Women and Substance Abuse–Risks and Issues

Torso of pregnant teen or woman

Women have many specific issues during addiction and chief among them is the risk of pregnancy. Pregnancy and substance abuse are a serious and high-risk combination of circumstances, posing unfortunate risks for both the woman and her baby. When pregnant women use addictive substances, their babies are inevitably and negatively affected. In utero exposure to substances can cause longstanding problems for children if they survive the risks of in utero adverse events leading to miscarriage or stillbirth. Pregnant addicted women also are at risk for severe health complications, and even in some cases, life-threatening ones. In all cases of addiction during pregnancy, specialized medical care is essential for the safety of a pregnant addicted woman and her unborn child. However, pregnancy is not the only potentially traumatic event women face during addiction.

Women are Vulnerable When Using Substances

Women who are addicted are particularly vulnerable to traumatic events during active substance use. Among these are single, but often serial physical and sexual assault, separation from their children, and domestic violence. Addiction can put women in high-risk situations with dangerous people, and compromise judgment, as well as the ability to protect themselves.

If addicted women come to the attention of the police, courts, or child protection agencies, they are at risk of losing custody of their children due to neglect. Addicted women are typically considered not able to provide adequate supervision, or to meet the basic needs of their children. Often children are removed from the mother’s care until significant addiction recovery progress can be demonstrated.

Addicted women are also often vulnerable to rely on others for basic needs while using. Many find themselves in abusive relationships, tied to abusers for survival needs, but controlled, coerced, manipulated, exploited and abused. When addicted, such situations can entrap women as their judgment, ability to mobilize resources and ability to plan and execute exit and safety plans are seriously compromised by drug use.

Double Standards Affecting Addicted Women

There are a great many social pressures exerted upon addicts of both genders. Men and women who are addicted both face social stigma because of their illnesses. Due to a great deal of misinformation about addiction, addiction is frequently considered a moral failing rather than an illness. Consequently, people with addictive illnesses and their loved ones can be ostracized and shamed, considered somehow immoral or generally of lesser character and social standing. Women, however, are not only victims of this common negative stereotyping, but also are further ostracized because they are women.

Overall, there is still a double standard in our culture between men and women. Women are commonly held to greater moral expectations and denigrated for the same sexual behavior that is excused in men, for instance. If women have children, they are expected to be the primary caregivers, and addicted women who are parents, face more ostracism that addicted men who are. If addicted women become pregnant, they are judged even more harshly.

Substance Use Among Pregnant Women

Of course, all drugs of addiction and abuse are used by women, but there are some commonly used substances whose effects on unborn babies and pregnant women have been well researched. Among these substances are alcohol, cocaine, and heroin–three drugs with widespread use currently and for many years among pregnant women.  Women of childbearing age who are addicted should be informed of the health risks involved in pregnancy while abusing substances.

For example all three addictive substances mentioned above–alcohol, cocaine, and heroin–cause risks of:

  • Impaired prenatal development
  • Lifelong negative effects for babies exposed in utero
  • Health risks for pregnant women
  • Miscarriage and stillbirth
  • Need for intensive neonatal medical care

Alcohol Use and Pregnancy

Alcohol use during pregnancy has long been documented as highly dangerous for an unborn baby. All alcohol consumed by a pregnant woman is consumed by the unborn baby because alcohol crosses the placenta. However, due to the fetal metabolism of alcohol which is slower than the pregnant woman’s, the fetus suffers greater effects of toxicity than the mother does. The results of such toxic fetal exposure can be quite severe.

Each year approximately 40,000 babies in the U.S. are born with Fetal Alcohol Spectrum Disorder (FASD) which is a range of birth defects caused by alcohol use during pregnancy. It is recommended that there is no quantity of alcohol safe for consumption by pregnant women due to the direct effects of any ingested upon a developing fetus. Effects of maternal alcohol use during pregnancy can result in birth defects ranging from mild to moderate or severe. Damage to the fetus can include organ and bone defects, for example. Also, learning disabilities and intellectual deficits result, among a range of other lifelong difficulties.

