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Physical and Behavioral Indications of Perinatal Substance Abuse

The first step in determining a drug- or alcohol-dependent pregnant woman's need for services is to identify the problem. In addition to the general indicators noted above, the following physical signs and symptoms are suggestive of perinatal alcohol and/or other drug abuse:

• lack of prenatal care,
• previous delivery of a prenatally drug-exposed infant,
• intrauterine growth retardation in the absence of other identifiable causes, and
• placental abruption in the absence of other identifiable causes.

Additional indicators of possible alcohol or other drug abuse may include women who deliver outside the obstetrical unit (in the emergency room, in the ambulance, or at home), or women who have abrupt deliveries. In order to promote consistency in assessment, the provision of appropriate prenatal services must be ensured. To ensure the child's safety after delivery, many hospitals have developed protocols to assist in identification and referral of pregnant and postpartum substance-abusing women and their offspring for treatment and supportive services.

Physical and Behavioral Indications of Relapse for Individuals in Recovery

Relapse is inherent in alcohol and other drug abuse. The identification of a substance-affected family is only the beginning of a long process toward healing and maintaining a sober lifestyle. For an individual in recovery, the following behavioral signs and symptoms may alert professionals to the imminent risk of relapse:

• increasing self-pity,
• increasing depression,
• setting expectations that are too numerous or unrealistic,
• feelings of being "all-powerful" or not needing support, and
• distancing from friends who are clean and sober.

Diagnostic Tests for Alcohol Use

After drugs or alcohol have been ingested, they pass via the bloodstream to various parts of the body, such as the liver and kidneys, where they are converted into substances called metabolites. Different drugs and their metabolites leave the body at different rates. The rate of drug and alcohol excretion is affected by many factors, including the amount of alcohol or other drug taken; the frequency of use; the user's daily liquid intake, health status, exercise, age, sex, body weight, and metabolic rate; and the concurrent use of other drugs, including alcohol and/or nicotine.

The most common tests for alcohol use include an evaluation of blood alcohol levels and a breath analyzer, both of which are routinely used to determine whether an individual is driving while under the influence. Because alcohol passes rapidly through the system, these tests must be conducted very quickly in order to ensure any degree of accuracy regarding alcohol consumption. For this same reason, the urine drug toxicology screens described below are generally not helpful in detecting alcohol use.

Toxicology Screening for Drug Use

Urine is the body fluid most commonly used for drug screening. For infants, meconium (the first stool passed by a newborn at birth) also can be used for toxicology screening. Compared with urine, the recovery rate and concentration of drug metabolites often are higher in meconium. However, collection of a newborn's first stool is not always possible because some meconium is eliminated during delivery. Hair analysis is another method currently being investigated in research studies to test for drug metabolites. Compared with other methods, hair is reported to provide a longer term of history of drug use.

The urine screening methods used by most laboratories generally can detect drug metabolites no more than 48 to 72 hours following drug use. Drugs such as marijuana and phencyclidine (PCP) are fat soluble and are stored in fat, liver, lung, and brain tissue; these substances or their metabolites often can be found in the urine several days after use. Other drugs such as cocaine and amphetamine are water soluble and are excreted from the body more rapidly.

When requesting and interpreting toxicology results, professionals must remember the following:

There are two types of testing procedures: screening tests such as thin layer chromatography (TLC) and immune assay tests (EMIT), and Confirmatory tests such as gas chromatography.

Screening tests are highly sensitive, whereas confirmatory tests are more specific. Because screening tests may yield false positive results, it is recommended that, when a positive result is obtained with a general screening procedure, it be confirmed by a less sensitive but more specific confirmatory method. Some laboratories may use a blood test to confirm a positive urine screen.

Tags: Addictions

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