Staying Principled

Click here to listen to the blog (3:54).

In 2009 a group of women gathered in Victoria BC Canada to discuss how we would approach the development of a network on FASD prevention. We were researchers, policy advocates, service providers, community activists and those with Indigenous wisdom – all with a commitment to seeing and acting on how social determinants affect women’s health and substance use, and the ability for them influence the conditions of their lives.

Out of our discussion emerged a consensus on 10 fundamental components or principles for approaching FASD prevention from a women’s health determinants perspective. Now, in 2022, we have updated that consensus statement, so that those interested in FASD prevention are directed to new evidence and resources. The update is a testament to the soundness of the original principles and to the ever-growing expertise of the network participants and international partners. We hope this will empower those working on FASD prevention to continue to use and build upon this principle-based approach.

The principles foundational to approaching FASD prevention are:

Respectful – Grounding prevention initiatives in respectful relationships is vital to reduce stigma and discrimination.

Relational – It can be a transformative experience for women who use substances to experience care that aligns with their needs, views them as a whole person, and offers respect, understanding, and authentic collaboration.

Self-Determining Health care and other support systems can facilitate self-determined care by supporting women’s autonomy, decision making, control of resources, and including exercise of their reproductive rights.

Women+ Centred Women+ centered care moves beyond a fetus/child-centered approach, and focuses on fostering safety and empowerment when providing support to women and gender diverse individuals who are pregnant or parenting.

Harm Reduction Oriented A harm reduction oriented approach focuses on safer substance use but also on reducing broader harms, including retaining or regaining custody of children, access to adequate and stable housing, and the challenges of poverty, food insecurity, and intimate partner violence.

Trauma- and Violence-Informed Trauma- and violence-informed services integrate awareness of the impacts of trauma on health into all aspects of service delivery including wellness support and prevention of secondary trauma.

Health Promoting – Holistic, health promoting responses to the complex and interconnected influences on women’s health and substance use are vital to FASD prevention.

Culturally Safe – Respect for individuals’ values, worldviews, and preferences in any service encounter is important, as is respect for and accommodation of a woman’s desire for culturally-specific healing.

Supportive of Mothering – FASD prevention efforts must recognize women’s desire to be good mothers and the importance of supporting women’s choices and roles as mothers.

Uses a FASD-informed and Disability Lens – Uses strengths-based responses, makes person-centered accommodations, and ensures equity of access to health and social services.

We hope you will find the Consensus Statement with these principles and supporting sources – journal articles, reports and infographics – an inspiration for action.

Actionable research! Reflecting on 5 years of FASD prevention research

Click here to listen to the blog (2:37).

Last month, the Journal of Fetal Alcohol Spectrum Disorder (FASD) released a special collection of articles about FASD prevention, diagnosis, intervention and support. The journal issue features the work of Canada Fetal Alcohol Spectrum Disorder Research Network staff, Research Leads, Family Advisory Committee (FAC) members, Adults with FASD Expert Collaboration Team (AFECT) members, trainees, board members, and community partners and collaborators. 

As part of the special issue, researchers from the Prevention Network Action Team contributed an article entitled At a Juncture: Exploring Patterns and Trends in FASD Prevention Research from 2015 – 2021 Using the Four-Part Model of Prevention. This article leverages off our annual annotated bibliographies, to identify trends in FASD prevention research over the six-year period.

From 2015 – 2020, n = 532 articles were identified that addressed:

  1. the prevalence and influences on alcohol use during pregnancy, 
  2. interventions at each of the Four-Part Prevention Model, and 
  3. systemic, destigmatizing, and ethical considerations. 

The majority of the research was from the United States (n = 216), Canada (n = 91), the United Kingdom (n = 60), and Australia (n = 58).

While the literature continues to have a heavy focus on the prevalence and influences on alcohol use during pregnancy, a trend could be seen towards research on evidence-based interventions which support positive health outcomes for women and their children.

  • Across both Level 1 and Level 2 prevention, there was an emphasis on the role of technology and its importance in disseminating education and messaging about alcohol use in pregnancy and FASD. 
  • Attention to Levels 3 and 4 demonstrated the importance of multi-service, trauma-informed, relational, and holistic approaches in supporting women and their children. 
  • While women’s voices were increasingly represented in the literature, further efforts are required to amplify their voices and address stigma. 

