Pubdate: Wed, 23 Jul 2003 Source: Advocate, The (LA) Copyright: 2003 The Advocate, Capital City Press Contact: http://www.theadvocate.com/ Details: http://www.mapinc.org/media/2 Author: Laurie Smith Anderson, Advocate staff writer Bookmark: http://www.mapinc.org/rehab.htm (Treatment) PROGRAM TARGETS SUBSTANCE ABUSE BY PREGNANT WOMEN Forty percent of some 850 pregnant women who were seen in prenatal clinics at Earl K. Long Medical Center in the past year screened positive for use of alcohol, tobacco or illicit drugs during pregnancy. "Of those, 63 percent had used alcohol or tobacco and 37 percent had used illicit drugs," said Jan Kasofsky, executive director of Capital Area Human Services District. Some of those women were occasional drinkers, though others were identified as having significant substance abuse problems, she said. Some were directed to education programs where they learned that "no alcohol is safe during pregnancy," and others were referred to treatment programs. CAHSD has prioritized substance abuse by pregnant women and is revamping its treatment programs to target that population, Kasofsky said. "We already had in place programs ranging from education to residential treatment. But, in the next week or two, we will open an intensive outpatient treatment program for pregnant women at Family Road. Treatment approaches are different for women, and this program will target pregnant women specifically. Child care will also be provided, removing one of the barriers that keeps women from getting treatment." Consumption of alcohol during pregnancy is the No. 1 preventable cause of mental retardation in children, she said. "If we can save these kids and keep families together, then we'll be fulfilling our mission." Kasofsky was one of a number of local, state and national speakers to address a Women and Substance Abuse Treatment Conference, "Healing Pathways for Women: Disease, Treatment and Recovery." The conference was sponsored here last week by CAHSD. Keynote speakers included Dr. Ira J. Chasnoff, president of The Children's Research Triangle and a professor at the University of Illinois College of Medicine in Chicago, Ill.; Martha A. Jessup, a fellow at the Institute for Health Policy Studies at the University of California in San Francisco, Calif.; and Rokelle Lerner, an international consultant on families and chemical dependency. The use of alcohol, tobacco and illicit drugs during pregnancy is a major public health concern, Chasnoff said. In a recent national survey of some 1,200 pregnant women, more than 54 percent said they had used alcohol or tobacco during their pregnancies, and 3 percent said they had used an illicit drug. An estimated 2 million children are born in this country each year exposed to substances that can affect fetal brain development. A recent survey of obstetricians revealed that the majority still tell their patients it's OK to drink alcohol, Chasnoff said. That means physicians haven't been educated about the long-term effects of prenatal substance abuse on the development and behavior of the exposed child. Leonard was a child whose mother abused alcohol and drugs while she was pregnant, he said. When he was 5 years old, Leonard and his 2-year-old brother were abandoned by their mother and placed in foster care. Between the ages of 5 and 12, Leonard was placed unsuccessfully in 17 different foster homes. At 12, he went to live in a group home. "Leonard came to my attention when, at the age of 17, he was getting ready to leave the state's custody. He had an IQ of 68 and the facial features of fetal alcohol syndrome. He had stab wounds and tattoos and was a member of a gang. When I asked him to draw a picture of himself, he drew his face in pretty good detail, but his body was in a fetal position and, across the front, he wrote 'feed me.' It was too late for Leonard but that's why we do this work -- to save the Leonards and to stop the cycle," Chasnoff said. While in Baton Rouge, Chasnoff addressed groups of physicians and consumers about prenatal substance abuse. He recommended that physicians incorporate a simple screening tool in taking medical histories of pregnant women. "In the month before you knew you were pregnant, how many cigarettes did you smoke and how many drinks did you consume?" are the key questions to ask, he said. Positive responses indicate the need for further assessment, and it is critical to have a referral system in place for those women who need treatment. Chasnoff said he definitely favors voluntary screening over mandatory urine toxicology tests for pregnant women. The U.S. Supreme Court has ruled that urine toxicologies can not be performed in pregnant women without their permission for therapeutic reasons, he said. To read more about Chasnoff's research on prenatal substance abuse with the Children's Research Triangle, visit the Web site: http://www.childstudy.org. WOMEN AND TOBACCO It's 2003 now and tobacco should be lumped in with alcohol and drugs when it comes to looking at the potential harm pregnant women can expose their unborn children to, Jessup said. One in five American women smokes and one in eight pregnant women smokes, according to statistics quoted by Jessup. Some women in lower socioeconomic levels believe that smoking during pregnancy is good because their babies will be born smaller or earlier, thus ensuring an easier delivery, she said. What they don't realize is that smoking during pregnancy has been linked to low birth weight, sudden infant death syndrome, prematurity and other problems during pregnancy and delivery. Children exposed to tobacco smoke experience higher rates of asthma, pneumonia, heart disease, ear infections, colds, flu and allergies. The U.S. Supreme Court has also ruled against attempts to incarcerate pregnant women who smoke, in effect stating that the habit should be viewed and treated as an addiction rather than prenatal child abuse. Some obstetricians have limited their practices to nonsmokers, a trend that Jessup said she finds "disturbing" and fraught with legal and ethical dilemmas. Instead, she said, physicians should counsel their patients and refer them to treatment. If ever there was a "teachable moment" between doctors and patients, it is when a woman is told she is pregnant and that her actions will influence the course of her unborn child's life from that point on. That's a strong motivation to stop smoking, she said. Order from chaos Anything that takes too large a share of your life can be viewed as an addiction, and the transition between using and recovery can be both a time of chaos and great opportunity, Lerner said. Some of the major themes that people in transition have to deal with are shame, abandonment, vulnerability, deprivation, mistrust and survival. Moving from a state of surviving to a state of thriving means the individual comes to believe "I am not responsible for what happened to me, but I am responsible for making sure it never happens again." Some individuals get stuck in their addictions partly because of "invisible loyalties," she said. If you do something good for yourself and feel guilty, if you feel like you're betraying someone by getting healthier, or if you know what you need to do and can't do it, you may need to look at those underlying issues, she said. Letting go is one of the first steps in the healing process of recovery, Lerner said. "The miracle of recovery means you will feel alive again, free from fear, with peace of mind, increased energy and creativity and a feeling of purpose, meaning and value in life." - --- MAP posted-by: Derek