Arthur 1

Lauren Arthur

Mr. Alburger

English 3 Honors

22 February, 2018

Drug Addiction and Neonatology

As widespread drug addiction in the United States increases many medical professionals

have to respond to this public health emergency in ways that go beyond their training and the

resources they have available. Addiction requires medical professionals to know not only the

physical implications but also the social and psychological implications it causes. With effective

drug addiction treatment in short supply widespread addiction has caused many unprecedented

public health issues. Hospitals have seen a large increase of emergency room visits for drug

overdoses and in some instances frequent hospitalizations for chronic users. The sheer number of

drug addicted individuals can make it difficult for doctors and even first responders to treat these

patients. Drug and alcohol addiction reaches all social classes, races, genders, and ages.

Professionals used to consider substance abuse an issue that only affected individuals on the

fringes of society however, now it occurs in the majority of communities across America with

21.5 million sufferers (Barfield). Despite the evidence of its diversity many people still believe

that addiction only occurs in males. This perception poses challenges to the 15.8 million women

who abuse drugs (Barfield). Lack of appropriate gender specific care options limit opportunities

for many women seeking addiction treatment. These issues feel exacerbated for the thirteen

percent of addicted women who have children. Mothers who abuse drugs while pregnant remain

at a high risk of delivering babies with Neonatal Abstinence Syndrome (NAS) or Fetal Alcohol
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Syndrome (FAS). Infants affected by Neonatal Abstinence Syndrome or Fetal Alcohol Syndrome

present many challenges to the healthcare community including difficulties finding appropriate

prenatal care for substance abusing mothers, evaluating appropriate discharge options for infants,

and addressing NAS and FAS in communities affected by drug and alcohol addiction.

Many barriers exist for drug addicted mothers seeking treatment. Mothers can face

prosecution for abusing substances while pregnant as ​twenty-four states consider substance use

during pregnancy child abuse under civil child-welfare laws, and three states consider it grounds

for incarceration. ​From 2005 to 2015 380 women went to prison for fetal endangerment by

abusing substances (“Breaking”). Research has shown that women who fear prosecution or

forced separation from their children prove less likely to seek prenatal or medical care

(Thompson). Without prenatal care mothers can find themselves at an increased risk for

developing complications during the course of their pregnancies. When doctors detect drug

addiction early on in pregnancies the prevalence of side effects caused by NAS and FAS reduces

greatly.

In addition to criminalization mothers who abuse drugs face significant social stigmas

(Finkelstein). People often view these mothers as weak willed, irresponsible, and even abusive.

Because of these stigmas mothers will sometimes deny having an addiction. The families of

pregnant addicts can also put pressure on these women by advising them to not seek treatment or

to have an abortion because of the potential damage to their reputations (Groody). Mothers who

abuse substances may feel ostracized by their families or communities. They may feel as if they

have no support system around them which can lead to further difficulties in receiving treatment

or supporting themselves and their children. Women who abuse substances can feel powerless in
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controlling their own lives. Addicts often seek relief from financial or emotional struggles by

using substances which can increase their risk of homelessness or mental illness. The substance

abuse cycle causes a lot of destruction and can potentially become deadly. Unfortunately, many

addicts find themselves permanently trapped in this cycle with no escape. Women in these

situations will often struggle to care for their children (Burns). Substance abuse can cause

mothers to struggle financially as addiction can impede their ability to hold a job. Feeding,

clothing, and housing their children may become difficult. In addition to this, living in homes

affected by poverty and drug abuse has detrimental effects on a child’s development. Many

children raised by addicts experience child abuse. The lack of structure in these homes can cause

children to take on responsibilities beyond their years such as providing financial support for

their families or caring for their parents and younger siblings (“Child”). When parents abuse

drugs their children become significantly more likely to abuse drugs as well causing them to end

up in similar situations to their parents (Burns). Even for women who desire treatment, often

times their circumstances make it an impossibility due to the lack of drug treatment facilities

offering child care. When female addicts lack the family support to help care for their children it

becomes almost impossible for them to dedicate their time to receiving drug treatment.