This review synthesized the current evidence and demonstrated how the work on FASD prevention has expanded in the recent years to reflect the nuance and interconnectedness of the Four-Part Prevention Model. The opportunities for prevention through research and evidenced-informed practice and policy are unlimited. We used the title “At a Juncture” as now we can definitely see a critical mass of research evidence on FASD prevention that can support practice and policy action related to awareness raising, brief support, wrap-around support, stigma reduction and change to alcohol policy!

The gift of sharing practice lessons

There are many influences, stressors and life circumstances that affect pregnant women’s and new mothers’ alcohol use, yet few so challenging and heartbreaking as the experience of intimate partner violence (IPV) and other forms of abuse.

Holistic community-based programs that aim to engage pregnant women and gender diverse individuals with lived experience of violence are challenged to help everyone feel safe, and to access the services that they and their children need. In many ways the overall service approaches of these programs – being harm reduction oriented, non-judgemental, culturally safe and trauma informed – go a long way towards creating the needed safety and support.

The Breaking the Cycle (BTC) program in Toronto took on the role of assisting community based programs that work with families who may be living with IPV, to articulate and enhance their support approaches. BTC received a grant from the Public Health Agency of Canada to develop and share with over 800 programs across Canada, both a resource manual (Building Connections: Supporting Community-Based Programs to Address Interpersonal Violence and Child Maltreatment) and training that helped these programs build further awareness of IPV and their capacity to deliver trauma informed approaches. Connections is a manualized group intervention that supports increased understanding by mothers about positive relationships and their importance to healthy parenting and healthy child development. This work illustrates BTC’s ever growing understanding of the many impacts of trauma on mothers and their children, and the importance of embedding trauma-informed approaches in the delivery of addiction, mothering and early childhood intervention services.

The Breaking the Cycle program recently published the findings arising from the evaluation of this work in the document “What we Learned”.  It documents the impact on: women who participated in the Connections groups, the group facilitators, other staff in the prenatal and child development organizations who engaged in the training and group delivery, and the organizations as a whole. Really compelling is the section on how women increased awareness of the impact of abuse, of children’s brain development, and of positive and mindful parenting; as well as their changes related to forgiveness and healing, self-care, self-esteem and empowerment. The facilitators also benefitted immensely in awareness, competency and overall through integrating and advocating for trauma-informed perspectives in their daily working relationships. The document is rich in detail about the impact of this important work to address intimate partner violence through relational and trauma informed approaches in community-based services, including Indigenous specific services.

Key to what they learned, Breaking the Cycle identified 4 fundamental practice principles which are definitely relevant to all the work we do on FASD prevention and intimate partner violence:

  1. Readiness is critical. There is background work that must be done first, before a group like Connections that addresses trauma can be implemented.
  2. Safety is vital. Trauma-informed principles must be established and integrated into your organizational practices before women will feel safe enough to get involved with Connections.
  3. Relationships are the building blocks of engagement. Women who experience IPV have limited experience of supportive relationships and find building safe and healthy relationships with others, including their children, difficult. It is imperative that service providers model supportive relationships during the implementation of Connections.
  4. Research and evaluation are critical components of all programs, with co-occurring commitment to respect community wisdom. The commitment to research and evaluation needs to be accompanied by a flexible group approach for participating organizations who know the needs of their communities best.

These lessons are a tremendous gift to all service providers who take on this important work. Much appreciated Breaking the Cycle!

Addressing stigma as a catalyst to reduce alcohol use in pregnancy

Substance use and addiction are highly stigmatized, particularly for pregnant women and women of reproductive age. Women who use substances often experience multiple forms of stigma and are required to navigate notions of ‘good’ motherhood. This can contribute to women’s own belief that substance use during pregnancy is an uncaring choice. Despite the pervasiveness of stigma and public health efforts to counter it and to help women prevent Fetal Alcohol Spectrum Disorder (FASD), women’s alcohol use during pregnancy is expected to increase.

Researchers from the Centre of Excellence for Women’s Health, University of Queensland, and the Canada FASD Research Network published a study exploring women’s reasons for continued alcohol use, reduction, and abstinence during pregnancy (1). In their research, they found that there is very little research that highlight’s women’s voices in efforts to understand the barriers and facilitator’s to alcohol use in pregnancy.

