Closing Case: The Growing Trade in Growing Grapes Wine is one of mankind’s oldest and most important industries. Archaeological evidence of wine production dates back to 6000 B.C.E Hieroglypics from 3000 B.C.E. depict Egyptians enjoying celebratory cups of wine. The Bible records Jesus’ first miracle, turning water into wine at the wedding feast at Cana. Today, some 18.6 million acres of land are devoted to vineyards, which yield 26 billion liters of wine annually. The EU produces about 55 percent of this output, with France, Italy, and Spain accounting for the bulk of the EU’s production. The United States, Australia, China, South Africa, Chile, and Argentina are the largest non-European producers. Unti the 1980s, French vineyards were the dominant force in the global wine trade, with Italy, Spain, and Germany trailing behind them. These Old-World producers benefitted from centuries of tradition and their reputations for quality and sophistication. The mystique of French wine was in part attributable to the belief by oenophiles (a word for wine experts) that terroir and the character of the grape itself contributed to the creation of unique characteristics for each vineyard’s wine. (Terroir means “a sense of place” and includes numerous factors that convey character to the wine, including soil chemistry, topography, and the microclimate of an individual plot of land.) So critical is terroir to the French wine industry that in the nineteenth century, French officials assessed the quality of the wine produced in each French vineyard and established an elaborate schema for categorizing the wines according to their location and quality – Grand cru, Premier cru, etc. Known today as the Appellation d’origine controlee (AOC) (controlled designation of origin) system, effectively the French government provided a quality assurance and consumer protection program for lovers of French wine. Under the AOC system, for example, the only wines that can bear the label “Champagne” must be fermented from grapes grown in the Champagne region of northeastern France. Grand cru champagne must originate from lands specifically designated as such by the AOC system. The Italian and the German governments established similar programs. The Old World producers, although dominant, were not invulnerable to global competition, particularly after the so-called “Judgment of Paris” in 1976, when a British wine merchant living in Paris organized a blind taste-testing competition between French and Californian wines. To the surprise of nearly everyone, the judges rated California wines as superior to those of French wines in the two contested categories. (Bottle Shock, a 2008 movie starring Alan Rickman, dramatizes the events surrounding the Judgment of Paris.) Nonetheless, French wines command a price premium in the export market, averaging more than $6.00 a liter compared to only $3.00 for wines from Australia, ...

1. Closing Case: The Growing Trade in Growing Grapes
Wine is one of mankind’s oldest and most important industries.
Archaeological evidence of wine
production dates back to 6000 B.C.E Hieroglypics from 3000
B.C.E. depict Egyptians enjoying celebratory
cups of wine. The Bible records Jesus’ first miracle, turning
water into wine at the wedding feast at Cana.
Today, some 18.6 million acres of land are devoted to
vineyards, which yield 26 billion liters of wine
annually. The EU produces about 55 percent of this output, with
France, Italy, and Spain accounting for
the bulk of the EU’s production. The United States, Australia,
China, South Africa, Chile, and Argentina
are the largest non-European producers.
Unti the 1980s, French vineyards were the dominant force in the
global wine trade, with Italy, Spain, and
Germany trailing behind them. These Old-World producers
benefitted from centuries of tradition and
their reputations for quality and sophistication. The mystique of
French wine was in part attributable to

2. the belief by oenophiles (a word for wine experts) that terroir
and the character of the grape itself
contributed to the creation of unique characteristics for each
vineyard’s wine. (Terroir means “a sense
of place” and includes numerous factors that convey character
to the wine, including soil chemistry,
topography, and the microclimate of an individual plot of land.)
So critical is terroir to the French wine
industry that in the nineteenth century, French officials assessed
the quality of the wine produced in
each French vineyard and established an elaborate schema for
categorizing the wines according to their
location and quality – Grand cru, Premier cru, etc. Known today
as the Appellation d’origine controlee
(AOC) (controlled designation of origin) system, effectively the
French government provided a quality
assurance and consumer protection program for lovers of French
wine. Under the AOC system, for
example, the only wines that can bear the label “Champagne”
must be fermented from grapes grown in
the Champagne region of northeastern France. Grand cru
champagne must originate from lands
specifically designated as such by the AOC system. The Italian
and the German governments established

3. similar programs.
The Old World producers, although dominant, were not
invulnerable to global competition, particularly
after the so-called “Judgment of Paris” in 1976, when a British
wine merchant living in Paris organized a
blind taste-testing competition between French and Californian
wines. To the surprise of nearly
everyone, the judges rated California wines as superior to those
of French wines in the two contested
categories. (Bottle Shock, a 2008 movie starring Alan Rickman,
dramatizes the events surrounding the
Judgment of Paris.) Nonetheless, French wines command a price
premium in the export market,
averaging more than $6.00 a liter compared to only $3.00 for
wines from Australia, Argentina, Chile, or
the United States.
The AOC system, although conferring some marketing
advantages, does have some disadvantages. It
requires that consumers have a fair degree of knowledge to
make wise wine purchases. Moreover,
individual vineyards are vulnerable to the vagaries of the
weather. If Mother Nature fails to cooperate, a
vineyard might receive too much or too little rainfall or
sunshine in a growing season; thus, the quality

4. of its grapes could vary from year to year. This may raise the
snob appeal of the Old World wines – you
can impress your friends with your expertise by recommending
one vintage over another. However,
many consumers, particularly first-time buyers, found that
downright confusing. Because the AOC
system tied the wine label to the land on which the grape was
grown, Old World vintners were also
limited in their ability to benefit from technological changes
and economies of scale. If someone
invented a machine to facilitate grape harvesting, you could not
necessarily buy out your neighbor to
capture economies of scale—his land might have a different
terroir, and perhaps a different government
cru classification. As a result, the average size vineyard in
France is only 7.4 acres and 1.3 acres in Italy,
compared to 167 acres in Australia and 213 acres in the United
States.
Driven by the Judgment of Paris and changes in consumption
patterns, wine production grew steadily
during the 1970s, 1980s, 1990s, and into the new century in
New World countries such as the United

5. States, Chile, Argentina, Australia, and South Africa. The New
World wine makers differentiated their
wines primarily by grape variety—pinot noir, cabernet
sauvignon, etc. -- rather than by the specific
vineyard or chateau where the grapes were grown. Moreover,
the New World wine makers relied on
branding, rather than vineyard names, to market their products.
This had several advantages. First, it
simplified the purchase decision for unsophisticated buyers –
remembering a brand name like Columbia
Crest or Yellowtail was often easier than recalling that of an
obscure, small French vineyard. Second,
New World vintners were able to blend grapes from various
vineyards to create a wine with consistent
taste from year to year, regardless of random changes in the
weather. Third, they were able to market
large volumes of wine under that brand name, allowing them to
distribute their products more easily
through mass-market retailers like Tesco, Marks & Spencer,
Kroger, and Walmart. As a result, New
World vintners are much larger than their Old World rivals and
are more able to capture economies of
scale from use of the latest technological breakthroughs and
labor-saving mechanization. The four

6. largest firms in the United States, for example, control 56
percent of U.S. sales; for Australia, 62 percent;
and Chile, 82 percent. In France, the four largest firms are
responsible for only 16 percent of sales;
Spain, 21 percent; and Italy, 10 percent.
Export markets are vitally important to both Old World and
New World vineyards. About 10 billion liters
of wine are traded in a typical year. The EU accounts for 61
percent of the export market and the United
States for 4 percent, primarily from California. Because both
are major consumers of wine, the bulk of
their production is consumed domestically. Such is not the case
for Chile, which exports 80 percent of its
crop, and New Zealand, which consumes only one-third of its
production.
Case Questions:
1. Both Old World vineyards and New World vineyards compete
in the global market place. What
are the competitive advantages and disadvantages of the Old-
World vineyards? Of the New
World vineyards?
2. Why are French wines able to command a price premium in

7. export markets?
3. Should the French government relax its AOC system,
allowing French vintners to expand the size
of their chateaux to capture economies of scale? Why or why
not?
4. Should the U.S. government adopt an AOC system to ensure
the quality of U.S. wines destined
for export markets?
5. “Bottle shops” -- small retail outlets specializing in selling
fine wines—might purchase a case or
two of a specific wine when placing an order. (A case typically
consists of a dozen 750-mililiter
bottles.) Buyers for large multistore firms such as Tesco or
Walmart often order thousands of
cases at a time. Which type of retailer is likely to specialize in
Old World wines? In New World
Wines? Give a reason for your answer.
ASSIGNMENT III: RESEARCH
Instructions: Prepare a typed, written response to the
questions. Information
from previous social work and social research

8. 1. Social Research Methods
A. Identify three social research methods that are in use
at your agency.
(Talk to people in your agency about how data is
collected, how programs
are evaluated, what kinds of surveys are used
to determine needs of client
systems, how annual reports are designed,
etc.). Explain how these
methodologies are used and why they are
useful.
B. Locate two empirical research studies from social
work sources
addressing the types of services delivered by your
agency. (i.e. mental
health, health care, protective services, etc.)
Give bibliographic references
for these studies. Briefly summarize the
findings of these studies.
Explain the relevancy of these studies for social work practice
in your agency.
C. What are the major instruments or systems used to
collect data on
client systems? On workers? On program activities?
What kinds of
data are collected?
D. How are research and data analysis methods
integrated into ongoing
social work practice within your agency?
2. Analysis of Data

9. A. Use the studies from 1B above. Identify the
statistical procedures
used to analyze the data in these studies. Explain
why these procedures
were or were not appropriate.
B. What kinds of reports does the agency generate from
the data collected
in 1C? What statistical procedures are used for
analyzing data in these reports?
3. Computer Usage
A. Briefly describe the ways in which computers are used to
help social
workers perform tasks in your agency. What are
limitations of your agency's computer
system(s)?
B. What kinds of problems do computers create for
social workers and
clients? In what ways could computers be used to
enhance services?
4. Practical Applications of Research
A. Define the scientific method.
B. Identify a major issue/question that is raised in your
agency about clients,
services, resources or effectiveness.** Is data
available to provide at least
partial answers to this question? ***Develop a
research question related to the
issue.

