Substance Abuse Attachment Theory Based Treatment Plan for Teenage Pregnancy


The purpose of this research is to explore Substance Abuse Attachment Theory Based Treatment Plan for Teenage Pregnancy. This chapter begins with background and context of the research, the attachment theory as a model of intervention, the connection of teenage Pregnancy and Substance Abuse, factors contributing to teenage pregnancy, risks issues relating to substance abuse and teenage pregnancy in the US. This study focuses on predictable association with problematic Substance Use. The first chapter describes the research problem, gaps existing in the context, research purpose, questions, and the importance of the study to clinicians.

Background and Context

Substance abuse and dependence represents a distinct end of a similar illness process. Various researchers have defined the term based on different research findings or data gathered in the field. Centre for Substance Abuse Treatment (2001) defines drug abuse as an intense need to obtain an increasing amount of a specific element(s) to the exclusion of all other activities. Similarly, according to Erickson et al (1985), substance abuse is a pattern of using drugs that contribute to a person’s health problems. The health problem in context can include family and friends issues, trouble with law and poor performance at school and work. Substance abuse is a regular issue that sweeps across all social classes and ethnic groups across the world; hence, according to Centre for Substance Abuse Treatment (2001), substance abuse is a major disease and not a character affecting huge percentage of teenagers worldwide. On the other hand, Alexander (1996) defines substance dependence has an attachment, to a particular agent, over a long period; this attachment contributes to behavior problems, physical harm and association of people who use drugs. Withdrawal or discontinuing the use of the substances often effects in specific withdrawal syndromes. Dickey and Azeni (1996) cite these syndromes alteration in the level of a person consciousness, mostly a reduction in sensitivity. Suppression of the brain is also noted, this condition can make a person stop breathing which can sometimes lead to death.

Newcomb and Bentler (1989) cite that teenagers have actively been involved in using substances in order to “get high”. The need to “get high” has contributed to substance attachment leading to depression and other health complications. In pregnant women, substance abuse can lead to physical and cognitive problems to a baby. The baby may be born with addiction and withdrawal syndromes (Dickey and Azeni, 1996). Hence, lack of effective intervention strategies has encouraged the situation.

Attachment Theory

The attachment theory attempts to explain the complex nature of human relationship and interactions. As Ainsworth et al (1978) notes, early childhood experiences play a major role in defining the manner in which one relates with others in adulthood. Such experiences will also affect romantic relations at later stages of an individual’s development. The type of expectations an individual will have in an intimate relationship will largely be influenced by the original family structure and values.

Newcomb and Bentler (1989) suggest that individuals express, to their romantic partners, the interaction developed between family members at a later stage. This means that a child brought up in a family where criticism, yelling and battering are the order of life tend to transfer the same to their romantic partners and vice versa (Ainsworth et al, 1978). The theory, therefore, emphasizes the critical role a child’s experiences emanating from parents’ actions, talks and behavior have on their relational behavior in the future. The theory is therefore, an important tool of information to solving problems of teenage pregnancy and other social ills be-devilling youths in societies.

As Cohn (1990) puts it, “a child who misses attachment needs in will go out to look for these needs in an illegal way” Children learn adults’ traits from their adult role models, in case such adult role models are missing, they opt to learn from their peers. A parent’s love is thus proved an irreplaceable gift to the child. It acts as a guide to the child’s behavior as an adult.

Connection of teenage Pregnancy and Substance Abuse

According to Newcomb and Harlow (1986), substance abuse and teenage pregnancy in the world is on the increase, especially among school dropouts who are not able to engage in meaningful activities. Newcomb and Harlow (1986) defines teenage pregnancy as underage girl (within the age bracket of 13 – 19) becoming pregnant.

