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Substance Abuse in African American Women

Harriet Curtis-Boles and Valata Jenkins-Monroe Journal of Black Psychology 2000 26: 450 DOI: 10.1177/0095798400026004007 The online version of this article can be found at: http://jbp.sagepub.com/content/26/4/450

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JOURNAL OF BLACK PSYCHOLOGY / NOVEMBER 2000 Curtis-Boles, Jenkins-Monroe / SUBSTANCE ABUSE

Substance Abuse in African American Women

Harriet Curtis-Boles Valata Jenkins-Monroe California School of Professional Psychology
Limited attention to ethnicity in research on substance abuse and women has resulted in assumptions that may not fit the experience of women of color. This study employed a combined quantitative and qualitative design to investigate substance abuse in African American women ages 21 to 48. Life experiences of women with histories of chemical dependence were compared with women who were maintaining a nonabusing lifestyle. Variables examined were history of parental substance abuse and child abuse, exposure to racism and traumatic events, and social support and spirituality. The substance abusing and nonabusing women were distinguished from each other in the areas of spirituality and family connectedness. Although all participants reported high violence exposure and personal losses, significantly more substance abusing women reported being battered, experiencing homelessness, and more traumatic events. Participants described multiple experiences with racism, though their descriptions of their responses to these experiences suggested different styles of coping. Findings have significant implications for prevention of substance abuse, particularly in the areas of religious involvement, family support, and the development of active problem-solving strategies.

Recent statistics have suggested that women are abusing drugs and alcohol with increasing frequency (Comfort, Shipley, White, Griffith, & Shandler, 1990; Lex, 1990; Marsh & Miller, 1985). Statistics have also demonstrated that African Americans (men and women) are more likely to be involved with more dangerous drugs and have the highest rate of drug-related emergencies (Kopstein & Roth, 1990; Murphy & Rosenbaum, 1992). In studies of drinking practices, the mortality rate for alcohol-related deaths for African American women has been reported to be between two to four times
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as high as the rate for White women (Gary & Gary, 1985; Lex, 1987; Rouse, Carter, & Rodriguez, 1995). African American scholars have raised an alarm about the crisis that substance abuse has created in the African American community. Concerns have been expressed regarding the devastating effects of drug addiction on the relationship between mother and child (Staples, 1990), on the transmission of African centered values and traditions (Poitier, Vanesta, & Makinrowe, 1997), and the escalating toll of AIDS on African American individuals and families. The African American woman has traditionally been the pillar of the family, providing primary nurturance, caretaking, and socialization of family members. The African American womans increasing involvement in the drug culture is tearing at the fabric of the extended family and compromising the development of African American children already faced with the overwhelming challenges of poverty and oppression (Staples, 1990). It is vital to understand substance abuse in African American women to begin to address and alleviate the consequences of this abuse on the individual, family, and community. This knowledge can be applied in developing culturally relevant prevention strategies and in assisting African American women in recovery to maintain clean and sober lifestyles. Until recent years, the field of substance abuse had been dominated by studies of White male populations with little attention to gender and ethnic variations in etiology or characteristics of use. Over the past two decades, though there has been considerable growth in studies devoted to examining chemical dependency in women (e.g., Cosden & Peerson, 1996; Gomberg, 1989; Lex, 1990; Marsh & Miller, 1985), few have focused on ethnic minority women despite their disproportionate representation in the substance abusing population (Roth, 1991). The literature to be reviewed will highlight those studies that reflect the African American experience in the areas of substance abuse and childhood trauma, life stress, racism, social support, and spirituality. Many of these variables were chosen because of their association with women and substance abuse in previous literature, whereas others (i.e., racism and spirituality) were identified because of their significance in the lives of African Americans.
CHILDHOOD TRAUMA: PARENTAL SUBSTANCE ABUSE AND CHILDHOOD ABUSE

Consistent with the general literature on chemical dependency, studies of African Americans and substance abuse have demonstrated histories marked by parental substance abuse and childhood physical and sexual abuse (Boyd, 1993; Boyd, Blow, & Orgain, 1993; Comfort et al., 1990; Wallace, 1990a,

