Information on Substance Abuse Treatment for Pregnant Women

Created On Thursday, 04, February 2016
Modified On Friday, 17, September 2021

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Pregnant women who become addicted to drugs are not only endangering themselves but the life of their child. Unfortunately, there is a common problem within the United States for women who are already addicts to become pregnant and pregnant women misusing drugs or alcohol. Substance abuse treatment for pregnant women is programs offering specific services, medical help, and counseling. More rehabilitation programs across the nation have begun to incorporate these services to help pregnant women struggling with addiction. Using drugs or alcohol during pregnancy causes significant long-term effects on the mother and child.

For example, smoking during pregnancy increases the risk of stillbirth, infant mortality, sudden infant death syndrome, and preterm birth, along with respiratory problems. Drinking during pregnancy leads to the child developing fetal alcohol spectrum disorders and enduring cognitive and behavioral problems, per the National Institute on Drug Abuse. Using drugs like opioids may cause withdrawal syndrome in newborns, also called neonatal abstinence syndrome. Babies with this condition are at a greater risk of seizures, respiratory problems, feeding difficulties, low birth weight, and death.

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Evidence-based treatment for pregnant women effectively helps protect the mother and child while treating the drug or alcohol addiction. Proper medical support and treatment provide a safe environment for the mother and unborn child. Per the National Institute on Drug Abuse, recent research has shown that smoking tobacco or marijuana, using pain medication, or illegal drugs during pregnancy is associated with double or even triple the risk of stillbirth. Some of the estimates have indicated that around five percent of pregnant women use one or more addictive substances. Infants that are born to mothers who have abused drugs show withdrawal symptoms at birth.

The type and severity of withdrawal symptoms depend on the drugs used, how long, and how often the birth mother used. Mothers who use tobacco are 1.8 to 2.8 times greater risk of stillbirth, while marijuana use is 2.3 times greater risk of stillbirth. The use of stimulants or pain medication; the child is 2.2 times greater risk of stillbirth. The entire rehabilitation process ensures the mother is safe along with the child—through detox, counseling, and aftercare, all the steps are monitored closely.

Newborn Withdrawal Symptoms and Effects of Substance Use During Pregnancy

When a mother is using drugs up to the point of being the child being born, the newborn does develop immediately or up to 14 days after birth, withdrawal symptoms. Some of the withdrawal symptoms include blotchy skin coloring, diarrhea, excessive or high-pitched crying, fever, increases muscle tone, irritability, poor feeding, seizures, slow weight gain, trembling, and vomiting. Even recreational drug use during pregnancy has risks, and the effects could be long-term and possibly fatal to the baby. These effects include birth defects, low birth weight, premature birth, small head circumference, and sudden infant death syndrome. Some of the general risks to the unborn fetus from substance abuse include placental abruption, miscarriage, premature birth, and developmental defects.

Some children develop heart defects because taking certain drugs or alcohol during pregnancy results in a hole in the heart, and most infants die within one year of life. There is also the risk of contracting infections like hepatitis C and HIV. The viruses are transmitted by people who share needles during injection drug use. The virus is then passed on to the unborn baby during pregnancy or at birth. Neonatal abstinence syndrome occurs when a baby is born to a mother addicted to pain medication. Fetal alcohol spectrum disorder is associated with a range of cognitive and developmental difficulties and usually lasts for life.

If the child survives birth in the first year of life, the substance-related development consequences become significant issues later in life. Many of these problems include behavior and learning deficits and slower growth rates in some children. According to a Morbidity and Mortality Weekly Report from the CDC regarding alcohol use among pregnant females, the report shows pregnant women in the first trimester reported higher current alcohol use than those in the second or third trimester. Among the first trimester respondents, 19.6% reported current alcohol use, and 10.5% reported binge drinking.

How Does Rehabilitation for Pregnant Women Work?

The rehabilitation process begins like any other, and during the initial assessment, the level of treatment and care is determined. An addiction assessment at a treatment center for pregnant women assesses the level of addiction, medical condition, state of the unborn child, and level of care is required. Detox is the first step, and this process should be done under proper medical supervision. Medical supervision ensures the safety of the child and the mother. Typically, detox methods depend on the substance that has been used, the level of abuse, and the mother's health and medical history. Inpatient medical detox is the best option because there is a risk of miscarriage during detox.

