nach oben

International Journal of Mental Health and Addiction

Erschienen in:

21.01.2022 | Commentary

A Comprehensive Care Approach for Pregnant Persons with Substance Use Disorders

verfasst von: Jennifer R. Mckinney, Matthew Russell, Andres Avellaneda-Ojeda, Catherine Gannon, Sonal Zambare, Michelle Hansford, Nidal Moukaddam, Catherine Eppes

Erschienen in: International Journal of Mental Health and Addiction | Ausgabe 5/2023

Einloggen, um Zugang zu erhalten

Abstract

Substance use disorders affect a significant number of pregnant persons in the USA and are associated with substantial maternal and neonatal morbidity and mortality. Treatment is complex and requires a comprehensive, interdisciplinary approach. Despite this, conventional perinatal medical systems are often without mental health and addiction medicine services and physically separated from established community treatment programs and resources. We outline an example of a multidisciplinary comprehensive care model integrating obstetrics, addiction psychiatry and psychology, neonatology, anesthesiology, social work and case management, established community services and resources, and the local legal system. Challenges with each component of the model are briefly described. Although outcome data is not available, the interdisciplinary clinic described represents a best practice approach based on existing interdisciplinary clinics aimed at improving substance use treatment engagement, maternal outcomes, and neonatal outcomes. Integration of addiction psychiatry/psychology, social work, and community services into prenatal care is crucial in achieving optimal outcomes for pregnant persons who use substances. We hope the recommendations based on identified challenges with establishing this model of care will help with program development across a variety of settings.

Significance

What Is Already Known on This Subject?

Although there are detailed accounts of interdisciplinary clinics focused on pregnant persons with substance use disorders, these authors are not aware of any published program overview that discusses integration of as many varied services for patient care and lessons learned within each specialty.

What This Study Adds?

There is a need for continued attention to best practice in care for pregnant persons with substance use disorders. The present article provides an outline for providers and medical facilities for development of interdisciplinary clinics to meet the needs of this vulnerable patient population.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics (2015) ACOG Practice Bulletin No. 633: Alcohol abuse and other substance use disorders: ethical issues in obstetric and gynecologic practice. Obstetrics and gynecology, 125(6), 1529–1537. Retrieved September 10, 2021. Retreived from https://doi.org/10.1097/01.AOG.0000466371.86393.9b

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics (2018). ACOG Practice Bulletin No. 201: Pregestational Diabetes Mellitus. Obstetrics and gynecology, 132(6), e228–e248. Retrieved January 2, 2020. Retrieved from https://doi.org/10.1097/AOG.0000000000002960.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics (2019). ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy. Obstetrics and gynecology, 133(1), e26–e50. Retrieved January 2, 2020. Retrieved from https://doi.org/10.1097/AOG.0000000000003020.

Armstrong, M. A., Osejo, V. G., Lieberman, L., Carpenter, D. M., Pantoja, P. M., & Escobar, G. J. (2003). Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes. Journal of Perinatology, 23(1), 3–9.CrossRefPubMed

Azuine, R. E., Ji, Y., Chang, H. Y., Kim, Y., Ji, H., DiBari, J., Hong, X., Wang, G., Singh, G. K., Pearson, C., Zuckerman, B., Surkan, P. J., & Wang, X. (2019). Prenatal risk factors and perinatal and postnatal outcomes associated with maternal opioid exposure in an urban, low-income, multiethnic US population. JAMA Network Open, 2(6), e196405–e196405.CrossRefPubMedPubMedCentral

Bailey, N. A., & Diaz-Barbosa, M. (2018). Effect of maternal substance abuse on the fetus, neonate, and child. Pediatrics in Review, 39(11), 550–559.CrossRefPubMed

Center for Substance Abuse Treatment. (2009). Substance abuse treatment: Addressing the specific needs of women. Treatment Improvement Protocol (TIP) Series, No. 51. Retrieved January 5, 2020. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK83252/pdf/Bookshelf_NBK83252.pdf.

Faherty, L. J., Kranz, A. M., Russell-Fritch, J., Patrick, S. W., Cantor, J., & Stein, B. D. (2019). Association of punitive and reporting state policies related to substance use in pregnancy with rates of neonatal abstinence syndrome. JAMA Network Open, 2(11), e1914078–e1914078.CrossRefPubMedPubMedCentral

Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166(21), 2314–2321.CrossRefPubMed

Goldman-Mellor, S., & Margerison, C. E. (2019). Maternal drug-related death and suicide are leading causes of postpartum death in California. American Journal of Obstetrics and Gynecology, 221(5), e481-489.CrossRef

Goodman, D., Whalen, B., & Hodder, L. C. (2019). It’s time to support, rather than punish, pregnant women with substance use disorder. JAMA Network Open, 2(11), e1914135–e1914135.CrossRefPubMed