Other authors such as Dickey and Azeni (1996) designate teen pregnancy as, unpremeditated pregnancy during adolescence. In America, about 750,000 of teenagers aged 15-19 years become pregnant each year (Dickey and Azeni, 1996). Teenage pregnancy has been connected with regular intercourse without reliable contraception, sexual compulsion, poor sexual communication among partners, the notion that one has to prove one’s fertility, promiscuity and poverty and substance abuse. The report released by SAMHSA (2011) looking into teenage pregnancy admissions to drug abuse and treatment in 1992 and 1997 indicates the level of substance abuse during pregnancy has changed. The SAMHSA (2011) was embraced in examining the pattern and how they have shifted in fifteen years across various ethnicities across the United States.

SAMHSA (2011) argues that all admissions examined were centered on teenagers between the ages 13 – 19 years. For example, in 1992 and 2007, nearly 4% admissions in this age bracket were pregnant (SAMHSA, 2011). The leading substance abuse by pregnant teen has transformed in the last 15 years. According to Alexander (1996) statistics, alcohol was mostly used substance by teenage mothers admitted for treatment in 1992; however, in 2007 the main substance reported being embraced was the Marijuana.

Marijuana abuse doubled with about 45.5 percent of admissions confirming the marijuana was their main substance in contrasts with nineteen percentages in 1992. In addition, methamphetamine was also another substance used by teenager mothers. Methamphetamine use increased from 4.3 percent to 18.8 percent (Alexander, 1996).

Research indicates a strong link of substance abuse and peer pressure. As emphasized by many social science scholars, different influential theories of teen pregnancy and substance abuse borrows heavily on the idea that peer relationships are in fact the driving risks factors associated with pregnant teen drug abuse (Alexander, 1996). The main socialization model illustrates the effect of socialization control in a child’s life. In this model, socialization controls in relation to family and schools, peers, influence adolescent behavioral outcomes in the association between her and the environment. This theory posits that a person’s character and tendencies are not only connected to substance abuse and deviancy, but they affect the results when they have emotional impact in the course of interaction existing between an individual and socialization sources. Hence, the assessment points out that sums that peer groups, on a larger scale, influence teen’s behavior (Dickey and Azeni, 1996). Consequently, on the second model, the peer cluster theory emphasizes the impact of close friends to decisions taken by an individual. Close friends, to a larger extend effect on the growth and acceptance of behavior culture. This model indicates that teens are more predispose to drug abuse if their peer supports this norm.

Causes of Teen Pregnancy

Ainsworth (1989) linked teenage pregnancy to peer pressure; he points out that during the adolescent period, teens feel intense pressure to establish friends in the society. Adolescence being a stage one is in search for identity will allow their peers to influence most of their decisions and choice without necessarily understanding the consequences of these decisions, like indulging in unprotected sex. Teenagers indulge in sex as an alternative to appear calm and sophisticated. However, in some instances; they end up with unplanned pregnancies. According to Najavits et al (1997), about 29% of pregnant teenagers reported that they felt pressured to indulge in sex, about 33% of pregnant teenagers confirmed that they were not prepared for a sexual relationship, but went ahead because of pressure exerted on them and fearing rejection or ridicule from their peers had to conform

The causes of teen pregnancy have been linked to various factors. Erickson et al (1985) illustrates that sexual abuse or rape has overtime contributed to increasing number of teen pregnancy across the world. Thompson (1980), states that about 43 to 62 percent of teenagers, as per findings from a research, confirmed that an adult male impregnated them. In addition, substance abuse has contributed greatly to the rise in number of teenage pregnancies. Many teenagers experiment with drugs and alcohol hence in the end; they form an attachment leading to substance dependency. Substance reduces a teenagers capacity to control her instincts, hence contributing to 75% of pregnancies that occur between the ages of 14 -21. According to survey carried out by National Institute on Drug Abuse (1997), about 91% of teens stated that although they were drinking, they did not have an original plan of having sex when they conceived. The film industries and media have overtime, increased the glamorization of teen pregnancy hence encouraging teen pregnancy (Drake and Mueser, 1996). The mass media has exaggerated teen pregnancy in new stories and movies, this has encouraged teens to seek exploration in the area. This has encouraged teens to indulge in irresponsible sexual activities. According to Ainsworth (1989), during adolescent period, teenagers center their attention on their personal appearance and how their peers view them.

