Compassionate curiosity supports women with substance use disorder

May is Women’s Health Month and also features Mother’s Day. This is an opportunity to draw attention to the needs of pregnant and parenting people who experience substance use disorder, or SUD (sometimes called addiction).

Researchers estimate that 10% to 15% of pregnant women use substances, with alcohol, cannabis and nicotine being the most common. This is more common than high blood pressure or diabetes in pregnancy, but often receives much less care and attention.

Part of a substance use disorder diagnosis means that a person is unlikely to be able to change their substance use patterns without help — even if they experience negative consequences related to their use. For this reason, punitive approaches to substance use, including substance use in pregnancy, only cause harm, not help. Health care providers can provide support, accurate medical information, and/or resources for treatment that support a healthy individual — and healthy pregnancy.

Many people with substance use during pregnancy do not receive the health care they want and deserve. Fear of child protective services and loss of custody prevent some people from receiving prenatal care at all. When people with substance use seek health care, and especially prenatal care, we should recognize the strength and courage that takes. It is up to the health care community to build a system that better cares for people with substance use and their families.

One stigmatizing belief about people with substance use during pregnancy is that they do not care about the health of their child — while nothing could be further from the truth. Many people have physical and mental health conditions that need treatment in order to be the best parent they can be, and this includes substance use disorders. I explain this idea to my patients with substance use during pregnancy, and hope that I can convey the message: “You are valuable and deserving of support and care. It is a challenge to be a parent any time, and especially when we have a medical or mental health condition that needs treatment. You do not have to do this all alone. Let’s make a plan together to help get the support or resources you want and need.”

I often encounter the misconception that a pregnancy will “fix” addiction. This is magical thinking. It’s unrealistic to think that becoming pregnant would cure a medical or mental health condition. We have a social expectation that “if a person really loved their children, they would quit.” Many people do stop using substances during pregnancy and we should encourage and support those who can make this change on their own. This is different for a person with SUD, meaning they will need dedicated and specialized treatment to make a change. Often I find that by the time a person comes to me for treatment, they have already reduced use as much as they can on their own and are highly motivated to keep working hard on their health.

The health care community has a specific responsibility to provide support so people can be the parents they want to be — sober and present, and involved in their children’s lives. One way we can support is by extending care and substance treatment beyond pregnancy. Accidental overdose and suicide are the leading causes of maternal mortality in Colorado, and the majority of these mothers, sisters, daughters, and friends died sometime in the 12 months after the end of their pregnancy. “Postpartum” is definitely not 2-6 weeks, and we should normalize increased access to support and treatment for a full year (or longer) after a pregnancy ends. This includes pregnancies that end in live birth, preterm delivery, pregnancy loss, and terminations. No matter how a pregnancy ends, that person is at higher risk for substance use recurrence and overdose, and should be wrapped into healthcare and recovery communities who can provide additional support.

Treatment for SUD belongs in health care, including prescription medications — and for many people, medical treatment is one part of recovery. Parents with substance use disorders also need and deserve safe, sober housing, community connection, opportunities for education and employment, legal advocacy, and physical and mental health care. Health care providers should provide direct treatment and guide patients to additional resources with compassion and empathy. Lift The Label does an incredible job of sharing real stories from people in Colorado to offer hope and spread the message that recovery is not only possible, but beautiful.