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1990b). These studies have reported parental substance abuse ranging from 51% to 86%. Reports of childhood abuse, physical and/or sexual, have ranged from 20% to 83%. Studies that have included gender comparisons (Boyd et al., 1993; Wallace, 1990a) reported higher rates of childhood sexual abuse for African American women than men. Differences in reported childhood sexual abuse were particularly high in a study by Boyd et al. (1993) in which 71% of the women and 8% of the men reported such abuse.
TRAUMATIC LIFE EVENTS, STRESS, AND RACISM

Some researchers (Gomberg & Lisansky, 1984; Kandell, 1996) have noted that women use substances to counteract negative affect, and that women are more likely than men to begin using drugs after a traumatic life experience (Nelson-Zlupko, Kauffman, & Dore, 1995; Quinby & Graham, 1993). A study by Taylor and Jackson (1990) examined factors affecting alcohol consumption in an urban sample of 289 African American women. This study found that stressful life events, physical health, and internalized racialism (defined as the extent to which Blacks identify with White stereotypes of Blacks) captured the greatest variance in alcohol consumption for this group of African American women. Stress was also found to be a factor contributing to drug use/abuse and relapse in African American women in studies by Allen (1995) and Boyd, Hill, Holmes, and Purnell (1998). Brunswick, Lewis, and Messeri (1992) identified discrimination experiences and racism as primary factors contributing to psychological distress in African Americans. It has been suggested that African American women who are often multiply victimized by race, gender, and class oppression turn to drugs to escape economic and social marginality and individual feelings of powerlessness and alienation (Rhodes, 1997; Staples, 1990). Findings from a structured support group of African American women in recovery suggested that racism contributed to alcohol and drug consumption, and that lack of recognition and attention to the oppression of African American women in treatment programs limited the effectiveness of recovery efforts (Saulnier, 1996).
SOCIAL SUPPORT AND SPIRITUALITY

Much has been written about the protective effects of social support in buffering individuals against the negative physical and emotional consequences of stress, particularly for women (Billings & Moos, 1981; Carver, Scheier, & Weintraub, 1989; Kaplan, Cassel, & Gore, 1977; Wills, 1990).

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Spirituality, manifest in church involvement, a close relationship with God, and the use of prayer, has also been identified as a key coping mechanism for African Americans (Gibbs, 1997; Pinkett, 1993). Surprisingly, few studies have examined the role of these factors in the substance use/abuse experiences of African Americans. Studies by Bendersky, Alessandri, Gilbert, and Lewis (1996) and Tucker (1982) demonstrated a positive correlation between lifestyles characterized by isolation and the absence of social support and drug abuse for African American women. Knox (1985) and Gary & Gary (1985) examined spirituality and substance use/abuse and treatment success for African Americans. These authors reported that African American women who were active in church had more disapproving attitudes toward alcohol and drug use and that spirituality is an important factor in maintaining sobriety for African American alcoholics. The present study examined the substance use of African American women in a cultural and social context. Life experiences of African American women with a history of substance abuse were compared with African American women who had never abused substances. This investigation was guided by four major hypotheses. African American women with a history of substance abuse, as compared with women without this history, will (a) more frequently report histories of parental substance use and childhood abuse, (b) report less involvement in spiritual practice (while growing up and at present), (c) demonstrate less consistency in the availability of social support over their lifetime and fewer current supports, and (d) report a greater number of life stress events, including incidents of racism.

METHOD The study employed a mixed design using quantitative and qualitative data. Data were gathered using a structured interview format.
PARTICIPANTS

The sample consisted of 30 African American women with substance abuse histories and 30 nonabusing African American women. One substance abuse woman described herself as mixed race (Black and Latina) and one nonabusing woman described a Caribbean Islander heritage. Table 1 shows demographic information separately for the substance abusing and nonabusing groups.

