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Porreca A, De Carli P, Filippi B, Bakermans-Kranenburg MJ, van IJzendoorn MH, Simonelli A. Maternal cognitive functioning and psychopathology predict quality of parent-child relationship in the context of substance use disorder: A 15-month longitudinal study. Dev Psychopathol 2024:1-12. [PMID: 38282537 DOI: 10.1017/s0954579424000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This longitudinal study aimed to investigate the role of maternal cognitive functioning and psychopathology in parent-child relationship quality during residential treatment for mothers with Substance Use Disorder (SUD), in order to identify factors that may enhance or limit intervention effects.We assessed cognitive functioning (Esame Neuropsicologico Breve-2 [ENB-2]) and psychopathology (Symptom Checklist-90 Revised [SCL-90-R]) in 60 mothers diagnosed with SUD (Mage = 30.13 yrs; SD = 6.79) at treatment admission. Parent-child relationship quality was measured during free-play interactions using the Emotional Availability Scales every three months from admission (Child Mage = 17.17m; SD = 23.60) to the 15th month of the residential treatment.A main effect of maternal psychopathology and an interaction effect of time and cognitive functioning were found. More maternal psychopathology predicted lower mother-child relationship quality. Mothers with higher cognitive functioning presented a better treatment trajectory, with an increase in mother-child relationship quality, whereas mothers with lower cognitive functioning showed a decrease in relationship quality after initial improvement.These findings suggest that maternal psychopathology and cognitive functioning may influence the treatment of parent-child relationships in the context of SUD, although causality is not yet established. Implications for assessment and intervention are discussed.
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Affiliation(s)
- Alessio Porreca
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
| | - Pietro De Carli
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, MI, Italy
| | - Bianca Filippi
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
| | | | - Marinus H van IJzendoorn
- Research Department of Clinical, Education and Health Psychology, Faculty of Brain Sciences, UCL, London, UK
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
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Mburu G, Ayon S, Mahinda S, Kaveh K. Determinants of Women's Drug Use During Pregnancy: Perspectives from a Qualitative Study. Matern Child Health J 2020; 24:1170-1178. [PMID: 32754861 PMCID: PMC7419458 DOI: 10.1007/s10995-020-02910-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women's decisions to use drugs during pregnancy. METHODS In 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy. RESULTS Four key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women's drug use during pregnancy. CONCLUSION Our paper reports women's drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.
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Affiliation(s)
- Gitau Mburu
- Centre for Global Health Policy, University of Sussex, Falmer, UK.
| | | | | | - Khoshnood Kaveh
- School of Public Health, Yale University, New Haven, CT, USA
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3
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Smith WT. Women with a substance use disorder: Treatment completion, pregnancy, and compulsory treatment. J Subst Abuse Treat 2020; 116:108045. [DOI: 10.1016/j.jsat.2020.108045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
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Hoang T, Czuzoj-Shulman N, Abenhaim HA. Pregnancy outcome among women with drug dependence: A population-based cohort study of 14 million births. J Gynecol Obstet Hum Reprod 2020; 49:101741. [PMID: 32438133 DOI: 10.1016/j.jogoh.2020.101741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/12/2020] [Accepted: 03/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Drug dependence is on the rise worldwide. The purpose of this study is to examine the association between drug dependency in pregnancy (DDP) and maternal and newborn outcomes. METHODS We carried out a population-based retrospective cohort study evaluating DDP using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1999 to 2014. DDP was identified using ICD-9 coding. The associations between DDP and maternal and newborn outcomes were estimated using multivariate logistic regression analyses to estimate adjusted odds ratios and 95 % confidence intervals. RESULTS Among 14,513,587 deliveries, 50,570 were to mothers with DDP for an overall prevalence of 35 cases/10,000 deliveries. The rate of pregnancies to drug-dependent women increased during the 15-year study period, from approximately 25/10,000 in 1999 to 69/10,000 in 2014. Women with DDP were younger in age, users of tobacco, and in lower income quartiles with more pre-existing health conditions, such as diabetes and hypertension. DDP was associated with greater risk of venous thromboembolism (OR 1.60; 95 % CI, 1.45-1.76), sepsis (OR 2.94; 95 % CI, 2.48-3.49), and maternal death (OR 2.77; 95 % CI, 1.88-4.08). Neonates born to mothers with drug dependence were at higher risk of prematurity (OR 1.37; 95 % CI, 1.33-1.41), intrauterine growth restriction (OR 1.60; 95 % CI, 1.54-1.67), and intrauterine fetal death (OR 1.27; 95 % CI, 1.16-1.40). CONCLUSION DDP is increasing in frequency and it is associated with maternal and newborn deaths and adverse events. Further research and public health initiatives should be undertaken to address prevention, screening, and treatment.
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Affiliation(s)
- Tuan Hoang
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada.
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Cook JL, Blake JM. Cannabis: Implications for Pregnancy, Fetal Development, and Longer-Term Health Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1204-1207. [PMID: 30268315 DOI: 10.1016/j.jogc.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON.
| | - Jennifer M Blake
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
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Kozhimannil KB, Dowd WN, Ali MM, Novak P, Chen J. Substance use disorder treatment admissions and state-level prenatal substance use policies: Evidence from a national treatment database. Addict Behav 2019; 90:272-277. [PMID: 30472535 DOI: 10.1016/j.addbeh.2018.11.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 11/18/2022]
Abstract
State policies pertaining to prenatal substance use have important implications for health outcomes of pregnant women and their infants. However, little is known about the impact of the various types of state-level prenatal substance use policies (i.e., treatment and supportive services; criminal justice initiatives; and health care provider reporting requirements) on substance use disorder treatment admissions. Using data from the 2002-2014 Treatment Episode Data Set - Admissions, we exploited state-level variation in the implementation of different types of policies to assess their impact on pregnant women's admission to substance use disorder treatment. The study found that state-level prenatal substance use policies focused only on the criminal justice sector were negatively associated with the proportion of women of reproductive age who were pregnant upon admission to treatment. Additionally, the implementation of policies that engaged all three sectors was positively associated with the proportion of women of reproductive age who were pregnant upon admission to treatment. These results were consistent across age groups and for both non-Hispanic white women and women of other racial/ethnic groups. The findings imply that states with cross-sector policy engagement around prenatal substance use and policies that take a multifaceted, comprehensive approach are more likely to see an increase in admissions to substance use disorder treatment during pregnancy.
