Polly Radcliffe

Motherhood, pregnancy, and the negotiation of identity: The moral career of drug treatment

In this paper I seek to engage with literature on recovery by focusing on gendered identity and motherhood in accounts of pregnant and postpartum women. Interview accounts are analysed as the site of moral work where women use discursive strategies to present themselves as plausible mothers and locate themselves in relation to a moral career of drug treatment and motherhood. I make the case that this performative work entails the representation of lived practices as well as the presentation of self. I argue that opportunities need to be provided for pregnant and postpartum drug users to engage with services and that their performative work needs to be acknowledged by professionals in order that non-stigmatizing identities can be endorsed.

Early Exit: Estimating and explaining early exit from drug treatment

BackgroundEarly exit (drop-out) from drug treatment can mean that drug users do not derive the full benefits that treatment potentially offers. Additionally, it may mean that scarce treatment resources are used inefficiently. Understanding the factors that lead to early exit from treatment should enable services to operate more effectively and better reduce drug related harm. To date, few studies have focused on drop-out during the initial, engagement phase of treatment. This paper describes a mixed method study of early exit from English drug treatment services.MethodsQuantitative data (n = 2,624) was derived from three English drug action team areas; two metropolitan and one provincial. Hierarchical linear modelling (HLM) was used to investigate predictors of early-exit while controlling for differences between agencies. Qualitative interviews were conducted with 53 ex-clients and 16 members of staff from 10 agencies in these areas to explore their perspectives on early exit, its determinants and, how services could be improved.ResultsAlmost a quarter of the quantitative sample (24.5%) dropped out between assessment and 30 days in treatment. Predictors of early exit were: being younger; being homeless; and not being a current injector. Age and injection status were both consistently associated with exit between assessment and treatment entry. Those who were not in substitution treatment were significantly more likely to leave treatment at this stage. There were substantial variations between agencies, which point to the importance of system factors. Qualitative analysis identified several potential ways to improve services. Perceived problems included: opening hours; the service setting; under-utilisation of motivational enhancement techniques; lack of clarity about expectations; lengthy, repetitive assessment procedures; constrained treatment choices; low initial dosing of opioid substitution treatment; and the routine requirement of supervised consumption of methadone.ConclusionEarly exit diminishes the contribution that treatment may make to the reduction of drug related harm. This paper identifies characteristics of people most likely to drop out of treatment prematurely in English drug treatment services and highlights a range of possibilities for improving services.

Drug use and motherhood: strategies for managing identity

Interviews with pregnant substance misusing women and women who had given birth in the previous two years suggest that they are engaged in a process of managing spoiled identities in order to present themselves as committed and motivated mothers. The work they engage in involves presenting themselves as regulated consumers by keeping to substitute prescribing regimes, keeping appointments with a multitude of agencies and aligning themselves with a normalised discourse of motherhood. Interview accounts emphasise the importance of caring networks in personal lives and in the service with which they are engaging.

Repositioning the cultural: intoxicating stories in social context.

In their analysis of drinking stories amongst Danish youth n the Bulgarian resort of Sunny Beach, Tutenges and Sandberg 2013), argue that the transgressions young people describe and he stories themselves are reflexively related to a stock of future tory-telling capital. The authors suggest that there may be a contitutive relationship between such story telling and social action o that drunken transgressions and the stories that describe them re a key aspect of the holiday experience and the representaion by these young people of what it means to have fun and to e young. The authors suggest that the stories they elicited from roups of young people rehearse the narrativising that takes place he morning-after-the-night-before and in the months after the oliday. In turn, young people in Sunny Beach engage in outrageous, ransgressive activities when drunk, which they hope will have narative potential: ‘substance use generates stories, but stories also otivate substance use’ (359).While we welcome the contribution hat this article makes to our understanding of the meanings and ocial organisation of drinking stories amongst young people, there re aspects of Tutenges’ and Sandberg’s analysis which we think ay be underexplored. Although the authors discuss the way in hich acts of public sex, stripping and the commercial sex indusry feature in the transgressions recounted and celebrated by young eople in their story telling, the analysis is starkly silent regarding he relations of gender, sexuality and the taken for granted hetronormativity that characterise many of the stories analysed. It ay be that this silence derives from the critique of previous cademic and journalistic accounts that have problematised and isrepresented young women’s drinking in the face of evidence f a slight decline in alcohol consumption, the continued differenial in the drinking levels of men and women (and higher levels f drinking amongst men of all ages), and the fact that it is the rinking of older, professional women at home that has risen most teadily since the mid 1990s (Measham & Ostergaard, 2009). Whilst e are certainly not seeking to refocus social anxiety on ‘ladette’ ulture (Jackson & Tinkler, 2007; Measham, 2008), for which secions of the UK press have not lost their appetite (Sun, 2013), e would like to question instead aspects of the drinking stories nalysed. These stories feature ‘whores’ and lap-dancers, ‘muscle en’ and ‘sissies’, public groping of women by men and acts by

