Psychology ETDs

Publication Date

Fall 12-15-2017


Accessible services for users of prenatal substances are lacking, and treatment engagement is poor with services that are available. Furthermore, legal consequences are often punitive, which ultimately damages the well-being of mother and child. Milagro and FOCUS are two New Mexico programs that provide comprehensive, coordinated care, including medication-assisted treatment, to former users of prenatal substances during pregnancy (in the Milagro Program) and for three years post-birth (in the FOCUS Program). This mixed methods study explored the lived experiences of women from this complex, high-risk population, using a high-engagement sample of women who utilized services at both Milagro and FOCUS. Twenty-four former opioid users ages 25 to 42, with children ages 3 months to 35 months, were interviewed about their experiences of substance use, treatment services, and motherhood. To further characterize this sample, the study measured adverse childhood experiences, socioeconomic status, social support, and participants’ therapeutic alliances with their early intervention specialists in the FOCUS program. Significant themes emerged from both qualitative and quantitative data highlighting considerable hardships but also the substantial resiliency of these women, especially as it related to their commitments to their children. Most had been surprised by their pregnancy, and half had tried and failed to obtain substance use treatment due to lack of services or accessibility, even before engaging with the Milagro program. All participants expressed desire to maintain sobriety for the sake of their children. Most reported at least one childhood trauma as well as current psychosocial stressors, and yet all women also reported some kind of positive growth or resiliency factor(s). All participants reported having positive interpersonal support from the Milagro and FOCUS programs. Such findings advance an alternative narrative to understanding this population than those motivating the punitive legal measures mandated in 24 states. This study suggests that comprehensive, coordinated care from pregnancy through toddlerhood that fosters strong therapeutic alliances between providers and patients, can effectively engage women in this population and help sustain both sobriety and well-being. Suggestions for future research, such as exploring the potentially critical role of therapeutic relationships in the engagement process for this substance-using population, are offered.

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First Committee Member (Chair)

Sarah J. Erickson, PhD

Second Committee Member

Peggy MacLean, PhD

Third Committee Member

Andrew Hsi, MD

Fourth Committee Member

Steven Verney, PhD




prenatal substance use, qualitative research, opioid use, comprehensive care, resiliency, treatment engagement

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