Treating Pregnant and Parenting Women for Substance Use Disorders: Behavioral and Medication Strategies



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Do not assume that the legality of a substance is related to the potential harms that a substance can have on the mother or fetus.

      • Do not assume that the legality of a substance is related to the potential harms that a substance can have on the mother or fetus.
      • Two of the substances that we have the most documentation on their harms include tobacco and alcohol.
      • However, even for alcohol, risk factors (for example: maternal age, genetics, nutrition) other than alcohol exist and serve to mediate, moderate or otherwise alter the effects of alcohol on the fetus and child.
      • As with all substances, the potential effects on the mother, fetus and child must be viewed in the context of the social determinants of health including the overriding influence of poverty and its radiating effects.
  • Substance Use During Pregnancy
  • Historical Context of Cocaine Use During Pregnancy
  • During the 1980s the “War on Drugs” was at its height and the media proclaimed a “crack baby” epidemic.
  • News stories cast these children as damaged and unable to learn.
  • Equally stigmatizing, the mothers of these children were portrayed as selfish and unloving.
  • “Crack baby" reports fueled the most punitive strategy towards substance-using pregnant women to date:
    • Legal actions against illicit drug using pregnant women under a variety of state laws such as delivery of a controlled substance to a minor, manslaughter, child abuse and neglect.
  • Kandall, Substance and shadow, 1996; Paltrow, Criminal Justice Ethics, 1990

  • What Does Addiction Look Like In Women?
  •  Untreated addiction places a woman and her fetus at risk for multiple adverse consequences
  • Issues facing drug-using pregnant women and their children
  • Exposure to violence and trauma
  • Generational drug use
  • Lack of formal education
  • Lack of job acquisition and maintenance skills
  • Gender inequality/male-focused society
  • Legal involvement
  • Multiple drug exposures
  • Limited parenting skills and resources
  • History of child abuse and neglect
  • Multiple psychiatric issues
  • Unstable housing
  • Lack of positive and supportive relationships
  • Food insecurity and lack of nutrition
  • These factors with or without drug use can influence mother and child outcomes.
  • Current Context of Opioid Use During Pregnancy
  • Image Credit: “Stress Definition Indicates Explanation Pressures And Tension” by Stuart Miles
  • Although less frequent than alcohol and tobacco use, opioid misuse during pregnancy is nonetheless a serious and growing issue.
  • This increase in use of opioids by pregnant women appears to be driving an increase in the incidence of neonatal opioid withdrawal.
  • Opioid use by pregnant women is often complicated by polydrug use, and often occurs intertwined with complex personal, interpersonal, family, social, and environmental factors that can contribute to adverse consequences.
  • Women have unique needs for addiction treatment and multi-faceted interventions are needed to help prevent and treat opioid-dependence among women during pregnancy and their infants.

Treatment Issues

At a minimum, providers receiving Grant funding, must either provide or arrange services for:

  • At a minimum, providers receiving Grant funding, must either provide or arrange services for:
  • Pregnant women;
  • Women with dependent children; and
  • Women who are attempting to regain custody of their children.
  • In delivering services for women, providers should always ensure that:
  • At least interim services are received within 48 hours after a pregnant woman is seeking treatment (if no facility has the capacity to admit the woman);
  • Those receiving services have no other financial means to obtain treatment;
  • Where appropriate, the family is treated as a unit, and both women and their children are admitted to treatment;
  • An admission preference is implemented based on the following hierarchy:
    • Pregnant injecting drug users;
    • Pregnant substance abusers;
    • Injecting drug users; and
  • The availability of services from the facilities and the fact that pregnant women receive preference are publicized.
  • SAMHSA SAPT Block Grant

Women

  • Women
    • Pregnant or with Dependent Children
    • Treatment Priority Given to Pregnant Women
  • Dependent Children of Women in Treatment
    • Family is Treated as a Unit
    • Medical Care for Women and Children, Therapeutic Interventions for Women and Children, Child Care, Case Management and Transportation
  • Gender Specific Treatment
    • Screening, Referral and/or Treatment for Depression - Peri & Post
    • Counseling on Domestic Violence and Abuse
    • Interventions for Parenting and Child-parent Relationships
    • Employment Skill Building
  • Appropriate Therapeutic Interventions For Children
  • Case Management and Transportation
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