Substance use, pregnancy, and parenthood : A study on problematizations and solutions

Sammanfattning: With the starting point in the view that how we interpret a problem is decisive for how we think this problem should be dealt with, the overall aim of this dissertation is to explore problematizations of substance use in relation to pregnancy and parenthood within different settings. The dissertation consists of four studies, based on different empirical materials, that analyze problematizations of substance use, pregnancy, and parenthood from different perspectives. Elucidating how these constructions are made in social work related settings can in the long run contribute to improve the ways that pregnant women and parents with substance use problems are approached.Study I analyzes the Swedish discussion on the diagnosing of Fetal alcohol spectrum disorders (FASD). The data consists of a report from a Swedish authority and webpage material from an FASD interest organization. The results show that the interest organization and the authority have different views on whether FASD diagnoses should be used. The analysis suggests that the discussion on FASD is structured by three main discourses; a scientific discourse, a pragmatic discourse, and an ethical discourse.Study II analyzes professional accounts of substance-using pregnant women’s transitions into parenthood. Professionals within maternity care were interviewed in focus groups. The results show that the professionals related to two, sometimes contradictory, ideals of, on the one hand, “believing in the patient” and on the other hand “being realistic” when reflecting on the patients’ prospects to function well as parents.Study III is carried out as a scoping review aimed to give an overview of research on psychosocial interventions targeting parents with substance use problems. It has a focus on underlying assumptions motivating these interventions. The results show that all studies but one focused on women as parents. Most of the interventions were primarily concerned with the psychological deficits of these mothers, while only seldom addressing broader social and structural factors.Study IV aims to explore how parents with previous substance use problems narrated their experiences of becoming and being parents. The study participants were all active in the 12-step movement. The results show that the way they narrated their experiences of substance use problems, recovery, and parenthood was structured by a classic 12-step storyline. The participants described how their recovery processes had made them more emotionally present and skilled in handling their own feelings – competences they described as important resources for them as parents. The four studies, taken together, show some patterns in how substance use, pregnancy, and parenthood were problematized in relation to each other. The problematizations tended to portray parents, and especially mothers, with substance use problems as posing risks towards their children’s psychological and physical wellbeing. Furthermore, there was a tendency to define these parents solely based on their substance use problems, without acknowledging potential individual variation in parenting capacity. Finally, the solutions presented had a clear individualistic focus, emphasizing, for example, the importance of individual motivation and the willingness to comply with treatment, but only occasionally taking contextual and structural factors into account.