Cocaine Use and Pregnancy

Cocaine, like alcohol, also crosses the placenta to directly affect an unborn baby, and it is estimated that approximately 750,000 pregnant women use cocaine annually. This is significant since any cocaine use has a far more lingering toxicity for the fetus than for the pregnant woman.  As with alcohol, the fetus metabolizes cocaine very slowly compared to the mother, and so retains cocaine toxicity longer. Therefore, the unborn baby can so can be exposed repeatedly and heavily to what can seem like infrequent or light use by the mother. Consequently, fetal death is a significant risk when pregnant women use cocaine. This can occur in several ways: through separation of the placenta from the uterine wall; through lack of oxygen to the fetus; fetal stroke, and fetal organ developmental problems.

For babies that survive maternal cocaine use during pregnancy, many issues can occur requiring special care after delivery and over the long term of childhood and later lives. These issues include neonatal cocaine withdrawal, underweight, and feeding and sleeping problems at birth, as well as a lack of responsiveness. Children can also be born with undeveloped organs, cerebral palsy, poor reflexes and poor sensory perception that require special care and present long-range problems.

Heroin Addiction and Pregnancy

A woman’s heroin use during pregnancy, like alcohol and cocaine use, also directly affects an unborn baby, crossing the placenta to enter the unborn baby’s bloodstream. Consequently, babies exposed to heroin in utero will have what is known as NAS, or Neonatal Abstinence Syndrome. This means the newborn is essentially in withdrawal and requires intensive medical care for symptoms such as excessive crying,  trembling, seizures, diarrhea, vomiting, and fever.

Needs of Children Exposed In Utero to Addictive Drugs

Children who were exposed to addictive drugs like alcohol, cocaine, and heroin in utero can have many needs as they grow and develop. They can be born with birth defects that require multiple surgeries and ongoing medical care, for example. They can also have developmental delays cognitively and in emotional maturity, movement and sensory issues. Such delays can require specialized education and therapeutic services to help children develop and master essential life skills.

Also, children who were exposed to drugs in utero may have many social and behavioral issues that affect their functioning in school, with peers and at home. For instance, they may have difficulty engaging with others, following directions, managing frustration and impulses, understanding social cues, and abiding by general rules of interaction and social conduct. Such children are also vulnerable to developing conduct disorders and acting out in various settings. Additionally, children who have needed intensive medical care and other specialized services may have difficulty developing independent living skills as they age.

Help for Pregnant Women with Addictions

No matter how severe a pregnant woman’s substance use, treatment can improve the likelihood of the woman’s improved condition as well as her unborn baby’s. Prenatal care at the earliest point possible is medically indicated. And, care should be taken to have medical supervision during any withdrawal attempt from an addictive substance. Otherwise, the baby’s safety can be compromised, as can the mother’s.

In the case of opiate use such as the use of heroin, pregnant women can be treated with medications that are less harmful to the baby. Babies will still experience withdrawal when delivered, but typically suffer less than they would if the mother continued heroin use. Opiate addicted pregnant women are not typically withdrawn and detoxed fully until after delivery.

Other Substances Issues and Problems in Pregnancy

Although we have discussed only 3 addictive substances here, any substance of abuse or addiction is problematic during pregnancy for both the mother and baby. Also, especially problematic is the use of more than one substance or polydrug use. Drugs such as methamphetamine and benzodiazepines have been well-documented as dangerous for unborn babies, and to cause health risks for the pregnant woman. Any use of an addictive substance should be thoroughly discussed with health caregivers. And, prescribed medications of all types should be discussed with prenatal caregivers. Additionally, the frequency of use and amounts of use should be honestly disclosed so healthcare givers can effectively manage withdrawal symptoms.

Getting the Right Help

It is always difficult to ask for help for an addiction. It is common to feel embarrassed and ashamed that substance use has become problematic. No one wants to feel helpless and hopelessness or to be known to others as unable to manage one’s own affairs. However, this is precisely where addiction takes us: to feeling degraded, ashamed and humiliated, and to having lost control over our lives.

These and other circumstances, such as domestic violence situations, partners who are addicted, and lack of childcare, create significant barriers to treatment for many women who desperately need help. Women can also feel they will be shamed and humiliated by others who find out they are addicted, and so will postpone getting help, or avoid it all together.

If you are an addicted woman or have a loved one who is, there is a great deal of help available in diverse settings. Give us a call today if you are ready to explore treatment options for yourself, or are helping someone you love. We offer free consultations in which we identify your specific needs and make appropriate referrals, no matter where you are.