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Affiliation(s)
- Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 729 Mayo, Minneapolis, MN 55455, United States.
| | - William N Dowd
- Behavioral Health Services, Policy, and Economic Research Program, RTI International, USA
| | - Mir M Ali
- Department of Health Services Administration, University of Maryland, USA
| | - Priscilla Novak
- Department of Health Services Administration, University of Maryland, USA
| | - Jie Chen
- Department of Health Services Administration, University of Maryland, USA
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Vazquez VE, Bergin A. Effectiveness of a Specialized Inpatient Treatment Program for Substance and Alcohol Abusing Pregnant Women. JOURNAL OF DRUG ISSUES 2019. [DOI: 10.1177/0022042619831986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Aine Bergin
- California Baptist University, Riverside, USA
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Bobb-Semple AA, Williams AF, Boggs ME, Gold KJ. Prenatal Point-of-Care Tobacco Screening and Clinical Relationships. Ann Fam Med 2018; 16:507-514. [PMID: 30420365 PMCID: PMC6231932 DOI: 10.1370/afm.2290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Up to one-third of female smokers with Medicaid deny tobacco use during pregnancy. Point-of-care urine tests for cotinine, a tobacco metabolite, can help to identify women who may benefit from cessation counseling. We sought to evaluate patient and clinician perspectives about using such tests during prenatal care to identify smokers, with particular focus on the impact of testing on clinical relationships and the potential for tobacco cessation. METHODS We conducted 19 individual interviews and 4 focus groups with 40 pregnant or postpartum women covered by Medicaid who smoked before or during pregnancy. Patients also took the urine cotinine test and received sample results. Interviews were conducted with 20 health care practitioners. We analyzed the transcripts using an inductive approach and developed a model of how prenatal testing for cotinine could affect the patient-clinician relationship. RESULTS Patients were more likely than clinicians to believe that testing could encourage discussions on tobacco cessation but emphasized that the clinician's approach to testing was critical. Clinicians feared that testing would negatively affect relationships. CONCLUSIONS Despite having reservations, low-income patients had a surprisingly favorable view of using point-of-care urine testing to promote smoking cessation during pregnancy, which could increase the availability of cessation resources to women who do not disclose their tobacco use to clinicians.
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Affiliation(s)
- Aisha A Bobb-Semple
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandria F Williams
- Department of Obstetrics & Gynecology, Harvard Medical School, Boston, Massachusetts
| | - Martha E Boggs
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Katherine J Gold
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan .,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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The Experience of Therapeutic Community: Emotional and Motivational Dynamics of People with Drug Addiction Following Rehabilitation. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-0008-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mburu G, Ndimbii J, Ayon S, Mlewa O, Mbizvo M, Kihara C, Ragi A. Contraceptive Use Among Women Who Inject Drugs: Motivators, Barriers, and Unmet Needs. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23293691.2018.1463737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gitau Mburu
- Division of Health Research, University of Lancaster, United Kingdom
| | | | | | | | | | - Cecilia Kihara
- International HIV/AIDS Alliance, Brighton, United Kingdom
| | - Allan Ragi
- Kenya AIDS NGO Consortium, Nairobi, Kenya
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Tarasoff LA, Milligan K, Le TL, Usher AM, Urbanoski K. Integrated treatment programs for pregnant and parenting women with problematic substance use: Service descriptions and client perceptions of care. J Subst Abuse Treat 2018; 90:9-18. [DOI: 10.1016/j.jsat.2018.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 01/17/2023]
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12
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Epidemiology and Effects of Substance Use in Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 39:906-915. [PMID: 28935056 DOI: 10.1016/j.jogc.2017.07.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/16/2017] [Accepted: 07/16/2017] [Indexed: 12/13/2022]
Abstract
Substance use during pregnancy has important implications for health care providers and policymakers and can negatively affect a woman's health and the health of her children. Understanding trends, patterns of use, and outcomes are critical to developing prevention campaigns, building awareness, and providing effective care. This review critically examines the current literature on substance use in pregnancy and during the postpartum period in terms of epidemiology, risk factors, and implications. The risk factors for substance use in pregnancy, the challenges associated with reporting these cases, and the adverse effects of common substances on maternal and fetal health are discussed.
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Ayon S, Ndimbii J, Jeneby F, Abdulrahman T, Mlewa O, Wang B, Ragi A, Mburu G. Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers. AIDS Care 2017; 30:480-487. [PMID: 29067855 DOI: 10.1080/09540121.2017.1394965] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There is limited data regarding women who inject drugs, and how harm-reduction services can be made more women-centered. This study explored experiences of Kenyan women who inject drugs, with regard to access to HIV, harm reduction and sexual and reproductive health (SRH) services. A total of 45 women who inject drugs and 5 key stakeholders participated in-depth interviews and focus group discussions. Thematic analysis of the data revealed that stigma, long distances, lack of confidentiality, user fees, multiple appointments, drug users' unfamiliarity with health facilities, disconnect in communication with healthcare providers, and healthcare providers' lack of understanding of women's needs were factors that impede women's access to health services. Community-based services, comprising of outreach and drop-in centers mitigate these barriers by building trust, educating women on their health and rights, linking women to health facilities, sensitizing health providers on the needs of women who inject drugs, and integrating women's SRH services into community-based harm-reduction outreach. Inclusion of SRH services into community-based harm-reduction activities increased women's interest and access to harm-reduction interventions. These findings underscore the need to strengthen community-based programming for women who inject drugs, and to integrate SRH services into needle and syringe exchange programs.
