Author ORCID Identifier

https://orcid.org/0000-0003-3201-1524

Semester

Summer

Date of Graduation

2024

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Social and Behavioral Sciences

Committee Chair

Alfgeir Kristjansson

Committee Co-Chair

Danielle Davidov

Committee Member

Danielle Davidov

Committee Member

Caroline Groth

Committee Member

Meghan Gannon

Abstract

For decades the United States has faced substance use epidemics that have devastating public health consequences, with the most recent epidemic being the opioid epidemic. While the substance that is the center of the epidemic’s changes over time, one factor that has been found to be positively related to substance use has remained consistent, that preventable risk factor is adverse childhood experiences (ACEs). Those who experience ACEs are at elevated risk for developing SUD. If the trauma that is a result of experiencing ACE is not treated it can complicate recovery and impact the individuals’ families. The children of individuals with SUD are at risk for experiencing ACE themselves as well as the other consequences that are associated with parental SUD. The presence of both phenomena in families can lead to a multigenerational cycle of ACEs, SUD, and poor health outcomes. With the increasing incidence of maternal SUD, it is vital to examine this cycle among mothers who are receiving substance use treatment and their children. This dissertation study will demonstrate the need for intergenerational trauma-specific substance use treatment by examining the prevalence of ACEs in this population as well as the consequences of ACEs on their children, while exploring how mothers perceive their SUD impacts their parenting and children. To accomplish the goal of this dissertation the following aims were fulfilled: 1) assessing ACEs scores in mothers in SUD treatment and their children in WV, 2) assessing emotional and behavioral problems in children of mothers in SUD treatment in WV and 3) exploring experiences of intergenerational ACEs, motherhood, and parenting in mothers in SUD treatment. A convergent mixed methods study design was employed, with a one-time survey being used to achieve Aims 1 & 2 and semi-structured interviews being used for Aim 3. The findings for Aim 1 shown that the mothers in SUD treatment and their children not only had a high ACE burden, but that they also experienced more ACE than the general population. Aim 2 suggested that children of mothers in SUD treatment may be at elevated risk for experiencing certain emotional and behavioral problems and that ACEs and the quality of the parent child relationship are positively associated with these outcomes. The analysis from Aim 3 revealed the following themes: 1) Battle between recovery and motherhood, 2) Absent parenting: a symptom of SUD, 3) Parenting within government and legal systems, which contained child protection services and separation as a subtheme, and 4) Impacts on children, which contained the subtheme of Age-dependent consequences. Mothers often reported that their SUD did negatively impact their children and that having SUD could act as a barrier and introduce challenges to parenting. Collectively, the findings from the three aims suggest that mothers receiving substance use treatment and their children have a high ACE prevalence that are associated with the children developing emotional and behavioral problems. Additionally, the findings also emphasize how the social environmental can negatively influence these mother-child dyads. The urgent need for trauma-informed treatment centers that included trauma-specific dyadic interventions which address ACEs is evident based on the results of this dissertation study. By addressing ACEs, it is possible that such interventions will not only improve treatment outcomes for mothers but prevent their children from experiencing negative health consequences. Currently, very few treatment programs offer such interventions. Future research should not only examine other types of ACE and trauma-related symptoms in mothers receiving SUD treatment and their children but explore how to best integrate trauma-specific care for the mother-child dyad into substance use treatment.

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