Many of the residential treatment centers within the United States are well versed in treating women who are pregnant. However, not all facilities are equipped to help women who are pregnant, so it is important to confirm that the facility has the services to treat pregnant women. According to the 2017 National Survey of Substance Abuse Treatment Services, approximately 22.4% of facilities are specifically tailored programs for pregnant women. Typically, these programs help with pregnancy and parenting education. Also, there is continuity with counselors, childcare services, transportation services, and housing services.

Overall, comprehensive addiction treatment for pregnant women may include medical detox, a specialized treatment plan, pregnancy education and counseling, parenting training, family therapy, individual therapy, group counseling, prenatal care, and life skills workshops. These services are most effective within an inpatient treatment center. Residential programs provide numerous therapeutic approaches to help mothers that are struggling with addiction. Some of the common therapy models include contingency management, which uses rewards and vouchers to reinforce positive behavior. Motivational interviewing helps pregnant women work through the hesitation surround treatment. Cognitive-behavioral therapy is common and helps pregnant women gain insight into the situations that lead them to abuse substances.

When is Substance Use Treatment for Pregnant Women the Best Option?

When you are pregnant, you are not only eating for two, but you are breathing and drinking for two. When you misuse alcohol, drugs, or even smoke, the baby is feeling the same effects. Smoking tobacco during pregnancy passing nicotine, carbon monoxide, and other harmful chemicals to the baby. The baby is likely to develop a disease like asthma and obesity. When you drink alcohol while pregnant, your child could be born with fetal alcohol syndrome. Illegal drug use causes underweight babies and learning problems. Misusing prescription drugs leads to birth defects, withdrawal symptoms experienced by the baby, and even the death of the child. The best approach when deciding on substance use treatment while pregnant is first to receive an addiction assessment.

An assessment with a qualified medical professional will ensure the right treatment is selected that has proper medical supervision and support. According to a journal article titled Substance Use During Pregnancy, in the United States, women comprise 40% of those with a lifetime drug use disorder and 26% of those who meet criteria for both an alcohol and drug use disorder. Unfortunately, women are at the highest risk for developing a substance use disorder during their reproductive years. Women who are pregnant or soon to be pregnant are at increased risk for substance abuse.

Many women face barriers, fear, and stigma, preventing them from entering a drug or alcohol rehabilitation program. Per an article titled Pregnant Women and Substance Use: Fear, Stigma, and Barriers to Care, women described multiple barriers to treatment and healthcare, including a lack of suitable treatment options and difficulty finding and enrolling in treatment. Approximately 9.4% of pregnant women aged 15 to 44 reported current alcohol use, 2.6% reported binge drinking, and 0.4% reported heavy drinking. Teen pregnant women have the highest rates of illicit drug use, followed by young adult women aged 18-25.

The treatment options of pregnant women include detox services, obstetric and pediatric care, therapy and counseling, parenting education and vocational training, support groups, transitional services, relapse prevention, and aftercare programs. Safe medical detox is the best option, and the detox process could last three to five days or longer. However, detox is not addiction treatment, but the first step. Residential rehabilitation programs are the best option for pregnant women. Typically, these are specialized facilities providing 24-hour supervision seven days a week. Many of these programs also offer services for women after the baby is born, such as housing and childcare options.

Specific Drug Use and the Effects on Pregnant Women

According to the Centers for Disease Control and Prevention, opioid use disorder among pregnant women is a significant public health concern in the United States. Between 1999 and 2014, the number of pregnant women with opioid use disorder at labor and delivery more than quadrupled. Opioid use during pregnancy causes neonatal abstinence syndrome, stillbirth, preterm birth, and maternal mortality. Drinking alcohol during pregnancy causes fetal alcohol spectrum disorders, birth defects, behavioral disorders, and impaired cognitive development. Per the Centers for Disease Control, about 40% of pregnant women report current drinking and current use of other substances.

Cocaine use also causes birth defects, and when the mother uses cocaine, it stays in the baby's body for a longer time. Cocaine use can also increase the risk of premature delivery, which cause serious health problems when the baby is born. Heroin use during pregnancy causes serious problems like premature birth, birth defects, and stillbirth. Some pregnant women view cannabis as harmless during pregnancy; however, it has been linked with preterm labor, low birth weight, and babies being admitted to the neonatal intensive care unit. Typically, there are a small number of effective therapies for substance use in pregnancy. These therapies include behavioral counseling and brief interventions that use motivational interviewing.