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Affiliation(s)
- Sylvia Ayon
- a Kenya AIDS NGO Consortium , Nairobi , Kenya
| | | | - Fatma Jeneby
- b Muslim Education and Welfare Association , Mombasa , Kenya
| | | | | | | | - Allan Ragi
- a Kenya AIDS NGO Consortium , Nairobi , Kenya
| | - Gitau Mburu
- e Division of Health Research , University of Lancaster , UK
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14
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Acquavita SP, Kauffman SS, Talks A, Sherman K. Pregnant women with substance use disorders: The intersection of history, ethics, and advocacy. SOCIAL WORK IN HEALTH CARE 2016; 55:843-860. [PMID: 27676115 DOI: 10.1080/00981389.2016.1232670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pregnant women with substance use disorders face many obstacles, including obtaining evidence-based treatment and care. This article (1) briefly reviews the history of pregnant women in clinical trials and substance use disorders treatment research; (2) identifies current ethical issues facing researchers studying pregnant women with substance use disorders; (3) presents and describes an ethical framework to utilize; and (4) identifies future directions needed to develop appropriate research and treatment policies and practices. Current research is not providing enough information to clinicians, policy-makers, and the public about maternal and child health and substance use disorders, and the data will not be sufficient to offer maximum benefit until protocols are changed.
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Affiliation(s)
- Shauna P Acquavita
- a School of Social Work , University of Cincinnati , Cincinnati , Ohio , USA
| | - Sandra S Kauffman
- b Department of Psychology , University of South Florida , Tampa , Florida , USA
| | - Alexandra Talks
- a School of Social Work , University of Cincinnati , Cincinnati , Ohio , USA
| | - Kate Sherman
- a School of Social Work , University of Cincinnati , Cincinnati , Ohio , USA
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Parolin M, Simonelli A. Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions. Front Psychiatry 2016; 7:152. [PMID: 27625612 PMCID: PMC5004230 DOI: 10.3389/fpsyt.2016.00152] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022] Open
Abstract
Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.
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Affiliation(s)
- Micol Parolin
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
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Roberts AC, Nishimoto R. Barriers to Engaging and Retaining African- American Post-Partum Women in Drug Treatment. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260603600103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about barriers to engaging and retaining African-American women in drug treatment. This descriptive study addressed three questions regarding barriers to substance abuse treatment for African-American women: What barriers made it difficult for women to participate in treatment? Did identified barriers differ by program modality? To what degree were barriers related to treatment retention? Findings revealed that barriers considered to be internal in nature, i.e., “drug severity,” “did not feel like going,” and “felt I could manage on my own,” were most frequently reported. Only a few program-related barriers were found to be related to length of time in treatment and both internal and programmatic barriers had an effect on treatment completion. Implications for policy decisions, future research, and clinical competence in addressing barriers to treatment for African-American women are discussed.
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Abstract
Prenatal substance use is a critical public health concern that is linked with several harmful maternal and fetal consequences. The most frequently used substance in pregnancy is tobacco, followed by alcohol, cannabis and other illicit substances. Unfortunately, polysubstance use in pregnancy is common, as well as psychiatric comorbidity, environmental stressors, and limited and disrupted parental care, all of which can compound deleterious maternal and fetal outcomes. There are few existing treatments for prenatal substance use and these mainly comprise behavioral and psychosocial interventions. Contingency management has been shown to be the most efficacious of these. The purpose of this review is to examine the recent literature on the prenatal use of tobacco, alcohol, cannabis, stimulants, and opioids, including the effects of these on maternal and fetal health and the current therapeutic options.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Sahker E, McCabe JE, Arndt S. Differences in successful treatment completion among pregnant and non-pregnant American women. Arch Womens Ment Health 2016; 19:79-86. [PMID: 25824855 DOI: 10.1007/s00737-015-0520-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 03/17/2015] [Indexed: 11/29/2022]
Abstract
The present study explores characteristics of successful substance abuse treatment completion of pregnant women through an analysis of retrospective outcomes data. Women without prior treatment admissions, aged 18-44, and not in methadone maintenance therapy were included (N = 678,782). Chi-square tests analyzed significant differences; logistic regression provided predictive probabilities; odds ratios (OR) and risk differences with 95 % confidence intervals represent the effect sizes and clinically meaningful differences. Pregnant women were less likely to successfully complete treatment than non-pregnant women (χ (2) = 321.33, df = 1, p < 0.0001), though the difference was not clinically meaningful (risk difference = 4.75, 95 % confidence interval (CI) = 4.23-5.26). Aside from criminal justice agencies, "other community agencies" refer the greatest percentage of pregnant women to treatment (risk difference = 6.37, 95 % CI = 5.89-6.84). Pregnant women successfully complete treatment more than non-pregnant women in only non-intensive outpatient settings (χ (2) = 10,182.48, df = 7, p < 0.0001). Further attention to referral source and treatment setting for pregnant women may improve successful treatment completion by targeting needs of pregnant women. Referring to non-intensive outpatient and residential hospital treatment settings may help to ameliorate prenatal substance abuse treatment contingent on the primary problem substance.
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Affiliation(s)
- Ethan Sahker
- Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, 100 MTP4, Iowa City, IA, 52245-5000, USA.,Department of Psychological and Quantitative Foundations, Counseling Psychology, College of Education, University of Iowa, Iowa City, IA, USA
| | - Jennifer E McCabe
- Department of Psychology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, 100 MTP4, Iowa City, IA, 52245-5000, USA. .,Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. .,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA.
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Abstract
Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these, contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health, and current treatments.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA.