10. C. Design a research study to answer the question
identified in B. It should
answer the following questions.
1. Given your research question, what research design
would you
use for this study and why?
2. How would you implement your study at your
agency?
3. How would you address issues of diversity and at-
risk populations
in your study?
4. What form of statistical analysis would you use to evaluate
the data of this
study?
5. How might this study impact your client systems
and your agency
if implemented?
5. Generalist Application of Research
A. **Discuss the purpose of research within Generalist
Social Work practice.
**Give two examples. !!!!
** Explain the significance of practice-
informed research
and researched informed practice.!!!!!!
6. Research Ethics
A.**Review the NASW position on research as stated in
the NASW Code of Ethics.***In what way is
your agency's collection/use of collected
information either consistent or inconsistent with this

11. code. (Section 5.02
in the Code).
B. Review the NASW Code of Ethics, Sections 4 and 5
related to Ethical
Responsibilities as Professionals and Ethical
Responsibilities to the
Profession.!!!!
How is research knowledge critical to the social
worker in
complying with these sections of the Code?
Santa Maria Hostel
Running Head: SANTA MARIA HOSTEL 2
SANTA MARIA HOSTEL 2
Santa Maria Hostel
Introduction
Santa Maria serves the women and children of Houston and the
surrounding area since the mid-1950s. It offers vital services
and life-changing support to women by providing a pathway to
success through recovery. Its mission is to empower women and
their families to lead healthy, prosperous, self-fulfilling, and

12. productive lives. The facility offers services to low -income,
substance use and co-occurring mental health disorders.
indignant adult women in over twelve countries. Primarily
provided below will highlight some of the events and services
carried out by the facility.
Social Work/Welfare History
It began with an 18-year old that aged out of CPS needing a
place to live. Nuns would go to the jail to offer homeless
women a place to stay, and the women were taken to a home on
paschal. It was discovered that the vast majority of the women
were on drugs and alcohol problems. Santa Mari Hostel was
started; they parted ways from the catholic church and became a
free-standing treatment facility with 17 women. In 1994, Cheryl
Empey (Director)and Kay Austin (Program Director) wrote a
State Grant to allow clients and their children to live with them
while they seek treatment. Santa Maria Hostel is the first
treatment center in the state of Texas to allow children. Mr.
Austin (LMSW) is the first male and the first social worker to
work for Santa Maria Hostel; he is still on board today
advocating for women and children.
A significant event in Santa Maria's history is Yolanda's Fetal
Alcohol Syndrome Disorder (FASD) journey. Yolanda is the
kind of mother that all women hope to be for their children and
Agency. Yolanda suffered from low self-esteem while she was
young and depended on alcohol and other drugs from 19 to 35.
She was in and out of prison and continued using drugs to the
point that she even used cocaine (Kaushik & Walsh 2019). At
the age of 26, she bore a child who suffered from Fetal Alcohol
Syndrome Disorder. Yolanda was also diagnosed with HIV and
started receiving early childhood intervention to help her
manage herself and her baby. Yolanda became free of her
addiction and started learning new skills and coping
mechanisms, and she is currently pursuing a master's degree.
Yolanda has become a mentor for many women as her child is
also learning even with the circumstances.
Another event that has had an enormous impact in Santa Maria

13. is the trauma cases it has received. Trauma is a disorder that
results from severe mental or emotional stress. Some people
will refer to it as Post-Traumatic Stress Disorder (PTSD). Santa
Maria treats trauma disorders through a commitment to trauma-
informed care and treatment. They identified the need for
counseling and programming that a person needs to get to a
healthy state. The other significant event is the holiday helpers.
During the festive season, meaningful gifts and toys are given
to mothers with new-born babies at Santa Maria Hostel. It
allows the community to appreciate women trying to overcome
drugs and other disorders (Santa Maria., 1997).
Structure of services and institutions
Santa Maria Hostel's executive team is headed by Elizabeth,
assisted by Keith's name's vice-chair. The treasurer, secretary,
and past Chair take part in ensuring that the organization is
successful. The board of directors is there to invigilate all
actions and provide proper activities (Santa-Maria 2021). The
Agency is a non-profit organization that depends on government
funds, private foundations, and community support to financing
Santa Maria Hostel operates under a federal block grant
administered by the Health and Human Service.
Santa Maria focuses on several activities that include the road
to recovery for mothers, baby and mother bonding initiative,
caring for two, court liaison services, prevention services, and
recovery support activities.
The Maternal Initiative for Reflective Recovery-Oriented
Residential Services
(MIRRORS) program is a family-focused medical and
behavioral health services for the residential pregnant and
postpartum mothers and their children and other family
members. Court Liaison services are also available. The
program has family coaches that will advance family service
and reunification plans while working with CPS caseworkers
and mediate for families.
Outpatient services are offered main treatment choices with
importance on relapse prevention of recovery within the

14. community setting. Group, family, and individual counselling
sessions are presented as part of the program, and childcare is
available. The outpatient program provides Substance use
disorder treatment and relapse prevention, PTSD counseling,
aftercare, Peer Recovery Support, a safe and healthy, supportive
nurturing environment Individualized treatment plans (Santa
Maria,2010).
One of the most important first steps in recovery is
detoxification. This program is uniquely the only one of its kind
in the region to reassure this level of service to non-insured
women with their children at Santa Maria Hostel. The medical
staff screens withdrawal from alcohol and opioids. Women are
then offered the opportunity to transition into residential
treatment following detox. Santa Maria Hostel has a full
medical staff on duty 24 hours a day, seven days a week. Santa
Maria Hostel has housing resources for homeless women and
children. Hope Housing Project offers stable housing and life
skills, education, and vocational assistance. Supportive services
include; case-manager, childcare, transportation, and
assistance—this program is offered for12 months (Santa
Maria,2010).
Women Helping Ourselves (WHO)a six-month program that is a
treatment alternate for incarcerated women or was headed to
TDCJ. This program focuses on women with substance use
disorders that meet specific program standards offenders are
pregnant, or possibly postpartum, or have serious health issues.
Clients attend classes that will address criminal thinning
chemical dependency, life skills, relapse prevention, parenting
skills, anger management, and women's issues. COPSD, Family
counseling, family education, and individual education are also
a part of the program.
The institution should also ensure post-check-up treatment for
children and mothers being released to the environment. This
ensures that habits like addiction and stress do not encounter
them and are willing to seek guidance in case of a need.
However, the program is costly for the institution as the running

15. activities also expend some costs. That is why a proper
evaluation is needed to cover the expenses. Santa Maria Hostel
offers services just like other institutions (Santa-Maria 2021).
Their relationship is that they want to bring the community
members' welfare and wellness up and be productive.
Policy Analysis
The most common policy analysis methodologies are cost-
benefit analysis, needs assessment, and secondary data analysis.
Organizations tend to analyze decisions, systems, and projects
by determining the value of intangibles. The model is
constructed by identifying the benefits of an action and
subtracting costs from the services. Santa Maria Hostel can
devise a cost-benefit analysis to analyze whether the benefits
chosen in an option exceed the price. A needs assessment is
essential in the institution as it determines and addresses needs
or gaps between current conditions and desired conditions
(Santa-Maria 2021). The discrepancy between the current
situation and wanted condition must be measured to identify the
organization's need.
Santa Maria can adopt these strategies when analyzing an
option: they will start by setting a plan on the opportunity. It
will be followed by the option's formulation, after which the
decision is chosen to adopt the situation. The policy is
implemented and evaluated to check whether it performs as it
should be. Santa Maria Hostel has to abide by several laws that
govern the conduct of its activities. They will start by accepting
all state laws within their jurisdiction and ensuring that they are
on good terms with the governing institutions (Santa-Maria
2021). They have to report their annual statements to the IRS
and ensure that all agreements contracted by them are followed
by the letter.
Effects of Policy on Client Populations from diverse
backgrounds
Santa Maria provides services for over 1663 women and
children. Seventy-eight percent of them are single. Ninety-four
percent were unemployed. Fifty-two percent had not graduated