Grant, T., Graham, J. C., Ernst, C. C., Peavy, K. M., & Brown, N. N. (2014). Improving pregnancy outcomes among high-risk mothers who abuse alcohol and drugs: Factors associated with subsequent exposed births. Children and Youth Services Review, 46, 11–18.CrossRef

Greenfield, S. F., Brooks, A. J., Gordon, S. M., et al. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1–21.CrossRefPubMed

Grossman, M. R., Lipshaw, M. J., Osborn, R. R., & Berkwitt, A. K. (2018). A novel approach to assessing infants with neonatal abstinence syndrome. Hospital Pediatrics, 8(1), 1–6.CrossRefPubMed

Hwang, S. S., Diop, H., Liu, C. L., Yu, Q., Babakhanlou-Chase, H., Cui, X., & Kotelchuck, M. (2017). Maternal substance use disorders and infant outcomes in the first year of life among Massachusetts singletons, 2003–2010. The Journal of Pediatrics, 191, 69–75.CrossRefPubMed

Kaltenbach, K., & Finnegan, L. (1998). Prevention and treatment issues for pregnant cocaine-dependent women and their infants. Annals of the New York Academy of Sciences, 846(1), 329–334.CrossRefPubMed

Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy, 21(3), 202–207.CrossRefPubMed

Kelly, J. F., Saitz, R., & Wakeman, S. (2016). Language, substance use disorders, and policy: The need to reach consensus on an “addiction-ary.” Alcoholism Treatment Quarterly, 34(1), 116–123.CrossRef

Kelly, J. F., Dow, S. J., & Westerhoff, C. (2010). Does our choice of substance-related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. Journal of Drug Issues, 40(4), 805–818.CrossRef

Kennedy, A. P., Epstein, D. H., Phillips, K. A., & Preston, K. L. (2013). Sex differences in cocaine/heroin users: Drug-use triggers and craving in daily life. Drug and Alcohol Dependence, 132(1–2), 29–37.CrossRefPubMedPubMedCentral

Kim, H. M., Smith, E. G., Stano, C. M., Ganoczy, D., Zivin, K., Walters, H., & Valenstein, M. (2012). Validation of key behaviourally based mental health diagnoses in administrative data: Suicide attempt, alcohol abuse, illicit drug abuse and tobacco use. BMC Health Services Research, 12(1), 1–9.CrossRef

Ko, J. Y., Tong, V. T., Haight, S. C., Terplan, M., Stark, L., Snead, C., & Schulkin, J. (2020). Obstetrician–gynecologists’ practices and attitudes on substance use screening during pregnancy. Journal of Perinatology, 40(3), 422–432.CrossRefPubMed

Lipari, R. N. & Park-Lee, E. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA) (Publication No. PEP19-5068, NSDUH Series H-54). Retrieved January 5, 2020. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf.

Maeda, A., Bateman, B. T., Clancy, C. R., Creanga, A. A., & Leffert, L. R. (2014). Opioid abuse and dependence during pregnancy: Temporal trends and obstetrical outcomes. Anesthesiology, 121(6), 1158–1165.CrossRefPubMed

Maternal Mortality and Morbidity Task Force. (2018). Maternal Mortality and Morbidity Task Force and Department of State Health Services joint biennial report. Retrieved January 5, 2020. Retrieved from https://www.dshs.texas.gov/mch/DSHS-Maternal-Mortality-and-Morbidity-Presentations-and-Publications/.asp.

Mengel, M. B., Searight, H. R., & Cook, K. (2006). Preventing alcohol-exposed pregnancies. The Journal of the American Board of Family Medicine, 19(5), 494–505.CrossRefPubMed

Najavits, L. M., & Weiss, R. D. (1994). Variations in therapist effectiveness in the treatment of patients with substance use disorders: An empirical review. Addiction, 89(6), 679–688.CrossRefPubMed

National Institute on Drug Abuse (NIDA). (2020). Summary: Substance Use in Women. Retrieved February 28, 2021. Retrieved from https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/summary.

Sarkola, T., Gissler, M., Kahila, H., Autti-Rämö, I., & Halmesmäki, E. (2012). Alcohol and substance abuse identified during pregnancy: Maternal morbidity, child morbidity and welfare interventions. Acta Paediatrica, 101(7), 784–790.CrossRefPubMed

Shojania, K. G., Ranji, S. R., McDonald, K. M., Grimshaw, J. M., Sundaram, V., Rushakoff, R. J., & Owens, D. K. (2006). Effects of quality improvement strategies for type 2 diabetes on glycemic control: A meta-regression analysis. JAMA, 296(4), 427–440.CrossRefPubMed

Smid, M. C., Stone, N., Baksh, L., Debbink, M. P., Einerson, B. D., Varner, M. W., Gordon, A. J., & Clark, E. A. (2019). Pregnancy-associated death in Utah: Contribution of drug-induced deaths. Obstetrics and Gynecology, 133(6), 1131–1140.CrossRefPubMed

Substance Abuse and Mental Health Services Administration (SAMHSA), & Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. US Department of Health and Human Services (HHS). Retrieved January 20, 2020. Retrieved from https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf.