Residential programs can last for several months and without childcare most mother’s cannot

attend these life saving programs Many substance abusing mothers cannot afford treatment as

programs with child childcare cost a lot of money

When a substance abusing mother receives prenatal care her doctor may recommend

hospitalization in order for her to safely detox from the drugs. The complications that can occur

during a drug detox include: seizures, flu like symptoms, severe depression, chills, sweating,
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hallucinations, and delirium. (Barfield). Detoxing while pregnant poses significant challenges

because many of the medications used to relieve the symptoms of drug withdrawal can harm the

fetus. Detoxing during pregnancy must occur after the 14th week of pregnancy and before the

32nd week because the symptoms of withdrawal will not cause fetal distress or miscarriages

during this time. Methadone, the most common medication used to treat pregnant women

addicted to drugs, keeps blood levels at an almost constant level (Barfield). This blood level

stability keeps the fetus from experiencing withdrawal symptoms reducing fetal stress. Despite

the dangers of not seeking prenatal care while abusing substances, seventy-five percent of female

addicts do not seek prenatal care. An increase of drug use in the United States, particularly of

opioids, such as heroin, fentanyl, and oxycontin has caused the amount of babies born with NAS

to rise. In 2,000, 2,920 infants presented with NAS while in 2012 that number had increased to

21,732 (Barfield). Withdrawal symptoms in infants usually occurs within forty-eight to

seventy-two hours after delivery and can include symptoms such as, seizures, crying, tremors,

poor feeding, vomiting, dehydration, low birth weight, and fevers.

If a mother shows signs of substance abuse a nurse will test the infant for NAS

forty-eight hours after delivery using the Finnegan Scoring Technique (O’Brien). After a

diagnosis of NAS infants transfer to a neonatal intensive care unit so they can safely withdraw.

Most infants will stay in the NICU for twenty-three days but some will stay for up to four

months. Most NICU stays for NAS cost $93,000 per infant (Barfield). While in the NICU infants

take morphine or methadone through an IV to ease withdrawal symptoms. Nurses closely

monitor their vital signs for any abnormalities that may occur. Infants with NAS may have

difficulties feeding so formula feeding often becomes the best option (Groody). However,
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mothers should breastfeed if tolerated by the infant. Once an infant with NAS has started to

improve they begin taking Clonidine a few days prior to discharging. Substance abusing mothers

may avoid spending time with their new babies making it difficult for maternal bonding to occur.

Practices such as Kangaroo Care and swaddling can soothe infants with NAS and improve

outcomes if available (Groody). Hospitals should contact social services if they believe that the

mother of an infant with NAS cannot care for her baby. Social Services can direct the mother to

further substance abuse treatment or the infant can move to an alternative living situation such as

foster care.

If the infant discharges into the mother’s care, the mother should return to a pediatrician

frequently in order to monitor the baby’s progress. Doctors should encourage mothers to seek

further addiction treatment for themselves as well. Mothers may require assistance with caring

for their children and in many cases extended family will step in to care for the infant.

Unfortunately, in some cases infants and children can still find themselves in abusive situations.

When mothers do not seek treatment for substance abuse, and continue actively abusing

substances while their children live with them, the success rates of those children reduce

significantly (Burns). Children whose parents abused substances have an increased risk of

developing mental health issues such as Attention-Deficit Hyperactivity Disorder (ADHD),

Anxiety, or Depression. These issues can decrease school performance and cause behavioral

problems in children. Children raised in unstable home environments may drop out of school,

become involved in illegal activity, or attempt suicide (“Child”). For these reasons it becomes

challenging for social workers and family court systems to improve the lives of children living in
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homes affected by substance abuse when the abuser does not want to seek treatment or cannot

achieve sobriety.

If returning to the mother does not seem like a viable option the infant will enter the care

of Child Protective Services. From there the infant will go into foster care where the foster

parents will take on the role of continuing treatment. Babies in foster care frequently move from

house to house with most moving three times in the first few months of foster care. (“Child”).

Infants need to develop a sense of security and stability with their caregivers and when they

frequently move homes they can experience developmental delays. If permanent custody of the

infant seems like a plausible option then the parents should have daily contact with their children

whenever possible. Consistent parental bonding dramatically increases the likelihood of infants

remaining with their families. Infants placed in the foster care system for long periods of time

tend to exhibit high instances of emotional disturbance later on in life (“Child”). Additionally,

infants exposed to trauma and abuse while in the foster care system can suffer from depression

and elevated levels of aggression as toddlers. Trained professionals must address these issues

early on or the child could exhibit negative behaviors such as dropping out of school, exhibiting

reckless behavior, abusing substances, and continuing the cycle of substance abuse modeled after

his or her parents.