Alexander (1996) in some of his studies concluded that teenage pregnancy could result from the absence of parents in their lives. Parents provide guidance and support that young teenagers demand in order to make informed choices in their lives (Dickey and Azeni, 1996). Such decisions include sex. Ainsworth (1989) also explores that when a teen feels constraints to share with her parents on matters regarding sex because of cultural link on reproduction, it is probable that, peers will assume the role of providing advice on sex matters. Considering these teenagers also have the same predicament with their parents, they lack important or proper sex education. Therefore, end up misleading the others too.

According to Najavits et al (1997), pre-natal drug abuse is a major troubling issue currently present in the world. Pregnant women who abuse substances expose not only themselves but put their unborn children’s to numerous health possibilities. Drake and Mueser (1996) illustrate that substance abuse associated birth deficiencies can occur in the form of either mental or physical, which, in most occasions are often severe.

In United States, statistics indicates that substance abuse among pregnant teenagers and mothers is significant. According to Dickey and Azeni (1996) in the year 2002-03, about 4.3% of pregnant teenagers aged between 15- 24 had used hard drugs in the initial months of their pregnancy in contrast to 10.4% of non- pregnant teenagers in this age bracket. Consequently, about 8.0 %, 15-25 years, were more likely to have tasted hard drugs in the past one month of their pregnancy (Substance Abuse and Mental Health Services Administration, 2004). Recent statistics asserts that the number of children born in the United states by mothers who have used drugs during pregnancy at about 222,000 annually (National Institute on Drug Abuse, 1997). The level of drug use during pregnancy for Hispanic, white and blacks women is categorized as 1.7, 3.6 and 6.2 percent respectively (Substance Abuse and Mental Health Services Administration, 2004). The direct influence of pre-natal illicit drug use in infants is contentious with some study indicating critical damage and other study indicating prolonged effects for both the mother and the infant (National Abandoned Infants Assistance Resource Centre, 2003).

The National Centre on Addiction and Substance Abuse (1999) illustrates that illicit drug use is liable for intense increase of child welfare issues for the last twenty years.

Risk Factors for Adolescence Substance Abuse

In an attempt to resolve the surging issue in the world, i.e. increasing pregnant mothers and substance abuse, researchers have explored various risk factors connected to teenager’s substance abuse (Mallouh, 1996). However, two, critical risk factor have been given a priority because of their great impact. Social research scientists have categorized these factors as individual and contextual based. According to Mallouh (1996) individual risk factors encompasses factors such as; personality, hereditary susceptibility and peer relationship. On the other hand, contextual risks factors have been grouped as drugs availability, social norms and standing drug regulations (Dickey and Azeni, 1996).

Other predisposing factors of teenagers to drugs include

Early Antisocial Behaviors, according to Najavits et al (1997), substance abuse is one outcome of “proneness to delinquent behavior” and indicates a larger symptom of deviance in which a wide array of delinquent behavior shared collective precipitants. Additionally, school factors such as poor performance, dropout, lack of education commitment and truancy have been noted as most antecedents to initiation, substance abuse and use of drugs. However, school challenges themselves may not lead directly to substance abuse, but rather social factors connected to education performance may be connected substance abuse.

Drake and Mueser (1996), in his research, he linked substance abuse as response to stress. Drake and Mueser (1996) investigated substance abuse among teenagers as strategy in response to a seeming loss of control, lack of hope in life and a sense of meaningless. He noted that adolescents might invoke substance abuse as an alternative of temporarily alleviating discomfort linked to life events, which they perceive as being uncontrollable, and can be attributed largely to comprehension of increased substance abuse among low esteemed teenagers and those from unstable family backgrounds.