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TABLE 1

Demographic Characteristics
Substance Abuser Characteristic Age 21 to 25 26 to 32 33 to 39 40 and older Education Less than 12 years High school Some college Household income (in dollars) 0 to 6,000 6,001 to 12,000 12,001 to 18,000 18,001 to 24,000 24,000 to 28,000 Employment Part-time Full-time Unemployed Marital status Single Married/living with partner Divorced n % n Nonabuser %

3 9 12 6 15 8 7 15 12 2 1

10.0 30.0 40.0 20.0 50.0 26.7 23.3 50.0 40.0 6.7 3.3

10 8 9 3 3 10 17 6 7 7 6 4 8 7 15 18 7 5

33.3 26.7 30.0 10.0 10.0 33.3 56.7 20.0 23.3 23.3 20.0 13.4 26.7 23.3 50.0 60.0 23.3 16.7

1 1 28 20 8 2

3.3 3.3 93.4 66.6 26.7 6.7

There were no significant differences between the abuser and nonabuser groups in age, income, employment, education, or relationship status. Participants were between the ages of 21 and 48 years with a mean age of 32.3 years. All participants were mothers of dependent children and of low-income status. The majority of participants were unemployed (72%), though unemployment was markedly more characteristic of the substance abusing than nonabusing group (93% vs. 50%, respectively). Approximately 82% of the participants reported household incomes of $18,000 or less. The mean years of education reported by the sample was 12.3. It is important to note that although not statistically significant, more than twice the number of nonabusing women reported some college than the substanceabusing women. For the purpose of this study, substance abuser was operationally defined as a woman in a drug abuse treatment program due to addiction to alcohol

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and/or one or more illicit drugs. The definition of addiction here includes tolerance, withdrawal, and social and occupational impairment. The substance abusing women in this sample reported a history of use averaging 21 years and were new to recovery with an average of 6 months in treatment. A nonabusing lifestyle included abstinence from all substances or infrequent social substance use without impairment in personal or occupational functioning. These definitions are consistent with the DSM-IV designation of substance dependence and substance abuse (American Psychiatric Association, 1994). Nonabusing women in this study could have no history of substance abuse, which meant that they had never been in treatment for substance use and did not consider themselves to be in recovery. In evaluating lifetime substance use for both groups, alcohol was the first substance used by the majority of both abusing and nonabusing women (36.7% and 43.4%, respectively). Approximately 33% of the nonabusing women reported never having used substances (see Table 2). The substance abusing and nonabusing group differed significantly in reported age of onset of substance use and number of substances used over their lifetime. Mean age of onset of substance use was 13.4 years for substance abusing women and 16.1 years for nonabusing women. Mean number of types of substances used over the lifetime was 4.3 for substance abusing women as compared with 1.2 for the nonabusing women. The majority of the substance abusing women identified crack cocaine (66.7%) as their drug of choice, followed by alcohol (16.7%), marijuana (10%), and heroin (6.7%). Though 45.5% of the nonabusing women reported drinking alcohol infrequently (few times a year) or socially (1 or 2 times weekly), the majority identified themselves as abstainers (54%), using no alcohol or illicit drugs.
PROCEDURES

Substance abusing women were recruited from a womans outpatient substance abuse treatment program in the San Francisco Bay Area. The study was described to these women in their treatment groups. It was emphasized that participation was completely voluntary, that participation would not affect the womens treatment status, and that they could refuse to participate or withdraw at any time without penalty. Women were also assured that their responses to interview questions would be confidential and would not be shared with program staff. Of the women who received information about the study in this setting, 85% agreed to participate. Interviews were scheduled at times convenient for the women and conducted in a private room at the treatment site.

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TABLE 2

Substance Use History

Substance Abusers n Number of types of drugs used during lifetime 0 1 to 2 3 to 4 5 and above Age of drug use onset (in years) 8 to 10 11 to 14 15 to 18 19 to 22 Never used First substance used Alcohol Marijuana Alcohol/marijuana Marijuana/crack Never used % n Nonabusers %