To analyze women’s reported barriers and facilitator’s to reducing alcohol use in pregnancy, the authors used the Action Framework for Building an Inclusive Health System. It was released in 2019 with Canada’s Chief Public Health Officer of Health’s 2019 report, and outlines different levels of stigma (individual, interpersonal, institutional, and population) and how they operate.

Stigma remains a pervasive challenge for pregnant and parenting women who use alcohol and other substances when accessing and receiving care. Interestingly, despite the literature’s focus on women’s individual choice about prenatal alcohol use, the barriers and facilitators to women’s alcohol use in pregnancy identified in this study were a result of interpersonal, institutional, and population-level factors, not individual choice.  

In Canada, toolkits and policy papers have been developed to contribute to addressing stigma and related barriers. In many countries, interventions are being developed and evidenced by communities and by health and other systems of care that are designed to reduce stigma and support women’s engagement in care, including:  

  • inclusive awareness building that reaches women, their partners and the public
  • relational, trauma-, gender- and culture-informed support offered by health and social care providers; and,
  • welcoming, non-judgmental services that wrap a wide range of needed practical supports around mothers and their children.

These interventions act as remedies to the challenges cited by pregnant women who use alcohol and find it difficult to reduce/stop alcohol use in pregnancy. In this way, action to prevent FASD can move beyond the usual recommendations for supporting individual change to be more accurately focused on service and system level changes that have the potential to make individual change possible.


  1. Lyall V, Wolfson L, Reid N, Poole N, Moritz KM, Egert S, et al. “The Problem Is that We Hear a Bit of Everything…”: A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy. Int J Environ Res Public Health. 2021;18(7).

The Remarkable Findings of the Co-Creating Evidence Evaluation Study

Preventing Fetal Alcohol Spectrum Disorder (FASD) requires a range of efforts from general awareness to targeted prevention and treatment services. In the Canadian Four-Part FASD Prevention Model, Level 3 and 4 programs provide low barrier holistic services for pregnant or parenting women who face substance use and a range of other health and social burdens and challenges.

Over a four-year period, the Co-Creating Evidence (CCE) evaluation study has involved eight different community-based Level 3 & 4 programs that support women through the provision of holistic, wraparound services, and in doing so, see FASD prevention as part of their mandate. These programs are guided by theoretical approaches such as being trauma-informed, relationship-based, women-centred, culturally grounded and harm reducing. The evaluation team has been led by the Nota Bene Consulting Group and has involved researchers from the Centre of Excellence for Women’s Health and representatives of the eight programs. 

This CCE evaluative study (2017-2020) has had three main research questions:

  1. What are the common elements of the diverse Level 3 programs across Canada?
  2. What program components are helpful from women’s perspectives?
  3. What are best measures to evidence outcomes and what outcomes are being achieved?

The answers to these questions are now available via:

In all these documents, service providers, researchers, policy makers and women with lived/living experience will see promising approaches and outcomes that these programs provide and the women who access these programs are realizing, together with their community partners. This study makes a significant contribution to our understanding of this level of FASD prevention. It hopefully will be an inspiration to all those committed to this important work. 

Funding for this project has been received from the Public Health Agency of Canada, Fetal Alcohol Spectrum Disorder (FASD) National Strategic Project Fund. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

Addressing the priorities of the pNAT in 2020

As we continue to connect our work in Canada on FASD prevention, via the Prevention Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective (pNAT), new priorities for action emerge.  These are five priorities that this virtual community identified for the coming year.

  1. Cross-sector collaboration

Collaboration across fields provides an important opportunity to support mothers, children, and women who may be at risk of using substances during pregnancy. Resources, such as Mothering and Opioids: Addressing Stigma – Acting Collaboratively, highlight opportunities for collaboration across fields to foster advocacy, streamline service delivery and referrals, and offer systems navigation.

  1. Indigenous approaches to FASD prevention

There are an increasing number of wholistic FASD prevention and wellness programs that are incorporating culture and language, traditional knowledge, and land-based programming, while responding to the needs of families and communities. Programs such as Circle of Life in Terrace, Xyólhmettsel Syémyem (Family Empowerment Team) in Chilliwack and others highlighted in the recent booklet, Revitalizing Culture and Healing: Indigenous Approaches to FASD Prevention, bring attention to the importance of community-led, community-driven FASD prevention and wellness programs.

