Today, I’m talking about an issue that does not attract much attention even in the circles which discuss pre-natal and post-natal depression. Honestly, even in the discussion of mental illness, this topic is often left out even if it is an especially common issue. Today, I am approaching drug abuse in pregnancy and in struggles attached to maternal mental health.
Maternal mental health is a minefield. This is something I discuss more often than most people because it is a topic near and dear to me. And, even now, as I’m changing jobs and requiring a new therapist in another city for my postpartum depression (PPD), I am struggling to find a qualified provider. I’ve talked about this before but I’m not done. Addiction is another issue. I have a “loaded” mental health family history and drug use –especially for self-medication – is another problem people in my life have suffered from. I am lucky in that I have no history of substance abuse. However, many people are at risk for this. People with mood disorders, people with a family history of substance abuse, and people who are having trouble coping with life experiences can be particularly at risk. Pregnancy and living with a newborn are important and challenging life events. Thus, all of us should be aware of these issues and should take heed. If not for your own mental health, do it so you can be a better friend and loved one.
I was contacted by a drug rehab resource called Advanced Recovery Systems (ARS) which runs DrugRehab.com, a resource with substance abuse and treatment information. ARS is already talking about this. They wanted to provide some literature and resources to my readers in hopes that women don’t feel alone. I thought this was a place I was lacking in my current discussion of mental health resources and challenges. It saddened me that I was lacking here because it is an issue I have seen firsthand and also an issue I’ve addressed in my professional life doing criminal justice research. So, today, I’m going to dig into substance abuse in motherhood and say we need to be doing so, so much more. This is a feminist issue and it is an issue impacting motherhood.
How prevalent are substance abuse issues among those who are suffering from a mental health challenge? The National Institute on Drug Abuse (NIDA) states that the relationship between drug addiction and mental health is a complicated. Like most things in social science and medical science, there are intervening variables that are difficult to unpack and address in studies. Still, responses to the National Epidemiology Study (NES), a prevalent survey used in a research on addiction, suggest comorbidity is a serious issue for those with a mental illness. The NES reports that more than 40% of those in treatment for a mood disorder and about a third of people in treatment for an anxiety disorder have used drugs. These numbers, when compared to research on rates of abuse in the total general population, show a difference. The National Survey on Drug Use and Health (NSDUH) shows that among all people surveyed, 24.6% of people have used drugs.
These numbers are not perfect. The general population figures should include those drug users who do have mental health conditions. Likewise, the numbers with mental health conditions are only those currently in-treatment. There are many more people (such as those who have struggled in my own family) who go untreated or undiagnosed. And, as with all self-reported surveys on “bad” behaviors, people are likely to under-report drug use. Still, while the data are not perfect and there are many factors that may influence this problem of comorbidity, the research shows that there are much higher rates of drug use among those with mood and even anxiety disorders.
This is not just a general health issue, though. This is a feminist issue and an issue for moms. In my own research, I’ve become aware of a great amount of literature suggesting that women are just as likely to abuse drugs and may also be more at risk of relapse. Likewise, women of color may have unique and more difficult challenges with substance abuse. NIDA has some great resources which go into more detail about pertinent studies on the topic.
In my professional work, I have addressed substance abuse in women a great deal in official publications, which I believe is a step forward in creating dialogue. However, it rarely gets tied back to feminism. Issues that affect women and their health have long been found to be “feminist issues”. However drug abuse, mental health, and comorbidity seem to be left out of much of this dialogue. I will argue that this is definitely something we should be doing a better job of including.
A representative from ARS contacted me to express that issues of substance abuse are issues affecting moms. I must admit that some of this was new to me. Also, I don’t think I had ever considered these issues to be specifically troubling for moms. However, they are. Moms are vulnerable especially in postpartum life and during pregnancies. They don’t receive support. I was dumbfounded that a lot of this information was new t me. The facts should wake you up in a similar way if you weren’t already aware.
It is not a surprise that, during pregnancy, drug abuse can have serious affects on the continuation of a pregnancy and can cause low birthweight, Fetal Alcohol Syndrome, and withdrawal in babies. Thus, getting women help with addiction in pregnancy should be a priority. In women most susceptible during pregnancy to comorbidity with drug abuse, this should be a paramount concern. Women with mental illness, such as myself, may also have to discontinue certain medications making this even worse.
The reality of addiction during pregnancy is that almost 5% of the cases of those who sought treatment for alcohol were pregnant and 27,000 babies were born dependent on drugs (per ARS). This is up significantly from only 3,000 babies in 2003.