0 3 17 10 5 16 7 2 0 11 10 8 1 0

0 10.0 56.6 34.4 16.7 53.3 23.3 6.7 0 36.7 33.3 26.7 3.3 0

10 15 5 0 1 4 11 4 10 13 7 0 0 10

33.3 50.0 16.7 0 3.3 13.4 36.6 13.4 33.3 43.4 23.3 0 0 33.3

Nonabusing women were recruited from three primary sources: health clinics, a support group for African American mothers, and a county department of human services within the San Francisco Bay Area. Recruitment was conducted primarily through flyers that were posted at the agency settings or distributed to the women by agency staff. Interested women contacted the researchers to get more information about the study and to schedule interviews. These women were given the option of being interviewed at their homes or at a community meeting room. All interviewees opted to be interviewed in their homes. Nonabusing women were screened for substance abuse problems using two subscales of the Addiction Severity Index (McLellan & Luborsky, 1985): the chemical abuse subscale and the legal subscale. These women were also asked if they had ever been in treatment for substance abuse or if they were in recovery. Women who responded affirmatively to substance abuse treatment or recovery and/or reported legal problems related to substances were not included in the nonabusing group. The substance use and history section of the Life History Interview (LHI) served as an additional check on substance abuse status for the nonabusing women. Three women were excluded from the study through these methods. Two of

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the three were identified through the LHI. Interviews for both groups were audiotaped and averaged 2 hours in length. All women received a $20 gift certificate to a local grocery or department store for their participation.
MEASURES

LHI. Data were collected through a structured, life history interview created by the researchers. This interview consisted of 112 questions covering demographics, health, substance abuse history and use, spirituality, social support, experiences of trauma, and significant losses and experiences with racism and discrimination. Of the interview items, 94 (84%) involved a forced choice or short answer response. The remaining items were openended questions and amenable to qualitative analysis. Only demographic questions and those items of the LHI specifically related to research hypotheses were examined for this study. Excluding demographic questions, this totaled 29 items, 4 of which were open-ended. Parental substance abuse was examined, with two questions addressing whether participants felt their mother or father ever abused alcohol or other drugs. Spirituality was assessed through four items and addressed the history of religious involvement and current spiritual practice. Questions in this area include, Are you currently a member of a church or spiritual group? and How do you practice your religion? Social support was evaluated using 4 questions and addressed support over the lifetime and current sources and types of support available to participants. Examples of questions in this area are, What people do you go to for support or assistance when you need it? and Who all helped you with problems in your life? Experiences of trauma and significant losses were assessed through 13 questions that evaluated the history of trauma including childhood sexual and physical abuse, deaths of significant others, and how participants were impacted by these losses. Questions in this area include, How many people have you known that have died from traumatic causes? and In what ways has your life been changed or been impacted by losses of important people? This section of the LHI included a modified version of a trauma and violent events measure used in a study by Fullilove, Fullilove, Smith, and Winkler (1994). Experiences with racism and discrimination were evaluated with 6 questions addressing whether, and in what situations, participants had experienced racism or discrimination and how they were impacted by and managed these experiences. Examples of questions in this area are, Have you experienced being treated

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differently because of your race? and In what areas of your life have you experienced racism or discrimination? Four of the open-ended questions in the LHI had direct relevance to research hypotheses: Was there any time that you stopped your religious practice and what was happening in your life at this time? In what ways do you feel your life was impacted by your losses? As you think about your adulthood and over your lifetime, in what ways has racism impacted your life? How did you handle your experiences with discrimination? Qualitative results were drawn from these questions.

RESULTS Forced choice and short answer interview items were quantified. Chi-square analyses and t tests for independent samples were conducted on these items to identify significant differences between groups. All variables entered into chi-square analyses were dichotomous. Qualitative analyses of open-ended questions involved four steps: (a) questions were reviewed by the researchers for emerging themes, (b) coding categories were created from consensual themes identified by the researchers, (c) questions were coded using established categories, and (d) 50% of the coded responses were checked for interrater reliability. Interrater agreement for each of the openended questions ranged from 90% to 94%.
CHILDHOOD TRAUMA: PARENTAL SUBSTANCE ABUSE AND CHILDHOOD ABUSE

Chi-square analyses were conducted to determine differences in reported parental substance abuse and child abuse for the substance abusing and nonabusing women. Contrary to predictions, there were no significant differences in reported parental substance abuse between the groups. Of the women, 33% of the substance abusing and 30% of the nonabusing reported mothers who abused substances, and 52% of the substance abusing and 72% of the nonabusing reported fathers who abused substances. There were also no significant differences between the groups in reported childhood physical or sexual abuse. Finally, 13% of the substance abusing and 16% of the nonabusing women reported childhood physical abuse, whereas 36% of the substance abusing and 23% of the nonabusing women reported sexual abuse.