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Perinatal substance use: a prospective evaluation of abstinence and relapse. Drug Alcohol Depend 2015; 150:147-55. [PMID: 25772437 PMCID: PMC4387084 DOI: 10.1016/j.drugalcdep.2015.02.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 02/04/2015] [Accepted: 02/23/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Substance use decreases in pregnancy but little prospective data are available on the rates of abstinence and relapse for specific substances. This study compared rates of abstinence in pregnancy and relapse postpartum for nicotine cigarettes, alcohol, marijuana, and cocaine. METHODS Data from 152 women drawn from a randomized controlled trial comparing psychological treatments for substance use in pregnancy were analyzed. Self-reports of substance use and urine for toxicology testing throughout pregnancy and 3-months, 12-months and 24-months post-delivery were collected. Multivariate Cox models were used to compare rates of abstinence and relapse across substances. RESULTS In pregnancy, 83% of all women achieved abstinence to at least one substance. The mean (SE) days to abstinence was 145.81 (9.17), 132.01 (6.17), 151.52 (6.24), and 148.91 (7.68) for cigarettes, alcohol, marijuana and cocaine, respectively. Participants were more likely to achieve abstinence from alcohol (HR 7.24; 95% CI 4.47-11.72), marijuana (HR 4.06; 95% CI 1.87-6.22), and cocaine (HR 3.41; 95% CI 2.53-6.51), than cigarettes. Postpartum, 80% of women abstinent in the last month of pregnancy relapsed to at least one substance. The mean days to relapse was 109.67 (26.34), 127.73 (21.29), 138.35 (25.46), and 287.55 (95.85) for cigarettes, alcohol, marijuana and cocaine, respectively. Relapse to cocaine was only 34% (HR 0.34; 95% CI 0.15-0.77) that of cigarettes. CONCLUSIONS Pregnancy-related abstinence rates were high for all substances except cigarettes. Postpartum relapse was common, with cocaine using women being less likely to relapse after attaining abstinence compared to women using cigarettes, alcohol or marijuana.
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Martin FS, Aston S. A “Special Population” with “Unique Treatment Needs”: Dominant Representations of “Women's Substance Abuse” and Their Effects. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/009145091404100304] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A number of studies suggest that the lack of “gender sensitive” drug treatment services for women represents a pressing social problem, second only to the problem of “women's substance abuse” itself. This article interrogates these “problem representations” by asking on what basis they are considered uniquely problematic. Through a critical analysis of research on women published between 1990–2012 in relevant high impact journals, the article identifies a dominant view of women in the drug field as a “special population” with “unique treatment needs.” The article suggests that this view not only reinforces a limited understanding of the harms associated with women's substance abuse, but might also paradoxically enable programs and services for women to remain as “add-ons” and/or narrow the range of “gender sensitive” approaches adopted.
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Sorsa MA, Åstedt-Kurki P. Lived experiences in help-seeking from the perspective of a mother with a dual diagnosis. Int J Qual Stud Health Well-being 2013; 8:20316. [PMID: 23965985 PMCID: PMC3749368 DOI: 10.3402/qhw.v8i0.20316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 11/14/2022] Open
Abstract
Mothers with a co-occurring mental illness and substance abuse (dual diagnosis) use numerous different services. Help-seeking and engagement are complex processes which have not yet been sufficiently conceptualized. A descriptive phenomenological approach was used to explore these experiences from different service contexts and to describe the decisions in and structure of help-seeking over a 13-year period. Four in-depth interviews were conducted and data were analysed with a descriptive phenomenological method developed by Giorgi. The essential meaning structure is an inner conflict within the client, including a realization that change starts from within. The essential meaning structure combines the other meaning structures: disbelief of receiving help and admitting the need for help, keeping up the perfect façade and the risk of total collapse, being given and making own choices regarding care and being forced to use services and inner emptiness and search for contentment in life. It is possible that clients in the help-seeking process do not always recognize they have a need for care. If the client experiences inner powerlessness as emptiness and resistance to being helped, it is probably not possible to create relationships with care providers. Clients may have several ambiguous inner processes which prevent them from accepting the need for care. Theoretically and empirically a long-term approach is crucial, since the inner transformative processes take time. The services can contribute new experiences to the personal level of understanding and decision-making, if they consider the experiential level of their clients.
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Affiliation(s)
- Minna A Sorsa
- School of Health Sciences, Nursing Science, University of Tampere and Finnish Doctoral Programme in Nursing Science, Tampere, Finland.
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Jackson A, Shannon L. Perception of Problem Severity, Treatment Motivations, Experiences, and Long-term Plans among Pregnant Women in a Detoxification Inpatient Unit. Int J Ment Health Addict 2013. [DOI: 10.1007/s11469-012-9417-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Belt RH, Flykt M, Punamäki RL, Pajulo M, Posa T, Tamminen T. Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug-abusing mothers. Infant Ment Health J 2012; 33:520-534. [DOI: 10.1002/imhj.21348] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hayatbakhsh MR, Kingsbury AM, Flenady V, Gilshenan KS, Hutchinson DM, Najman JM. Illicit drug use before and during pregnancy at a tertiary maternity hospital 2000-2006. Drug Alcohol Rev 2012; 30:181-7. [PMID: 21355910 DOI: 10.1111/j.1465-3362.2010.00214.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS To study the prevalence of use of illicit drugs by women of reproductive age before and during pregnancy and the changes in rates of illicit drug use in pregnancy over recent years. DESIGN AND METHODS All pregnant women attending the public antenatal clinic over a 7 year period (2000-2006) were routinely interviewed about their use of illicit drugs by a midwife at the antenatal booking visit. MEASUREMENTS Records for 25,049 women, who self-reported previous and current use of cannabis, amphetamines, ecstasy and heroin, were included in the study. RESULTS Cannabis was the most common illicit drug used before and during pregnancy; 9.3% of women were engaged in regular use prior to pregnancy and 2.5% were users during pregnancy. A very low proportion of women reported use of amphetamines, ecstasy or heroin in pregnancy. There was an increase in ever regular use and any past use of cannabis, amphetamines and ecstasy over time. CONCLUSIONS The prevalence of illicit drug use by young women prior to becoming pregnant is of concern. While pregnancy appears to be a strong motivator for women to cease substance use, there is a need to study whether women resume drug use after their baby is born.