  1. Trauma-informed practice

Trauma-informed practice and policy development are essential components in responding to each level of the four-part prevention model. Trauma-informed services recognize the interconnections of trauma, mental health, and substance use and the role that substance use may have in coping with past or current violence or trauma. When discussing alcohol and other substance use, trauma-informed approaches will promote building relationships, building upon individuals’ strengths, and offering choice and collaboration in service provision.

  1. Stigma reduction

There has been an increasing focus on reducing stigma that mothers and women who use substances during pregnancy experience. By reducing stigma, pregnant women and mothers will be able to better access necessary supports and servicces that support stigma reduction. The recent issue paper from the Canada FASD Research Network on mothers’ experience of stigma through a multi-level model offers recommendations and recommended resources for service providers, health systems planners, and policymakers.

  1. Keeping families together

More attention is being brought to service delivery models that have the goal of keeping families together. These programs, which range from co-located multi-service programming to mentor and peer support models increase women’s access to prenatal care, health care, social support, advocacy, and childcare. PNAT members from programs such as the Parent-Child Assistance Program, Sheway in Vancouver, HerWayHome in Victoria, H.E.R. Pregnancy Program in Edmonton, Manito Ikwe Kagiikwe (the Mothering Project) in Winnipeg, and Mothercraft (Breaking the Cycle) in Toronto are helping us understand how this goal can be achieved in community contexts.

The Prevention Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective (pNAT)

In Canada, FASD prevention advocates work together to link up the local, provincial and national efforts through a virtual prevention research network, which receives financial support from the Canada FASD Research Network (CanFASD). Recently CanFASD refreshed their website, so national action on prevention is profiled. See https://canfasd.ca/topics/prevention/

The Prevention Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective (pNAT) has four objectives. To advance prevention research, the pNAT builds multidisciplinary research teams, which develop research proposals, and conduct research, including evaluation research.  A second objective is to develop and implement strategies for moving “research into action”, for example through preparing and delivering workshops and curricula (both online and offline), and preparing and distributing policy briefs and reports. A third objective is to influence policy and service provision by proactively and collaboratively working with governments and communities to identify and implement service and policy improvements. It is through the fourth objective of networking and networked learning, that the other objectives are achievable. A virtual, national network becomes a location for sharing knowledge, expertise and skills.

The participants in the Canadian pNAT are inclusive of researchers, service providers,

jan 24, 2020
This document about 10 fundamental components of FASD prevention was one of the first documents that the pNAT members wrote together, ten years ago now
https://canfasd.ca/wp-content/uploads/2016/09/ConsensusStatement.pdf

health system planners, policy analysts, community based advocates and (where possible) mothers with lived experience. To achieve this participation, the pNAT employs a virtual community of inquiry (vCoI) model, supplemented by face-to-face meetings often held in conjunction with national and international conferences. Through the vCoI, participants are able to voluntarily attend monthly webmeetings to:

  • Share updates on their work;
  • Learn of recent additions to the evidence on FASD prevention;
  • Discuss research, service provision and advocacy developments undertaken by members and by others in Canada; and
  • Plan collective action.

In this way, participants learn together about FASD prevention, and are able to situate their own work within the field.

The community of inquiry framework developed by Garrison and colleagues (2003) provides the foundational, evidence-based design of the virtual community, and grounds it as a ‘learning’ one. In communities of inquiry, people construct meaning through epistemic engagement, as learners, teachers and social connectors (Shea & Bidjerano 2009). In key ways this virtual learning community model reflects the approach that service providers are finding helpful in interactions with mothers and families: i.e. as both teachers and learners, in relationships that prioritize safety, resilience and connectedness.

In addition to the monthly virtual community meetings, the pNAT uses this blog to share outwardly some of the key issues identified in the virtual community.  Visit the https://canfasd.ca/topics/prevention/ location to learn more about the pNAT and its many activities.

Garrison, D. R. and T. Anderson (2003). E-Learning in the 21st Century: A framework for research and practice. New York, NY, Routledge Falmer.