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SPIRITUALITY

Chi-square analyses were performed to determine if substance abusing and nonabusing women differed in age of first involvement in church, having stopped their religious practice at some time in their lives, and in current religious practices. A significantly higher number of nonabusing women (93%) versus substance abusing women (69%) reported involvement in church at an early age (i.e., before age 7), 2(1, 59) = 5.77, p < .05. Conversely, a significantly greater percentage of substance abusing women (89%) versus nonabusing women (57%) reported having stopped their religious practice at some time in their lives, 2(1, 55) = 6.98, p < .05. There were no differences between the groups in reported religious practices including church membership or frequency of prayer, reading the bible, or spiritual meditation. An analysis of qualitative responses provides some understanding of why women stopped their religious practice. Of substance abusing women, 62% indicated substance use as the reason for leaving church. These women also reported themes of disillusionment and loss of faith, as well as feelings of shame, guilt, and worthlessness during their absence from church. The experience of Mary, a 45-year-old polysubstance abuser who started using drugs at the age of 14, illustrates these themes. I stopped going to church because of drugs. I felt ashamed, like I didnt have a right to pray because I was doing wrong. I wondered if God was really there. Why didnt he take the pain away? In contrast, 53% of the nonabusing women reported adolescent rebellion or some form of life crisis as precipitants to leaving church. Many of these women reported that although absent from church, they continued to pray and believe in God. Natasha, a 35-year-old mother of seven, reported, I stopped going to church for a while when my mother was sick and I was having trouble with the kids, but Ive always prayed. When I feel like things are out of my hands, I pray and ask for guidance.
SOCIAL SUPPORT

Chi-square analyses were performed to determine differences between the groups in reported sources of support, type of support received, and consistency of support over the lifetime. Participants were asked to identify who they go to for support or assistance. Participant responses were coded into four categories: family, friends, professionals, and other. The two groups differed in reported support from family and professionals; 80% of the nonabusing and 57% of the substance abusing women identified family members as sources of support, 2(1, 56) = 6.12, p < .05, whereas 60% of substance abusing and 10% of nonabusing

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women identified professional/institutional supports, 2(1, 56) = 18.6, p < .0001. It is important to note that over 90% of the professional/institutional supports identified by the substance abusing women were recovery related (i.e., counselors, group leaders, Narcotics Anonymous or Alcoholics Anonymous sponsors). With regard to type of support received (i.e., financial, practical, or emotional), the groups differed significantly in financial support: 57% of nonabusing and 30% of substance abusing women reported financial assistance from supportive others, 2(1, 59) = 3.93, p < .05. Consistency of support over the lifetime was measured by asking participants to identify who helped them with problems in response to four developmental periods: early childhood (before 7 years), latency, adolescence, and adulthood. Participants who identified at least one supportive person at each of the four developmental periods were rated as having consistent support. A significantly greater percentage of nonabusing women (83% vs. 57%) reported having someone available to them in all four of these developmental periods, 2(1, 60) = 5.07, p < .05. Of the substance abusing women who indicated consistency of support, 18% identified an institutional support (e.g., counselor, foster parent) during their childhood or teenage years. A significantly higher percentage of substance abusing women (28%) than nonabusing women (7%) reported no one available during their teenage years when substance use is generally initiated, 2(1, 59) = 4.58, p < .05.
TRAUMA EXPOSURE AND SIGNIFICANT LOSSES

