Keren Gueta

Can a 12-Step Program Work in Methadone Maintenance Treatment?

Three consecutive, professionally led (as opposed to self-help) groups following the 12-step program (TSP) were integrated into a methadone maintenance treatment (MMT) program that included 32 heroin-addicted individuals in recovery. This report describes our experience in meeting the challenges that arose and our conclusions regarding the therapeutic potential of this integration. A professional therapeutic staff guided the groups. In-depth interviews of 10 participants and the reflections of the group leaders provided data for learning about the groups’ experience. Initially the participants rejected the concepts of Step 1, powerlessness and unmanageability of life. The assimilation of Step 4 (defining character defect) also aroused some resistance. The participants eventually adopted the pragmatic aspects of TSP, including its terminology. The establishment of a common language of recovery helped to create group coherence and a sense of belonging, and helped to meet the needs of those who felt stigmatized by both the nonaddicted and addicted population undergoing nonmethadone recovery. TSP could be adapted to various aspects of daily life, produced a sense of self-efficacy, and stimulated motivation for change. Therapeutic implications are discussed.

Moulding an emancipatory discourse: How mothers recovering from addiction build their own discourse

In this study, we investigated how mothers in different stages of recovery from addiction negotiate their identities along this process. We mapped the discursive fields in which those mothers act and the subject-positions available to them. The first discourse in this field was the popular discourse that according to it addicted mothers are compared to ‘monsters’. Another discourse was the institutional discourse that stems from the milieu in which the women were treated. The discourse analysis demonstrated that the participants did not automatically accept the institutional discourse, but rather constructed a new identity based on several different discourses, borrowed from other treatment models demonstrating resilience, creativity and adaption to their unique experience. This reconstruction of identity served as an alternative to the ‘monstrous mother’ identity imposed on them by the popular discourse. The findings support the view that while social forces shape individual identity, individuals also create their own agency through language, relationships and cultural attributes.

Self-Forgiveness in the Recovery of Israeli Drug-Addicted Mothers A Qualitative Exploration

It has been suggested that self-forgiveness plays an important role in the process of recovery from addiction, especially for women, but this issue has been largely overlooked in the research. This study explored self-forgiveness from the perspective of 25 recovering drug-addicted mothers associated with the same therapeutic community, either as current residents in the course of recovery or as past residents who maintained recovery. The participants were interviewed in a dual-research design (35 interviews) that enabled comparative-longitudinal examination of the self-forgiveness process. Qualitative methods were used to identify the emotional, cognitive, and offense-related factors associated with self-forgiveness regarding mothering patterns during addiction. The results indicated that self-forgiveness involves cognitive flexibility by using the disease model, creating new constructions of motherhood, and changing mothering patterns. Furthermore, self-forgiveness is accompanied by diminishment of guilt and enables construction of a new shame-free identity. The findings may inform self-forgiveness interventions in the addiction field.

Child abuse, drug addiction and mental health problems of incarcerated women in Israel

The mental health problems and pathways to drug addiction and crime among female inmates have long been of interest to researchers and practitioners. The purpose of the current study was to examine the possible association between multiple types of childhood abuse, mental health problems, and drug addiction and the incarceration of 50 Israeli women in prison. The findings indicated that female inmates come from risky families with a high prevalence of family mental health problems, parental drug addiction and crime, and sibling drug addiction and crime. Furthermore, they revealed that incarcerated women from risky families were victims of multiple types of childhood abuse and neglect by their parents, as well as their siblings. Overall, the results suggest that the adverse consequences of a familys mental health problems are much more dramatic than we assumed to date, and that women are more likely than men to be the victims of multiple types of childhood abuse and neglect, as well as suffering more severe psychiatric problems, depression, and drug addiction. The implications of these findings are discussed.

Recovering Drug-Dependent Mothers’ Perspective on Gender-Sensitive Therapy An Israeli Case

This study examined issues of gender-sensitive therapy, such as relational self, motherhood, and single-gender treatments from the perspective of recovering drug-dependent mothers. Using a social constructionism framework, 25 recovering drug-dependent mothers in different stages of recovery were interviewed and 5 of them were followed for another 2 years. The results challenge the argument presented by advocates of gender-sensitive therapy in the addiction field and underscore the importance of context, especially the therapeutic narrative that elicited an alternative construction of gender, motherhood, and gender-sensitive therapy. The findings suggest possible new directions for addressing therapeutic issues and the need for additional research.

