The Effects on Substance Abuse on Unborn Children
The Effects of Substance Abuse on Unborn Children Substance abuse is a problem that many pregnant women in the United States struggle with. Substance abuse is defined as the overindulgence in and the dependence on an addictive substance, especially alcohol or a narcotic drug. Generally, pregnant addicts abuse multiple substances, using a combination of drugs to self medicate themselves. In addition, women are usually addicted to drugs or have issues with alcoholism before they become pregnant.
Substance abusing women have also been shown to have histories of physical and sexual abuse dating back to childhood (Gale, 2003). Many of these women are in abusive relationships in which they tend to stay in throughout their addiction. In this case, the use of drugs helps to numb the addict’s pain of such abuse. Most of these women feel distrustful of people in general and therefore, have very little support from their peers. Drug dependence is a disease. Drug dependence is the habituation or addiction to the use of a drug or chemical substance, with or without physical dependence.
It is extremely difficult for a woman to abstain, even if she does become pregnant. In addition, if a woman decides to seek treatment she may face many barriers. This paper will address the prenatal effects of drug dependence, barriers to treatment, social policy, and what a comprehensive treatment program provides to women who are addicted to drugs and who are also pregnant. Prenatal substance abuse is wrong because there is no question that it poses serious health risks to the fetus, but also poses problems for mother.
The prenatal effects of drug addiction vary among the type of drugs that are used by the mother. These drugs include the licit drugs of alcohol and tobacco. Alcohol may produce Fetal Alcohol Syndrome (FAS); a condition characterized by abnormal facial features, intrauterine growth retardation, and central nervous system problems (CDC, 2003). This can occur if a woman drinks during her pregnancy. Children with FAS may have physical disabilities and problems with learning, memory, attention, problem solving, and social/behavioral problems.
Research has also shown that boys born to mothers who consumed alcohol during their pregnancies are more likely to develop attention deficit disorders and delinquent behavior (Rothman, 2000). Smoking also has many negative effects to the reproductive process; including impaired fertility, earlier menopause, increased risk of ectopic pregnancy, as well as placenta previa, abruption placenta, and premature rupture of the membranes (CDC, 2003). In severe cases, newborn children may die of acute intoxication. According to Dr.
Mark Willenbring, the director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, recovering from this disease can be a long road. After a year of completing a treatment program, about a third of alcoholics are sober or can have a drink occasionally without problems. An additional forty percent show substantial improvement but still drink heavily on occasion; and twenty five percent have experienced a complete relapse (Bock). Tobacco use during pregnancy can be particularly harmful to the baby as well.
Studies have shown that smoking a single pack of cigarettes during pregnancy can elevate the risks of nicotine dependency in children (Buka, Shenassa, & Niaura, 2003). Research has also shown that a physiological link between maternal smoking during pregnancy and smoking among offspring is plausible because nicotine and other substances in cigarette smoke cross the placental barrier and may have direct and long-term effects on the neurological development of the fetus. The nicotine that passes from mother to fetus stimulates nicotinic receptors, which are present from the early stages of fetal development.
This activity may cause permanent abnormalities in the brain’s dopaminergic regulation. These effects, which may occur even at low nicotine doses and in the absence of notable fetal abnormalities, may result in a greater liability to nicotine dependence than in those who have not been exposed to tobacco smoke in utero (Buka, Shenassa, & Niaura, 2003). The second group of drugs, are categorized as illicit and include; heroin and crack/cocaine. Heroin is an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates.
Heroin, and methadone, a pharmacological replacement of heroin are both considered opiates. These drugs contribute to the development of Neonatal Abstinence Syndrome (NAS) occurring sixty to ninety percent of the time in opiate dependent infants (Jansson & Velez, 1999). Neonatal Abstinence Syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics in-utero. However, since the drug is no longer available, the baby’s central nervous system becomes over-stimulated causing the symptoms of withdrawal.
Although NAS symptoms and severity vary from child to child, many infants that are affected may display irritability, excessive crying, impaired sleeping and or feeding, fever, vomiting, frequent yawning, skin excoriation, hyperactivity, tremors, and seizures (Jansson & Velez, 1999). NAS can be successfully managed with Phenobarbital; a non-narcotic sedative, Denatured Tincture of Opium (DTO); an effective narcotic replacement, combination therapy, and weaning therapy (Brown, 1998).
Infants exposed to methadone in-utero may not have symptoms on the first day of life, and extreme symptoms may not appear until the third or fourth day of life. In addition, the higher the dose of methadone, the longer the duration before onset of symptoms, and the longer it will take to clear from the infant’s system. The effects of prenatal crack/cocaine on the fetus are not well understood. Cocaine is a powerfully addictive stimulant that directly affects the brain. Crack, is the street name given to the freebase form of cocaine that has been processed to form to a smokeable substance.