Participants were asked to identify from a list of nine specific traumatic events, those events they had experienced over their lifetime. The list included experiences of personal victimization (e.g., rape or sexual assault, battering, becoming homeless), witnessing of violence, and the loss of significant others. Chi-square analyses were performed to determine differences between substance abusing and nonabusing women in traumatic experiences. A t test for independent samples using mean number of traumatic events reported by the groups was conducted to determine differences in number of traumatic events experienced over the lifetime. In the areas of trauma exposure and loss, participants differed significantly in the experiences of battering, homelessness, and number of traumatic events. These differences were in the predicted direction: 93% of the substance abusing and 63% of the nonabusing women reported being battered, 2(1, 60) = 7.95, p < .005, whereas 57% of substance abusing women and 30% of nonabusing women had experienced homelessness, 2(1, 60) = 4.34, p < .05. A greater number of

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traumatic events were also experienced by substance abusing than nonabusing women (5.6 vs. 4.6), t(58) = 2.05, p < .05. Both groups identified loss of immediate family members (e.g., parents, grandparents, siblings, uncles, and aunts) by violent means. These losses were reported as related to substance abuse, crime, and domestic violence. More nonabusing women (42%) than substance abusing women (26%) reported witnessing these deaths directly. Analysis of qualitative data revealed that 52% of the nonabusing women described lifestyle decisions ranging from closely monitoring their children, to spiritual and religious connection, to having dreams of a better future in response to these losses. Tanya, a 23-year-old mother of two, stated,
Ive known probably more than a dozen people that have died from violence. When I was 11, I saw my uncle kill his girlfriend. I hid for 2 days and only my grandma could comfort me. But I still have a lot of dreams for my life and Im probably overprotective of my children. I dont want them to experience what I did.

Conversely, in discussing the impact of losing significant family members and violence exposure, 62% of the substance abusing women indicated minimal to no impact or negative responses like being hardened or turning to drugs in response to these losses, and 15% reported that these losses served as a catalyst to recovery. Teiasha, a 30-year-old woman with a 16-year history of alcohol and crack abuse, reported,
Ive seen a lot of death from acquaintances to close family. The first time I witnessed a man being murdered I was 9 or 10; from then on Ive been numb to death. I live in a housing complex where violence is an everyday thing. I hear about somebody being killed and its just another person gone. It doesnt impact me. Its just typical life in the projects.

Rachel, a 30-year-old woman with a 16-year history of crack abuse, described the death of her father as motivating her recovery.
My father got shot in the heart over drugs when I was 29 years old. He was a loving person until he used drugs. After he died I realized his life was my life and I needed help or I was going to die, too. Thats when I started recovery.
RACISM AND DISCRIMINATION

There were no significant differences between the groups in reports of racism or discrimination, with approximately 80% of both groups reporting direct experiences of racism. The most commonly reported incidents of racism

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occurred in the areas of employment, housing, and public facilities (i.e., restaurants and stores). Though this suggests an equal acknowledgment of racist experiences, an analysis of qualitative data revealed that 53% of the substance abusing women denied any impact from these experiences or reported withdrawal in response to racism. Additionally, 8 out of 30 of these women responded with anger and violence. Lisa, a 39-year-old polysubstance abuser who started using drugs at age 15, commented, Ive experienced racism all my life. When I was 10, I was beat up by a bunch of White kids walking home from school. I was confused and didnt understand why. Ive just learned to block it [racism] out. Judy, a 37-year-old woman with a 21-year history of crack abuse, stated, Ive gone to stores and because Im Black clerks wouldnt give me change in my hand; they didnt want to touch me. Racism made me a bully. Id get violent. Conversely, 67% of the responses of nonabusing women revealed themes of personal growth and mastery. In responding to the question of how racism impacted their lives, these women reported that these experiences made them more motivated to succeed, more assertive, and inclined to retaliate against injustice, and that they were striving to create a better environment and future for their children. Mary, a 29-year-old woman who spent her early childhood years in Mississippi, stated,
When I was little I was always told I was a Nigger even though I had light skin. People told me my momma was a whore because she slept with White men, but that wasnt true. It was my grandma that pulled things together for me. She told me I was intelligent and pretty, but concentrate on my intelligence. I wanted to know more about myself and to succeed, which made me push more to educate myself. Its taking me a while, but I want to be a lawyer.

