Treatment of Substance Abuse During Pregnancy

Model Programs and Key Indicators for Success
Name	Type of program	Key components related to outcome	Ref.
Camp and Finkelstein (1995) Nurturing Program for Families in Substance Abuse Treatment and Recovery	Residential	Parenting component After-care services Measured self-esteem Evaluated birth outcomes	72
Szuster et al. (1996) Salvation Army Treatment Program	Residential	Children included Family groups Parenting component Parent-child interaction therapy Therapeutic nursery Psychiatric day treatment for children	73
Stevens et al. (1989) Amity, Inc.	Residential	Children included Increased female:male client ratio Supportive environment for females	74
Hughes et al. (1995)	Residential	Children included Parenting component Parent-child interaction therapy Therapeutic nursery	75
Haller et al. (1993)	Outpatient	Time-limited program	76
Strantz and Welch (1995)	Outpatient	Intensive day treatment Cognitive-behavioral plan Parenting component Parent-child interaction therapy Therapeutic nursery Relapse/lapse considered part of treatment Female staff Lower staff caseload	77
Suffet and Brotman (1984) PAAM	Outpatient	Prenatal care Parenting component Therapeutic nursery Infant developmental assessment	36
Brindis et al. (1997) Options for Recovery	Outpatient and residential	Intensive day treatment Comprehensive case management Foster parent recruitment Biological and foster parenting component Respite care for infants Multimethod approach to evaluation Developmental assessment of infant	78

Background

Gestational exposure to licit and illicit drugs of abuse is the single largest preventable cause of in utero developmental compromise of infants in the USA today.
Treatment for women who use drugs during pregnancy is complicated by mental health comorbidities, domestic violence, poverty, poor health, needs of their children, involvement with child protective services and legal systems, parenting and social stigma.

Barriers to Treatment

Barriers to treatment include lack of resources such as health insurance, transportation and child care, and lack of availability of treatment programs.
Fear of punishment drives women away from the healthcare system, jeopardizing prenatal care.

Evidence-based Approaches

Treatment that begins during pregnancy.
Increased length of treatment, whether residential or outpatient.
Comprehensive treatment including, but not limited to, prenatal care, mental health services, child care, parenting and women's issues.
Home-based treatment.

Promising New Approaches

Motivational interviewing and contingency management.
Emphasis on the mother-infant relationship.
Treatment integrated with child protective services and the court, such as the establishment of family treatment drug courts.

Research Limitations

Studies are limited by methodological problems including small sample size, many confounding variables, inability to randomize patients to treatment conditions, and unblinded observers.
There is no 'one size fits all' model but there are strategies that can be drawn from different models that can be adapted to a specific population.
Choice of a specific approach depends, in part, on the circumstances of the particular population, although there is consensus that comprehensive treatment is preferred.
There is some evidence that treatment is cost-effective.

Authors and Disclosures