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Affiliation(s)
- Mohammad R Hayatbakhsh
- School of Population Health, University of Queensland, Herston Road, Herston, Qld 4006, Australia.
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Lindsay B, Albrecht J, Terplan M. Against professional advice: treatment attrition among pregnant methamphetamine users. Subst Abuse Rehabil 2011; 2:189-95. [PMID: 24474856 PMCID: PMC3846313 DOI: 10.2147/sar.s25083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pregnant methamphetamine users who leave substance use treatment against professional advice may be at risk of poorer health outcomes. To examine the hypothesis that methamphetamine use during pregnancy may be associated with leaving substance use treatment against professional advice, the 2006 Treatment Episode Data Set was analyzed. A logistic regression adjusting for age, race, service setting, prior substance abuse treatment, criminal justice referral, and education was conducted. Inclusion criteria were met by 18,688 pregnant admissions; 26.4% identified methamphetamines as their primary substance of use. Frequency of use was identified as an effect modifier, therefore results were stratified by less than weekly use and weekly or more use. Methamphetamine use was significantly associated with leaving treatment against professional advice regardless of usage level. However, the odds of leaving treatment were greater among women using methamphetamine less than weekly. Further investigation into this association may be warranted due to the complications that may result from methamphetamine use during pregnancy.
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Affiliation(s)
- Brianna Lindsay
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Jennifer Albrecht
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Mishka Terplan
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA ; Department of Obstetrics, Gynecology, and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
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Effect of waiting time on substance abuse treatment completion in pregnant women. J Subst Abuse Treat 2011; 41:71-7. [DOI: 10.1016/j.jsat.2011.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 12/20/2010] [Accepted: 01/14/2011] [Indexed: 11/21/2022]
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Morris M, Seibold C, Webber R. Drugs and having babies: an exploration of how a specialist clinic meets the needs of chemically dependent pregnant women. Midwifery 2011; 28:163-72. [PMID: 21658823 DOI: 10.1016/j.midw.2011.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/08/2011] [Accepted: 03/06/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES to explore the extent to which a specialist clinic meets the needs of chemically dependent women. DESIGN a critical ethnography informed by theorists such as Habermas and feminists' interpretation of Foucault. SETTING a specialist antenatal clinic for chemically dependent pregnant women at a major metropolitan women's hospital in Melbourne, Australia. PARTICIPANTS a purposive sample of twenty (20) chemically dependent pregnant women who attended the clinic. Data collection and analysis included three taped interviews (two preceding the birth and one post birth), observation of the interactions between the women and the clinic staff over a 25-month period and chart audits. FINDINGS similar to other studies there were multiple factors influencing development and maintenance of chemical dependency in this group of women, including family instability, family history of drug and alcohol abuse, childhood sexual abuse, having a chemically dependent partner and having a dual diagnosis of both drug addiction and mental illness. Initially there was considerable variation between the women and the clinic staff's expectations with regard to attending for antenatal care and conforming to a set regime as the women struggled with the contradictions inherent in their lifestyle and that of the 'normal' expectant mother. Aspects of that struggle included their belief that their opinions and knowledge of their lives was largely ignored, leading to episodes of resistance. Several women alleged the clinics staff's relationship with them was influenced by a belief that the women were 'hopeless addicts in need of expert medical and midwifery care' and that the clinic staff exercised control in an authoritarian manner. However, as they explored possibilities for collaboration, they realised they could exercise power and work towards a more equal relationship with staff. The quality of relationships in most instances improved over time, and if not always strictly collaborative, was situated at various points along a continuum from minimal to full co-operation, with concomitant varying levels of success in terms of outcomes. It was often the attitude of individual staff members, particularly midwives, that was the key to the way in which the women responded to care. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE comprehensive history-taking and engaging women as early as possible in pregnancy; providing continuity of care - particularly midwife care - to assist in developing a collaborative approach to care; provision of an extended period of postnatal support to at least six months for those women able to parent their children was a key recommendation.
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Affiliation(s)
- Michelle Morris
- Faculty of Health Sciences, Australian Catholic University, Australia.
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Hser YI, Evans E, Huang D, Messina N. Long-term outcomes among drug-dependent mothers treated in women-only versus mixed-gender programs. J Subst Abuse Treat 2011; 41:115-23. [PMID: 21466942 DOI: 10.1016/j.jsat.2011.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 02/05/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
This study examined the long-term outcomes of women who were pregnant or parenting at admission to women-only (WO; n = 500) versus mixed-gender (MG; a matched sample of 500) substance abuse treatment programs. Administrative records on arrests, incarcerations, mental health services utilization, and drug treatment participation were collected, covering 3 years preadmission and 8 years postadmission. Women treated in WO programs had lower levels of arrest, mental health services utilization rates, and drug treatment participation during the first year after drug treatment. No differences were found between the two groups in the long-term trajectories except that the WO program participants had lower incarceration rates during the third year after treatment. The study findings suggest a positive short-term impact of WO versus MG programs with regard to arrest and mental health services utilization. Limited long-term gain is shown in the reductions in posttreatment incarceration. The study findings suggest the added value of specialized WO programs and begin to address the gap in knowledge regarding long-term outcomes for substance-abusing women.