Shona, a 38-year-old mother of four, reported,

Ive experienced racism at school, at work, and even in looking for housing. Its challenged me to be aggressive in stating what I want in spite of obstacles. Im more determined. I stand up for myself and my kids. When I have a problem, I work peoples nerves to get what I need.

DISCUSSION Limited attention to ethnicity and class in research on substance abuse in women has resulted in beliefs and assumptions that may not fit the experiences of women of color and of varying socioeconomic status. An examination of substance abuse in this sample of low-income African American

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women suggested that cultural traditions and the realities of inner city living are important to consider in forming an understanding of substance abuse in this population. Past research has suggested that parental substance abuse and high levels of trauma are important predictors of substance abuse in women (Boyd, 1993; Rhoads, 1983; Wallace, 1990b). In this study, although substance abusing women reported more incidents of battering and homelessness, all the women interviewed had been exposed to substantial trauma evidenced in high violence exposure and personal victimization. Parental substance abuse was also a common pattern. Most of the study participants grew up and live in communities that have been likened to war zones, where drugs are freely accessible. Their life stories reflect the consequences of these realities. The substance abusing and nonabusing women were distinguished from each other in areas central to African American life, including family connectedness and spirituality and in their responses to racism and discrimination. These areas of difference appeared to contribute to their level of involvement in drugs and alcohol.
SOCIAL SUPPORT

Supportive family relationships and extended kin have been central to African American survival since slavery years. In this study, significant differences were found between the substance abusing and nonabusing women in current supports and consistency of support over the lifetime, suggesting that nonabusing women were able to draw on traditional sources of support in ways that substance abusing women could not. Family membersincluding mothers, aunts, uncles, and siblingswere the typical supports identified by nonabusing women in adulthood and throughout their lifetime. Institutional supports (e.g., counselors, group leaders, or Narcotics Anonymous) were particularly prevalent as supports for substance abusing women in adulthood, but also surfaced during the childhood years in the form of foster parents or therapists. This suggests greater emotional turmoil and family instability throughout the lives of the substance abusing women. During the teenage years when youth are particularly vulnerable and subject to negative peer influence, a considerable number of substance abusing women reported that no one was available to support them. The nurturing relationships with family and fictive kin that nonabusing women described as important aspects of their lives may have buffered them during difficult times in their lives, allowing them to resist unhealthy drug usage.

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SPIRITUALITY

It has been well documented that religion and spirituality are important sources of strength and aid for African American people in times of distress (Boyd-Franklin, 1989; Gibson, 1982; Neighbors, Jackson, Bowman, & Gurin, 1983). In this study, though there were no reported differences in current religious practices, a significantly higher number of nonabusing than substance abusing women reported early involvement in church (i.e., before age 7) and significantly more substance abusing women reported having stopped their religious practice at some time in their lives. African Americans speak of being raised in the church, which reflects not only church involvement from early childhood but also an important aspect of socialization that includes values transmission; positive modeling by older peers, adults, and elders; and important lessons in managing life. African Americans raised in a church typically have strong religious roots and are well grounded in their faith. This early foundation was present for more of the nonabusing than substance abusing women in this sample. Study results also suggest that during periods of crisis in their lives when many of the nonabusing women reported absence from church, they were typically able to maintain their faith and relationship with God through prayer. It can be speculated that whereas the substance abusing women turned to drugs in times of stress, the nonabusing women drew on their spirituality. Contemporary African American leaders have lamented the abandonment of churches by African American youth, suggesting that this has contributed to the social problems of this generation. This study supports the importance of growing up in a church as a potential preventive factor of substance abuse in African American women.
RESPONSES TO RACISM

Though all study participants reported multiple experiences with racism, qualitative descriptions of their responses to these experiences suggested important differences in styles of coping. Nonabusing women described active problem-solving, determination, and persistence in fighting against the obstacles of racism. These constructive responses were supported by a sense of personal efficacy and self-confidence. On the other hand, substance abusing women reported a limited repertoire of defensive strategies chiefly characterized by denial or acting out through anger and violence. These

