1. + Maternal Substance Abuse Kristen Trahan, Emily Tucker, Kimberly Thompson, Heather Lynch, Alix Beaulieu

2. + How Prevalent is it? In 2003 6.1 million US children were living in households with at least one parent with substance abuse or dependence. 1/3 of these children were 5 years old or younger. 50-80 % of cases investigated by the child welfare system are associated with maternal drug and alcohol abuse Up to 70% of women in substance abuse treatment have children 27% (294,00) have had 1 or more children removed by welfare services The majority of women who abuse substances are of child- bearing age Fetal Alcohol Syndrome is estimated to occur 1 in 300 births These are only the reported ones

3. + What Are Some of the Affects Alcohol and Drug Abuse? Alcohol Fetal Alcohol Syndrome Cocaine Drug Addicted Newborns, Neurobehavioral Abnormalities, Increased risk of SIDS Nicotine Low-Birth Weight, Prematurity, Stillbirths, Secondhand Smoke Marijuana Prematurity, Lower Cognitive Functioning in Preschool-Aged Children

4. + Drug Exposed Newborns In the United States, the estimated number of drug-exposed infants born each year ranges from 100,000-375,000. Children born to women who used substances during pregnancy are at a greater risk for prematurity, low birth weight, impaired physical growth, and development, behavioral problems, learning disabilities, and substance use.

5. + How Are Children Affected? Children whose parents abuse substances may be twice as likely to experience physical or sexual abuse There is an increased risk of sexual abuse from someone outside the family Substance-using mothers have been found to rely on more severe disciplinary practices Authoritarian Parent Style Parental substance use may result in victimization directly through impaired parent behavior and discipline or indirectly through inadequate child monitoring and protection The postnatal environment of children born to women with substance abuse issues also puts them at high risk for poor outcomes In a study of preschool age children of mothers with substance abuse issues, cognitive limitations were diagnosed in 69%, emotional or behavioral problems in 16%, and medical problems in 83% In Adolescence, children are more likely to have a major psychiatric disorder and use alcohol and other drugs themselves

6. + Mother & Daughter on Bus Philidelphia, PA - Little girl (around 7 years old) tries to hold her mother up as she “Nods” (a sign of heroin use) while they are on public transportation.

7. + Why They Abuse Substances Mothers who have substance abuse disorders typically have experienced Physical Abuse Sexual Abuse Parents who abused substances Mothers’ childhood risk indicators including: one or both parents abused alcohol/drugs (about 90%); physical abuse (about 50%), and sexual abuse (about 60%). 842 individuals found that self-reported physical (though not sexual) abuse occurring between ages 10 and 17 predicted later self-reported adult alcohol, marijuana, and other drug problems. Childhood sexual abuse was significantly related to lifetime heavy alcohol or other drug use. Attachment research has suggested that maternal insensitivity and unresponsiveness to child emotional cues is often a function of the caregivers own unmet attachment needs stemming from the caregivers own experience with early caregivers

8. + Outcomes Substance-abusing women are twice as likely as are non-substance-abusing women to lose custody of their children because of child neglect. According to intergenerational pathways, childhood maltreatment increases the risk for subsequent substance use problems which then, as individuals become parents, increase the risk of their own children’s abuse and neglect. Mothers with heavy substance use histories were more likely to have children who were placed outside their home.

9. + Obstacles Research has shown that women who abuse substances may have difficulties providing stable, nurturing environments for their children compounded by challenging life circumstances, including severe economic and social problems, such as lack of affordable housing and homelessness. Emotional cues signaled by the child are likely to trigger the mothers own unresolved experiences of trauma and loss, increasing her emotional distress, and resulting in her avoidance of the stressful stimulus ** Many obstacles are also involved when it comes to treatment programs for mothers. The Mothers and Toddlers Program is a 12-week, individual psychotherapy intervention that was designed for delivery onsite at the substance-abuse clinic where mothers are enrolled in standard outpatient treatment services. Mothers are eligible if they are actively engaged in substance-use treatment, caring for a child between birth-3 years. They meet weekly with MTP clinician for 1 hour onsite at the outpatient clinic ** Treatment that addresses alcohol and other drug abuse only may well fail an contribute to a higher potential for relapse**

10. + Outlook Rates of substance abuse in women have been increasing (Greenfield, 2002) and substance abuse in women also is associated with a unique constellation of risk factors and needs, including greater vulnerability to averse physiological consequences than men, greater prevalence of mental health problems, histories of physical or sexual abuse, serious medical problems, poor nutrition, relationship problems (including domestic violence), and deficits in social support.

11. + Treatment Numerous integrated programs have been developed to specifically meet the needs of pregnant and parenting women with substance abuse issues (Niccols, et al., 2010) Substance abuse goes unacknowledged and untreated too often, and mothers who seek treatment are more likely to report that they have used drugs than those who do not seek treatment (Niccols, et al., 2010) Mothers seeking treatment by participating in integrated or non-integrated programs are more likely to stay sober (Niccols, et al., 2010)

12. + Treatment Children with mothers who were receiving treatment for their substance abuse scored higher on the Early Social Communication Scales than children with mothers who were not seeking treatment (Niccols, Milligan, Smith, Sword, Thaban, Henderson, 2012) Behavioral problems and emotional detachment is reduced in children when their mothers participate in integrated programs (as a way of treatment) (Niccols, Milligan, Smith, Sword, Thaban, Henderson, 2012). Malnutrition in both mothers and children is significantly decreased when mothers seek treatment for their substance abuse issues

13. + Types of Treatment Integrated and non-integrated programs Includes counseling, setting goals for oneself, regular urine screenings Rehabilitation facilities Behavioral therapy Includes cognitive and multidimensional therapy and motivational interviewing and incentives Cold turkey (medications help with the withdrawal)