16. high school. Eighty-nine percent were homeless or had no
permanent, stable living environment. Forty-three percent had
an active CPS case. Forty percent were victims of domestic
abuse. Seventy-eight had co-occurring psychiatric disorders.
Ninety-nine percent were at or below the poverty level. Santa
Maria Hostel ensures that women in the facility feel safe to
compose themselves make themselves comfortable. This works
well for the organization as most women get out of the facility
healthier and better. The population at Santa Maria Hostel is
predominately white, the Hispanic, Black many clients at Santa
Maria are self-check-in, and some are paid through private
insurance or cash (Santa-Maria 2021).
How social workers influence social policy
Social workers advocate helping individuals, families, and
groups cope with problems they face to improve their clients'
lives—social workers teaching skills and developing
mechanisms for patients to rely on to better their lives and
experiences. Social workers serve as liaisons between different
organizations to assist clients and join forces with other
healthcare professionals to safeguard patient well-being.
Familiarity with all possibilities and to refer clients to
community resources. Social Workers also engage in research,
policy development, and advocacy for services (Raymond,
Beddoe & Staniforth 2017).
Generalists application of social policy
Social policy purposes are to improve human welfare and meet
human needs for education, health, housing, and economic
security. The social policy addresses how states and societies
respond to global social demographic and economic change,
poverty, migration, and globalization. Social policy analyses the
different roles of national governments, governments, families,
and international organizations in providing essential services
and support across the life course from childhood to old age.
These services and support include child and family support,
schooling and education, housing and neighborhood renewal,
income maintenance and poverty reduction, and unemployment

17. support. The overall objectives are to identify and find ways of
reducing inequalities in access to services and support between
social groups defined by social-economic status, race, ethnicity,
and age between countries (Dukelow & Considine 2017).
References
Dukelow, F., & Considine, M. (2017). Irish social policy: A
critical introduction. Policy Press.
Kaushik, V., & Walsh, C. A. (2019). Pragmatism as a research
paradigm, implications for social work. Social Sciences, 8(9),
255.
Raymond, S., Beddoe, L., & Staniforth, B. (2017). Social
worker's experiences with whistleblowing: To speak or not to
speak?. a New Zealand Social Work, 29(3), 17.
Santa-Maria (2021). Santa Maria Hostel: addiction recovery,
housing, prevention, and intervention programs. Retrieved from
https://www.santamariahostel.org/
Narratives of Low-Income Mothers
in Addiction Recovery Centers:
Motherhood and the Treatment Experience

18. Catherine Hiersteiner
ABSTRACT. This study examines the narratives shared by low -
in-
come women in addiction recovery centers about the meaning
they
attach to being a parent in recovery and how they view current
pro-
gram models that include children in daily treatment. Their
stories
reflect the centrality of the mothering role to women in
recovery and
offer insights that can guide treatment and program planning
with fami-
lies. [Article copies available for a fee from The Haworth
Document Delivery
Service: 1-800-HAWORTH. E-mail address:
<[email protected]>
Website: <http://www.HaworthPress.com> © 2004 by The
Haworth Press, Inc. All
rights reserved.]
KEYWORDS. Low-income women, substance abuse treatment,
moth-
erhood, parent identity, narrative, qualitative research
INTRODUCTION
This study examines what low-income mothers in substance
abuse
treatment centers say about their experience in recovery, with a
focus on
Catherine Hiersteiner, MSW, LSCSW, is Adjunct Instructor in
the School of Social
Work, University of Missouri-Kansas City, and a doctoral

19. candidate at the University
of Kansas, School of Social Welfare. She maintains a private
practice with children,
youth, and families.
Journal of Social Work Practice in the Addictions, Vol. 4(2)
2004
http://www.haworthpress.com/web/JSWPA
© 2004 by The Haworth Press, Inc. All rights reserved.
Digital Object Identifier: 10.1300/J160v04n02_05 51
http://www.HaworthPress.com
http://www.haworthpress.com/web/JSWPA
the support they receive as parents to their children. The
purpose of this
inquiry is to sensitize practitioners and administrators to the
critical role
that motherhood plays in the identities of women in the process
of re-
covery and to reinforce treatment practices that build on the
centrality of
motherhood in the women’s identities and day-to-day lives
(Azar,
1996; Hardesty & Black, 1999). Using in-depth interviews and
methods
of narrative inquiry and analysis, the study focuses on the
women’s per-
sonal “storied lives on storied landscapes” (Clandinin &
Connelly,
2000, p. 8). By telling their stories, the women allow us into
their worlds
as they share their insights about themselves, their children,
their family

20. members, and other women in the recovery process.
As a result of partnership efforts among federal, state, and
private
agencies, networks of residential centers for recovering drug
and alco-
hol-dependent women have been established in the last decade.
Just as
the population of chemically-dependent women with children is
hetero-
geneous and diverse, programs designed to meet their needs
differ in
size, treatment approach, and setting. They range from short-
term,
detox inpatient units in hospitals for pregnant abusers (Malow
et al.,
1994) to long-term outpatient community support programs
(Greif &
Drechsler, 1993; Rogoff-Plasse, 1995) to small, community-
based resi-
dential treatment centers with length-of-stay ranging from 30-60
days
designed for 12 to 20 women to remain in residence with their
children
(Brown, Sanchez, Zweben, & Aly, 1996; Plasse, 2000;
Schumacher,
Siegal, Socol, Harkless, & Freeman, 1996; Szuster, Rich,
Chung, &
Bisconer, 1996). Most centers provide follow-up day treatment,
coun-
seling, and support groups, although some refer women to
community
programs for addiction recovery and case management. While
some
women are self-referred to programs, most are court-referred as
a result

21. of poor parental functioning due to drug or alcohol abuse. A
critical
component of treatment for many of these women is the
provision of
parenting classes, parent-support groups, family counseling, and
thera-
peutic groups for children (Carten, 1996; Moore & Finkelstein,
2001;
Plasse, 2000; Sun, 2000).
Recent studies suggest that parenting skill development and
support
is a critical treatment component for mothers in recovery and
that re-
building parenting skills and relationships with children and
other fam-
ily members can be an important component of relapse
prevention
(Carten, 1996; Moore & Finkelstein, 2001; Plaase, 2000;
Stevens &
Patton, 1998). Findings from researchers who have listened
closely to
mothers with substance abuse issues confirm that motherhood
plays a
central, defining role in the lives of many of these women
(Azar, 1996;
52 JOURNAL OF SOCIAL WORK PRACTICE IN THE
ADDICTIONS
Hardesty & Black, 1999), challenging public images of them as
uncar-
ing and unconcerned about their children. For many women
struggling

22. with addictions, the role of motherhood provides a stable
identity and an
anchoring set of activities amidst the chaos of poverty, abuse,
and
marginalization and during the recovery process as well
(Hardesty &
Black, 1999).
APPROACH OF STUDY
This qualitative study was exploratory and descriptive in nature
and
guided by social work ethics and feminist values (National
Association
of Social Workers, 1996; Reinharz, 1992). Six mothers in two
addiction
recovery centers, one urban and one rural in the Midwest, each
partici-
pated in an hour-long on-site interview with the researcher and
a second
telephone interview a few weeks later. Participants were
recruited in the
parent support groups at each center by a staff member who
described
the study and asked for volunteers.
A model of multidimensional inquiry, which invited stories
from the
mothers about their own inward landscapes and contextual
environ-
ments, guided this study (Clandinin & Connelly, 2000;
Riessman,
1993). The interviews were semi-structured with a number of
open-ended questions that invited narrative responses. The
primary top-
ical questions, supplemented by follow-up questions, included:

23. • What is your personal story about being a mother with young
chil-
dren in substance abuse recovery treatment?
• How would you describe the center’s approach to helping
mothers
with parenting? What has your experience been with this ap-
proach?
• About having your children here with you?
• What are some of your successes and accomplishments right
now
as a parent in recovery? Some of your struggles and concerns?
Lieblich, Tuval-Mashiach, and Zilber (1998) have proposed a
classi-
fication system in which to locate a study’s strategy for
understanding
transcribed interviews using one of four methods: categorical -
content,
holistic-content, holistic-form, and categorical-form. “None of
the ap-
proaches . . . is as productive alone as in combination with the
other
ways of reading a life story” (Lieblich et al., 1998, p. 111). This
study
combined strategies from the categorical-content and the
holistic-form
Catherine Hiersteiner 53
approaches, resulting in a layered style of analyzing and

24. interpreting the
women’s narratives. The categorical-content approach builds
upon
Strauss and Corbin’s model of content analysis, which attends
to
separate parts of the story within and between participant
narratives
(Strauss & Corbin, 1990). In the holistic-form approach, the
researcher
examines a participant narrative or group of narratives for a
pattern or
focus of the entire story. In this study, the researcher analyzed
the texts
in order to understand the meaning of motherhood to the women
in the
context of personal identity and the recovery experience.
All interviews were confidential and tape-recorded, with the
partici-
pants’ permission. Typed transcripts were returned to each
woman for
her review and feedback. Each participant received a $20 gift
certificate
to a local supermart. Transcript material was analyzed, aided by
a soft-
ware program called winMax 98 (Kuckartz, 1998). When the
inter-
views were completed, the researcher performed a content
analysis in
order to identify themes in the interviews and to pull out
passages stated
in the participant’s own words that highlighted an issue in a
forceful or
unique way. Narratives were then examined to understand how
mother-
hood was expressed in the structure of the women’s stories.

