Academic journal article Social Work

Principles for Practice with Substance-Abusing Pregnant Women: A Framework Based on the Five Social Work Intervention Roles

Academic journal article Social Work

Principles for Practice with Substance-Abusing Pregnant Women: A Framework Based on the Five Social Work Intervention Roles

Article excerpt

Traditionally, substance abuse treatment programs are designed for men and are not readily available to women, particularly pregnant women (Blume, 1998; Finkelstein, 1994). Although more programs became available to substance-abusing pregnant women (SAPW) in the 1990s through federal funding policies, many do not provide pregnancy-specific treatment (Breitbart, Chavkin, & Wise, 1994). Cohen (2000) stated that although women-specific substance abuse treatment programs increased 53 percent during the past decade, some "do not facilitate them in a way that is supportive and positive for women" (p. 91). Using the five social work intervention roles (that is, teacher, broker, clinician, mediator, and advocate) (Compton & Galaway, 1994) as a framework and integrating relevant literature, I discuss components essential to a comprehensive pregnancy-specific treatment practice. [Compton and Galaway originally used the term "enabler." I changed "enabler" to "clinician" to avoid an association with "enabling" substance-abusing behavior, which has a negative connotation in the substance abuse treatment field.] Issues and elements related to substance abuse during pregnancy, although not exhaustive, are identified, and a systematic approach for working with SAPW is presented.

The Role of Teacher

Although specificity of perinatal substance-abuse knowledge varies with different audiences, all practitioners should understand drug effects on fetuses to effectively explain nonuse during pregnancy (Farkas, 1995). Sharing information with the SAPW is critical in prevention and rehabilitation and may help reduce their guilt and anxiety, thus increasing rapport and cooperation (Little & Gilstrap, 1998). Information should be explained nonjudgmentally (Siney, 1995) and in a way suitable to the woman's comprehension (Little & Gilstrap). Five areas may be shared with them.

Effect of Substance Abuse on Nutrition

Nutrition is emphasized for any pregnant woman, but it is particularly a concern for SAPW. Substance abuse can affect a pregnant woman's nutrition directly and indirectly. Directly, habitual alcohol and other drug (AOD) use may depress appetite, impair metabolism, and change nutrient activation and therefore may affect both maternal and fetal nutrition (Center for Substance Abuse Treatment [CSAT], 1995). Indirectly, the often chaotic lifestyle of the substance-using woman may lead to self-neglect, including poor diet (Sparey & Walkinshaw, 1995).

Effect of Substance Abuse on Medical Conditions

Drug Impact on Fetus. A fetus is much more vulnerable to drug effects because fetal tissue is more sensitive to drugs, and the fetus has not developed the enzyme systems to metabolize drugs (Geller, 1991). Prenatal AOD exposure may cause short- and long-term damage to the infant's physical, cognitive, and behavioral development (Little & Yonkers, 2001; Streissguth, 1997; Van Beveren, Little, & Spence, 2000). However, not all drug-exposed infants show significant medical complications or developmental problems, and it is difficult to predict outcomes for individual children. Depending on the type and combination of drugs used, reactions of the mother using the drugs, amount and frequency of use, the trimester in which the drug is used, and the fetus's genetic susceptibility to AOD, a baby may show severe, mild, or no symptoms (Kropenske & Howard, 1994; Little & Gilstrap, 1998; Streissguth). The concept of "critical periods" suggests that first-trimester drug exposure may cause congenital anomalies, whereas exposure during the second or third trimester may affect growth (Coles, 1994; Little & Gilstrap). The brain may be particularly susceptible because its development occurs throughout the pregnancy (personal communication with Colleen Morris, MD, University of Nevada School of Medicine, October 27, 2003).

The Neonatal Abstinence Syndrome (NAS). AOD-exposed fetuses, particularly those exposed to alcohol or heroin, may develop withdrawal symptoms at birth when the maternal drug supply stops. …

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