Teenage pregnancy In the United States

In the United States, teen pregnancy has become a countrywide endemic i.e. more and more adolescents fall pregnant and ultimately gives birth and decides to raise their children. However, this asserts a great financial burden to the society and individual families when “children” give birth to their own children. Presently, in the US, 12 million adolescent girls are sexually active. Statistics illustrates that, the age of instigating sexual activity is 16 years Thompson (1980). However, in some states such as New York, the average of first initial sexual contact is 15 years for white, 12 for blacks and 13 for Hispanic teenager’s (Thompson, 1980). In real figures, a large percentage of white than other ethnicity teenagers become pregnant, however, disadvantages teenagers account for disparate figure of teen pregnancies in the country. Whereas, 27% of the teenager population is made up of minority, they account for 40% of teenage pregnancies and childbirths (Thompson, 1980). The high percentage of teenage pregnancies has been linked to lack of information on reproduction, poverty and family.

Statement of the Research problem

In the United States during the counter-revolutions of the 1960’s, teenager substance abuse emerged to be one of the universal issues. This was not only happening in America, but substance abuse was also sweeping across the world. In 1979, statistics indicates that 31.8 percentages of teenagers aged 12 – 17 acknowledged using hard drugs (Najavits et al, 1997). In 1980’s, an amalgamation of anti-drug, alcohol initiatives and public sensitization appeared to have successfully reduced teenager substance abuse by almost one-third. However, despite this major initiative, in early 1990’s teen illicit drug abuse was again on the increase. A large percentage of teen do not willingly plan to become parents.

However, a sizeable number of teens will embrace parenthood, especially if they are married to the child’s father (Newcomb and Harlow, 1986). For most teenagers and their families, however, pregnancy normally gets them unprepared. Pregnancy can be a stressful for the teen and the family. Research has indicated that pregnant teenagers have been diagnosed with a high percentage of family dysfunction (Newcomb and Harlow, 1986).

In contrast to non-pregnant teenagers, pregnant teenagers have illustrated poor communication towards their mothers and fathers (Erickson, 1985). Nonetheless, teenage pregnancy asserts a distinctive strain on a teenager and her family. These communication breakdowns have critical repercussions. Among the pregnant teenagers, reduced or lower social association or support is connected to depression, substance abuse and dependence. According to Erickson (1985), several researchers have documented a correlation between lower level of family support and substance abuse in teens. According to Drake and Mueser (1996), pregnant teenagers have few or limited life goals or ambition compared to their counterparts, and fewer opportunities for laying strategies for their future lives.

Hence, substance abuse has been viewed as a solace providing short-term strength and hope. Ainsworth (1989) indicates that alcohol consumption and cigarette smoking have widely formed part of pregnant teenagers. Hence, dependence on these substances has contributed to strong attachment. The implication of this attachment has shown itself through symptoms such as attention problems, reduced or low IQ, conduct disorder (Dickey and Azeni, 1996). Besides, empirical evidence regarding alcohol consumptions during pregnancy has been clear. It has been associated with exposure of the unborn child to cognitive problem, in other words, if a pregnant teenager drinks, their child tend to have a higher concentration of alcohol substance in their blood stream.

In this case, over time, the unborn child develops an attachment to alcohol. The strong addiction or attachment placed on these substances has provided a substantial problem for health workers in devising fitting strategies. Hence, presently, it follows; teen pregnancy and substance abuse endeavors to epitomize a subtle and severe social issue calling for effective strategies for containing it.

Knowledge Gaps and the Relationship with the Research

Despite major developments in the area of substance abuse and teenage pregnancy, there still exist gaps in fixing the right prevention and treatment strategy. Hence both prevention and treatment assessment are required to reduce the connection between substance abuse and teenage pregnancy.

Attachment theory, overtime, has been used generally in preventing substance abuse among adult’s behaviors, hence failing to address the needs of teen pregnancies. Moreover, much of the research done by various social scientists on substance abuse among teen pregnancy have focused on attachment and individual differences in attachment, in the context of romantic relationship and peer relationship, however, in recent years, much attention has been geared towards teen pregnancy and to teen mothers i.e. care giving thus extending towards personal relationship. Hence, this calls for further research in the field to grant effective strategies for clinicians and caregivers in the prevention of substance abuse among teenagers.

