Extrinsic barriers to substance abuse treatment among pregnant drug dependent women

The objective of this qualitative study was to examine extrinsic barriers to substance abuse treatment among pregnant and parenting women enrolled in residential perinatal substance abuse treatment programs in Northern California. Life history interviews were conducted with 36 women to examine help-seeking behaviors before treatment enrollment. Data analysis used the analytic framework of Mandelbaum (1973) to describe dimensions, turnings, and adaptations of participants. Results indicated that the majority (n = 34) of participants sought prenatal care but identified fear of punitive actions from helping institutions and individuals as a major barrier. Other extrinsic barriers included substance abuse treatment program barriers, partners, the status of opiate dependency, and the status of pregnancy. Biological, socio-cultural, and psychosocial dimensions of participants' care-seeking experiences were identified. The turning was pregnancy and adaptations included preserving the family, managing fear and manifesting faith. Findings describe the transformation of the therapeutic alliance and the gendered impact of two decades of the War on Drugs in the United States. Participants' coping strategies suggest that the desire for child custody and concern for fetal and child well-being was a priority and motivated care seeking despite extrinsic barriers perceived to be threatening to the woman's safety and autonomy.