“I Wanted to Rebel, But There They Hit Me Even Harder” Discourse Analysis of Israeli Women Offenders’ Accounts of Their Pathways to Substance Abuse and Crime

This study examined women offenders’ accounts of their pathways to substance abuse and crime and the intersection between them, to reach a holistic understanding that captures the dynamics of victimization, agency, and gender. Discourse analyses of the accounts of 11 Israeli women offenders indicated differential use of two discourses. Five participants used the victimization discourse, which viewed substance abuse as an attempt to medicate the self that was injured following victimization experiences; two used the agency discourse, which viewed substance abuse as a way to experience pleasure, leisure, and control over their destiny. Four of the participants used these two contradictory discourses simultaneously. The findings indicate the absence of a cultural discourse that encompasses women’s complex experience of gender, victimization, and agency. Possible implications for intervention are discussed.

Men and Women Inmates’ Accounts of Their Pathways to Crime: A Gender Analysis

ABSTRACT Most of the research on gender differences in crime has been based on quantitative methods and focused on either women or men, but not both. In this qualitative study, we explored the association between gender and perceived pathways to crime. We employed a thematic analysis of 20 interviews with inmates, focusing on how they negotiated notions about femininity and masculinity while constructing their own pathways to crime. Men and women presented different pathways, but both oscillated between pathways guided by victimization and by power seeking. The findings suggest possible new directions regarding the use of gender binaries in criminology research and indicate the heavy toll of gender essentialism on both genders.

A qualitative study of barriers and facilitators in treating drug use among Israeli mothers: An intersectional perspective

RATIONALE Despite the benefits and availability of drug treatment in Western countries, research has shown low utilisation rates, especially by mothers. Studies have indicated internal barriers (e.g., shame) and external/structural barriers (e.g., poverty) to womens utilisation of drug treatment, but little is known about the interrelated axes of marginalization that create such barriers and, even less, facilitators of treatment. A promising avenue for examining this path may be the theoretical perspective of intersectionality, which has often been used to illustrate how womens experiences are shaped by gender in conjunction with other factors, including class, age, and race. OBJECTIVE The purpose of the study was to obtain a deeper understanding of the barriers and facilitators of drug-abuse treatment among substance-abusing mothers, including practical implications. METHODS In-depth interviews were conducted with 25 Israeli-born and immigrant mothers known to child protection and welfare agencies. A critical feminist theoretical perspective informed by intersectionality was adopted to examine the barriers to and facilitators of their enrolment in drug treatment. RESULTS Thematic analysis revealed three themes in the interrelationships of different factors and treatment utilisation. First, the threat of losing child custody was interrelated with lack of social and family support, immigration status, being post-partum, and economic hardship to shape barriers to treatment. Second, a set of coping resources originating in their marginality was interrelated with opportunity for treatment. Last, the participants suggested changes that would encourage treatment utilisation, with focus on non-judgmental referral procedures. CONCLUSIONS The findings indicated that barriers and facilitators are interrelated and co-constructed, reflecting the interlocking of power and oppression across the axes of class, gender, and ethnicity. Focusing on social inequality and gender in policies and research on womens drug treatment, the findings may inform the development of strategies to overcome treatment barriers.

Childhood Abuse and Mental Health Problems: Does Gender Matter?

Abstract Gender differences in the relationship between mental health problems and childhood abuse have long been of interest to researchers. The purpose of the present study was to examine gender differences in the relationship between childhood abuse and mental health problems among 110 Israeli inmates (50 women and 60 men). The findings indicated that female inmates reported higher prevalence of physical, emotional, and sexual abuse and were more likely to suffer from mental health problems, compared with the male inmates. Additionally, the findings revealed that more female than male inmates had parents with mental health problems. Female inmates who reported mental health problems in their families also reported higher rates of child abuse relative to male inmates with a similar family history.

Lifetime history of suicidal ideation and attempts among incarcerated women in israel.

Background: Evidence indicates that rates of death by suicide are higher among female inmates compared with male inmates and the general population. Despite the high rate of lifetime suicidality, little is known about the predictors of suicidality for these women. Objective: The purpose was to examine sociodemographic, criminological, and psychological variables associated with a history of suicidal ideation and suicide attempts among incarcerated women. Method: This cross-sectional study investigated a history of suicidal ideation and suicide attempts in a sample of 46 Israeli incarcerated women. Participants completed a confidential interview that included the Addiction Severity Index, the Renard Diagnostic Interview, self-report measures of the Childhood Trauma Questionnaire, and the presence of symptoms of depression. Results: More than half of the women reported a history of suicidal ideation or attempts. Those who reported such a history were characterized by a high prevalence of childhood victimization, early onset of substance abuse, high prevalence of mental health problems, and high prevalence of mental health problems in the family. Child abuse, depression, and family mental health problems are related to suicidal ideation and attempts in incarcerated women. Conclusions: As the number of women with mental health concerns entering prison grows, corrections staff are faced with increasing challenges to provide services that mitigate the risk of death by suicide. Inquiring about childhood abuse and symptoms of depression and mental health problems, as well as providing treatment for the emotional impact of trauma exposure, may reduce the risk of suicidality in this population.