Alcohol and tobacco are some of the most common substances used by pregnant women. According to the SAMHSA, among women aged 15 to 44 who were not pregnant, 55.5% drank alcohol in the past month, and 24.7% binge drank alcohol. Most alcohol use among pregnant women occurred during the first trimester. However, alcohol use was lower during the second and third trimesters. Overall, alcohol disrupts fetal development at any stage during pregnancy, even before a woman knows they are pregnant. Smoking during pregnancy poses a serious risk of early death and disease for women. Annually, smoking kills an estimated 202,000 women each year in the U.S. In 2016, 13.5% of women in the country smoked, and smoking is directly responsible for 80% of lung cancer deaths in women.

Common Terms with Substance Use Among Pregnant Women

Term Definition
Fetal Alcohol Spectrum Disorders drinking alcohol during pregnancy causes a group of conditions called fetal alcohol spectrum disorders. Children who are born with FASD can have a mix of problems, such as medical, behavioral, educational, and social problems.
Stillbirth unfortunately, this is a common problem for pregnant women who are abusing drugs or alcohol. A stillbirth occurs when a baby dies in the womb after 20 weeks of pregnancy.
Low Birthweight occurs when a baby is born weighing less than 5 pounds 8 ounces, and this is also a common problem among pregnant women who are abusing drugs or alcohol.
Miscarriage unfortunately, this occurs when a baby dies in the womb before 20 weeks of pregnancy. Pregnant women who abuse prescription drugs, alcohol, or illicit street drugs are at risk of a miscarriage.
Neonatal Abstinence Syndrome is a problem that occurs when a baby is exposed to a drug in the womb before birth and then goes through drug withdrawal after birth. NAS frequently occurs with pregnant women abusing opioids like pain medication or heroin.
Placental Abruption this is a serious condition where the placenta separates from the wall of the uterus before birth. The result is heavy bleeding that can be deadly for both mother and baby. The problem occurs with pregnant women that are drinking heavily or abusing drugs.
Contingency Management is an effective therapy process for pregnant women addicted to drugs or alcohol. The therapy gives patients tangible rewards to reinforce positive behaviors, such as abstinence.
Cognitive Therapy is a successful method that helps pregnant women prevent relapse. The central element of CBT is anticipating likely problems and enhancing patients' self-control by helping them develop effective coping strategies.
Motivational Enhancement Therapy is a common therapy approach used with pregnant women and helps them resolve their ambivalence about engaging in treatment and stopping drug use.
Parental Counseling is a specific method of counseling, helping expecting mothers work through underlying issues connected to their drug use. The counseling also helps them prepare for motherhood and living a sober life.

CONTRIBUTORS TO THIS ARTICLE

Marcel Gemme, DATS - Author

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Marcel Gemme has been helping people struggling with addiction for over 19 years. He first started as an intake counselor for a drug rehabilitation center in 2000. During his 5 years as an intake counselor, he helped many addicts get the treatment they needed. He also dealt with the families and friends of those people; he saw first-hand how much strain addiction puts on a family and how it can tear relationships apart. With drug and alcohol problems constantly on the rise in the United States and Canada, he decided to use the Internet as a way to educate and help many more people in both those countries. This was 15 years ago. Since then, Marcel has built two of the largest websites in the U.S. and Canada which reach and help millions of people each year. He is an author and a leader in the field of drug and alcohol addiction. His main focus is threefold: education, prevention and rehabilitation. To this day, he still strives to be at the forefront of technology in order to help more and more people. He is a Licensed Drug and Alcohol Treatment Specialist graduate with Honours of Stratford Career Institute. Marcel has also received a certificate from Harvard for completing a course entitled The Opioid Crisis in America and a certificate from The University of Adelaide for completing a course entitled AddictionX: Managing Addiction: A Framework for Succesful Treatment.


Michael Leach, CCMA - Medically Reviewed on September 17, 2021

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Michael Leach is a Certified Clinical Medical Assistant, who has over 5 years of experience working in the field of addiction. He spent his career working under the board-certified Addictionologist Dr. Rohit Adi. His experience includes working with families during their loved one’s stay in treatment, helping those with substance abuse issues find treatment, and teaching life skills to patients in a recovery atmosphere. Though he has worked in many different areas of rehabilitation, the majority of his time was spent working one on one with patients who were actively withdrawing from drugs. Withdrawal and the fear of going through it is one biggest reason why an addict continues to use and can be the most difficult part of the rehabilitation process. His experience in the withdrawal atmosphere has taught him that regardless of what approach a person takes to get off drugs, there are always mental and emotional obstacles that need to be overcome. He believes having someone there to help a person through these obstacles can make all the difference during the withdrawal process.