Despite the apparent obstacles, health care providers and researchers continue to discover

more information about NAS and FAS all the time. The development of holistic treatment

options such as residential drug treatment for women and children, community outreach, and

crisis pregnancy centers also continue to improve. Mothers who discharge from hospitals with

infants affected by NAS or FAS need intensive support to assist them with achieving sobriety
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and keeping their infants safe and healthy. Directly entering a drug addiction treatment center

after delivery can help point mothers in the right direction and increase their chance of long term

sobriety. At the Queen of Peace Center in St. Louis Missouri women receive residential drug

treatment while living with their children. In a study done in 2013 by Dr. Debra Zand, a team of

medical professionals facilitated classes on bonding mothers with their children, child abuse

prevention, and family reunification at the Center. Her findings showed that as a result of the

programing the mother’s outcomes greatly improved. (“Breaking”). At the Village South

Rehabilitation Center in Miami Florida sixty-five mothers and 125 children live in the Families

in Transition program (FIT), a drug treatment program in a community like setting with onsite

mental health care, medical care, family therapy, day care, and support groups. The program

lasts for six months during which mothers work to become drug free, balance their family lives,

and improve their personal wellbeing. (Jackson). The program takes an integrated approach to

substance abuse treatment. Case managers, therapists, childcare workers, behavioral health

technicians, and other medical professionals individually assist families. The treatment team for

each family collaborate with each other about the family’s progresses in order to make

appropriate treatment decisions. Mothers who abuse substances can struggle with nurturing their

children often due to cultural or economic circumstances. Families going through the FIT

program learn about bonding strategies and healthy parenting skills to encourage nurturing

children (Jackson). Mothers in the program look after their children at all times during the course

of the program with the exception of participating in adult specific programming. The children at

the FIT program also receive treatment alongside their mothers. Many of the children that go

through the program have high instances of emotional disturbances, mental illness, and poor
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school performance. The FIT program works closely with the local school district to monitor the

academic and behavioral progress of the patients enrolled there while simultaneously treating

them for problems like ADHD and social isolation at the center. The FIT program has a high

success rate and they have treated over 800 mothers and over 2,000 children since they opened.

Programs like FIT and the Queen of Peace Center help combat the effects of substance abuse on

families. Centers like these rely on funding and community support to continue providing their

services. In some cases government funding under the F​ederal Substance Abuse and Mental

Health Services Administration’s Center for Substance Abuse Treatment Initiative assists the

treatment centers in financially supporting the programming (Jackson). Increased government

funding for such programming is imperative for the expansion of substance abuse treatment.

In addition to this, allowing infants to receive treatment for NAS on an outpatient basis

has shown promising results. In a study done by The Department of Pediatrics at Ohio State

University, infants that received treatment in a non-intensive care nursery setting spent

significantly less time receiving treatment for NAS and cost almost half of a traditional NICU

stay. (Backes). Although the treatment proved cheaper and shorter, the results of the infants

treated on an outpatient basis remained virtually the same as the infants treated in the inpatient

setting. Most doctors in the United States do not utilize this approach because of the treatment’s

relatively new development (Backes). The results of these findings could potentially help offset

the insurance costs of NAS treatment and also allow mothers and infants to bond in a non

clinical setting.

Outpatient treatment also remains an essential tool in treating addiction. For mothers who

do not have access to residential treatment centers or need a less intensive level of care can
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benefit from programs such as The Twelve Steps Program, meetings with an addiction therapist,

or programs run by church groups and homeless shelters. If financial challenges hinder substance

abusing mothers from seeking treatment, programs run by government or church organizations

offer free enrollment or very small fees and some mothers can apply for medicaid so they can

afford medical treatment for their addictions (“How”). By utilizing these services mothers feel

empowered to support themselves and their children. Some outpatient programs offer classes for

job skills, vocational training, and even assistance with purchasing household items like food and

clothing. In some cases recovering addicts may live in a drug free home together sharing the rent

and keeping each other accountable usually under the supervision of therapists, fully recovered

addicts, or non-profit organizations (“How”). This situation benefits individuals who do well in a

more structured environment but do not need close monitoring. Financial support coupled with

counseling can help substance abusers achieve sobriety and rebuild their lives. Outpatient

treatment remains especially important after staying in a residential facility in order to maintain

recovery. Gender specific treatment programs often prove easier to find in an outpatient setting.

