Tsuda-McCaie Freya, Kotera Yasuhiro
Online Learning, University of Derby, Derby, UK.
School of Health Sciences, University of Nottingham, Nottingham, UK.
Drug Alcohol Rev. 2022 May;41(4):851-862. doi: 10.1111/dar.13421. Epub 2022 Jan 17.
Addressing opioid use disorder (OUD) among pregnant women is of growing importance, and substance use treatment positively impacts outcomes for mother and baby. Understanding substance use treatment experiences is important to improve access, and retention, and no review or synthesis of research addressing the treatment experiences of pregnant women exists.
Thus, a qualitative meta-synthesis was conducted, which investigated the psychological motivators and barriers of pregnant women with OUD trying to access treatment and their perceptions of treatment.
A total of 3844 articles were retrieved from the literature search. Nine articles met eligibility criteria, were appraised, then synthesised using a comparative thematic approach. Four themes: (i) Embodied Experiences; (ii) Institutional Pressures; (iii) Social Context; and (iv) Reconstructing Selves; indicate that women with OUD are motivated to engage in treatment to pursue the safety and custody of the unborn baby and to pursue and enact the changes necessary to claim 'normal' parenthood status. Pregnant women describe psychological and relational barriers to engaging in treatment, including anxieties about the baby's health, fears of authorities' involvement, stigma and experiencing relationships with treatment providers as constrictive or invalidating.
Identity theory's concepts of identity verification, closed environments and master status identities illuminate the findings. Implications include recognising the salience of bodily experiences, providing medication-assisted treatment support groups and promoting validating relationships in treatment using strengths-based approaches.
Pregnant women face unique psychological challenges in accessing and engaging in substance use treatment for OUD.
解决孕妇阿片类物质使用障碍（OUD）问题的重要性日益凸显，物质使用治疗对母婴结局有积极影响。了解物质使用治疗经历对于改善治疗的可及性和持续性很重要，然而目前尚无针对孕妇治疗经历的研究综述或综合分析。
因此，进行了一项定性元综合分析，调查患有阿片类物质使用障碍的孕妇寻求治疗的心理动机和障碍以及她们对治疗的看法。
通过文献检索共获取3844篇文章。9篇文章符合纳入标准，经过评估后，采用比较主题分析法进行综合分析。四个主题：（i）身体体验；（ii）机构压力；（iii）社会背景；（iv）自我重构；表明患有阿片类物质使用障碍的女性有动力接受治疗，以追求未出生婴儿的安全和监护权，并寻求并做出必要改变以获得“正常”的父母身份。孕妇描述了接受治疗时的心理和人际关系障碍，包括对婴儿健康的焦虑、对当局介入的恐惧、耻辱感以及将与治疗提供者的关系体验为限制或无效。
身份理论中身份验证、封闭环境和主地位身份的概念阐明了研究结果。启示包括认识到身体体验的重要性、提供药物辅助治疗支持小组以及采用基于优势的方法促进治疗中具有验证作用的关系。
孕妇在寻求和接受阿片类物质使用障碍的物质使用治疗时面临独特的心理挑战。