Maternal substance use and child protection: a rapid evidence assessment of factors associated with loss of child care

This article reviews the literature on the factors associated with mothers who use substances losing care of their children. A rapid evidence assessment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Medline and PsycINFO databases were searched to identify primary research studies published in English during January 2000-September 2016. Studies were included if they presented individual, formal support (e.g., receiving substance use treatment) or informal support (e.g., receiving social and family support) factors associated with mothers who use substances retaining or losing care of their child/ren (losing care refers to child protection services placing child/ren under the custody of a family relative, foster care, child care institution, or adoption). Evaluation studies or trials of interventions were excluded as were studies that focused on reunification or re-entering care as the outcome. Thirteen studies were included. Factors associated with mothers who use substances losing care of their children included: maternal characteristics (low socioeconomic status, younger age of first child, criminal justice involvement); psychological factors (mental health co-morbidity, adverse childhood experiences); patterns of substance use (use of cocaine prenatally, injection drug use); formal and informal support (not receiving treatment for substance use, fewer prenatal care visits, lack of social support). There is not enough evidence to determine the influence of substance use treatment in preventing mothers losing care of their children. Factors identified in this review provide the evidence to inform a prevention agenda and afford services the opportunity to design interventions that meet the needs of those mothers who are more likely to lose care of their children.

The need for evidence-based responses to address intimate partner violence perpetration among male substance misusers

Intimate partner violence is common in all cultures and countries (WHO, 2013), and is more prevalent among people who report problem alcohol and drug use in both general population and treatment samples. Research suggests that around half of all men in substance misuse treatment have been violent to their intimate partners (O’Farrell et al., 2004; El-Bassel et al., 2007) and similar proportions of men in perpetrator programmes have problems with alcohol and/or drugs (Bennett, 2008). Police reports suggest that much of this violence occurs when the offender is intoxicated (Gilchrist et al., 2014; Friend et al., 2011), with alcohol use resulting in more severe physical violence being perpetrated (Graham et al., 2011). Heavy episodic drinking and drug use are strongly correlated with intimate partner violence (Ten Have et al., 2014; Foran and O’Leary, 2008; Moore et al., 2008). Yet while alcohol and drug use are commonly accepted risk factors for intimate partner violence (Capaldi et al., 2012; Stith et al., 2004), the nature of their contribution remains an area of great debate. Some argue that the pharmacological properties of a substance lead to impaired cognitive processing that results in such violence (Leonard and Jacob, 1998), others argue that substance use causes marital conflict that can lead to it (Murphy et al., 2001) or that the two are linked through shared risk factors (Kuhns, 2005). In addition, there is a

The politics of providing opioid pharmacotherapy.

People using opioid pharmacotherapy (OPT, methadone and uprenorphine medications used for maintenance purposes) have ecently provided accounts of the stigma that is often part of the reatment experience (Anstice, Strike, & Brands, 2009; Harris & cElrath, 2012; Strike, Millson, Hopkins, & Smith, 2013), as well s the restrictive and punitive practices (Chandler et al., 2013; rawford, 2013), and structural violence (Treloar & Valentine, 013), inherent within the treatment systems they encounter. The iews of treatment providers about their social and political locaion and agency within OPT systems have not, we believe, been dequately examined from a critical perspective. While Neale, n her editorial for this special issue (2013), refers to research n providers’ perspectives, such studies have tended to focus n specific clinical aspects of OPT rather than locating providers ore explicitly within the contexts of what many understand o be an inherently controversial and contested area of health are. Physicians have spoken out for some time about the recuring political anxiety linked to OPT, and the polarised and often deologically-driven discussions that commonly fail to engage eaningfully with either the new or old science on the effectiveess of this treatment, or with the practitioner ‘art’ of OPT in its any guises (see Ford, 2010, 2012; McNamara, 2012; Robertson Burrowes, 2010; Robertson, 2012; Wodak, 2002). However, the mpact has received little attention. We have therefore considered the papers in this special issue or the ways that they pay attention to the different political, social nd cultural contexts of OPT in the countries they are describing. e aim to discern the impact such heterogeneous contexts (China nd Nepal are featured as well as European, North American and ustralian examples) have on the development and ‘mainstreamng’ of OPT, access to treatment and treatment systems, regimes nd practices. We hope that this editorial goes some way towards ddressing the absence of explicit provider perspectives in this ompilation.