25. THE INTERVIEW PARTICIPANTS
The six women ranged in age from 20 to 34, and had from 2 to 6
chil-
dren. All were single mothers and participated in the Temporary
Assis-
tance to Needy Families (TANF) program. All were court-
mandated
program participants. The three mothers from the rural center
were
white; one mother was white and two mothers were African-
American
from the urban recovery center. Two mothers were currently in
resi-
dence, one with a newborn, while the other four had completed
the resi-
dential treatment program and were continuing as outpatients,
attending
the centers four or five full days weekly. Two mothers had older
chil-
dren in foster care and were working towards reunification.
Three of the
mothers were repeat participants who returned after relapse, and
three
had participated continually in the program from their initial
referral.
All but one of the mothers were in recovery from narcotics
abuse. Two
of the mothers had been hotlined for giving birth to infants with
positive
toxicology screens. None of the women had been court-ordered
due to
physical child abuse but rather due to child neglect.
Both centers addressed parenting issues with mothers in

26. individual
counseling sessions and in group treatment. Both centers also
invited a
54 JOURNAL OF SOCIAL WORK PRACTICE IN THE
ADDICTIONS
parenting specialist in weekly to conduct issue-oriented groups
on child
development, discipline, and child health and safety. Parenting
was also
addressed by counselors in a supportive way during spontaneous
inter-
actions among the women and children, for example, at
mealtimes and
during recreational time.
HOW THE WOMEN DESCRIBED THEIR EXPERIENCE
AS RECOVERING PARENTS IN TREATMENT
All of the women were candid, cooperative informants and
described
the parenting aspects of the recovery programs as helpful,
useful,
and vital to their process of attaining and maintaining clean and
so-
ber lifestyles. Most, but not all, expressed initial relief at
referral into the
programs, sometimes following a period of ambivalence. They
demon-
strated good understanding of the parenting skills reinforced at
the cen-
ters and worried about surviving without the support of Center
programs and staff. Below are portions of their narratives, in

27. their own
words, with the pseudonyms chosen by the mothers themselves.
Their
words invite us into their lifeworlds and serve to deepen our
under-
standing of their experience as parents in recovery (Van Manen,
1990).
Life as a ‘Using’ Parent
Prior to treatment the mothers described feeling oblivious to the
needs of their children, cushioned from life stresses in an
intoxicated
fog. They rarely included other adults in the picture they
described.
Loneliness and isolation pervade the home, despite one’s sense
that
there are concerned or enabling family members or “friends” in
the
wings.
I used with all six children. It’s a really sad process because,
when
one was born, it was like, ‘Well, that’s over with.’ And I did
not ex-
pect another one, but as they came, I was using so much that I
didn’t
have time to have safe sex. I wouldn’t have an abortion because
that
was against my religion. And I got to thinking about the little
money
from welfare. ‘Oh, I’m gonna get a little more money. Here’s
an-
other child.’ But when I got to the last three, I did not want no
part of
it. I got to using, and hoped that it would go away . . . and it

28. never
did. (Cheryl)
Catherine Hiersteiner 55
Before I was in recovery, my father was using, and I was using
with him. It was horribly bad, because he was going to report
me to
SRS (Child Protective Services). (Maxine)
Before I came into recovery, I didn’t watch my kids. I would
look
right at them and not know what they were doing. It was
because I
wasn’t paying attention to them . . . I wasn’t being a mother.
(Pam)
Pretty much I did not have time for my kids. ‘Go play,’ or
‘Come
and get these kids, you all . . .’ or ‘You can all sit here,’ to the
three
little ones because I figured they didn’t know (what the drug
para-
phernalia meant). But they soaked in a lot. The three little ones,
they’ve been through this with me twice. (Brenda)
While not all women who abuse substances are neglectful
parents all
of the time, these mothers in treatment observed that their
interest in
parenting and attention to their children was diverted by their
involve-
ment with drugs. They reported these experiences with a sense
of guilt,

29. implying an abandonment of a role in their families and
communities
that held importance for them. Treatment approaches should
address
this personal conflict between mothering identity and drug use
as part of
the process of substance abuse recovery and relapse prevention.
Coming into the Programs
The mothers voiced a range of opinions about their entry into
recov-
ery, expressing feelings of reluctance, resignation, resistance,
fear, and
relief. They described adjustment reactions among their
children,
mostly expressed as angry acting out or anxiety about
separation from
their mothers in a new place with new people.
Relieved on my first day was what I felt because I had someone
working with me and I knew that there was an out and it wasn’t
all
dark anymore. But the first time when I came into recovery my
son
was so angry because I was parenting him for the first time.
(San-
dra)
When my kids came up here, they were a little shy. My son
wouldn’t
play with other kids because they wasn’t his cousins. He would
wet the bed a lot at night because it wasn’t his room, or it
wasn’t a
place on the floor. The bathroom was maybe too much for him
be-

30. 56 JOURNAL OF SOCIAL WORK PRACTICE IN THE
ADDICTIONS
cause it had its own door and nobody was coming up to him and
saying, “Hurry up! Get out! I gotta use it!” (Maxine)
The mothers’ words suggest a sensitivity to their children’s
worries
about coping in a new environment. Noticing and attending to
the feel-
ings and needs of others is a core mothering skill, a cornerstone
of iden-
tity in many women often practiced in the absence of emotional
support
from other adults for the mother herself. Reinforcing this skill
of sensitiv-
ity to others and helping a woman make the connection between
getting
her own needs met in order to be an effective parent are
important compo-
nents of the recovery process. Practitioners can help women
understand
how self-awareness and self-care are skills that can complement
caring
for others. One mother’s words illustrate her insight that
separation and
autonomy were significant issues for both her children and for
herself:
I’m proud that I came here. I’m glad that I came here. The treat-
ment has helped me a whole lot. The program has helped me set
boundaries. I’m codependent. I mean I used to be codependent.
But to tell you the truth, on my first day I was terrified because

31. I
had never been around very many people at one time. And I had
never left my children. They stayed right with me. That was
really
hard for them and me (when I’d go off to groups and the
children
would go to day care). (Cheryl)
Not all women were completely compliant with the program.
The
women’s stories reflected their own experience as well as their
observa-
tions about other women in the program.
I was referred by a probation officer because I had quite a case
for
selling narcotics. I came as an inpatient. I was pregnant. I
stayed
and worked the program for 90 days. I used three times in the
pro-
gram, truly because I didn’t want the program. I felt violated
and
dragged into the program. But it was because I was using. I
wasn’t
aware of my sickness. (Sandra)
I saw a mother leave here in mid-morning, a dark morning,
leave
her children here. When we woke up for breakfast, the children
were in the room by themselves, crying. (Veronica)
It was New Year’s Eve and we all came back here to have a get-
to-
gether to watch TV for the clock-down. One lady goes into her
Catherine Hiersteiner 57

32. room and counts her own self down. She used. She brung drugs
in
with the paraphernalia. Everyone could smell it. She had just
two
days before she went to court to get her children. That was very
devastating. That touched a part of my life. (Cheryl)
The mothers demonstrate, in their description of women who
relapsed while in treatment, a strong reaction to the
abandonment of children
by a parent whose craving for narcotics overwhelms her
responsibility to
her children. Helping women develop skills for identifying
triggers that
occur in the context of the stress of parenting children is a first
step to-
wards confronting addiction as a coping mechanism. Exploring
a
woman’s thoughts and feelings about this fundamental conflict
between
relationships with one’s children versus one’s relationship to
sub-
stances is critical to relapse prevention. Understanding how
relapse
threatens a woman’s core sense of self as an effective mother
and can
evoke feelings of guilt and shame deepens the treatment
process.
Mother Pride
The women spoke with pride about their increased abilities to
play