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women described feeling set back and bad about themselves as a function of their racist experiences. A sense of powerlessness or angry ventilation lacking in constructive consequences marked their experience. In addressing treatment issues for substance abusing African American women, Rhodes (1997) emphasized the importance of helping these women to understand the ways in which they are oppressed by racism and sexism and developing self-protective mechanisms that support personal advocacy and selfassertion.
STUDY LIMITATIONS

This study presents a preliminary investigation of substance abuse in African American women; it should not be assumed that results are generalizable to African American women as a whole. The limitations of the study require that the results be viewed with caution. The sample is small and represents experiences of low-income African American women only. Each of the women in the study faced the challenges of inner-city urban environments, including limited access to resources, exposure to gunshots and other violence, multiple deaths of loved ones, and drug-infested neighborhoods. These life conditions contributed to similarities among the substance abusing and nonabusing women that were unexpected, particularly with regard to personal trauma and parental substance abuse. It is anticipated that these types of similarities would not be found in African American women from other socioeconomic groups. The substance abusing women were in treatment for an average of 6 months. It is possible that substance abusers who are not in treatment and actively using may respond differently to research questions and measures. Future studies with larger sample sizes and greater diversity are needed to better understand substance abuse in this population. The use of open-ended questions allowed the researchers to capture aspects of these womens personal stories that would not have been possible with quantitative measures alone. Traditional measures, by limiting the choice and the depth of responses, restrict what we need to know and understand about the experiences of these women. Using women with a substantial history of recovery as an additional comparison group might be particularly useful in forming treatment recommendations. Much can be learned from these women about strategies and supports for staying clean and sober, which could not be determined by using nonabusing women for comparison.

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CONCLUSIONS Though the results of this study must be viewed with caution, findings suggest several risk factors that may be associated with substance abuse for low-income African American women. Early drug use onset, use of multiple illicit substances, lack of consistent support across the lifetime, and the absences of supportive family relationships and a spiritual foundation characterized the substance abusing women in this sample. Consistent with a drug dependent lifestyle, dysfunctional coping strategies of avoidance and denial were apparent methods of responding to difficult and stressful life circumstances. These findings have clear implications for prevention and treatment. Interventions with this populations should include assisting these women to find healthy ways to connect with their natural support systems of family and extended kin, to make an exploration of spiritual values and resources, and to receive instruction and support in active coping skills. It is likely that family relationships may require substantial repair before they can be accessed as supports, in addressing both the potential issues of childhood rejection and abandonment for the abuser and the damages to these relationships wrought by years of substance abuse. It seems important that this repair begin with the provision of a safe treatment environment in which these women can share their pain and trauma. They must be able to acknowledge and confront these difficult issues personally before family work can commence in a therapeutic setting. Treatment must be paced in a manner such that these women do not feel overwhelmed, to prevent risk of relapse. Involving the children in treatment of women who are mothers is crucial. As children, substance abusing mothers are typically exposed to early trauma and significant losses, contributing to limited parental role modeling. In recovery, these women need to be taught how to be parents in an effective and healthy manner, including establishing age-appropriate expectations for their children, developing appropriate adult/child role relationships, and setting appropriate limits for themselves and their children. The children must be helped to address their losses, violations of trust, and other consequences of their mothers abuse. Involving the children in treatment provides an opportunity for mothers to receive consistent feedback about their parenting styles. Treatment with all family members aids in fostering stronger family functioning and allows the therapist to address unhealthy patterns of codependency. These interventions have the potential of reducing the risk of intergenerational substance abuse. Many of the substance abusing women reported guilt and shame, which interfered with their ability to fully use church and religion. Addressing these

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issues goes beyond resuming religious practices. These women should be helped to talk about these feelings so that they can use their religion and church more effectively in recovery. Church can play an important role in prevention efforts with active youth ministries that provide healthy peer interactions, adult role modeling, and substance abuse education. It can also support recovery through active outreach and ministry to the substance abusing population. This ministry could include church-sponsored Alcoholics and Narcotics Anonymous meetings, discussion and support groups, public acknowledgement and community celebration of recovery achievements, and individual mentorship for guidance and encouragement.

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