Background and Objective: In 2018, 51% of the 63 pregnancy-associated deaths of women in Indiana were attributed to substance use disorder (SUD), with Black women being disproportionately affected. To address the need for more effective SUD treatment interventions, the community-based addiction reduction (CARE) program connects women of child-bearing ages with SUD with addiction recovery coaches (ARCs) to provide personalized supports throughout recovery. To identify program characteristics that influence the retention of women of color in the program, quantitative analysis of CARE survey data and qualitative analysis of CARE ARC narrative entries of participant encounters were performed.
Project Methods: 251 women were enrolled in the CARE program. Chi-square/T-tests compared survey responses by race for treatment status, treatment motivation scales, and retention in the program at intake, 2-, 6-, 9-, and 12-month follow ups. Qualitative analysis of ARC narrative entries was conducted following thematic analysis and crystallization immersion analytic methods based on the grounded theory.
Results: Statistical analyses revealed White compared with Black women in the CARE program were significantly more likely to be in treatment at intake (p<.001) and more motivated to engage in recovery treatment (p<.001). Despite these differences, Black women were retained longer in the CARE Program at 2- (p<.006), 6- (p<.011) and 9-(p<.004) months. The ARC narrative entries were initially coded and emergent themes mapped well to the four types of supports provided by peer recovery coaches as outlined by the Substance Abuse and Mental Health Services Administration: emotional, instrumental, informational, and affiliational. Qualitative analysis of ARC narrative entries by race are currently underway.
Conclusion and Potential Impact: The inclusion of ARCs as integral members of SUD recovery programs may preferentially provide Black women with SUD the opportunity to build more trusting relationships with these peer coaches, thereby increasing their participation and retention in SUD-related treatment.
Children's literature published in the United states during the 1820s contributed significantly to a common cultural understanding among nineteenth-century whites of African Americans as cheerful dependents when treated with kindness and dangerous rebels when abused. In this fiction, representations of black adults as childlike figures grateful to their masters for taking care of them helped to defuse fears of black violence but also suggested that people of African descent did not deserve the same political and legal rights that white citizens possessed. Since children of the 1820s grew up to be the adults of the Antebellum period, these texts played an important role in shaping how white Americans engaged in and responded to the contentious debate over slavery and the place of African Americans in society as the civil war approached.
American authors of the 1850s perpetuated the same racial themes found in children's literature of the early nineteenth century in the novels they wrote to condemn or to defend the slave system. Like juvenile literature of the 1820s, these texts infantilized African Americans to make them seem unthreatening to white readers. As debates over slavery heated up, however, antislavery authors of the 1850s began to turn to light-skinned slave characters to elicit sympathy from a mainly white audience. While such a literary strategy persuaded some Americans of the injustice of a system that held whites in bondage, it failed to promote the cause of full citizenship for all African Americans.
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