Pregnant, Substance-Using Women
Treatment Improvement Protocol (TIP) Series 2

^1. The alcohol and drug treatment field uses different terms to refer to the population at risk and the problems that result from their use of alcohol and other drugs, including chemically dependent, substance-abusing, and substance-using. In this report, this at-risk population is referred to as substance-using women.

^2. Office for Substance Abuse Prevention. Alcohol, Tobacco, and Other Drugs May Harm the Unborn, by Cook, P.S.; Petersen, R.C.; and Moore, D.T. DHHS Pub No. (ADM) 90-1711. Rockville, MD: the Office, 1990.

^3. Scott, K.G.; Urbano, J.C.; and Boussy, C.A. Long-term psycho- educational outcome of prenatal substance exposure. Seminars in Perinatology 15(4):317-323, 1991.

^4. Freier, M.C.; Griffith, D.R.; and Chasnoff, I.J. In utero drug exposure: Developmental follow-up and maternal-infant interaction. Seminars in Perinatology 15(4):310-316, 1991.

^5. Freier, M.C.; Griffith, D.R.; and Chasnoff, I.J. In utero drug exposure: Developmental follow-up and maternal-infant interaction. Seminars in Perinatology 15(4):310-316, 1991.

^6. Chasnoff, I.J.; Landress, H.J.; and Barrett, M.E. The prevalence of illicit drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. New England Journal of Medicine 322:1202-1206, 1990.

^7. Hurt, H. 1000 Babies: Philadelphia 1989 (abstract). Pediatric Research 27:93a, 1990.

^8. Centers for Disease Control. Statewide prevalence of illicit drug use by pregnant women -- Rhode Island. MMWR 39:225-227, 1990.

^9. Frank, D.A.; Zuckerman, B.S.; Amaro, H.; et al. Cocaine use during pregnancy: Prevalence and correlates. Pediatrics 82:888-895, 1988.

^10. This report uses the term medical withdrawal and not detoxification to more accurately reflect the actual process that occurs under medical observation.

^11. Although there are separate sections addressing individual drugs, it is important to recognize that many women will use more than one drug. Polydrug abuse is the norm, not the exception.

^12. Jessup, M., and Green, J.R. Treatment of the pregnant alcohol-dependent woman. Journal of Psychoactive Drugs 19(2):193-203, 1987.

^13. Jessup, M., and Green, J.R. Treatment of the pregnant alcohol-dependent woman. Journal of Psychoactive Drugs 19(2):193-203, 1987.

^14. Stabilization refers to maintenance or medical withdrawal.

^15. Finnegan, L.P. Treatment issues for opioid-dependent women during the perinatal period. Journal of Psychoactive Drugs 23(2):191-201, 1991.

^16. Providence Hospital, Inc., Elm Street Health and Human Services Center. Pregnant Addicts Protocol: Methadone Stabilization. Holyoke, MA: Providence Hospital, Inc., n.d.

^17. Pond, S.M.; Kreek, M.J.; Tong, T.G.; Raghunath, J.; and Benowitz, N.L. Altered methadone pharmacokinetics in methadone-maintained pregnant women. Journal of Pharmacology and Experimental Therapy 233:1-6, 1985.

^18. American Hospital Formulary Service. AHFS Drug Information 90. Bethesda, MD: AHFS, 1990.

^19. Sanchez, L. Pregnancy, addiction and mental health. In: A Guide to the Detoxification of Alcohol and Other Drug-Dependent Pregnant Women. Cambridge, MA: Coalition on Addiction, Pregnancy, and Parenting, 1991.

^20. Hoegerman, G.; Wilson, C.A.; Thurmond, E.; and Schnoll, S.H. Drug-exposed neonates. The Western Journal of Medicine (Special Issue-Addiction Medicine) 152(5):559-564, 1990.

^21. American Public Health Association, AIDS Working Group. Pediatric HIV Infection. Washington, DC: APHA, 1989.

^22. Mitchell, J.L.; Tucker, J.; Loftman, P.O.; and Williams, S.B. "Preterm Labor Management of Substance Abusing Gravidas." Paper presented at the Office for Substance Abuse Prevention (OSAP) National Conference, Special Topic Peer Review Interdisciplinary Workshop, Washington, DC, July 14-15, 1992.

^23. Adapted from Women and Infants at Risk for HIV Infection: Guidelines and Protocols for Prevention and Care. San Francisco, CA: City and County of San Francisco Department of Public Health, Family Health Bureau Perinatal AIDS Project, n.d.

^24. Sperling, R.S.; Stratton, P.; and the members of the Obstetric-Gynecologic Working Group of the AIDS Clinical Trials Group, National Institute of Allergy and Infectious Diseases. Treatment options for human immunodeficiency virus-infected pregnant women. American Journal of Obstetrics and Gynecology 79:443-448, 1991.

^25. See Center for Substance Abuse Treatment. Drug-Exposed Infants Treatment Improvement Protocol (TIP). Rockville, MD: the Office, in press.

^26. Brazelton, T.B. Neonatal Behavioral Assessment Scale. Philadelphia: Lippincott, 1975.

^27. This section focuses on urine toxicology because this is the most widely used method of screening for most drugs. However, the most widely used method of detecting alcohol is through testing the blood or breath, although urine can be used. In discussing alcohol, this protocol therefore refers to blood and breath testing.

^28. Bean, X. Understanding toxicology reports, table 5. Eden Center Training Material. Los Angeles, CA: Charles R. Drew University, n.d.

^29. Legal Action Center. Confidentiality: A Guide to the New Federal Regulations. New York: Legal Action Center, 1988.

^30. 42 CFR, sections 2.12-2.13(a)

^31. 42 CFR, sections 2.13(b)-2.20

^32. 42 CFR, section 2.20