Shea, P., & Bidjerano, T. (2009). Community of inquiry as a theoretical framework to foster “epistemic engagement” and “cognitive presence” in online education. Computers & Education, 52(3), 543-553.

Addressing Stigma – Acting Collaboratively

Key challenges in FASD prevention are the stigma directed to pregnant women and new mothers who use alcohol and other substances, and the fear of having children removed from mothers’ care if they report their use and/or seek help.  A new resource, in toolkit format,  Mothering and Opioids: Addressing Stigma – Acting Collaboratively addresses these long standing dilemmas for women and for service providers.

This toolkit provides tools, worksheets, and factsheets to aid substance use and child welfare workers in building capacity to offer mother-child centred, trauma informed, culturally safe, and harm reduction-oriented services and policies. The toolkit’s four sections each address a specific area or need in service delivery and provision:

  1. Addressing Stigma in Practice

The first section examines how women who use opioids experience stigma and includes tools for assessing potentially stigmatizing practices. This section also includes a script for responding constructively to coworkers’ stigmatizing behaviour arising from the work of Lenora Marcellus and Betty Poag, as well as a factsheet entitled “10 Things Pregnant and Parenting Women Who Use Substances Would Like Practitioners to Know” created by women with lived experience accessing services at HerWay Home in Victoria BC.

  1. Improving Programming and Services

The second section describes how stigma relates to the barriers that women face. It identifies promising practice and policy responses that address stigma and health, substance use, and child protection concerns. Tools are provided to facilitate integrating promising approaches into our responses, and to identify ways in which barriers can be overcome. It honours and advances the differing roles of substance use services and child welfare services in supporting women and children, as well as evidence informed shared approaches (See diagram from page 21)

M+O

  1. Cross System Collaboration and Joint Action

The third section includes information and tools to facilitate cross-system collaboration. Collaboration between the child welfare and substance use fields provides an opportunity to improve child safety and support the recovery of parents. Cohesive working relationships between these sectors can foster advocacy, consultation, system navigation, safety planning, and streamlined referrals. In this, as in all sections there are resources that focus on Indigenous approaches to child welfare and substance use.

  1. Policy Values

The final section discusses policy matters, and how defining and affirming policy values can clarify our work in both systems of care. This section emphasizes viewing mothers and children as a unit when developing policy and programming to facilitate the goal of keeping mothers and children together.

Researchers at the Centre of Excellence for Women’s Health worked with other researchers, service providers and women with lived experience to create a practical and forward looking resource designed to inspire self-reflection and action, to promote an immediate impact on current policy and practice. The tools are designed to help us continue to build on our capabilities to make mothers’ needs and voices central in our work, and to offer mother-child centred, trauma informed, culturally safe and harm reduction-oriented services and policies related to women’s use of alcohol, opioids and all other substances.

Emerging Approaches to FASD Prevention

One year ago, the Centre of Excellence for Women’s Health released Doorways to Conversation: Brief Intervention on Substance Use with Girls and Women. Since then, there has been a growing interest in expanding work on brief interventions and FASD prevention, to be inclusive of multiple substances and multiple health issues for women, their families and communities.

Here are four innovative ways that brief discussion about alcohol and other substance use is being expanded:

In Sexual Health

Sexual health clinicians are well positioned to deliver brief substance use interventions due to their open, non-judgmental and harm reduction-oriented model of practice. Sexual health providers are able to discuss substance use together with contraceptive use and/or sexually transmitted and blood borne infections [1, 2]. Conversations about substances, sex, and safety can support a woman’s decisions and confidence for change towards improving health in whatever area fits for her.

Linking Discussion of Multiple Substances

Cannabis legalization provides a ‘window of opportunity’ to engage in discussions about alcohol, tobacco, and cannabis use in pregnancy. Discussing what we know and don’t know about cannabis use in pregnancy can now be linked to open conversations about alcohol and other substance use in pregnancy.

Understanding the Link to Adverse Childhood Experiences (ACEs)

Research on ACEs shows how a history of childhood stressors, including physical, sexual, and emotional abuse, may influence alcohol use among adults including pregnant women [3]. Adopting a trauma-informed approach in conversations about alcohol use in pregnancy supports women who experienced childhood adversity with safety, choices, collaboration, self compassion and skills for change.

