Pregnant and Parenting Women.................................................................................
Barriers to treatment access and completion can
be particularly acute for women who are
pregnant or post-partum, despite the fact that
pregnancy may provide substance-using women
with the motivation they need to reduce their
substance use or seek treatment.^183 In 2010,
only 15.9 percent of facilities nationwide that
provided addiction treatment services offered
services specific to pregnant or post-partum
women.^184
Limited availability of child care for parenting
women in addiction treatment is a significant
barrier to treatment entry and retention.
National data indicate that only 6.5 percent of
outpatient addiction treatment facilities that
serve women offer child care, although facilities
that served women only were significantly
likelier than facilities serving both men and
women to offer child care services.^185
Some pregnant smokers report reluctance to quit
smoking due to fear of weight gain,^186 not
believing in the harmful effects of smoking to
themselves or their fetus due to prior
pregnancies with no observable harm and a
social environment where smoking is
prevalent.^187
Some women also fear being branded as “bad
mothers” by treatment personnel.^188 One study
found that more than one-third of pregnant
smokers reported being apprehensive about
attending smoking cessation counseling because
they believed the counselor would judge them
harshly.^189
Pregnant and parenting women might shy away
from accessing treatment for addiction involving
alcohol or other drugs (excluding nicotine) for
fear that entering treatment may result in losing
custody of their children;^190 they may be
apprehensive of the involvement of child
protective services if they were to be identified
as having addiction.^191 CASA Columbia’s
survey of treatment providers in New York State
found that a significant proportion of the
respondents said that fear of losing child custody
“somewhat” (25.3 percent of program directors
and 37.0 percent of staff providers) or “very
much” (73.5 percent of program directors and
58.7 percent of staff providers) stands in the way
of people looking for needed addiction
treatment.^192Substance use during pregnancy is considered a
form of child abuse under civil child-welfare
statutes in 15 states and is considered grounds
for civil commitment (i.e., forced admission into
a treatment program)^ in three states.^193 Pregnant
substance users have been charged with such
crimes as fetal abuse, child abuse and neglect,
delivering drugs to a minor, corruption of a
minor, assault with a deadly weapon and
manslaughter.^194 Some states have used prenatal
substance use as grounds to terminate parental
rights.^195Adolescents ................................................................................................................
Few diseases affecting adolescents are as
extensively under-treated as addiction, even
though addiction is a disease with firm roots in
adolescence.^196 The significant treatment gap in
the adolescent population--which is particularly
acute among black and Hispanic youth^197 --is due
in large part to the failure to understand the
developmental nature of addiction and the
failure of health care professionals to look for
and prevent risky substance use or to identify
and address addiction in their adolescent patient
populations.^198The Society for Adolescent Health and Medicine
has called for greater access for adolescents and
young adults to health care through
nontraditional health care providers such as
school health centers, community health centers
and other public health agencies that rely
primarily on public funding, and expanded
insurance coverage.^199 Unfortunately, systems
responsible for the welfare of young people--
schools, juvenile justice, child welfare-- too
often miss opportunities to intervene with young
people in need of treatment and continue to
allow them to fall through the cracks undetected
and unaided.^200Treatment models with a strong evidence base in
adult populations are not necessarily applicable