Resolution on Substance-Related Disorders in Pregnant and Postpartum
Substance use disorders are a public health issue with many risk factors and complicated etiologies (e.g., genetics, traumatic events, and environmental factors) (Khoury, Tang, Bradley, Cubells, & Ressler, 2010; NIDA, 2010; NIDA, 2011; NIDA, 2016);
Whereas, in the United States, the prevalence of pregnant adolescent girls and women who use illegal substances has remained largely steady at 4.7 percent over the last five years (Center for Behavioral Health Statistics and Quality, 2016 SAMHSA, 2014);
Whereas adolescent girls and women younger than 25 (Center for Behavioral Health Statistics and Quality, 2016); in the first or second trimester compared to the last trimester (Center for Behavioral Health Statistics and Quality, 2016); adolescent girls and women who meet criteria for possible psychopathology, including depressive, anxiety, and panic disorders, as well as adolescent girls and women who meet criteria for possible psychopathology, including depressive, anxiety, and panic disorders (Havens, Simmons, Shannon & Hansen, 2009; Smith, Costello, & Yonkers, 2015). Pregnant women who abuse prescription opioids, for example, are more likely than non-users to develop major depressive disorder (16 percent vs. 8%), generalized anxiety disorder (18% vs. 9%), post-traumatic stress disorder (11 percent vs. 4%), or panic disorder (6 percent vs. 4%). (Smith, Costello, & Yonkers, 2015). Other risk factors include the biological father's substance use, being single, childhood trauma, and delinquency (el Marroun et al., 2008; Young, Deardorff, Ozer, & Lahiff, 2011).
Premature birth, low birth weight, being small for gestational age, as well as behavioral and cognitive effects, such as attention deficit disorders, language development, emotional reactivity, and externalizing (Derauf et al., 2016; El-Mohandes et al., 2003; Eze, et al., 2016; LaGasse, et al., 2012; Lester, Adreozzi, & Appiah, 2004), are all possible outcomes
Whereas there is a need for research to determine the rate of illicit drug use among pregnant adolescent girls and women who identify with a sexual minority group (Fredriksen-Goldsen et al., 2013); and there is a need for scientific literature to determine evidence-based practices for pregnant adolescent girls and women who identify with either a sexual minority group;
Whereas there is a need for research to determine the rate of illicit drug use among pregnant adolescent girls and women who identify as disabled (National Council on Disability, 2012); and there is a need for scientific literature to determine evidence-based practices for pregnant adolescent girls and women who identify as disabled (National Council on Disability, 2012);
Whereas there is a need for scientific literature examining the interplay of the biological impact of illicit substance use on infant and child outcomes, including behavioral dysregulation during early childhood and into adolescence, as well as cognitive outcomes; as well as literature comparing these outcomes to other child risk and protective factors such as maternal mental health and stress, connectedness to parents/others, expectancy and motivation, parent-child interaction, and parent-child interaction; and literature comparing these outcomes to other child risk and protective factors such
Prenatal treatment benefits all pregnant adolescent girls, women, and their newborns, but it is particularly beneficial for pregnancies including substance use problems (el-Mohandes et al., 2003; Lester, Andreozzi, & Appiah, 2004; Parrott & Daniels, 1996).
Only 19 states have either built or sponsored specialized treatment programs for pregnant women; only 12 states provide pregnant women priority access to state-supported services; and only four states prohibit state-funded programs from discriminating against pregnant women (Guttmacher Institute, 2016).
According to a 2017 SAMHSA assessment, just 13% of the country's more than 13,000 treatment institutions provided specialized services to pregnant women, and only 7.5 percent provided childcare (Smith & Lapari, 2017).
Whereas, according to deAngelis (2001), the junction of substance use and pregnancy is underrepresented in psychologists' practice settings as well as in psychological literature and research papers;
Currently, 18 states seek to punish women who take drugs while pregnant by accusing them of child abuse and/or neglect, reckless endangerment, assault, or fetocide (Angelotta & Weiss, 2016; Lester, Andreozzi, & Appiah, 2004). Such laws rarely account for standard medical protocols that include the prescription of methadone or an opioid-like substance as part of medication-assisted therapy, which can result in positive tests for the presence of opioids, effectively making it illegal for pregnant women or girls to follow a prescribed medical regimen.
Punitive approaches and stigmatization cause pregnant women with substance abuse disorders and HIV/AIDS, which frequently co-occurs with substance abuse disorders, to be significantly less likely to seek substance abuse treatment and prenatal care due to fear of prosecution, removal of infants and other children from their custody, and limited access to specialized treatment programs (Amaro, Larson, Zhang, Acevedo, Dai, and Matsumoto, 2007).