Limiting loss: a grounded theory of mothers who use illicit drugs

Abstract

Illicit drug use is a major public health problem with women who use illicit drugs being one of the most marginalised minority groups in our society. In Australia, the most commonly used illicit drug is marijuana/cannabis, followed by ecstasy, meth/amphetamines, opioids (heroin, non-maintenance methadone, and other opiates), and cocaine, with polydrug use being common practice.This research focuses on Western Australian women who use illicit drugs whilst pregnant and mothering. There is a paucity of literature related to the multifaceted psychosocial phenomenon of mothers who use illicit drugs. As a result, the extent of problems faced by these women and their families has been poorly understood. Grounded theory was the method of choice to investigate the phenomenon as it allowed an exploration of participants’ experiences from within their social context. The method provided strategies to discover the shared basic psychosocial problem, the processes employed to cope with the identified problem, and the conditions influencing the problem and the process.Women who were experiencing the phenomenon, were knowledgeable about the topic and were able to articulate detailed experiential information were invited to participate. This thesis presents the findings from 14 mothers who were using illicit drugs and is supported by interviews with relevant health professionals. The 14 mothers had 60 pregnancies with 35 live births, 2 women were pregnant at the time of interview, and the mothers had collectively experienced 31 loss experiences. Twenty eight children were in the custody of their mother at the time of interview. Data were collected from individual in-depth interviews, informal interviews, field observations, review of case records, and a brief quantitative questionnaire to elicit demographic information. Data were managed using QSR NUD*IST software and analysed using the constant comparative method consistent with grounded theory methodology.The central problem, relevant to all study participants, was the threat of loss. The threat of loss emanated from (a) judgment and disapproval by self and others; (b) being abused, manipulated, overwhelmed, and dependent; (c) damaging myself and damaging my baby; (d) losing my baby or having my baby taken off me; (e) having a sense of not belonging; and (f) not trusting others and not being trusted. These problems resulted in loss of respect; loss of freedom; loss of health; loss of child; loss of identity; and loss of trust. In an attempt to overcome the threat of loss, the basic psychosocial process employed by mothers who use illicit drugs was: limiting loss through a process of safeguarding.The mothers engaged in this core process through three sub-processes: safeguarding during pregnancy; safeguarding as mother; and safeguarding to preserve integrity. Depending on the perceived nature of the threat and the influencing conditions, the safeguarding processes employed by the mothers oscillated between reactive responses of struggling and proactive strategies of taking back control. Whilst struggling during pregnancy the mothers struggled to make decisions and struggled to find a way. When struggling as mother they engaged in trial and error nurturing; and when safeguarding to preserve integrity they struggled to preserve their integrity. However, when they were stronger, had more resources, and were more knowledgeable they were able to take back control and promote health during pregnancy. This was achieved by changing their priorities and by actively taking care of self. When taking back control as mother they were able to strive to be ‘good mother’ through nurturing and by increasing their capacity. When taking back control when safeguarding to preserve integrity the mothers engaged in redefining to preserve integrity where they actively created a better environment; controlled events; accessed support systems; and remodelled self. Conditions that influenced the mothers’ threat of loss and limiting loss through a process of safeguarding included: the self; the nature of support from significant others; negative influences of others; attitudes and practice of health professionals; fear of being ‘bad mother’; and maturation of children.This substantive theory of limiting loss through a process of safeguarding provides a better understanding of the subjective experience of mothers who use illicit drugs. Whilst it has previously been reported that these mothers fear losing their baby to social services, this study has identified that it is multiple forms of loss that is problematic for these mothers. Additionally, this theory presents new understandings of mothers who use illicit drugs and demonstrates not only the struggle they endure but attributes of strength, resilience, motivation, capacity and ‘good mothering’. The development of this theoretical framework has provided a foundation on which to inform health care provision, future research, education and policy development for this vulnerable but resilient group of women.