Are magistrates doing justice to women

The profile of the women who tend to get caught up in the criminal justice system has changed little over the past 30 years. Compared to the general population, they are socially and economically disadvantaged, poorly educated and have high incidence of mental health and substance misuse problems. Experience of physical violence and sexual abuse is depressingly prevalent in their biographies (see for example, Gelsthorpe et al., 2007). In addition, the steep rise, compared to men, in the imprisonment of women throughout the 1990s, most commonly for short sentences of six months or less, exacerbated their marginalisation and failed to reduce reoffending.

Help-Seeking Behaviors for Intimate Partner Violence Perpetration by Men Receiving Substance Use Treatment: A Mixed-Methods Secondary Analysis:

Despite the high prevalence of intimate partner violence (IPV) perpetration by men receiving substance use treatment, little is known about their help-seeking behaviors for IPV. A secondary analysis of a mixed-methods study of men receiving substance use treatment who perpetrated IPV examined the prevalence, characteristics, and barriers associated with IPV perpetration disclosure and help-seeking. In total, 170 men were interviewed using a structured questionnaire, and a subsample of 20 were interviewed in-depth about their experiences. Logistic regression determined variables associated with disclosure and help-seeking. Thematic analysis of the in-depth interviews explored barriers to disclosure and help-seeking. Only half the participants had told anyone about their IPV perpetration and about one quarter reported having sought any sort of support. Whereas participants were more likely to disclose their IPV perpetration to informal resources (such as friends or family), they tended to seek help from formal resources (such as health professionals or the police). A greater proportion of physical IPV perpetrators, who had disclosed, had been arrested or had police involvement for IPV, suggesting that their disclosure may not have been voluntary. The following themes emerged from the qualitative data about the barriers to disclosure and help-seeking for IPV perpetration: fear that their children would be taken into care by social services, shame and embarrassment, and a minimization or normalization of their behavior. In addition, many participants highlighted that they had never been previously asked about IPV during treatment for substance use and stressed the need for greater expertise in or knowledge of this topic from specialist services. Substance use treatment services should enquire about mens relationships and IPV perpetration to facilitate disclosure and provide support. Further research is necessary to determine the context of disclosure and help-seeking for IPV perpetration to increase the likelihood of identification.

Opiate Pharmacotherapy: Treatment, Regimes, Constructions and Control

The terms ‘pharmacotherapy’, ‘substitution therapy’, ‘substiution treatment’, ‘agonist treatment’, ‘agonist pharmacotherapy’, nd ‘agonist replacement therapy’ all refer to “the adminisration under medical supervision of a prescribed psychoactive ubstance, pharmacologically related to the one producing dependnce, to people with substance dependence, for achieving defined reatment aims” (WHO/UNODC/UNAIDS, 2004). Various pharacological agents are used in substitution programmes for llicit opioids (including methadone, buprenorphine and injectable iamorphine) and studies (including randomised trials and obserational research) consistently show that opioid pharmacotherapy OPT) is effective in the treatment of opioid dependence (Bell, 2012; ICE, 2007; WHO/UNODC/UNAIDS, 2004). Despite this, the polcy and practice world of OPT often resembles a fairground hall f mirrors. This is because wherever one stands and in whichever irection one looks, unexpected, distorted and frequently trouling images of therapy stare back. OPT is a widely practised, ell-evidenced treatment; yet it is also persistently controverial, politically divisive, and much maligned – even by those ho use it.