33. with their children, to use appropriate discipline methods, and
to ver-
bally encourage their children.
For me when I first started, everything just seemed to be piling
up.
And now I can actually spend time with the children, play
games,
go to the park, instead of just sitting there all day saying, ‘No,
no,
no, no.’ (Pam)
I’m not totally against spanking, because sometimes I do, but
I’m
totally against spanking when I’m angry. Because when I’m an-
gry, I can get violent. So I have to let my children go into the
bed-
room and I put earplugs in so that I don’t hear a peep because it
irritates me. Then I calm down and I can handle things.
(Veronica)
One of the mothers also described an increased sense of
closeness
with her children complemented by clearer parent-child
boundaries.
Her own growth in the recovery process and her increased trust
of self
and others is reflected in her wishes for her children:
I’ve learned to be more nurturing. To recognize the little things
they do. . . . My goal is by getting myself better than my
children
58 JOURNAL OF SOCIAL WORK PRACTICE IN THE
ADDICTIONS

34. will start opening up to me more and trusting me more so when
they do have some problem they feel they can come to me. I was
afraid to come to my parents when I was a kid. (Cheryl)
Her pride in herself as a mother who can love, listen to, and
protect
her children has been renewed, her identity as a caring parent
restored.
Because mothering children is a core organizing role for these
women,
treatment that addresses bonding, communication, and
relationships
with their children is critical to their feelings of success as a
parent and
a cornerstone of recovery.
The Meaning of Participating in the Recovery Programs
All of the mothers indicated in a variety of ways that they were
at-
tached to the program, felt supported by the staff, and that the
treat-
ment experience has been significant in their lives.
As of today, I am a recovering parent. I feel proud, thankful. I
feel
appreciated. Trustworthy. And I’ve gained the trust of my chil -
dren. And I feel more confident in myself. (Veronica)
The staff treats me like I am somebody. People here are always
willing to lend a helping hand when you have problems. They’re
very caring people. (Sandra)
Without this program, my children would be gone. They would

35. be in foster care and I’d probably lose custody of them. So I
wouldn’t have anything. I’m not even sure I’d be alive, to be
completely honest, at the rate I was going. Its been life-giving.
(Maxine)
In response to questions about the importance she attributes to
the
parenting programs at the centers, each woman naturally shifts
to the
relationships she has formed there. The women’s positive
experiences
in treatment appear to result in large part from the support,
respect, ac-
ceptance, and encouragement they feel. Their conversations
suggest
that supportive interaction with staff is a key element in their
growth
and increased sense of self-worth and self-confidence. An
affiliative
environment in a recovery center sets the stage for facing tough
issues
with addictions and for re-engaging with the role of a loving,
effective,
and protective mother.
Catherine Hiersteiner 59
Having or Not Having Children in Residence
Policy makers have maintained that including children in
residence
with their mothers in recovery removes barriers to treatment by
provid-
ing childcare and avoiding the trauma of foster care placement.

36. This de-
velopment has been seen as gender-sensitive and in the best
interest of
the woman and her family. The women had a variety of
responses to
questions about having their children with them and living in
close
quarters with a number of other families.
It’s harder when you’ve got your kids with you because they
want
attention or need milk or something. But I’d rather have my
chil-
dren with me in treatment because I know they’re safe and no-
body’s gonna hurt them. For me, I didn’t have any place for
them
to go so I was grateful for this program that I could have them
here
with me. (Pam)
It was real hard having my kids with me. Because I was the only
one with small children and it was real hard to learn how to
parent
because of all the other women wanting to tell me what to do.
Ev-
ery morning we would have group and every morning I would
be
told what kind of behavior problems my kids were having. (Ve-
ronica)
It was real hard for me, too, but the parent specialist would
come
over and help me. ‘That is their stuff and this is what we’re
work-
ing on. . . .’ Having them not there would have been really hard
be-

37. cause I don’t let my children get very far away from me. So I
don’t
think I would have been able to handle not having them there.
(Brenda)
When new mothers and kids come in, I see myself in them like I
was before I got the knowledge that I have today. Stress kicks
in
quick. What they don’t know yet is that this is a very structured
en-
vironment. Sometimes I have to say to myself, ‘Whoa, that’s not
your job to do, trying to tell them about the program. They have
boundaries, too.’ You can’t fix and help everybody. (Maxine)
The children-in-residence policy may deserve further study in
order
to move it from the realm of ideal belief to a practical,
effective,
well-tested solution. The variety of concerns expressed about
the living
60 JOURNAL OF SOCIAL WORK PRACTICE IN THE
ADDICTIONS
arrangements at the centers may prompt a closer look at the
assumptions
that may have guided early program and policy implementation.
While
isolation is reduced and separation fears are quelled, boundary
stresses
complicate treatment.
What began as a policy to better meet the needs of women and
their

38. children may inadvertently serve oppressive ends because it
also as-
sumes that all mothers should take care of their children all the
time and
at all costs. Possibly lurking behind the curtain of benevolence
is the
agenda to save money by avoiding a costly foster care
placement. Ade-
quate facilities and differential case planning may, in the end,
serve in-
dividual needs more effectively. One mother reluctantly but
forcefully
emphasized that her program needed some improvements.
I’ve got four kids. I’ve only got one set of eyes and ears. After
din-
ner here they say to keep your children with you. But if they
would
give them something to do. Some toys or something for them to
play with. A little area just for them. In the evening instead of
‘bonding time,’ I’d say let them have a room for themselves to
play in. And you play with them. They need something to do in-
stead of just staying in our bedroom. And that room is not big
enough to keep them in there. The kids want to go out of the
room
and move around. (Brenda)
The challenge of planning programs and space needs around
mothers
and children in residence is ongoing. All mothers and children
need bal-
anced opportunities for closeness and for separation. Low -
income, sin-
gle mothers rarely get child care relief, often neglecting their
own needs
for rest and recuperation. Centers which expect mothers to

39. participate in
a full day of treatment followed by a full evening of taking care
of chil-
dren may want to talk further with women as experts on their
own situa-
tions and to re-examine levels of funding necessary to support
quality
programs. One of the mothers observed:
I want to tell you something. This is a good program. Because I
hear some of the other ladies talking about (an outpatient
recovery
program nearby). It’s outpatient all the way, so your mind’s not
into it. You can’t get a good grip on life . . . you’ll use again.
But
you need a playroom up here (for children). That would keep
your
program real competitive. And I’d sure tell the people to come.
. . .
(Brenda)
Catherine Hiersteiner 61
IMPLICATIONS FOR PRACTICE
Mothers who collaborated in the authoring of this study were
thoughtful in their reflections about their experiences in the
parent sup-
port programs and provided details that should enrich treatment
provid-
ers’ response to them and their children at the policy and
program level.
Their accounts about parenting skills learned; their observations
about

40. themselves, their children and the other members of the center
commu-
nity; and their willingness to share their stories are evidence of
program
concepts that are working overall. Adequate staffing and
facilities are
critical to the women’s successful participation in recovery
programs.
Restoration and maintenance of oneself as a loving, protective,
and
effective mother was a fundamental, organizing theme in the
women’s
stories and, therefore, has important implications for practice.
Treat-
ment programs for women in residence with their children need
to
present ongoing opportunities for each woman to describe, own,
and
practice the kind of mother she wants to be. Even in the case of
a
woman who has or will face losing custody of a child due to
past neglect
or abuse, treatment conversations should open space for her to
give
voice to the meaning of motherhood to her–past, present, and
future.
These conversations about motherhood with recovering women
must
also honor meaning across diverse cultures and in the context of
com-
munity (Hardesty & Black, 1999; Ohye, 2001).
Naming and reclaiming motherhood is a cornerstone of the
recovery
process, according to the women in this study. Narrative theory

41. pro-
vides a guiding paradigm for not only listening to women’s life
stories
but also for helping them live new stories every day that can
guide and
nourish their recovery (Friedman & Combs, 1996; White &
Epston,
1990). As women with children re-story themselves in recovery
from
substance abuse, treatment should provide a variety of venues
for each
woman to understand, express, and, in some cases, re-engage
with the
importance of motherhood to her, to her children, to her family,
and to
her community. Residential treatment centers offer a sheltered,
inten-
sive environment with sufficient social support to address deep
parenting issues and themes. When women leave the centers and
are
ready for less structure and supervision, ensuring that they
continue to
have audiences to participate in and help them sustain their
newly
authored or revived parenting narratives is a responsibility that
commu-
nities must embrace so that these stories can continue into the
future and
in future generations.
62 JOURNAL OF SOCIAL WORK PRACTICE IN THE
ADDICTIONS
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RECEIVED: 07/15/02
REVISED: 05/20/03
ACCEPTED: 08/07/03
64 JOURNAL OF SOCIAL WORK PRACTICE IN THE
ADDICTIONS
A New Gender-Based Model for Women’s
Recovery From Substance Abuse: Results of
a Pilot Outcome Study
Lisa M. Najavits, Ph.D.,
1
Marshall Rosier, M.S.,
2
Alan Lee Nolan,
M.S.W., L.C.S.W.,
2
and Michael C. Freeman, M.S., L.A.D.C.