In North Carolina opioid addiction has increased 884% since 2010 and drug withdrawal in

newborns has increased 830% from 2004 to 2014 (“North Carolina”). The overwhelming

increase of opioid use in the state have prompted policy makers to distribute Naloxone, an

overdose reversal drug, to first responders in high risk countries and needle discarding services

to decrease the spread of infectious diseases (North Carolina). As addiction across the country

reaches a crisis level many volunteer and nonprofit organizations in North Carolina have

organized to combat the problems posed by opioid addiction from addiction counseling in

homeless shelters to crisis housing. The Charlotte Rescue Mission operates The Dove’s Nest, a
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free residential drug treatment facility for women and children. The Dove’s Nest has 120 beds

and the program length averages 120 days. During their stay the women receive ​mental,

emotional, physical and sexual abuse treatment and a team of specialists to assist with the care of

their children. The Community Pregnancy Center of Lake Norman offers free pregnancy tests,

ultrasounds, a parenting support program, and pregnancy support information. The center also

offers a store where mothers can pick out gently used clothes and supplies for their babies at no

cost. The Neighborhood Care Center in Cornelius North Carolina offers services to low income

families in the surrounding area including lunch deliveries, financial planning classes, job

searching, after school tutoring for elementary school children, drug addiction support groups,

and individual counseling.

Drug addiction affects the lives of so many people across the nation and no group

remains more affected and overlooked then women and their children. Health care professionals

need to learn about the far reaching impacts that substance abuse has in order to make

appropriate care decisions. In the field of neonatology especially, doctors and nurses need to

familiarize themselves with their patients situations and understand the physical and emotional

implications associated with substance abuse during pregnancy and to stay up to date with their

training in providing treatment for infants affected by neonatal abstinence syndrome and fetal

alcohol syndrome. Early detection and treatment of substance abuse remains a vital of care and

moving forward gender specific treatment options and empowering women with children to seek

treatment will remain crucial in the fight against widespread drug addiction that only gets worse.
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Works Cited

“How to Find Free Drug Rehab and Detox Centers.” ​American Addiction Centers.
<​https://americanaddictioncenters.org/rehab-guide/free/​>

Backes, C.H., et al. "Neonatal Abstinence Syndrome: Transitioning Methadone-Treated Infants

from an Inpatient to an Outpatient Setting." ​Journal of Perinatology,​ no. 6, 2012, p. 425.
EBSCO​host,​
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Barfield, Wanda . “The Problem of Neonatal Abstinence Syndrome.” ​Primary Prevention and
Public Health Strategies to Prevent Neonatal Abstinence Syndrome,​ CDC Public Health
Grand Rounds, 16 Aug. 2016,
<​https://www.cdc.gov/cdcgrandrounds/pdf/archives/2016/august2016-H.pdf​>

“Breaking Substance Abuse Cycle: SLU Studies Parenting Program for Young Mothers and
Children." ​Mental Health Weekly Digest,​ 2013. EBSCO​host​,
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Burns, Deborah L. and Anita J. Catlin. "Positive Toxicology Screening in Newborns: Ethical
Issues in the Decision to Legally Intervene." ​Pediatric Nursing​, no. 1, 1997, p. 73.
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“Child Welfare Information Gateway.” (2014). ​Parental substance use and the child welfare
system.​ Washington, DC: U.S. Department of Health and Human Services, Children's
Bureau.
<https://www.childwelfare.gov/pubPDFs/parentalsubabuse.pdf>

Finkelstein, Norman. "Treatment Issues for Alcohol- and Drug-Dependent Pregnant and
Parenting Women." ​Health & Social Work​, vol. 19, no. 1, Feb. 1994, pp. 7-15.
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Groody, Kerry. Personal Interview. 18, February 2018

<​https://docs.google.com/document/d/1dnjDlKtxQbkh7lSgxSRqX8LZRVgEbrRxailc9j
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Jackson, Valera. “Residential Treatment for Parents and Their Children: The Village
Experience.” ​Science & Practice Perspectives​ 2.2 (2004): 44–53. Print.
<​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851019/​>

“North Carolina’s Opioid Action Plan.” ​North Carolina Department of Health and Human
Services.
<​https://files.nc.gov/ncdhhs/NC%20Opioid%20Action%20Plan%208-22-2017.pdf​>

O'Brien, Jane E., et al. "Neonatal Abstinence Outcomes in Post-Acute Care: A Brief Report."
Journal of Pediatric Rehabilitation Medicine​, vol. 8, no. 2, Apr. 2015, pp. 157-160.
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Thompson, Barbara L., et al. "Prenatal Exposure to Drugs: Effects on Brain Development and
Implications for Policy and Education." ​Nature Reviews Neuroscience,​ no. 4, 2009, p.
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