Social Issues Related to Substance Use and Abuse

Pregnancy and Substance Abuse

Rates of women who abuse substances are increasing. Most of the women who abuse substances are of child bearing ages. This presents a number of unique, complex and socially relevant issues. Including

  • Effects on children of substances used during the pregnancy.
  • Effects of attachment and mothering- state issues related to child-rearing
  • Effects of possible HIV infection due to contaminated needle usage during and after pregnancy

Treating professionals must also be aware of ethical issues related to suspicions of substance use on the part of a mother. These ethical concerns center around whether the mother is doing harm to an unborn child and whether the professional has a duty to warn social services agencies. Further, in terms of physical health physicians also must weigh to whom they have a duty to treat in the best interest of the mother or the unborn child.

Maternal consumption of alcohol and other drugs during any time of pregnancy can cause birth defects or neurological deficits.

Alcohol

  • Alcohol use by a woman who is pregnant is said to affect the fetus in a dose dependent manner. With “very high repetitive doses” there is a 6-10% chance of the fetus developing the fetal alcoholic syndrome manifested by prenatal and postnatal growth deficiency, specific craniofacial dysmorphic features, mental retardation, behavioral changes and a variety of major anomalies (Ornoy & Ergaz, 2010).
  • Cognitive performance is less affected by alcohol exposure in infants and children whose mothers stopped drinking in early pregnancy, despite the mothers’ resumption of alcohol use after giving birth.
  • Prenatal alcohol effects have been detected at moderate levels of alcohol consumption in nonalcoholic women. Even though a mother may not regularly abuse alcohol, her child may not be spared the effects of prenatal alcohol exposure
  • Offspring of mothers using ethanol during pregnancy can suffer from developmental delays and/or behavioral difficulties. High repetitive doses of alcohol 6-10% chance of fetus developing the fetal alcoholic syndrome manifested by prenatal and post natal growth deficiency, specific craniofacial dysmorphic features, mental retardation, and other major anomalies. Even with lower repetitive doses risk of slight intellectual impairment, growth disturbances and behavioral changes. Binge drinking imposes danger of slight intellectual deficiency. (Ornoy A, Ergaz Z.)
  • Studies were done on 12 year olds exposed to tobacco versus to 12 year olds unexposed to compare brain function. Researchers found that children who were prenatally exposed to tobacco show increased rates of behavior problems related to response inhibition deficits.

Methamphetamines

Children that are born to women who use methamphetamines are more likely to experience preterm delivers, have lower Apgar scores, increase rates of cesarean delivery and increased neonatal mortality (Good MM, et., al, 2010)

Cocaine

  • • Studies have shown that exposure to cocaine during fetal development may lead to subtle but significant deficits later on, especially with behaviors that are crucial to success in the classroom, such as blocking out distractions and concentrating for long periods.Children ages four to nine whose parents had used cocaine were studied to measure their cognitive abilities. The study showed that gender effected the outcome because boys whose mothers who used cocaine had lower IQ scores, and placed boys at risk for problems of inhibitory control, emotional regulation, and antisocial behavior (Bennett, D., et., al, 2008).
  • It was also found that children exposed to cocaine during the first trimester were smaller on all growth parameters than the children who were not exposed to cocaine during the first trimester.
  • The results of these studies also indicate cocaine associated deficits in attention processing through the age 7.
  • It was also found that boys who were prenatally exposed to cocaine reported engaging in more high-risk behaviors

Tobacco

  • Smoking during pregnancy most prevalent risk factor (Burstyn I, Kapur N Cherry NM.
  • Attachment difficulties appear if mother is incarcerated secondary to drug usage. (Cassidy J, Ziv Y, Stupica B, Sherman LJ, Butler H, Karfgin A, Cooper G, Hoffman KT, Powell B.

HIV

  • For women who have drug-usage related HIV treatment for drug abuse during pregnancy which can include methadone and buprenorphine may have drug interactions with HIV medications, and HIV medications. ( mcCance-Katz EF)
  • Treatment include several integrated programs that have been specifically developed to meet the needs of pregnant and parenting women with substance abuse issues. These programs are aimed more specifically at the needs of the children and to educate them about the damages to the children caused by the substance. Evidence shows that these programs are indeed effective but no more effective than regular treatment programs for women who abuse substance ( Milligan, K., et., al, 2010).

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