to pharmaceutical interventions.* 80 Withdrawal
from addictive substances during detoxification
can be highly risky to a fetus; for example,
sudden withdrawal from certain opioids and
sedatives can lead to fetal distress or death.^81 As
a result, detoxification protocols should include
careful monitoring of the pregnant woman and
her fetus and medical supervision of the
detoxification process itself--for example,
through the use of buprenorphine to treat or
prevent opioid withdrawal during pregnancy†--
preferably under the direction of a physician
with experience in perinatal addiction.^82
Medically supervised detoxification typically
takes place during the second trimester because
of the risk of miscarriage in the first trimester
and the increased risk of premature delivery or
fetal death in the third trimester.^83
Research on the safety and efficacy of
pharmaceutical therapies for addiction treatment
among pregnant women is limited.^84 Certain
medications, such as disulfiram, are not
considered safe for pregnant women, while
others, such as methadone, are less risky and
may be preferable to continued substance use.^85
Case management is particularly critical for
pregnant women with addiction.^86 Case
management services typically assure
standardized assessments, access to prenatal and
pediatric care, mental health services, vocational
and parenting classes, childcare and
transportation services.^87
Pregnant women with co-occurring addiction
and mental health disorders require additional
medical monitoring because pregnancy can
aggravate certain symptoms of mental illness,
including depression and anxiety.^88 Hormonal
changes, increased stress and pregnancy-specific
medications all can contribute to the potential
exacerbation of mental illness symptoms.^89
- Specific psychosocial treatment approaches that
work for pregnant women with addiction do not
appear to differ from those found to be effective in
the general population of women.
† Opioid withdrawal during pregnancy can lead to
fetal death.
Although federal law requires that pregnant
women receive priority admission into addiction
treatment programs, allowing them to bypass
waiting lists,^90 numerous barriers prevent many
pregnant women from accessing needed
treatment.‡ While pregnant women may be
more motivated than other women to receive
addiction treatment because of the known risks
of substance use to pregnant women and their
babies, they are less likely to stay in treatment
once admitted, and reductions in substance use
often are transient and dissipate once their
children are born.^91Older Adults .....................................................................................................................
Treatment approaches for older adults must take
into account their increased risk of developing
addiction involving prescription drugs due to the
use of medication to treat chronic pain, sleep
disorders, depression and anxiety--problems that
are common in this age group--as well as the
fact that their bodies become even more
vulnerable to the effects of alcohol and other
drugs with age.§ 94 Co-occurring health
conditions and medical complications due to
age-related health problems can interfere with
addiction treatment and make it harder for older
adults to follow treatment instructions and
plans.^95‡ See Chapter VII.
§ See Chapter IV for a discussion of the unique risks
that older adults face with regard to substance use
and addiction.The Center for Substance Abuse Treatment’s
(CSAT) Pregnant and Postpartum Women
demonstration program provided comprehensive
clinical, medical and social services, over the
course of six to 12 months, to pregnant women
and mothers of children under the age of one.^92
During the six months following discharge from
this program, 61 percent of the women had
achieved and maintained their abstinence from
alcohol and other drugs. Program participation
also was associated with increased employment
rates and decreased rates of arrest, foster care
involvement and premature deliveries, low birth
weight and infant death.^93