack life: An ethnographic overview of crack use and sexual behavior among African-Americans in a midwest metropolitan city

    Journal of Psychoactive Drugs

    (1991)
  • R.G. Carlson et al.

    An ethnographic approach to targeted sampling: Problems and solutions in AIDS prevention research among injection drug and crack-cocaine users

    Human Organization

    (1994)
  • Child Welfare League of American. (2001). One in four children affected by parental substance abuse. New government...
  • E.D. Cohen

    An exploratory attempt to distinguish subgroups among crack-abusing African-American women

    Journal of Addictive Diseases

    (1999)
  • Colten, M. (1980). A comparison of heroin-addicted and non-addicted mothers. In NIDA Services Research Report:...
  • M. Dennis

    Global appraisal of individual needs (GAIN) administration manual

    (1998)
  • S. Dowling-Guyer et al.

    Reliability of drug users’ self-reported HIV risk behaviors and validity of self-reported recent drug use

    Assessment

    (1994)
  • W. Fals-Stewart et al.

    Predictors of the psychosocial adjustment of children living in households of parents in which fathers abuse drugs: The effects of postnatal parental exposure

    Addictive Behaviors

    (2002)
  • L.P. Finnegan

    Outcome of children born to women dependent upon narcotics

    Advances in Alcohol & Substance Abuse

    (1982)
  • General Accounting Office (GAO). (1994). Foster care: Parental drug abuse has alarming impact on young children....
  • General Accounting Office (GAO). (1997, October). Implications for children, the child welfare system, and foster care...
  • General Accounting Office (GAO). (1998, September). Foster care: Agencies face challenges securing stable homes for...
  • J. Griffith et al.

    TCU/DATAR forms: Description of composite variables

    (1997)
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    This work was supported by the National Institute on Drug Abuse (NIDA) Grant No. 1 R01 DA 11609, Wendee M. Wechsberg, Principal Investigator.

    ☆☆

    The interpretations and conclusions do not necessarily represent the position of NIDA or the U.S. Department of Health and Human Services.

    Preliminary analyses for this paper were presented at the Victimization of Children and Youth: An International Research Conference, August 4–7, 2002.

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