Substance Abusing Pregnant Women and Mothers

by SAMHSA

(Page 16 of 20)

A significant percent of adults who abuse substances also have co-occurring mental health issues, and rates for comorbid substance abuse among adults with mental illness are high. Primary diagnoses include major depression, panic disorder and post-traumatic stress disorder. Women who abuse substances are also at increased risk for attempting suicide. There is likely to be considerable overlap between mothers who abuse substances and those with mental illness.

Similar to women with mental illness, substance-abusing women often face a myriad of social, emotional, psychological, and physical problems, in addition to pragmatic concerns about housing, employment, transportation and finances. Pregnant and parenting women have a special set of circumstances to consider. Substance abusing pregnant women are at increased risk of contracting sexually transmitted diseases, HIV and Hepatitis B. Possible outcomes for children include prematurity, low birth weight, Fetal Alcohol Syndrome and HIV exposure, all of which have short- and long-term consequences. Children whose parents abuse drugs and alcohol are more likely to be abused and neglected that children whose parents do not. Substance abusing pregnant women and mothers are less likely to seek prenatal or general health care, due to stigma, denial, the lack of gender-specific treatment options, and the dearth of treatment options for mothers with their children. In addition, many substance abuse programs will not enroll pregnant and parenting women.

Substance abuse treatment strategies were originally designed for male substance abusers. This trend changed in the mid-1970s, with the passage of Public Law 94-371 mandating the creation of specialized treatment programs for women. As a result, research and programming specific to substance abusing women has increased over the past 25 years. Tailoring programs to women has meant moving away from traditional male dominated, confrontational models of treatment towards modalities that address the different needs of women. The paradigm is shifting from treatment of an individual client, to a mother-child/family-centered orientation in which treatment is coordinated around the family unit, and where prevention and early intervention are stressed. Variations in services may include programs where mothers and children live together in a treatment setting, are educated regarding child development, and where treatment schedules are modified to meet the needs of mothers with small children.

Substance abuse prevention efforts have targeted youth as a vulnerable at-risk population for substance abuse. SAMHSA's Center for Substance Abuse Prevention has identified effective, model programs created to assist youth in overcoming exposure to risk factors through the enhancement of protective factors. Programs like The Strengthening Families Program coordinated by the University of Utah's Health Promotion and Education Department provide interventions including parent training, social and life skills training, and family practice sessions. SAMHSA is creating opportunities for the application and evaluation of these types of intervention strategies to families living with mental illness. For example, the SAMHSA-funded Women with Co-Occurring Disorders and Histories of Violence multi-site initiative will provide empirical evidence of the effectiveness of interventions for families derived from the substance abuse prevention and treatment arena, and applied to the special population of women coping with mental illness, substance abuse, and trauma, and their children.

SUMMARY: There is considerable overlap between the population of parents with substance abuse and those with mental illness, given the high rates of co-occurring substance abuse and mental health disorders and the prevalence of parenting in both groups. However, knowledge gained in the substance abuse treatment community regarding mother-child/family-centered prevention and treatment does not seem to have been applied widely in the mental health arena, though SAMHSA is providing opportunities for the application and evaluation of intervention strategies derived from this arena to other special population, e.g., women with co-occurring disorders and histories of violence, and their children. Few programs have been developed specifically to meet the needs of parents with co-occurring disorders and their families.

RECOMMENDATIONS: Substance abuse and mental health systems and providers need to coordinate and integrate services, and work together with other systems of care (i.e., child welfare, rehabilitation) to create a continuum of care for parents and families. Substance abuse treatment programs that have been modified to meet the needs of women, and to coordinate and provide services for families can serve as models to program development efforts for parents with mental illness and their families.

Women and Trauma/Violence

Twenty to thirty percent of women in the United States have experienced some form of sexual or physical abuse during their lifetime. Abuse is usually not an episodic occurrence, but rather part of a history of violence and trauma. Violence against women is a growing public health crisis. Victims of violence often struggle with related issues including poverty, homelessness, substance abuse and mental illness. Women victims of violence are at increased risk for depression, post-traumatic stress disorder and suicide attempts. Children are affected by witnessing violence in their home or neighborhood environments. Having childhood experiences of trauma or abuse can contribute to women's difficulties in current relationships and parenting.

Women receiving mental health care are rarely asked about a history of sexual or physical abuse. When professionals ignore these experiences, women may discount the devastating impact of violence on their lives. They may not receive needed treatment with respect to trauma or the impact of trauma on parenting. Women with a history of trauma have multiple service needs that are best met through integrated and coordinated systems of care, and a holistic approach to treatment that embraces the related issues of mental health and substance use. Recovery can only be achieved through attention to the interconnectedness of the issues that face women, and through the creation of a multidisciplinary, comprehensive treatment model including, for women with children, the issues of family.

SUMMARY: Prevalence of trauma among women and parents with mental illness is likely to be high. Trauma histories are likely to impact overall functioning and parenting in particular. Mental health providers do not always assess trauma histories sufficiently, consider the impact of trauma on parenting, or provide appropriate treatment. The issues of parents who are trauma survivors are disregarded by providers in service planning for adults and in treatment relationships with their children.

RECOMMENDATIONS: Epidemiological studies are needed to describe the extent to which women trauma survivors are parents and, likewise, the extent to which parents are trauma survivors. Descriptive studies are needed to explore the ways in which trauma experiences are related to aspects of parenting among adults with mental illness. Mental health providers need to be aware of the impact of trauma in women's lives, and the need to address this in trauma-sensitive treatment approaches, particularly with respect to the parenting role. Children's service providers must be sensitive to the needs and respectful of the preferences of all parents and, in particular, the unique issues of those who are trauma survivors.

About the Author

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