"You're Not Alone": The Power of Peer Mentoring for Pregnant Women With Substance Use Disorder

Purpose:  Substance use disorder (SUD) accounts for an estimated 10.9% of mental health disease burden globally¹. In the United States, SUD is increasing nationwide², particularly in rural areas³, and more than 11% of women of reproductive age and 5% of pregnant women use illicit drugs². For many women, pregnancy is a time of hope and an opportunity to address substance use^4,5. Increasing social support is important to the recovery process for pregnant and postpartum women with SUD, particularly through connection with other women in similar situations⁶. Programs that provide social and community support, integrated with clinical care for pregnant women with SUD, are recommended^4,7. Peer mentoring models have been demonstrated to be effective in promoting SUD recovery among veterans⁸ but little is known about the effect of peer mentoring for pregnant substance users. This is relevant as substance use during pregnancy has significant maternal and neonatal health consequences⁹ and pregnant women with SUD may fear potential legal consequences, including the loss of parental rights¹⁰. Understanding the value of peer mentoring from the insider perspective of women in recovery who are peer mentors with lived experience of SUD in pregnancy is important in order to develop effective programs to support pregnant women with SUD. Therefore, the purpose of this study was to describe from the perspective of women in recovery with lived experience of substance use in pregnancy, (1) the experience of mentoring currently pregnant women with substance use disorder, and (2) what it means to be in recovery, in order to discover opportunities for nurse-led interventions that could bridge community support and clinical care in a way that will promote recovery from substance use and lead to positive family building.

Methods:

Design: Ethnographic, community-based participatory study using narrative inquiry

Participants: Five women with lived experience of SUD in pregnancy who are in recovery and serve as peer mentors for currently pregnant women with active SUD

Setting: A rural community in Massachusetts, United States

Data collection: Peer mentors took part in a 3-day collaborative digital storytelling workshop¹¹, in which each participant wrote and produced a three-minute digital story telling her personal story of peer mentoring, in her own words. Each participant also took part in a follow-up, in-depth, individual interview approximately one month after the workshop. The researchers wrote field notes in and around the digital storytelling workshop and the individual interviews, to document contextual (etic) details. Key workshop activities and the follow-up interviews were audio-recorded to capture emic, or insider, viewpoints.

Analytic approach: At the end of the digital storytelling workshop, the five digital stories were screened and discussed by the group, serving as a first level of analysis. The authors then conducted additional content analysis of the stories and interviews, focusing on findings in the emic data (i.e. transcripts of audio-recordings of digital storytelling activities and follow-up interviews) related to the experience of peer mentoring and what it means to be in recovery from substance use.

Results:  Women in the study described the hopelessness and loss they experienced related to addiction, the path to recovery, the meaning of being in recovery, and the ways in which peer mentoring supports each of these phases. Realizing that as women and mothers they were not alone in their struggle with addiction, and seeing other women in recovery, motivated their own recovery and their drive to provide continued peer mentorship to others. The work of achieving recovery was an “inside job”, strengthened by social and community support. As women in recovery, they viewed themselves as contributing to the development of hope for women with active addiction. Peer mentoring became an all-encompassing job, one that not only supported their mentees, but also bolstered the continued recovery of the mentors themselves.

Conclusion:  Peer mentoring may be a powerful tool for providing social and community support to pregnant women with SUD in rural settings. Further work is needed to understand the benefit of peer mentoring for women with SUD in other settings in the United States and globally in order to promote health and recovery from SUD. Nurses are in a unique position to link such community level support with existing clinical care programs in order to maximize the health of pregnant women and their neonates who are affected by substance use disorder.