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



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Women are less likely than men to enter treatment.

  • Women are less likely than men to enter treatment.
    • Sociocultural: stigma, lack of partner/family support
    • Socioeconomic: child care, pregnancy, fears about child custody
  • Children are a big motivator to enter treatment or avoid it.
  • Availability of appropriate treatment for co-occurring disorders is important.
  • Gender Differences in Treatment I

Few gender differences are evident in:

  • Few gender differences are evident in:
    • Retention
    • Outcome
    • Relapse rates
  • When differences are noted, typically women have better:
    • Drug treatment outcomes than men
    • Shorter relapse episodes
    • Are more likely to seek help post-relapse
    • Residential programs that include children have better retention rates.
  • Gender Differences in Treatment II
  • Greenfield et al., 2006

Child care

  • Child care
  • Prenatal care
  • Gender only and responsive services (e.g., trauma history)
  • Mental health and psychiatry services
  • Transportation
  • Employment services leading to jobs that pay more than minimum wage
  • Key Services to Improve Outcomes for Women

Length of stay in treatment

  • Length of stay in treatment
  • Treatment completion
  • Decreased use of substances
  • Reduced mental health symptoms
  • Improved birth outcomes
  • Employment
  • Self-reported health status
  • HIV risk reduction
  • Ashley et al., 2003; Greenfield et al., 2007

Rapidly address what the woman identifies as her high priority issue, and build a bridge to the other issues

  • Rapidly address what the woman identifies as her high priority issue, and build a bridge to the other issues
  • Female role models at all levels of hierarchy
  • Positive male role models available
  • Clear feedback but not aggressive confrontation
  • Monitor the intensity, especially for women who are more disturbed
  • Sexual boundary issues
  • Treatment Culture

Foster greater interaction, emotional and behavioral expression

  • Foster greater interaction, emotional and behavioral expression
  • More variability in interpersonal style
  • Women in mixed groups engage in a more restrictive type of behavior; men show wider variability (and interrupt women more)
  • Women-Only Groups
  • Hodgkins et al., 1997

Untreated psychiatric disorders, especially depression and trauma sequelae (PTSD)

  • Untreated psychiatric disorders, especially depression and trauma sequelae (PTSD)
  • Intimate partner
  • Underestimating the stress of reunification or ongoing parenting
  • Isolation, poor social support
  • High level of burden
  • Relapse Issues for Women

Women are more likely than men to have co-occurring drug use and mental disorders.

  • Women are more likely than men to have co-occurring drug use and mental disorders.
  • Women are more likely to have multiple co-morbidity (three or more psychiatric diagnoses, in addition to substance use disorder) than are men.
  • Women who use drugs may be using them
  • to self-medicate distressing affect.
  • Anxiety disorders and major depressive
  • disorders are the most common
  • co-occurring diagnoses.
  • Eating disorders and Post-Traumatic Stress Disorder (PTSD), a common reaction following exposure to violence and trauma, also often co-occur in women with drug use disorders.
  • Agrawal et al., 2005; Kessler et al., 1997; Zilberman et al. 2003
  • Co-Occurring Mental Health Issues
  • https://pixabay.com/en/girl-worried-woman-wait-sit-think-1215261/
  • 3 out of every 10 women who enter treatment have tried to commit suicide.
  • Many of these women are in relationships with individuals who also use licit and illicit substances – and may subject the women to ongoing emotional, physical, and sexual abuse.
  • https://pixabay.com/en/woman-desperate-sad-tears-cry-1006102/
  • Eggleston et al., Compr Psychiatry, 2009; Jones et al., Counselor, 2009.
  • Suicide and Interpersonal Violence
  • Physical/Stress Related
  • Injury
  • Sleep problems
  • Nutritional / Low weight gain
  • Substance abuse / Smoking
  • Chronic pain
  • Hypertension
  • Inadequate prenatal care
  • Miscarriage
  • Pre-term labor
  • Fetal fracture / Fetal death
  • Placental abruption
  • Uterine rupture
  • Psychological
  • Anxiety
  • Depression / Suicide
  • PTSD
  • Poor self-esteem
  • Blame and guilt
  • Uncontrollable emotions
  • Effects of Interpersonal Violence
  • Image Credit: “Stop Violence” by geralt
  • Women Abuse Screening Tool (WAST) – Short Form
  • In general, how would you describe your relationship?
  • Do you and your partner work out arguments with…
    • Great difficulty, some difficulty, no difficulty
  • Correctly classified 92% victim and 100% non-victim
  • Takes 4 minutes to complete
  • If women endorse these or other questions indicating risk for violence
  • Listen to her and believe her
  • Acknowledge her feelings and let her know she is not alone
  • Let her know that no one deserves to be abused
  • Provider her with resources (hotline, women’s shelter)
  • Chen et al.. Ann Fam Med 2007
  • http://www.k4health.org/sites/default/files/311701.pdf
  • Screening for Interpersonal Violence
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