Substance use during pregnancy and motherhood is both a public health and criminal justice concern. Negative health consequences associated with substance use impact both the mother and the developing fetus, and there are ongoing attempts to criminalize substance use during pregnancy that put pregnant substance-using women at risk of detection, arrest, and punishment. Although there has been research on the consequences of maternal substance use, little is known about why some women are motivated to desist during pregnancy and why others persist. The purpose of this dissertation was to advance the understanding of (1) women's decision-making regarding substance use and motherhood, (2) how women desist from substance use during and after pregnancy, and (3) how women navigate or overcome barriers to care. To accomplish the aims of this study, narrative identity theory was employed as a theoretical framework for understanding women's sense-making of their experiences. Based on data from in-depth life history interviews with thirty recently-pregnant women who had used alcohol, tobacco or other drugs during their pregnancies, this study captured the experiences of substance-using mothers as they navigated health and criminal justice consequences and accessed needed resources in the community. The data reveal multiple patterns of substance use desistance behavior, from prompt desistance to persistence throughout the pregnancy. Women who desisted described themselves as exercising their agency in pursuing opportunities for desistance. Desisting women were less likely to be embedded in social networks that included other substance-using individuals. Women supported their desistance during and after pregnancy by reinterpreting their life stories as narratives of redemption. They achieved this reinterpretation by highlighting past experiences that demonstrated that they had good core selves and had simply been overwhelmed or distracted by substance use. By reinterpreting their past suffering as redemptive, desisting women were able to narrate prosocial and generative futures in which they would tell their stories to others to show that desistance is possible. Finally, women's stories highlighted their strategies for managing their risk of detection by health or criminal justice authorities and revealed multiple barriers to treatment and healthcare, including a lack of suitable treatment options. The theoretical and policy implications of the findings are discussed, particularly the need for further development of narrative identity theory and the expansion of treatment programs and social services to meet the needs of substance-using women.
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