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Infant Birth Outcomes Among Substance Using Women: Why Quitting Smoking During Pregnancy is Just as Important as Quitting Illicit Drug Use. Matern Child Health J 2011; 16:414-22. [DOI: 10.1007/s10995-011-0776-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yonkers KA, Howell HB, Gotman N, Rounsaville BJ. Self-report of illicit substance use versus urine toxicology results from at-risk pregnant women. JOURNAL OF SUBSTANCE USE 2010; 16:372-389. [PMID: 23956685 DOI: 10.3109/14659891003721133] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Many factors comprise a patient's decision to disclose use of drugs. Pregnant women may report drug use because they would like help with their addiction but the stigma associated with drug use may dampen their willingness to disclose. Knowledge about the accuracy of self-reported drug use as compared to urine toxicology screens can assist clinicians in the management of substance use in pregnancy. METHOD We compared the urine toxicology screens and self-reported use of marijuana or cocaine for 168 women enrolled in an integrated obstetrical/substance abuse treatment program. We stratified by various periods of self-reported use and race and utilized Cohen's kappa to measure overall agreement between self-report and toxicology tests. RESULTS Most women with a positive toxicology screen reported use in the past 28 days (78% for marijuana, 86% for cocaine). However, many women reported their most recent use to be outside of the assays' detection window (14% for marijuana, 57% for cocaine). We did not find differences in self-report for women with positive urine between Whites and non-Whites (p = 1.00). Agreement over the previous month was good (Kappa = 0.74 and 0.70 for marijuana and cocaine, respectively.). SUMMARY A question about use of marijuana or cocaine during the preceding month rather than the prior few days may be a better indicator of use.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA ; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT, USA
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Milligan K, Niccols A, Sword W, Thabane L, Henderson J, Smith A. Length of stay and treatment completion for mothers with substance abuse issues in integrated treatment programmes. DRUGS-EDUCATION PREVENTION AND POLICY 2010. [DOI: 10.3109/09687637.2010.511638] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Terplan M, Garrett J, Hartmann K. Gestational age at enrollment and continued substance use among pregnant women in drug treatment. J Addict Dis 2009; 28:103-12. [PMID: 19340672 DOI: 10.1080/10550880902772399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Substance use during pregnancy is associated with poor obstetrical and neonatal outcomes. Although intervention for substance use including alcohol improves pregnancy outcomes, a substantial number of women continue to use drugs or consume alcohol during treatment. To determine whether gestational age at entry into treatment (specifically first trimester enrollment) was associated with lower risk of continued substance use, we analyzed the North Carolina Treatment Outcomes and Program Performance System, an administrative database of drug treatment clinics, between 2000 and 2004. There were 847 pregnant women using substances who met our inclusion criteria. Demographic and other risk factor data were collected. We conducted logistic regression and a Generalized Estimating Equation analysis. Gestational age at enrollment was not associated with continued substance use (odds ratio [OR] = 0.88; 95% confidence interval [CI] = 0.51, 1.51). Women who had child care provided, were less likely to continue substance use (OR = 0.64; 95% CI = 0.48, 0.84), whereas those referred from the criminal justice system were more likely to continue (OR = 1.53; 95% CI = 1.01, 2.30). Although earlier gestational age at enrollment in treatment does not predict greater abstinence at any time point, this data does suggest that the provision of childcare may improve treatment success.
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Affiliation(s)
- Mishka Terplan
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA.
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Wolfe EL, Guydish JR, Santos A, Delucchi KL, Gleghorn A. Drug treatment utilization before, during and after pregnancy. JOURNAL OF SUBSTANCE USE 2009; 12:27-38. [PMID: 22719224 DOI: 10.1080/14659890600823826] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study retrospectively explored drug treatment utilization before, during and after pregnancy for all identified substance-using women delivering at a county hospital over a 4-year period (n=431). Drug treatment data were linked to hospital data to analyse treatment utilization. Fifty-three per cent received treatment the year before, during, or within the year after delivery, with a significantly higher proportion receiving treatment during and after pregnancy. There were significant increases in methadone and residential treatment services during pregnancy. Women spent significantly more time in treatment after delivery compared with before or during pregnancy. However, 47% of these women did not receive drug treatment. These findings support current literature suggesting that pregnancy presents an opportunity to engage women in treatment. However, there is a need to decrease the institutional, legal, and funding barriers that exist between health care and drug treatment providers. Utilizing available data to track perinatal substance use and treatment utilization are important to plan for adequate availability of treatment services for this population.
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Affiliation(s)
- Ellen L Wolfe
- Treatment Research Center, Department of Psychiatry, University of California, San Francisco
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35
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Niccols A, Sword W. “New Choices” for substance‐using mothers and their children: Preliminary evaluation. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/146598904123313416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Reichman NE, Corman H, Noonan K, Dave D. Infant health production functions: what a difference the data make. HEALTH ECONOMICS 2009; 18:761-82. [PMID: 18792077 PMCID: PMC2697267 DOI: 10.1002/hec.1402] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We examine the extent to which infant health production functions are sensitive to model specification and measurement error. We focus on the importance of typically unobserved but theoretically important variables (typically unobserved variables, TUVs), other non-standard covariates (NSCs), input reporting, and characterization of infant health. The TUVs represent wantedness, taste for risky behavior, and maternal health endowment. The NSCs include father characteristics. We estimate the effects of prenatal drug use, prenatal cigarette smoking, and first trimester prenatal care on birth weight, low birth weight, and a measure of abnormal infant health conditions. We compare estimates using self-reported inputs versus input measures that combine information from medical records and self-reports. We find that TUVs and NSCs are significantly associated with both inputs and outcomes, but that excluding them from infant health production functions does not appreciably affect the input estimates. However, using self-reported inputs leads to overestimated effects of inputs, particularly prenatal care, on outcomes, and using a direct measure of infant health does not always yield input estimates similar to those when using birth weight outcomes. The findings have implications for research, data collection, and public health policy.
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Affiliation(s)
- Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08903, USA.
