Residential Substance Abuse Treatment for Pregnant and Postpartum Women and Their Children: Treatment and Policy Implications

Article excerpt

In FY 1993 and FY 1995, the federal government awarded 27 five-year grants that supported 35 residential treatment projects for substance-abusing pregnant and postpartum women and their children. These projects provided comprehensive culturally and gender-specific treatment. Preliminary aggregated data collected in a national cross-site evaluation of 24 of these projects are encouraging with respect to infant mortality and morbidity, treatment retention and completion rates, and behavioral changes in the participating mothers at six months postdischarge. Local evaluations reflect other benefits of treatment. Cost data are expected to demonstrate the efficiencies and benefits of these projects compared to no treatment.

n response to 1992 amendments to the Public Health Service Act (PL. 102-321), the Substance Abuse and Mental Health Services Administration (SAMHSA), through the Center for Substance Abuse Treatment (CSAT), awarded 27 grants in fiscal years 1993 and 1995 to expand comprehensive residential treatment services for substance-abusing women who were pregnant or were postpartum (within one year of giving birth). These fiveyear grants comprised the pregnant and postpartum women (PPW) program, a $113 million federal effort. The grants supported 35 projects for pregnant and postpartum women. These projects were specifically designed so that newborns, infants, and other minor children could live in the residence with their mothers. Their locations are listed in table 1. A national cross-site evaluation of the PPW program was initiated in FY 1996 and continues with data collection and analysis through September 2001. Due to budget constraints, only 24 projects are participating in the cross-site evaluation. Client-level data are collected at admission, discharge, and six-months postdischarge. This report presents an analysis of data from 1,847 women for whom complete data are available.

Residential Treatment Services for Pregnant and Postpartum Women and Their Children

The impetus for establishing the PPW program came not only from legislation, but from an increasing focus on research corroborating the significant consequences of substance abuse for women and their children. Women are likely to have different reactions to substance abuse than their male counterparts [CSAT 1994]. For example, they tend to suffer more severe and prolonged medical complications from alcohol abuse, even when they have shorter drinking histories and consume less alcohol. In addition to substance abuse, they are likely to have concurrent mental health disorders such as depression or anxiety that may be related to previous sexual or physical abuse [CSAT 1994]. Their drug habits often lead to arrests for theft, drug sales, or trading sex for drugs and to increased risk for HIV infection and other sexually transmitted diseases. Many substance-abusing women have other social problems such as low incomes, poor education, limited job skills, abusive partners, homelessness, and daunting responsibilities as single mothers.

Maternal substance abuse also has negative effects on pregnancy, the developing fetus, and minor children. Continued use of toxic substances, inadequate nutrition, and lack of prenatal care are correlated with high rates of miscarriage and premature births. In utero drug exposure may result in fetal anomalies, growth retardation, and neonatal withdrawal syndromes. Emerging evidence indicates that prenatal exposure to cocaine causes persisting, but treatable, delays in infants' gross and fine motor skill development [Arendt et al. 1999]. Child abuse and neglect are also negative consequences of mothers' substance abuse, often requiring interventions by child protective services (CPS) or termination of child custody. Although abuse and neglect statistics vary across studies, due to differences in criteria and methodology, a survey of state child welfare administrators found that parental substance abuse was a factor in at least 50% of substantiated reports of child abuse and neglect [Child Welfare League of America 1998]. …