Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: a meta-analysis
1 Integra, (25 Imperial Street.), Toronto, ON, (M5P 1B9), Canada
2 Department of Psychiatry and Behavioural Neurosciences, McMaster University, McMaster Children's Hospital - Chedoke site, (565 Sanatorium Road.), Hamilton ON, (L8N 3Z5), Canada
3 School of Nursing, McMaster University (1200 Main Street West), Hamilton ON, (L8N 3Z5), Canada
4 Department of Clinical Epidemiology and Biostatistics, McMaster University, St. Joseph's Healthcare, (50 Charleton Avenue East), Hamilton ON, (L8N 4A6), Canada
5 Centre for Addiction and Mental Health, University of Toronto, (33 Russell Street), Toronto, ON, (M5 S 2S1), Canada
6 Department of Psychiatry and Behavioral Neurosciences, McMaster University, McMaster Children's Hospital - Chedoke site (565 Sanatorium Road), Hamilton, ON, (L8N 3Z5), Canada
7 Department of Mathematics and Statistics, McMaster University (1200 Main Street West), Hamilton ON, (L8N 3Z5), Canada
Substance Abuse Treatment, Prevention, and Policy 2010, 5:21 doi:10.1186/1747-597X-5-21Published: 1 September 2010
The rate of women with substance abuse issues is increasing. Women present with a unique constellation of risk factors and presenting needs, which may include specific needs in their role as mothers. Numerous integrated programs (those with substance use treatment and pregnancy, parenting, or child services) have been developed to specifically meet the needs of pregnant and parenting women with substance abuse issues. This synthesis and meta-analysis reviews research in this important and growing area of treatment.
We searched PsycINFO, MedLine, PubMed, Web of Science, EMBASE, Proquest Dissertations, Sociological Abstracts, and CINAHL and compiled a database of 21 studies (2 randomized trials, 9 quasi-experimental studies, 10 cohort studies) of integrated programs published between 1990 and 2007 with outcome data on maternal substance use. Data were summarized and where possible, meta-analyses were performed, using standardized mean differences (d) effect size estimates.
In the two studies comparing integrated programs to no treatment, effect sizes for urine toxicology and percent using substances significantly favored integrated programs and ranged from 0.18 to 1.41. Studies examining changes in maternal substance use from beginning to end of treatment were statistically significant and medium sized. More specifically, in the five studies measuring severity of drug and alcohol use, the average effect sizes were 0.64 and 0.40, respectively. In the four cohort studies of days of use, the average effect size was 0.52. Of studies comparing integrated to non-integrated programs, four studies assessed urine toxicology and two assessed self-reported abstinence. Overall effect sizes for each measure were not statistically significant (d = -0.09 and 0.22, respectively).
Findings suggest that integrated programs are effective in reducing maternal substance use. However, integrated programs were not significantly more effective than non-integrated programs. Policy implications are discussed with specific attention to the need for funding of high quality randomized control trials and improved reporting practices.