Statement of the Purpose

The population of teenagers predisposed to substance abuse across the world is increasing at an alarming rate. There is a direct and indirect connection to the consequences for these teenagers such as illness, physiological issues and emotional concerns such as detachment from the society and disruption of a bond existing between the families. Hence, the purpose of this applied research dissertation is to develop an attachment-theory based, psycho-educational program for the treatment of substance abuse disorder among teenage mothers. The focus will be on reducing or elimination of drug abuse during pregnancy and after the birth of the baby. With the growing need to give recognition to attachment style of the young mothers and the attachment that they will develop to their babies, it seems important to give clinicians a tool to work with this population.

Research Objectives

The objectives of this applied research are to explore the following:

  1. To determine whether the attachment-theory based, psycho-educational program can be an effective treatment for substance-abuse disorder among teenage mothers.
  2. To establish whether the attachment-theory based, psycho-educational program improve the parenting skills of substance-abusing teenage mothers.
  3. To determine whether this program can help clinicians work with and understand teenage motherhood

Research Questions

  1. Can the attachment-theory based psycho-educational program be an effective treatment for substance-abuse disorder among teenage mothers?
  2. Can the attachment-theory based psycho-educational program improve the parenting skills of substance-abusing teenage mothers?
  3. Might the program help clinicians work with and understand teenage motherhood


Substance abuse among pregnant teens and after the birth of the baby is a major health challenge. This can bread other undesirable issue such as; family violence, depressions, death, child abuse. This study therefore will try to incorporate the real causes of substance abuse among teenage pregnancy. By embracing the attachment model and psycho-educational program, the study will be providing a more precise intervention for the cause. Additionally, through attachment-based theory, the study aims at equipping teenager mothers with effective parenting skills. These skills will be important in strengthening attachment with the child.

Reference List

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Ainsworth, M. D. S, Blehar, M., Waters, E., & Wall, S. (1978). Patterns of Attachment: A Psychological Study Of The Strange Situation, New Jersey: Erlbaum.

Ainsworth, M. D. S. (1989). Attachments beyond Infancy. American Psychologist, (44), pp., 709- 716.

Center for Substance Abuse Treatment. (2001). Telling their Stories: Reflections of the 11 Original Grantees that Piloted Treatment for Women and Children for CSAT. Rockville: DHHS Publication.

Cohn, D. A. (1990). Child-mother Attachment of Six-year Olds and Social Competence at School. Child Development, (61), pp. 152-162.

Dickey, B. & Azeni, H. (1996). Persons with Dual Diagnoses of Substance Abuse and Major Mental illness: their Excess Costs of Psychiatric Care. American Journal of Public Health, (86), pp. 973-977.

Drake, R.E., Mueser, K.T., Clark, R.E., & Wallach, M.A. (1996). The course, treatment, and outcome of substance disorder in persons with severe mental illness. American Journal of Orthopsychiatry,(66), 1, pp. 42-51.

Erickson, M., Sroufe, A., & Egeland, B. (1985). The Relationship between Quality of Attachment and Behaviour Problems in Preschool in a High-Risk Sample. Growing Points of Attachment Theory and Research. Monographs of the Society for Research in Child Development, (50), pp. 147-166.

Mallouh, C.M. (1996). The Effects of Dual Diagnosis on Pregnancy and Parenting. The Journal of Psychoactive Drugs, (28), 4, pp. 367-380.

Najavits, L.M., Weiss, R.D., & Shaw, S.R. (1997). The Link between Substance Abuse and Posttraumatic Stress Disorder in Women: A Research Review. American Journal on Addictions, (6), pp. 273-283.

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Newcomb, M. D., & Harlow, L.L. (1986). Life Events and Substance use among Adolescents. Mediating Effects of Perceived Loss of Control and Meaninglessness in Life. Journal of Personality and Social Psychology, (51), pp. 564-577.

SAMHSA (2011). Quick Statistics from Drug and Alcohol Services Information System

Thompson, K.S. (1980). A comparison of Black and White Adolescents’ Beliefs about having Children. Journal of Marriage and the Family.