46. 2
1Harvard Medical School, Boston, Massachusetts, USA and
McLean Hospital,
Belmont, Massachusetts, USA
2Connecticut Counseling Centers, Inc., Waterbury, Connecticut,
USA
Abstract: Despite repeated calls for gender-based recovery
models for women,
there has been a lack of empirical research on this topic. We
thus sought to evalu-
ate a women’s manual-based substance use disorder recovery
model in a pilot
study. Participants were opioid-dependent women in a
methadone maintenance
treatment program who received 12 sessions of the gender-based
model in group
format over two months. Assessment was conducted before and
after the inter-
vention, with results indicating significant improvements in
drug use (verified
by urinalysis), impulsive-addictive behavior, global
improvement, and knowledge
of the treatment concepts. Patients’ high attendance rate (87%
of available ses-
sions) and strong treatment satisfaction additionally support the
potential use
of this treatment model. Future research would benefit from
larger samples
and enhanced scientific methodology.
Keywords: Addiction, gender, methadone maintenance, opioid
dependence,

47. outcome, substance abuse, treatment, women
For decades, there has been a call for gender-based addiction
treatment,
particularly for women. Although women have a lower rate of
substance
use disorder (SUD) than men (1), in many domains they have
greater
SUD-related problems. Women have more SUD-related health
problems
and co-occurring mental disorders, higher death rates, a quicker
course of
Address correspondence to Lisa M. Najavits, Ph.D., National
Center for PTSD
(1166-3), VA Boston Healthcare System, 150 South Huntington
Ave., Boston,
Massachusetts, USA. E-mail: [email protected]
The American Journal of Drug and Alcohol Abuse, 33: 5–11,
2007
Copyright Q Informa Healthcare
ISSN: 0095-2990 print/1097-9891 online
DOI: 10.1080/00952990601082597
5
addiction, and greater social isolation and stigma (2–4). Yet
historically,
SUD treatment was developed primarily for men.
We know of no empirical outcome evaluation of any SUD

48. recovery
model designed for women. We thus conducted a pilot study to
evaluate
A Woman’s Addiction Workbook (5) in a sample of women with
severe
and chronic SUD. The workbook offers a gender-based approach
to
SUD recovery, focusing on themes and psychoeducation
relevant to
women.
METHOD
The study was conducted at an outpatient methadone
maintenance treat-
ment program (MMTP) on 8 opioid-dependent women, with
diagnosis
based on DSM-IV and positive urinalysis. Selection criteria
were pending
admission to the MMTP and willingness to participate in the
study. Incen-
tives were a free copy of A Woman’s Addiction Workbook and
expedited
admission to the MMTP. Participants stabilized on methadone
for
3 weeks prior to the study, and all began the study treatment on
the same
day. They were randomly assigned to one of two clinicians
(their primary
clinical contact as well as study treatment group co-leaders),
with four
participants per clinician. One clinician was a master’s-level
male; the
other was a female SUD counselor. Participants received 2 one-
hour
methadone-related individual sessions as part of the MMTP

49. protocol.
The only other professionally-led treatment were the study’s 12
group
sessions (each 1.5 hours) in 8 weeks (twice-weekly groups,
except for
4 weeks at once-weekly). They were not referred to external
treatments
during the study.
Session topics represented one or more chapters from A
Women’s
Addiction Workbook, which participants received before group.
The ses-
sion format was a check-in, topic from the workbook, check-
out, and
homework. The check-in was: ‘‘Since the last session . . . (1)
Share one
positive and one negative update about your recovery; (2) Any
substance
use? (3) Did you complete your homework? and (4) Share one
idea you
gained from the homework.’’ Topics were adapted for group
modality
by having the group leaders summarize 2 or 3 main points from
them.
The check-out was: ‘‘Share one thing you got out of today’s
session.’’
At study end, participants attended an exit interview.
Assessment. Measures included substance use (urinalysis and
the
Addiction Severity Index ‘‘lite’’ version) (6); functioning
(BASIS-32)
(7); psychiatric symptoms (Brief Symptom Inventory) (8);
treatment
alliance (Helping Alliance Questionnaire; HAQ) (9); global

50. improvement
6 L. M. Najavits et al.
(Clinical Global Impressions Scale, patient version; CGIS) ( 10);
cogni-
tions (Beliefs About Substance Use) (11); coping (Coping
Strategies
Inventory; CSI) (12); satisfaction (Client Satisfaction
Questionnaire;
CSQ) (13); and knowledge of principles from A Woman’s
Addiction
Workbook (using the book’s questionnaire). On all measures
higher
scores indicate worse functioning, except for the HAQ, CSI,
employment
composite of the ASI, and knowledge test.
Measures were collected at study intake, and months 1 and 2
there-
after. Intake and month 2 had identical assessments; month 1
was just the
ASI, CGIS, and HAQ. Supervised urine samples were collected
randomly
and without warning as verification of ASI data, approximately
weekly.
Patients gave 10–14 urine samples (M ¼ 12.12) during the
study.
Data Analysis. Outcome analyses were 2-tailed paired-sample t-
tests for
all variables that were available at 2 timepoints. For the ASI
(the only
measure at 3 timepoints), a repeated measures approach

51. modeled the cor-
relation between the pair of assessments per subject (equivalent
to a
paired t-test when complete data are available). The advantage
of the
repeated measures approach is that all subjects were retained in
the model
regardless of complete data. All subjects provide an estimate for
average
level at baseline, thus providing a full intent-to-treat analysis.
Two ASI
composite scores could not be calculated: legal and alcohol. The
former
was missing on some participants and thus, per ASI
instructions, could
not be calculated. On the latter, participants did not report any
alcohol
use. We suspect under-reporting of alcohol due to clinic
policies on alco-
hol consumption (e.g., loss of take-home methadone privileges).
RESULTS
Sample Characteristics. Sociodemographic information was as
follows,
from the intake ASI. Average age was 34.88 years (SD ¼ 8.69);
7 parti-
cipants were Caucasian and one was Hispanic; most were
unmarried
(n ¼ 5); and most were unemployed (n ¼ 6), with 2 working
part-time.
All participants reported 30 days of drug problems, and the
average num-
ber of days of psychiatric problems was 21.25 (SD ¼ 12.75).
Lifetime use
of drugs indicated an average of 11.62 years for heroin (SD ¼

52. 11.56),
12.63 years for cannabis (SD ¼ 11.10), and 7.50 years for
cocaine (SD ¼
4.07). Current SUD diagnoses (DSM-IV criteria) were as
follows: all
participants had opioid dependence; in addition, 6 had cocaine
abuse,
3 cannabis abuse, and 1 each alcohol abuse and benzodiazepine
abuse;
every client had 2 SUD diagnoses, and 3 had 3 SUD diagnoses.
Model for Women’s Recovery From Substance Abuse 7
Outcome Results. Table 1 provides a summary of outcome
results. Overall,
improvements were found on the variables most directly related
to the
content of the workbook: ASI drug composite, urinalysis,
knowledge of
the workbook concepts, and impulsive-addictive behavior (a
BASIS-32 sub-
scale). Also, the general measure CGIS was significant. Scales
of more per-
ipheral or related areas were not significant, but all were in the
direction of
improvement based on means (e.g., ASI composites for
psychological pro-
blems, family, legal, medical, and employment; all BASIS-32
subscales other
than impulsive-addictive behavior; and Beliefs about Substance
Use).
Table 1. Outcome results

53. Measure
Intake
Mean (SD)
Month 1
Mean (SD)
Month 2
Mean (SD)
Across time
t
1
Addiction Severity Index
Drug composite .34 (.05) .32 (.05) .25 (.08) �4.75��
Family composite .54 (.30) .46 (.24) .54 (.25) 1.17
Psychological composite .52 (.27) .53 (.21) .46 (.28) �1.06
Employment composite .68 (.18) .58 (.28) .60 (.29) .55
Medical composite .18 (.37) .26 (.39) .18 (.33) �1.32
Clinical Global
Impressions Scale
– 2.57 (.54) 1.79 (.57) 5.28��
Beliefs about Substance Use 1.25 (.87) – .66 (.47) 1.80
Basis-32
Impulsive-addictive subscale .85 (.77) – .31 (.34) 2.52�
Depression-anxiety subscale 1.46 (.87) – 1.15 (.68) 1.10
Daily living skills subscale 1.42 (.79) – .91 (.47) 1.53
Psychosis subscale .25 (.27) – .25 (.27) .00
Relation to self and
others subscale

