Treatment
Treatment Goals
Keep the mother and baby safe and healthy
- Promote journey through stages of change to successful sustained abstinence and recovery
- Protect the baby postpartum
- Provide medication that might prevent withdrawal and promote recovery
- Address multiple needs
- Stop illegal substance use, if necessary and possible
Keep in mind the following factors when considering treatment options for substance using pregnant woman:
- Support systems, mental health, access to money, housing, childcare, and social services, partner violence, trauma, and the experience of stigma and shame during treatment.
Treatment Options
For any treatment option, it is important that mothers have skills to manage their emotional regulation, decision making, problem solving, and trauma, in addition to the skills needed to avoid cues and temptations that may impact adherence to treatment/medication.
Medication Assisted Treatment
Medications are used to either mimic or counter the brain effects of addiction.
Mimic Medications tend to focus on harm reduction and help the addicted person to function better (Methadone, Buprenorphine, Nicotine Replacement) usually so they can quit. Some of the medications that mimic are very helpful for harm reduction, though they are also stigmatized among some addiction treatment professionals, addicted individuals, and the public.
Countering medications reduce the effects of the substance (Naltrexone, Vivitrol, Chantix, Zyban).
MAT is most effective when combined with other psychosocial supports like individual counseling, group counseling, halfway houses, mutual support groups, or residential treatment centers.
Title
Medications Used for....
- Methadone
- Pill, water soluble, or wafer taken daily
- Produces a strong sense of euphoria as it fits to opiate receptors, this tricks brain into thinking it’s using opiates
- Should not be prescribed without simultaneous counseling
- Can have long term side effects
- Buprenorphine
- Semi synthetic opioid that binds to opioid receptors, preventing other opioids from attaching
- Used for detox, opioid maintenance, & pain management
- Short & long term substitute for opioid addiction and withdrawal management
- Vivitrol, Revia (Naltrexone)
- Blocks the euphoric effects of opioids
- Injection or pill form, which should not be prescribed to individuals with recent opioid use, typically prescribed 7-10 days after abstaining from opioids
- Antabuse (Disulfiram)
- Daily medication to assist in abstinence maintenance of alcohol
- Does not reduce the craving for alcohol. Therefore, there is often poor compliance with this medication
- If individual consumes alcohol while on medication, they will experience side effects such as nausea, vomiting, and throbbing headaches
- Should not be consumed if individual has consumed alcohol in the last 12 hours
- Vivitrol (Naltrexone)
- Used to reduce cravings for alcohol
- Used to reduce cravings for alcohol
- Campral (Acamprosate)
- Used to reduce cravings for alcohol, recommended to use right after detox
- Can be used along with Naltrexone
- Nicotine replacement gum such as gum (Nicorette), patches, lozenges, inhalers, nasal spray
- Bupropion (Zyban, Wellbutrine)
- Counters effects of nicotine
- Counters effects of nicotine
- Chantix (Varenicline)
- Counters effects of nicotine
Currently, there are no FDA approved medications to assist in treating cocaine, marijuana, and amphetamine use.
Motivation Not JUST Medication
To make change happen, it is important for providers to help people through the process of change and complete tasks of the stages of change. Many mother's using substances may:
• Need counseling and support using motivational communication
• Need skills to avoid the cues and temptations
• Need skills to manage life – emotion regulation, decision making, trauma, emotional problems, problem solving, assertiveness.
Barriers to Treatment
The number one barrier women with substance use issues face when engaging in treatment is their access to childcare.
Please check our resource page for in-patient substance use programs that allow children.
Distrust in the medical system
Many women have had prior negative experiences with the medical system, or have heard of other women with negative experiences, and may fear what will happen if they disclose information (of drug use) to their medical providers.
Some negative experiences may include receiving unsolicited advice, engaging with judgmental staff members, and being treated only for their substance use, and not as a whole person.
*If you would like to see Dr. Katie Mark's full interview, please click here
Stigma / fear
Stigma and fear can play a huge role in a substance using mother’s adherence and engagement in treatment. If a mother perceives she is being judged by her provider, she may drop out of treatment programs, not follow up with necessary OBGYN visits, and/or be reluctant in taking drugs tests if there is the fear that her baby will be taken away. It is important for providers to be open and honest with mother's seeking treatment, explain the protocols and procedures of drug testing and other necessary components of treatment, and create an environment that does not further add to the mother's fear.
*If you would like to see Dr. Marc Fishman's full interview, please click here
Addressing Your Own Stigma & Bias
As a professional, your attitudes and practices must promote the mothers self-esteem, self-efficacy, and journey through recovery. Prior to working with a substance using mother, it is important to reflect upon your own personal views of substance use, and identify which (if any) biases may impact the working relationship with and recovery process of a mother using substances.
By using open communication, teamwork, and trust, you can encourage women to access the follow-up services and support they need to manage their substance use.
Click here to review motivational interviewing skills on our Communication Curriculum page
*If you would like to see Tiffany Brown's full interview, please click here