Pregnant, Substance-Using Women Treatment Improvement Protocol (TIP) Series2
Janet L.
Mitchell, M.D., M.P.H. Consensus Panel Chair U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 DHHS Publication No. (SMA) 95-3056 Printed 1993
Reprinted 1995
This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program.
All material appearing in this volume except quoted passages from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the authors.
Citation of the source is appreciated.
This publication was written under contract number ADM 270-90-0001 from CSAT.
Richard Bast served as the Government project officer.
The opinions expressed herein are those of the Consensus Panel members and do not reflect the official position of the Substance Abuse and Mental Health Services Administration (SAMHSA) or any other part of the U.S.
Department of Health and Human Services (DHHS).
No official support or endorsement of SAMHSA or DHHS is intended or should be inferred.
The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.
CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch to facilitate the transfer of state-of-the-art protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknow- ledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources.
The dissemination of a TIP is the last step in a process that begins with the recommendation of an AOD abuse problem area for consideration by a panel of experts.
These experts include clinicians, researchers, and program managers, as well as professionals in such related fields as social services or criminal justice.
Once a topic has been selected, CSAT creates a Federal Resource Panel, with members from pertinent Federal agencies and national organizations, to review the state of the art in treatment and program management in the area selected.
Recommendations from this Federal Panel are then transmitted to the members of a second group, which consists of non-Federal experts who are intimately familiar with the topic.
This group, known as a non-Federal Consensus Panel, meets for about 3 days, makes recommendations, defines protocols, and arrives at agreement on protocols.
Its members represent AOD abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners.
A Chair for the Panel is charged with responsibility for ensuring that the resulting protocol reflects true group consensus.
The next step is a review of the proposed guidelines and protocol by a third group whose members serve as expert field reviewers.
Once their recommendations and responses have been reviewed, the Chair approves the document for publication.
The result is a TIP reflecting the actual state of the art of AOD abuse treatment in public and private programs recognized for their provision of high quality and innovative AOD abuse treatment.
This TIP on guidelines for the treatment of pregnant, substance-using women is the second published by CSAT since a treatment improvement initiative began.
It represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve AOD abuse treatment.
One of the best opportunities we have to approach and intervene with the substance-using woman is when she is pregnant.
The child's birth may give her a powerful motive to seek treatment for her addiction.
Early intervention efforts during the prenatal period increase the likelihood that she will successfully recover from alcohol and other drug abuse.
It is equally important to provide the pregnant, substance-using woman with optimal, comprehensive obstetrical care.
The results of prenatal drug exposure are well documented and can include intrauterine growth retardation, prematurity and low birth weight, central nervous system damage, and congenital physical malformations, among others.
A continuum of followup services is a third critical element for an improved quality of life for the substance-using woman and her family.
She often lives in a stressful environment that may include physical and sexual abuse, single parenthood, and limited financial and social support.
Interventions during the postnatal period are needed to help her successfully parent her child, abstain from the use of alcohol and other drugs, and address complex social needs.
The Center for Substance Abusement Treatment (CSAT) is keenly aware that pregnant, substance-using women and their children suffer from the adverse effects of addiction and is dedicated to enhancing and mobilizing the health and human services that they need.
With this commitment, CSAT sought the advice and direction of a Federal Resource Panel.
Based on their guidance, a national Consensus Panel of experts was convened.
The medical care, alcohol and other drug treatment, and legal and ethical guidelines presented in this document are the result of their efforts.
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