54. 1.57 (.67) – 1.32 (.78) .91
Overall mean 1.17 (.55) – .82 (.39) 1.82
Knowledge Test
Multiple choice .42 (.12) – .59 (.15) �4.25��
True=false .52 (.13) – .66 (.15) �3.60�
1t-values represent paired t-tests for data available at 2
timepoints, and estimate of
fixed effects over time for data available at 3 timepoints (see
Data Analysis section).
�P<.05.
��P<.005.
Notes: (1) All t-tests are for paired samples.
(2) On all measures in this table, higher scores indicate worse
functioning,
except the ASI employment composite and the Knowledge Test.
(3) All are means across all items in the scale unless otherwise
indicated.
8 L. M. Najavits et al.
Verification of Drug Use Data. Weekly random urinalysis
verified
self-reported drug use on the ASI. For month 1, of the 32
possible
comparisons (i.e., 8 patients�4 drug types), 93.75% were
accurate.
For month 2, of the 32 comparisons, 84.38% were accurate.
Treatment Attendance. Participants attended an average of 9.88
groups

55. (range 8–12). Percent attendance was 87% of available groups
(SD ¼ .10).
Treatment Satisfaction. On the CSQ, scaled 1 to 4, the mean at
month 2
was 3.49 (SD ¼ .36). On the HAQ, scaled 0 to 4, the mean at
month 1
was 2.84 (SD ¼ .56) and at month 2 was 3.12 (SD ¼ .62).
Comments from
participants at the exit interview included: ‘‘There are a lot of
issues that
affect women differently than men . . . I felt more comfortable
talking about
issues men just would not understand;’’ ‘‘If I didn’t have that
book, I would
have been back out there [using drugs ] in a heartbeat;’’ ‘‘When
I was read-
ing the material I swear this woman [author] was talking at me
when she
wrote this book . . . [It] gave me reasons into why I do what I
do and how
I can change the things that I do.’’ The most common
suggestions were
to make the treatment longer and include discussion of
parenting.
DISCUSSION
This study appears to be the first outcome study of a gender -
focused,
manual-based substance abuse recovery model for women.
Despite
numerous calls for women’s gender-based substance abuse
treatment
(2–4), there has been an absence of empirical research using
manual-

56. based models.
This pilot study evaluated an existing model, titled A Woman’s
Addiction Workbook (5). The workbook was modified for group
co-led
therapy while remaining faithful to the book. Patients completed
readings
and exercises from the workbook, but on a time-limited
schedule of 12
group sessions. We also sought a sample of opioid-dependent
women
in a community-based methadone treatment program to test its
impact
in a naturalistic treatment setting, and among women with
severe and
chronic SUD.
Results indicated significant improvements from intake to 2
months
later on key variables most related to the treatment: the ASI
drug com-
posite, impulsive-addictive behavior, global improvement, and
knowledge
of the workbook concepts. The ASI drug composite was,
moreover, veri-
fied with random urinalysis. Other variables, despite being
nonsignificant
over time, were largely in the direction of improvement based
on means.
Model for Women’s Recovery From Substance Abuse 9
Given the small sample and high severity of the sample, the
results are

57. particularly encouraging and suggest that future trials may be
warranted.
Patients’ high attendance rate (87% of available sessions) and
treatment
satisfaction additionally support the potential use of this model.
The study benefited from rigorous intake SUD diagnoses,
metha-
done stabilization prior to study treatment, a lack of treatment
other than
the experimental group (plus 2 methadone-related individual
sessions
required by the MMTP), the use of standardized assessments,
and some
minority representation (12.5%). Weaknesses, however, were
the pilot
nature of the trial: no control, one group cohort, a small sample,
the
inability to analyze alcohol or legal problems, and no follow -up.
Some modifications to the treatment might be helpful in future
projects. The women wanted more focus on parenting and a
longer treat-
ment. Also, it might be useful to evaluate which book chapters
are most
helpful. The session check-in could also be shortened to allow
more time
for discussion of the material. Future research could compare
the work-
book alone to the therapy group version of the workbook in this
project.
Results of this study are highly encouraging, but preliminary.
With
women’s SUD rate rising over time and at increasingly younger
ages

58. (5), there is a serious need to refine and test promising models
that might
improve women’s recovery.
ACKNOWLEDGMENT
Ms. Glenda Atherton, M.B.A., L.A.D.C., is thanked for co-
leading the
group on which this article is based.
REFERENCES
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Lite-CF, 2005.
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pdf (Accessed February 6, 2005).
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vioral health outcomes in outpatient programs: Reliability and
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report. Psychol Med 1983; 13:595–605.
9. Luborsky L, Crits-Cristoph P, Margolis L, Cohen M. Two
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signs versus
a global rating method. J Nervous Mental Dis 1983; 171:480–
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Assessment Manual
for Psychopharmacology-Revised. Rockville, MD: US
Department of
Health, Education, and Welfare, 1976; 218–222.

60. 11. Wright FD. Beliefs about Substance Use. Philadelphia, PA,
Unpublished
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hierarchical factor
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Model for Women’s Recovery From Substance Abuse 11
Explain how these methodologies are useful !!!!!!!!
(1)
Social Research Methods
A) Identify 3 social research methods used at your Agency
Surveys are manually passed out monthly to clients to complete
regarding treatment modality and staff presentation and their
professionalism and clarity of material.
Participant Observation- Clients are selected from each group
and taken to a selected area by the Agency’s senior director of
quality improvement and given a survey to complete concerning
the quality of service. Their experience facility is documented
to collect data on clients to implement treatment plan as a goal
or objective to be completed law's arrest record helps determine

61. treatment plan for legal needs
Field research -gathering data from the full range of community
needs related to substance use disorder community’s
environment concerning drugs addiction, prostitution, and
homelessness.
Annual reports are design in a pamphlet format and via
web called the Impact report -It provides the total number of
women and children and family members provided services
6274 also 939 adults benefited from prevention services. 1,433
women benefited from treatment and recovery support services.
1,747 children benefited from prevention services. 361 women
benefited from pregnant /postpartum intervention services 263
healthy babies born 97% maintain recovery from substances at
60 days post treatment follow up treatment services 95%
continued engagement in ongoing recovery support programs
and groups at 60 days post treatment follow-up 81% of clients
of all programs discharged to stable housing support in revenue
$11,824,604
Expenses $ 11, 862. 194 – (program services) substance use
disorder services/integrated services /education
/outreach/Management and General, Fundraising.
(See Attachment) 2 research studies!!!!!!!!!
(B)Two empirical Research Studies (Read Syllabus)
(C)What major instruments or system -CMBHS is a web-based
software application for Clinical Management Behavior Health
Service. All of the client’s personal information all
psychosocial information and assessment are stored in this
software. CMBHS case management treatment plan and
screening, and client reports admissions /discharge status,
assessments and client services by month. client tobacco use
counselor case load, report drug court summary, financial
eligibility for active clients, and progress note and psycho
educational note detail.
(D)The CMBHS Clinical Management of Behavioral Health
Services will be utilized by a social worker to assist the client
in meeting their psychosocial needs such as employment stable

62. housing Matt medicated assistant treatment meant to health
treatment
(2) Analysis of Data
(See Attachment 2 research studies)
(3) Computer Usage
Social workers use computers to help compile data and keep
accurate records of clients at Santa Maria. so that their duties
are performed productively and effective, also adhere to legal
stipulations such as privacy laws and HIPAA using computers
also helped meet the needs of the clients.
(B) Limitations for Social Workers keeping up with passwords
and changing passwords, also loss of data during inclement
weather
**Computers are used to enhance service Increase
your productivity. Connects you to the Internet. ...Can store
enormous amounts of information. Beneficial for sorting and
organize, and search for information.
4.Practical Applications of Research
(A)The scientific method made its way into the new world since
the 17th century, it is still used today as it sets the standard for
uncovering knowledge through investigation or inquiry of
questions that relate to the problem at hand or to one that is
projected (Reid, 2001). It defines one’s curiosity for adding to
one’s expertise and dictates that there is sufficient truth towards
the end resolve. A human service worker can build on this
proficiency by conducting an inquiry under the principles of the
scientific method. It assumes that problem solving concludes

63. with the validity and credibility of scientific awareness.
Scientific methods have proven to provide superiority where
knowledge has evolved to be the most powerful induced form of
investigation (Reid, 2001). Defining Scientific Method is
congruent with the research of any topic, situation or world
phenomenon (Rubin & Babbie, 2000). Although, the human
service worker uses this method to uncover the specifics and
ascertains the principles of the scientific method, assessing the
client’s needs and acknowledging peer/family support.
(B)The concern is in the agency would be the percentage of
clients that remain abstinence after treatment.
(C) How to help clients remain abstinent once they Leave
recovery?
1. How to help clients remain abstinent once they Leave
recovery.
What Research design I will use- would be Survey. Many
clients have returned to the agency because they couldn’t stay
sober!!!
2. How would you implement your study- I would pass out
questionnaire to clients that has retuned to the facility at Santa
Maria and allow them to fill it out. I would also have specific
questions on there, that would help them stay sober once they
leave.
3.How would you address issues of diversity and at-risk
population.
4.What form of Statistical Analysis – Causal Analysis
(5) Generalist Application of Research –
A) Social work research addresses psychosocial problems,
preventive interventions, treatment of acute and chronic
conditions, and community, organizational, policy and
administrative issues. Covering the lifespan, social work
research may address clinical, services and policy issues. It
benefits consumers, practitioners, policymakers, educators, and
the general public by: •Examining prevention and intervention
strategies for health and mental health, child welfare, aging,