Substance Abuse and Mental Health Services Administration (SAMHSA). A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders. (2016b). Retrieved August 20, 2021. Retrieved from https://ncsacw.samhsa.gov/files/Collaborative_Approach_508.pdf

Substance Abuse and Mental Health Services Administration (SAMHSA) (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Retrieved January 5, 2020. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2018R2/NSDUHDetailedTabs2018.pdf.

Substance Abuse and Mental Health Services Administration (SAMHSA-HRSA) Center for Integrated Health Solutions. Substance use disorder and pregnancy: Screening. Retrieved January 5, 2020. Retrieved from https://www.integration.samhsa.gov/about-us/integration-edge/substance-use-disorder-and-pregnancy.

Wagner, E. H. (2000). The role of patient care teams in chronic disease management. BMJ, 320(7234), 569–572.CrossRefPubMedPubMedCentral

Walsh, J. M., McDonald, K. M., Shojania, K. G., Sundaram, V., Nayak, S., Lewis, R., Owens, D., K., & Goldstein, M. K. (2006). Quality improvement strategies for hypertension management: a systematic review. Medical care, 646–657.

White, W. (2007). Language and recovery advocacy: Why we worry about the words. Recovery Rising: Quarterly Journal of The Faces and Voices of Recovery. Winter, 2007, 1–3.

Wright, T. E., Schuetter, R., Fombonne, E., Stephenson, J., & Haning, W. F. (2012). Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women. Harm Reduction Journal, 9(1), 1–10.CrossRef

Wright, T. E. (Ed.). (2018). Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge University Press.

Unyime, I., & Habib, A. S. (2018). Enhanced recovery after cesarean delivery. F1000 Faculty Rev-513.

Yonkers, K. A., Forray, A., Howell, H. B., Gotman, N., Kershaw, T., Rounsaville, B. J., & Carroll, K. M. (2012). Motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice: A randomized trial for treatment of hazardous substance use in pregnancy and after delivery. General Hospital Psychiatry, 34(5), 439–449.CrossRefPubMedPubMedCentral

Titel: A Comprehensive Care Approach for Pregnant Persons with Substance Use Disorders
verfasst von: Jennifer R. Mckinney
Matthew Russell
Andres Avellaneda-Ojeda
Catherine Gannon
Sonal Zambare
Michelle Hansford
Nidal Moukaddam
Catherine Eppes
Publikationsdatum: 21.01.2022
Verlag: Springer US
Erschienen in: International Journal of Mental Health and Addiction / Ausgabe 5/2023
Print ISSN: 1557-1874
Elektronische ISSN: 1557-1882
DOI: https://doi.org/10.1007/s11469-022-00760-x

Neu im Fachgebiet Psychiatrie

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Wartezeit nicht kürzer, aber Arbeit flexibler

Psychotherapie Medizin aktuell

Fünf Jahren nach der Neugestaltung der Psychotherapie-Richtlinie wurden jetzt die Effekte der vorgenommenen Änderungen ausgewertet. Das Hauptziel der Novellierung war eine kürzere Wartezeit auf Therapieplätze. Dieses Ziel wurde nicht erreicht, es gab jedoch positive Auswirkungen auf andere Bereiche.

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

A Comprehensive Care Approach for Pregnant Persons with Substance Use Disorders

Abstract

Significance

Neu im Fachgebiet Psychiatrie

Darf man die Behandlung eines Neonazis ablehnen?

Wartezeit nicht kürzer, aber Arbeit flexibler

Chirurginnen und Chirurgen sind stark suizidgefährdet

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

Update Psychiatrie

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Abstract

Significance

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2023

Understanding the Role of Adult Mental Health and Substance Abuse in Perpetrating Violent Acts: In the Presence of Unmet Needs for Mental Health Services

Association Between Psychiatric Symptoms and Craving in Drug Withdrawal

Cognitive and Behavioral Inflexibility as a Transdiagnostic Process Underpinning Exercise Dependence

The Relationship Between Social Media Addiction, Happiness, and Life Satisfaction in Adults: Analysis with Machine Learning Approach

Defining the Border Between Workaholism and Work Addiction: a Systematic Review

Factors Associated with Substance Use Disorder: Male Adolescents’ Lived Experience

Neu im Fachgebiet Psychiatrie

Darf man die Behandlung eines Neonazis ablehnen?

Wartezeit nicht kürzer, aber Arbeit flexibler

Chirurginnen und Chirurgen sind stark suizidgefährdet

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

Update Psychiatrie