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SPOONER CATHERINE, HALL WAYNE, MATTICK RICHARDP. An overview of diversion strategies for Australian drug-related offenders. Drug Alcohol Rev 2009. [DOI: 10.1080/09595230120079594] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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38
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Grella CE. From Generic to Gender-Responsive Treatment: Changes in Social Policies, Treatment Services, and Outcomes of Women in Substance Abuse Treatment. J Psychoactive Drugs 2008; Suppl 5:327-43. [DOI: 10.1080/02791072.2008.10400661] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Erickson SJ, Tonigan JS. Trauma and Intraveneous Drug Use among Pregnant Alcohol/Other Drug Abusing Women: Factors in Predicting Child Abuse Potential. ALCOHOLISM TREATMENT QUARTERLY 2008. [DOI: 10.1080/07347320802072040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah J. Erickson
- a Department of Psychology , Center for Alcohol, Substance Abuse, and Addictions (CASAA), University of New Mexico , Albuquerque, NM, 87131 E-mail:
| | - J. Scott Tonigan
- a Department of Psychology , Center for Alcohol, Substance Abuse, and Addictions (CASAA), University of New Mexico , Albuquerque, NM, 87131 E-mail:
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Bonfà F, Cabrini S, Avanzi M, Bettinardi O, Spotti R, Uber E. Treatment dropout in drug-addicted women: are eating disorders implicated? Eat Weight Disord 2008; 13:81-6. [PMID: 18612256 DOI: 10.1007/bf03327607] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A high prevalence of eating disorders among drug-addicted female patients has been noted, and it could be associated to psychopathological underlying factors. Our aim was to assess eating disorder traits in women approaching a residential program for drug addiction. We hypothesized that these traits would correlate to more general psychopathological factors, and would influence treatment relapse. A sample of 204 substance dependent women attending a residential treatment was screened for psychopathological indices, and follow-up data were obtained at the end of the treatment. Clients had a high risk for eating disorders (15%), and lifetime prevalence was even higher (20%). Disordered eating was associated to psychopathological distress, in particular harm avoidance resulted significantly lower (p=0.005), evoking higher unresponsiveness to danger. Drug addiction treatment outcome is associated to completion of defined programs, and eating disorder was a key covariable in determining treatment relapse or success (p=0.03). Clinicians should be aware of this potential co-morbidity, and concurrent treatments should be attempted, in order to prevent symptomatic shifting.
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Affiliation(s)
- F Bonfà
- Centre of Eating Disorders, Ser.T of Cortemaggiore, AUSL of Piacenza, 29016 Cortemaggiore, Italy.
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Winhusen T, Kropp F, Babcock D, Hague D, Erickson SJ, Renz C, Rau L, Lewis D, Leimberger J, Somoza E. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. J Subst Abuse Treat 2008; 35:161-73. [PMID: 18083322 DOI: 10.1016/j.jsat.2007.09.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 09/27/2007] [Accepted: 09/30/2007] [Indexed: 10/22/2022]
Abstract
Pregnant substance users can benefit significantly from substance abuse treatment, but treatment retention can be challenging. Two hundred pregnant substance users entering outpatient substance abuse treatment at one of four treatment programs were randomized to receive either three individual sessions of Motivational Enhancement Therapy for pregnant substance users (MET-PS) or the first three individual sessions normally provided by the program. All participants were encouraged to participate in all other treatment offered by the program. Outcome measures included treatment utilization according to clinic records, qualitative urine toxicology measures, and self-report of substance use. One hundred sixty-two (81%) participants completed the 1-month active phase. Participants attended 62% of scheduled treatment on average and reported decreased substance use during the first month of treatment, with no differences between MET-PS and treatment-as-usual (TAU) participants. There was some evidence that the efficacy of MET-PS varied between sites and that MET-PS might be more beneficial than TAU in decreasing substance use in minority participants. These results suggest that MET-PS is not more effective than TAU for pregnant substance users in general but that there might be particular subgroups or treatment programs for which MET-PS might be more or less effective than TAU.
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Affiliation(s)
- Theresa Winhusen
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
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Amodeo M, Chassler D, Oettinger C, Labiosa W, Lundgren LM. Client retention in residential drug treatment for Latinos. EVALUATION AND PROGRAM PLANNING 2008; 31:102-112. [PMID: 18222144 DOI: 10.1016/j.evalprogplan.2007.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 05/04/2007] [Accepted: 05/08/2007] [Indexed: 05/25/2023]
Abstract
Client drop out from treatment is of great concern to the substance abuse field. Completion rates across modalities vary from low to moderate, not ideal since length of stay has been positively and consistently associated with better client outcomes. The study explored whether client characteristics shown to be related to retention were associated with treatment completion and treatment duration for a sample of 164 Latino substance users who entered a culturally focused residential program. In-person client interviews were conducted within a week of program admission. Logistic regression analysis was used to examine research questions. Clients most likely to drop out had self-reported co-occurring psychiatric diagnoses; they were 81% less likely to complete the program, suggesting that clients with mental health problems have a more difficult time remaining in residential treatment. Clients using drugs in the three months prior to entry were three and a half times more likely to be in the shorter stay group, and clients who lived in institutions prior to program entry were three times more likely to be in the longer-stay group. Factors contributing to drop out for this Latino sample were similar to those identified in the literature for non-Latino samples. Methods for addressing the needs of clients with co-occurring disorders are discussed.
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Affiliation(s)
- Maryann Amodeo
- Boston University School of Social Work, Center for Addictions Research and Services, 232 Bay State Road, 4th Floor, Boston, MA 02215, USA.
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Hser YI, Niv N. Pregnant women in women-only and mixed-gender substance abuse treatment programs: a comparison of client characteristics and program services. J Behav Health Serv Res 2007; 33:431-42. [PMID: 16688389 DOI: 10.1007/s11414-006-9019-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compared characteristics of pregnant women treated in women-only (WO) and mixed-gender (MG) substance abuse treatment programs and compared services provided by these two types of programs. Participants were 407 pregnant women who were admitted to 7 WO programs and 29 MG programs in 13 counties across California during 2000-2002. Pregnant women treated in WO programs demonstrated greater severity in drug use, legal problems, and psychiatric problems than those treated in the MG programs. They were also less likely to be employed and more likely to be homeless. Women-only programs were more likely to offer child care, children's psychological services, and HIV testing. The greater problem severity of pregnant women treated in WO programs suggests that these specialized services are filling an important gap in addiction services, although further expansion is warranted in psychiatric, legal, and employment services.
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Affiliation(s)
- Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025, USA.