64. substance abuse, community development, managed care,
housing, economic self-sufficiency, family well-being, and
more.
• Studying the strengths, needs, and interrelationships of
individuals, families, groups, neighborhoods, and social
institutions.
• Providing evidence for improved service delivery and public
policies.
Give TWO EXAMPLES
• Psychosocial assessment and intervention strategies for
persons at risk of and living with cancer.
• Access to mental health services for youth in urban and rural
settings • Depression among elders in long term care and home
health care settings.
• HIV/AIDS prevention and intervention in urban communities.
Explain the significance of practice-informed research
and researched informed practice.!!!!!!
(Practice-Informed Research)
As a social work practitioner, I may recognize the need for
further research to best help my clients. This may occur due to
lack of research about particular struggles, populations, or
interventions. It is important to utilize my practice experience
to support any scientific inquiry. My practice experience will
allow me to avoid certain biases or methods that could harm
subjects or prevent effective, generalizable research findings.
For example, if I have experience with the Latino populati on, I
can avoid including potentially offensive phrases in my research
as I understand their culture. Also, it may become apparent
through practice that there is a lack of evidence-based
interventions. I can utilize research to understand what practices
have shown potential and their likelihood to apply them to the
population(s) I engage with. Practice-informed research
promotes more valid, acceptable research thus encouraging
evidence-based practices.
Research-Informed Practice
To best serve my clients, it is essential to utilize evidence-

65. based practice. By informing my practice with primary and
secondary research, I can ensure the interventions used promote
the best outcome for clients. Research, combined with practice
experience and clients’ values, will provide evidence to support
the use of certain interventions with particular populations. For
instance, from previous experience I may be aware that there
are often feelings of hopelessness associated with depression
and anxiety; therefore, I can use secondary research to find the
best intervention to alleviate those feelings for clients suffering
from either or both mental illnesses. I cannot rely on practice
experience and clients’ values alone. People’s understandings of
certain populations and interventions are often changing as
research continues to be conducted; thus, it is important to
constantly be informed. My clients will rely on my knowledge
and abilities to help them; therefore, I must remain informed
about the most effective interventions for their individual case.
(6) Research Ethics
(A) Santa Maria collection of information is consistent with
code (section 5.02)
(B) NASW code of ethics (section 4 and 5)
4. SOCIAL WORKERS’ ETHICAL RESPONSIBILITIES AS
PROFESSIONALS
4.01 Competence(a) Social workers should accept responsibility
or employment only on the basis of existing competence or the
intention to acquire the necessary competence. (b) Social
workers should strive to become and remain proficient in
professional practice and the performance of professional
functions. Social workers should critically examine and keep
current with emerging knowledge relevant to social work.
Social workers should routinely review the professional
literature and participate in continuing education relevant to
social work practice and social work ethics.
4.02 Discrimination Social workers should not practice,
condone, facilitate, or collaborate with any form of
discrimination on the basis of race, ethnicity, national origin,

66. color, sex, sexual orientation, age, marital status, political
belief, religion, or mental or physical disability.
4.03 Private Conduct Social workers should not permit their
private conduct to interfere with their ability to fulfill their
professional responsibilities.
4.04 Dishonesty, Fraud, and Deception Social workers should
not participate in, condone, or be associated with dishonesty,
fraud, or deception.
4.05 Impairment (a) Social workers should not allow their own
personal problems, psychosocial distress, legal problems,
substance abuse, or mental health difficulties to interfere with
their professional judgment and performance or to jeopardize
the best interests of people for whom they have a professional
responsibility. (b) Social workers whose personal problems,
psychosocial distress, legal problems, substance abuse, or
mental health difficulties interfere with their professional
judgment and performance should immediately seek
consultation and take appropriate remedial action by seeking
professional help, making adjustments in workload, terminating
practice, or taking any other steps necessary to protect clients
and others.
4.06 Misrepresentation (a) Social workers should make clear
distinctions between statements made and actions engaged in as
a private individual and as a representative of the social work
profession, a professional social work organization, or the
social workers’ employing agency. (b) Social workers who
speak on behalf of professional social work organizations
should accurately represent the official and authorized positions
of the organizations. (c) Social workers should ensure that their
representations to clients, agencies, and the public of
professional qualifications, credentials, education, competence,
affiliations, services provided, or results to be achieved are
accurate. Social workers should claim only those relevant
professional credentials they actually possess and take steps to
correct any inaccuracies or misrepresentations of their
credentials by others.

67. 4.07 Solicitations (a) Social workers should not engage in
uninvited solicitation of potential clients who, because of their
circumstances, are vulnerable to undue influence, manipulation,
or coercion. (b) Social workers should not engage in solicitation
of testimonial endorsements (including solicitation of consent to
use a client’s prior statement as a testimonial endorsement of
their particular circumstances, are vulnerable to undue
influence.
4.08 Acknowledging Credit (a) Social workers should take
responsibility and credit, including authorship credit, only for
work they have actually performed and to which they have
contributed. (b) Social workers should honestly acknowledge
the work of and the contributions made by others.
5. SOCIAL WORKERS’ ETHICAL RESPONSIBLITIES TO
THE SOCIAL WORK PROFESSION
5.01 Integrity of the Profession(a) Social workers should work
toward the maintenance and promotion of high standards of
practice. (b) Social workers should uphold and advance the
values, ethics, knowledge, and mission of the profession. Social
workers should protect, enhance, and improve the integrity of
the profession through appropriate study and research, active
discussion, and responsible criticism of the profession. (c)
Social workers should contribute time and professional
expertise to activities that promote respect for the value,
integrity, and competence of the social work profession. These
activities may include teaching, research, consultation, service,
legislative testimony, presentations in the community, and
participation in their professional organizations. (d) Social
workers should contribute to the knowledge base of social work
and share with colleagues their knowledge related to practice,
research, and ethics. Social workers should seek to contribute to
the profession’s literature and to share their knowledge at
professional meetings and conferences. (e) Social workers
should act to prevent the unauthorized and unqualified practice
of social work.
5.02 Evaluation and Research (a) Social workers should monitor

68. and evaluate policies, the implementation of programs, and
practice interventions. (b) Social workers should promote and
facilitate evaluation and research to contribute to the
development of knowledge. (c) Social workers should critically
examine and keep current with emerging knowledge relevant to
social work and fully use evaluation and research evidence in
their professional practice. (d) Social workers engaged in
evaluation or research should carefully consider possible
consequences and should follow guidelines developed for the
protection of evaluation and research participants. Appropriate
institutional review boards should be consulted. (e) Social
workers engaged in evaluation or research should obtain
voluntary and written informed consent from participants, when
appropriate, without any implied or actual deprivation or
penalty for refusal to participate; without undue inducement to
participate; and with due regard for participants’ well -being,
privacy, and dignity. Informed consent should include
information about the nature, extent, and duration of the
participation requested and disclosure of the risks and benefits
of participation in the research. (f) When evaluation or research
participants are incapable of giving informed consent, social
workers should provide an appropriate explanation to the
participants, obtain the participants’ assent to the extent they
are able, and obtain written consent from an appropriate proxy.
(g) Social workers should never design or conduct evaluation or
research that does not use consent procedures, such as certain
forms of naturalistic observation and archival research, unless
rigorous and responsible review of the research has found it to
be justified because of its prospective scientific, educational, or
applied value and unless equally effective alternative
procedures that do not involve waiver of consent are not
feasible. (h) Social workers should inform participants of their
right to withdraw from evaluation and research at any time
without penalty. (i) Social workers should take appropriate
steps to ensure that participants in evaluation and research have
access to appropriate supportive services. (j) Social workers

69. engaged in evaluation or research should protect participants
from unwarranted physical or mental distress, harm, danger, or
deprivation. (k) Social workers engaged in the evaluation of
services should discuss collected information only for
professional purposes and only with people professionally
concerned with this information. (l) Social workers engaged in
evaluation or research should ensure the anonymity of
confidentiality of participants and of the data obtained from
them. Social workers should inform participants of any limits of
confidentiality, the measures that will be taken to ensure
confidentiality, and when any records containing research data
will be destroyed. (m) Social workers who report evaluation and
research results should protect participants’ confidentiality by
omitting identifying information unless proper consent has been
obtained authorizing disclosure. (n) Social workers should
report evaluation and research findings accurately. They should
not fabricate or falsify results and should take steps to correct
any errors later found in published data using standard
publication methods. (o) Social workers engaged in evaluation
or research should be alert to and avoid conflicts of interest and
dual relationships with participants, should inform participants
when a real or potential conflict of interest arises, and should
take steps to resolve the issue in a manner that makes
participants’ interests primary. (p) Social workers should
educate themselves, their students, and their colleagues about
responsible research practices.