With the opiate epidemic currently facing the U.S. at this time, it seems drug abuse and pregnancy will continue to be an issue. Another issue the information at Advanced Recovery Systems present is the problems in a marriage which can lead to divorce when a partner suffers from substance abuse. This was something that seemed obvious after reading it but wasn’t something I had directly related to an issue disproportionately affecting women. As I’ve written about many times before, divorce may disproportionately harm women as women who have chosen to work in the home are most likely to have trouble getting back on their feet. Marriages are strained under the weight of mental illness. Add to that substance abuse and a newborn and your situation becomes markedly more complicated.
Treatment is available and can be incredibly effective. It can also assist with treatment of comorbidity issues such as mental illness, too. Still, almost 23 million people have a problem requiring treatment and only about ten percent of those people receive such treatment.
Why don’t people seek care? There are likely many reasons. The first is probably the nature of addiction. People may not think they really need treatment or ashamed to seek it. One of the most basic is also economic pressure. Many of the women struggling with issues simply cannot afford to seek in-patient treatment. There are still millions of uninsured Americans and millions more on plans that do not cover or only sparingly cover such services. Those lucky enough to have such insurance coverage may still struggle with the cost after insurance of such a service. Of course, qualified outpatient options are available but these programs are often difficult to find – especially in rural areas. A friend recently sought an outpatient qualified program for a family member and was unable to find any programs that both accepted insurance and had spots available within an hour’s drive. Finally, the issue that angers me the most and seems to impact women disproportionately is that of public policy.
Policies have been created to punish both those on public assistance. Since women (and their children) are more likely to end up on Temporary Assistance for Needy Families (TANF) which is colloquially known in the U.S. as “welfare”, failing a drug test can be devastating. In fact, almost half of all TANF caseloads follow children-only families (meaning adults in the household do not receive care) women account for about 85% of TANF adult-only caseloads. Likewise, WIC, another large scale assistance program specifically targeted at pregnant women, postpartum women, and children up to age 5 which provides nutritional assistance, lactation services, and parenting resources to, provides services to more than half of the families who give birth in the U.S.
These public policies are largely cost ineffective – the cost for the state to administer the tests is greater than that of the cost to taxpayers on giving assistance to those using illegal drugs – and are punitive so recipients may actively not seek help for a self-medication problem. Likewise, because these policies are punitive, rather than help those violators, the problem is made worse by a new extreme financial hardship. Instead of helping those most in need, they are harming people and especially harming children living in already precarious situations.
Public policies do not stop there, though. In more recent years, there have been bills enacted which ultimately seek to bring pregnant women who have babies born with drugs in their system up on criminal charges. One such bill even crossed my desk for review in a past legislative session. 20 states also have enacted statutes which seek to separate newborns from their mothers under the condition of drug abuse via social services. A study of criminal actions against mothers who used drugs between 1973 and 2005 found that a majority (64.5%) of children did not have adverse affects after birth.
So, while drug exposure to fetuses is a very serious issue, the overreaction of criminally prosecuting a mother or removing her children from the home does not seem to be the best response. I think we can all agree that parenting while abusing drugs is bad, punishing women seems to only harm women and children. I plan to write a post later to describe how using drugs during pregnancy to cure a variety of ills is a terrible idea. I am not on the side of “this is all fine”. I’m just not of the belief that the punishment here is effective or warranted. These women need rehabilitative services not criminal or civil punishments. Punitive responses will only drive more women to either choose to give birth in unsafe conditions or to feel as though they cannot seek help during their pregnancy.
Mental illness is an issue affecting millions of women in the United States. They often face large barriers such as a lack of resources, a lack of education on resources, or social stigma with this issue alone. Especially when pregnant or dealing with postpartum concerns, women are facing an uphill battle. On top of this, substance abuse and self-medication make matters worse. Doctors should be screening women and helping them seek treatment when they need it. They should not be mandated to conduct drug tests to punish patients. Likewise, if the government is concerned about the position of children in households or the safety of fetuses, they should do far more to help such women seek inpatient or outpatient treatment.
To anyone struggling with addiction or for anyone who is a friend or family member struggling with addiction, there are resources and inpatient and outpatient treatment options. A good place to start if you have insurance is to call your insurance provider and ask about programs or to talk to your OB, GP, or psychiatrist. Most medical professionals will at least know who to contact if they are alerted you are struggling. Most people are not out to get you or report things at the drop of a hat. Most caregivers are considerate and take their oath of professional ethics very seriously. Below is a list of links to information at the end of this post. To anyone dealing with mental illness or addiction, please know that it is better to seek care and that you do deserve professional and courtesy treatment. To anyone who chooses to judge a mother for seeking such resources, please educate yourself on these issues. Mental health and drug addiction are feminist issues. They are mom issues. We need to do more.
Resources for those seeking help or supporting someone struggling:
Note: Addiction Recovery Systems contacted me to share information. They have not in any way sponsored my post with goods or services. I am linking to them as a resource that some people will undoubtedly find helpful but I am in no way financially related to ARS or DrugRehab.com