However many clinicians agree that preterm delivery, placenta abruption, low birth weight, and increased pregnancy loss are all increased in crack-using mothers and their infants. There is no true withdrawal syndrome among cocaine exposed newborns. However, they have been characterized as severely neuro-developmentally impaired, despite a lack of methodologically sound scientific evidence (Lester, 1998). Children of mothers who used cocaine during pregnancy may be more likely to experience delayed language development.
Dr. Virginia Delaney-Black states that these children are 2. 4 times more likely to be in the low language ability group than those who are not exposed (Rothman, 2000). Drug dependent expecting mother often look to the community for support and treatment programs but find that many of these programs are male centered, they generally do not cater to women’s needs and may reject them due to their pregnancy (Gale, 2003). These women are left to navigate the public health system independently.
Most medical training programs lack adequate education surrounding substance abuse and because of this many become punitive and judgmental towards this population. Another frequent barrier to care is the woman’s fear of criminal prosecution or the removal of her already existing children by the welfare system. Because women tend to withhold from telling medical caretakers of their addiction, this inhibits needed medical intervention in the form of substance abuse treatment or enhanced screening for medical complications associated with substance abuse nd pregnancy. Accessibility to the treatment facility poses as yet another barrier to care; transportation and childcare are vital necessities. Having to decide between the daily welfare of their children and the daily attendance at a drug treatment facility is an unfair choice to impose, and choosing one over the other will always be interpreted as a bad choice by the caretakers or society (Jansson & Velez, 1999). Social policy has recently contributed a fair solution in dealing with the issues of pregnancy and addiction.
According to Berger & Walfogel cases are referred to Child Protective Services (CPS) only if a child has been tested positive for drugs and there are indications that the mother or father cannot adequately take care of him or her. Children who test positive to being exposed to drugs in the womb are referred to a clinician for an assessment to determine whether or not they require a developmental intervention; such as home visiting by a nurse or social worker specializing in early intervention with substance-exposed children.
In addition, the parents of these children are referred to substance abuse treatment programs for detoxification and recovery. With evidence, cases are referred to CPS only when the substance abuse treatment worker or home-health provider has concerns that warrant protective intervention. Lastly, screening is helpful to determine if an infant has been exposed prenatally to drugs. Screening also allows the physician to offer counsel and refer the mother for treatment prior to giving birth.
Comprehensive treatment programs have been designed to fulfill the many needs of substance abusing women. Johns Hopkins Bayview Medical Center in 1991 established the Center for Addiction and Pregnancy (CAP) to provide a multidisciplinary approach for the treatment of substance dependent women. CAP was the first gender specific treatment center in Maryland and it has served as a national model ever since. Their program offers easy accessibility to the center by providing transportation and childcare services.
In addition, CAP offers residential and outpatient care, drug treatment and detoxification, individual and group therapy, educational classes, couples counseling, and outreach services. All infants born to CAP patients, including their older siblings, are eligible for pediatric care until the age of twenty-one regardless of their mother’s participation (Jansson & Velez, 1999). CAP provides a “one-stop shop” to patients, with all their services located in one building. Their program accepts women that other programs do not want, such as women with behavioral problems and women who continually relapse.
Only two restrictions apply to being a patient at CAP; women have to be pregnant and violence of any kind will not be tolerated. In addition, there are other treatment programs in Maryland modeled after CAP. Prince George’s County and the Eastern Shore both have programs that cater to the needs of pregnant addicts with the exception of services in one building. However, they do provide transportation to and from locations and also offer childcare services. Overall, the outcome of such women and their children vary from mother –infant dyad to another.
Some children will be separated into foster care at birth, while others will be monitored while living with their mother and possibly their father in treatment programs. Some children start out in foster care and then move back home when evidence shows their mom and/or dad is sober and well into the recovery process. Other children may remain in foster care for the rest of their childhood and adolescence, possibly never knowing who their biological parents are. However, if the child is to remain with their drug dependent mother, the issue of abuse and/ or neglect can become a major problem.
Characteristically, the drug dependent mother who is given responsibility for their child goes into a living situation where she is forced to assume total care. She rarely has the support of her family of origin, and if there is a man in the household, he rarely assumes responsibility for childcare. Whether the substances are licit or illicit, drug dependent women are less able to care for their infant or young child because they are simply not aware of what their needs are, as her consciousness is too frequently dulled by drugs.
The dangers involved with taking drugs during a pregnancy involve health risks associated not only with the mother but also the unborn fetus and include complications that extend well into the newborn’s life. Therefore, when considering the welfare of children, the high prevalence of relapse found among drug dependent mothers needs to be taken into account. References Berger, L. M. , & Walfogel, J. (2000). Prenatal Cocaine Exposure: Long-Run Effects and Policy Implications. Social Service Review, 30-47. Bock, J (December 15). Mom: Drunk, killer, victim. McClatchy – Tribune Business