Familial Influences on Treatment and Substance Use Among Mothers Engaged in Prostitution

• Published date: 01 October 2021
• Author: Aaron Murnan,Megan Ferriby Ferber
• Date: 01 October 2021
• DOI: http://doi.org/10.1111/fare.12492

A M The Ohio State University

M F F Saint Louis University

Familial Inuences on Treatment and Substance Use

Among Mothers Engaged in Prostitution

Objectives: This study explores how the family

system, which includes family members, roman-

tic partners, and children, inuences substance

use treatment decisions and behaviors among

women engaged in street-level prostitution.

Background: Women engaged in street-level

prostitution can be involved in and benet from

substance use treatment; however, these women

report worse treatment outcomes comparedwith

other treatment-seeking women. Little is known

about systemic inuences on women’s substance

use treatment, which may contribute to poor

treatment outcomes.

Methods: Wom en ( n=15) between the ages of

20 and 53 years participated in qualitative inter-

views exploring their perceptions of how their

family system inuenced substance use treat-

ment decisions and behaviors. Inductive content

analysis was used to analyze data and identify

themes within participant responses.

Results: Women reported on multiple shared

experiences of how family members, romantic

partners, and children directly and indirectly

inuenced their substance use treatment deci-

sions and behaviors.

Conclusions: Intervention efforts that engage

supportive family members and children in

women’s treatment or support women’s positive

Abigail Wexner Research Institute, Nationwide Children’s

Hospital, 700 Children’s Drive, Columbus, OH 43205

(aaron.murnan@nationwidechildrens.org).

Key Words: Family systems theory, street-level prostitution,

substance use treatment.

interactions with family are likely to provide

unique advantages compared with individual

treatment.

Implications: Providers serving these uniquely

vulnerable women should consider their fam-

ily systems’ inuence when conceptualizing

and intervening, in an effort to promote better

long-term treatment outcomes.

In the United States, the pervasive and

widespread risks associated with street-level

prostitution have been well established (Chu-

dakov et al., 2002; Dalla et al., 2003; Salfati

et al., 2008; Walls et al., 2009). Women engaged

in street-level prostitution often report severe

patterns of substance use, as well as a desire

to reduce both substance use and street-level

prostitution involvement (Dalla, 2002; Gilchrist

et al., 2005; Sallmann, 2010). Despite high rates

of substance use treatment, women engaged

in street-level prostitution report signicantly

worse substance use treatment outcomes com-

pared with treatment-seeking women not

engaged in street-level prostitution (Burnette

et al., 2009). Little research to date has explored

how the family and its individual members

inuence women’s substance use treatment

decisions and behaviors among this high-risk

population. This represents an important gap in

the literature given the well-established recip-

rocal relationships between family factors and

substance use (Rowe, 2012).

The bidirectional relationship between

street-level prostitution and substance use

1162 Family Relations 70 (October 2021): 1162–1177

DOI:10.1111/fare.12492

Familial Inuences on Treatment and Substance Use 1163

is well documented (Gilchrist et al., 2005;

McCracken, 2013; Sallmann, 2010). Many

women engage in street-level prostitution to

support their substance use and report more

severe patterns of substance use than women in

similar circumstances who are not engaged in

prostitution (Gilchrist et al., 2005; Nuttbrock

et al., 2004). Substance use is strongly cor-

related with street-level prostitution; as the

length of prostitution involvement increases,

so does severity and frequency of substance

use (Burnette et al., 2009; Murphy, 2010; Sur-

ratt et al., 2004). Even so, women engaged in

street-level prostitution report a desire to reduce

street-level prostitution (88%) but identify sub-

stance use as a signicant barrier (Dalla, 2002).

This suggests that substance use treatment may

represent a critical rst step in helping women

achieve treatment goals related to substance use

and street-level prostitution.

Substance Use Treatment and Family Systems

Theory

A limited number of studies have evaluated sub-

stance use interventions among this population.

Generally, women reporting street-level prosti-

tution enter treatment as a result of involvement

in the criminal justice system or an emergency

department visit (Arnold et al., 2000; Dewey

& St. Germain, 2016). Once in treatment,

women commonly receive detoxication and

other medically assisted treatments, as well as

traditional 21- or 28-day treatment, outpatient

counseling, and 12-step programming (Nut-

tbrock et al., 2004). Only two studies have

tested individual-based interventions target-

ing substance use with women engaged in

street-level prostitution (Burnette et al., 2009;

Yahne et al., 2002), and one tested a family

systems intervention (Murnan et al., 2017).

Findings show that this population of women

can be engaged in and benet from substance

use treatment. Specically, reductions in sub-

stance use, as well as subsequent reductions in

prostitution posttreatment, were observed. How-

ever, women engaged in street-level prostitution

still report signicantly more severe substance

use and mental health symptoms posttreatment

compared with other women who are seeking

substance use treatment (Burnette et al., 2009).

These ndings suggest that limitations exist

within traditional, individual-based substance

use treatment approaches in addressing the com-

prehensive and unique needs of this population.

Family therapy and family systems the-

ory informed interventions are not commonly

received by this population. A secondary anal-

ysis conducted from a larger clinical trial

evaluating the effects of an ecologically based

family therapy (EBFT) incorporating a family

systems approach as an adjunct to women’s

substance use treatment was conducted with

women reporting street-level prostitution (Mur-

nan et al., 2017). Findings indicated that women

engaged in street-level prostitution benet

from participation in a family systems theory

informed intervention with their child. Specif-

ically, Murnan et al. (2017) found that women

assigned to the family systems informed EBFT

reported greater reductions in substance use

and depressive symptoms, as well as greater

improvements in mother–child interactions,

compared with those assigned to an individually

delivered health intervention.

One of the hallmarks of family systems

theory is the conceptualization of individuals

within their family system and examining how

family members’, particularly children’s, reac-

tions inuence individuals’ decision-making.

This may be particularly salient for women who

report street-level prostitution because most

have children (91%; Sloss et al., 2004) and

cite their children as motivators for reducing

and maintaining lower rates of substance use

(Murnan, in press). Women also report ten-

sion within relationships with their children

and children’s primary caregiver (Murnan &

Holowacz, 2020), which likely contributes to

their substance use and treatment behaviors.

A richer understanding of the family dynam-

ics and relationships in which these women

are embedded, and how the family inuences

their substance use and treatment behaviors,

is imperative to informing future intervention

efforts.

Family systems theory. Family systems theory

(Broderick & Smith, 1979; Jackson, 1965;

Kantor & Lehr, 1975) posits that individuals

cannot be understood without understanding the

larger systems in which they are embedded and

considers the family system to be the most inu-

ential system (Christensen & Arrington, 1987;

Kantor & Lehr, 1975). Through this lens, the

whole of the family is greater than the sum

of its individual members (Broderick, 1993).