Advancing Indigenous Wellness Approaches

Holistic, relational, community-based, and culture-led FASD prevention initiatives are key to wellness for pregnant women in Indigenous communities [4]. These interventions address the broad social and structural determinants of health that are associated with substance use and respond to the Truth and Reconciliation Commission Call to Action #33.

References

  1. Lane, J., et al., Nurse-provided screening and brief intervention for risky alcohol consumption by sexual health clinic patients. Sexually Transmitted Infections, 2008. 84(7): p. 524-527.
  2. Crawford, M.J., et al., The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR). Health Technology Assessment, 2014. 18(8): p. 1-48.
  3. Frankenberger, D.J., K. Clements-Nolle, and W. Yang, The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Women’s Health Issues, 2015. 25(6): p. 688 – 695.
  4. Wolfson, L., et al., Collaborative Action on Fetal Alcohol Spectrum Disorder Prevention: Principles for Enacting the Truth and Reconciliation Commission Call to Action #33. International Journal Of Environmental Research And Public Health, 2019. 16(9).

Trauma-informed FASD Prevention and Care – Upcoming Webinar

Service providers and FASD prevention advocates are well aware of the intersections of trauma, substance use, and mental health issues as first described by researchers like Lisa Najavits (Najavits, Weiss, & Shaw, 1997). Research from the Women and Co-occurring Disorders and Violence study substantiated what many understood intuitively – that women with substance use problems facing complex life issues are best served through multi-leveled, integrated service models that are trauma-informed, gender-specific, and holistic (Amaro, Chernoff, Brown, Arévalo, & Gatz, 2007; Brown & Melchior, 2008).

There is an upcoming opportunity to learn more about applying these approaches to FASD prevention and care in a webinar on April 18th at 9:00 am MST. The CSS Learning Series webinar as part of their FASD Learning Series will feature speakers Candice Sutterfield, Lakeland Centre for FASD, and Dr. Peter Choate, Assistant Professor of Social Work at Mount Royal University and clinical supervisor for the Alberta College of Registered Social Workers. They will address both a prevention and supports & services perspective. Sign up here: http://csslearningseries.ca/trauma-informed-fasd-prevention-and-care-registration-2/

Programs in Canada, like Breaking the Cycle and HerWay Home, currently offer integrated programs for/with pregnant and parenting women with substance use issues. Their program frameworks are trauma- and FASD-informed and they offer substance use treatment/support programming as well as needed social services and referrals at a single access point. Program evaluation findings show that relationship building is the key component benefiting women’s growth and supporting the mother-child relationship long-term. (See their evaluations here: Breaking the Cycle and HerWay Home).

In a very recent study undertaken in Ontario, findings from interviews with women participating in integrated programs, described qualities of a therapeutic relationship that helped women improve emotional regulation and executive functioning (Milligan, Usher, & Urbanoski, 2017). Therapeutic relationships that incorporate trust, care, positive regard and a non-punitive attitude can create a safe attachment from which women can apply effective problem solving in all areas of their lives.

Sign up for the webinar and see these earlier posts for more information:

The Mother-Child Study: Evaluating Treatments for Substance-Using Women, March 18, 2015

HerWay Home Program for Pregnant Women and New Mothers in Victoria, BC, February 12, 2013

REFERENCES

Amaro, H., Chernoff, M., Brown, V., Arévalo, S., & Gatz, M. (2007). Does integrated trauma-informed substance abuse treatment increase treatment retention? Journal of Community Psychology, 35(7), 845-862.

Brown, V. B., & Melchior, L. A. (2008). Women with co-occuring disorders (COD): Treatment settings and service needs. Journal of Psychoactive Drugs, SARC SUPPL 5, 365-385.

Milligan, K., Usher, A. M., & Urbanoski, K. A. (2017). Supporting pregnant and parenting women with substance-related problems by addressing emotion regulation and executive function needs. Addiction Research & Theory, 25(3), 251-261. doi:10.1080/16066359.2016.1259617

Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1997). The link between substance abuse and posttraumatic stress disorder in women. A research review. The American Journal On Addictions / American Academy Of Psychiatrists In Alcoholism And Addictions, 6(4), 273-283.