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Noonan K, Reichman NE, Corman H, Dave D. Prenatal drug use and the production of infant health. HEALTH ECONOMICS 2007; 16:361-84. [PMID: 17001753 DOI: 10.1002/hec.1171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We estimate the effect of illicit drug use during pregnancy on two measures of poor infant health: low birth weight and abnormal infant health conditions. We use data from a national longitudinal study of urban parents that includes postpartum interviews with mothers, hospital medical record data on the mothers and their newborns, and information about the neighborhood in which the mother resides. We address the potential endogeneity of prenatal drug use. Depending on how prenatal drug use is measured, we find that it increases low birth weight by 4-6 percentage points and that it increases the likelihood of an abnormal infant health condition by 7-12 percentage points.
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Affiliation(s)
- Kelly Noonan
- Rider University and NBER, Lawrenceville, NJ 08648, USA.
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45
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Greenfield SF, Brooks AJ, Gordon SM, Green CA, Kropp F, McHugh RK, Lincoln M, Hien D, Miele GM. Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug Alcohol Depend 2007; 86:1-21. [PMID: 16759822 PMCID: PMC3532875 DOI: 10.1016/j.drugalcdep.2006.05.012] [Citation(s) in RCA: 657] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 05/02/2006] [Accepted: 05/09/2006] [Indexed: 11/22/2022]
Abstract
This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.
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Abstract
Illicit drug use during pregnancy is common and probably underestimated in the majority of published studies. The infant exposed to opiates or other drugs of dependency during intrauterine development is at risk for post-natal withdrawal as well as to long-term problems that are associated with drug-effects and often, adverse social circumstances. This article examines the early management of the infant and mother for detection and monitoring of drug-exposure, pharmacological intervention for withdrawal and the management of associated, particularly infective and psychosocial, problems. Practical concerns surrounding these issues are discussed and further research on psychosocial intervention to improve long-term outcome are much needed.
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Affiliation(s)
- Julee Oei
- Department of Newborn Care, Royal Hospital for Women, and School of Women's and Children's Health, University of New South Wales, New South Wales, Australia
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47
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Wunsch MJ. A Chart Review Comparing Paregoric to Methadone in the Treatment of Neonatal Opioid Withdrawal. J Addict Dis 2006; 25:27-33. [PMID: 16956866 DOI: 10.1300/j069v25n03_04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neonatal opioid withdrawal often requires treatment but there have been few recent studies of current pharmacological interventions to guide treatment. This retrospective chart review provides an exploratory examination of newborns treated with either methadone or paregoric for opioid withdrawal and outlines dosage ranges and intervals, side effects, and clinical outcomes of the two regimens. The outcome variables examined were time to resolution of withdrawal symptoms, rate of decrease in symptom severity, and length of hospital stay. There were no observed differences in outcome variables between the two treatment groups and side effect profiles were similar. Dosages, dosage intervals, and tapering regimens were consistent with American Academy of Pediatrics recommendations. Although the sample size is small and standardized regimens were not used, this study provides preliminary data about dosing levels and dosing intervals of these two pharmacologic treatment agents. Both groups of infants had favorable outcomes, although given the variation in treatment regimens it is difficult to draw an equation of equivalency. These results are applicable to the design of future studies of pharmacological interventions.
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Affiliation(s)
- Martha J Wunsch
- Department of Pediatrics, Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA 24060, USA.
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48
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Claus RE, Orwin RG, Kissin W, Krupski A, Campbell K, Stark K. Does gender-specific substance abuse treatment for women promote continuity of care? J Subst Abuse Treat 2006; 32:27-39. [PMID: 17175396 DOI: 10.1016/j.jsat.2006.06.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/06/2006] [Accepted: 06/15/2006] [Indexed: 11/20/2022]
Abstract
Research has stressed the value of providing specialized services to women and suggests the importance of treatment duration. This quasi-experimental retrospective study reports on the continuity of care for women with children who were admitted to long-term residential substance abuse treatment. Women were admitted to 7 agencies offering specialized, women's only treatment (SP, n = 747) or to 9 agencies that provided standard mixed-gender treatment (ST, n = 823). Client and treatment data were gathered from administrative sources. We hypothesized that women in specialized treatment would demonstrate higher continuing care rates after controlling for treatment completion and length of stay. Women in SP programs (37%) were more likely than those in ST programs (14%) to continue care. Multivariate analyses revealed that SP clients who completed treatment with longer stays were most likely to continue care. The findings show that specialized treatment for women promotes continuing care and demonstrate the importance of treatment completion.
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Affiliation(s)
- Ronald E Claus
- Missouri Institute of Mental Health, University of Missouri School of Medicine, St. Louis, MO 63139, USA.
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49
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Pajulo M, Suchman N, Kalland M, Mayes L. ENHANCING THE EFFECTIVENESS OF RESIDENTIAL TREATMENT FOR SUBSTANCE ABUSING PREGNANT AND PARENTING WOMEN: FOCUS ON MATERNAL REFLECTIVE FUNCTIONING AND MOTHER-CHILD RELATIONSHIP. Infant Ment Health J 2006; 27:448. [PMID: 20119507 PMCID: PMC2813060 DOI: 10.1002/imhj.20100] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Substance abuse during early motherhood has become a significant problem and has led to accelerated efforts to develop specific treatment facilities for these mothers and children. Despite the often intensive treatment efforts in residential settings, there is surprisingly little evidence of their efficacy for enhancing the quality of caregiving. The situation of these mother-child pairs is exceptionally complex and multilevel, and has to be taken into account in the content and structuring of treatment. Intensive work in the "here and now" focusing on the mother-child relationship from pregnancy onwards in an effort to enhance maternal reflective capacity and mindedness is considered a key element for better treatment prognosis, in terms of both abstinence and quality of parenting. Pioneering work with such a focus is described in this article.
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Affiliation(s)
- Marjukka Pajulo
- University of Tampere, Finland, and Yale University, Child Study Center
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50
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Terplan M, Grimes D. Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [DOI: 10.1002/14651858.cd006037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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