Prenatal Drug Exposure and Social Policy: The Search for an Appropriate Response

Abstract

Prenatal drug exposure continues to be a controversial topic. Views of what constitutes an appropriate response to drug-exposed infants vary, in large part due to the many complex issues endemic to perinatal substance use. The purpose of this article is to review the controversy surrounding prenatal drug exposure, outline the policy dilemmas that complicate attempts to respond appropriately, review current practice in this area and the effectiveness of those practices, and offer specific recommendations as a starting point for debate. It is suggested that earlier controversy regarding the sequelae of prenatal drug exposure may be decreasing as research identifies specific and subtle deficits in some affected infants. It is also suggested that the postnatal effects of parental substance abuse (e.g., in terms of abuse/neglect, attachment, and development) are the more appropriate focus of child protection efforts, and that different disciplines must collaborate to reach a consensus regarding the nature of these efforts.

State Responses to Alcohol Use and Pregnancy: Findings From the Alcohol Policy Information System

“…This study finds that mixtures of supportive and punitive policies relating to alcohol use during pregnancy are common – that, in fact, almost one fourth of states have “mixed” policy environments. The variability in policies pertaining to alcohol use during pregnancy is consistent with previous analyses of state policies relating to drug use during pregnancy, which have found considerable variability in the types and specific characteristics of policies across states (Drescher-Burke & Price, 2005; Ondersma et al, 2000). While the overall finding of variation is consistent between alcohol and drug-related policies, we note that distinguishing policies relating to alcohol from policies relating to drugs is important because some policies (such as warning signs) only apply to alcohol.…”

“…Analyses of policies on the state level have generally focused primarily or exclusively on policy responses to illicit drug use during pregnancy (Chavkin, Breitbart, Elman, & Wise, 1998; Dailard & Nash, 2000; Figdor & Kaeser, 1998; Guttmacher Institute, 2013; Kang, 2003; Lester, Andreozzi, & Appiah, 2004; Ondersma, Simpson, Brestan, & Ward, 2000). By contrast, little attention has been paid to describing policies relating to alcohol use during pregnancy.…”

Treatment of Cocaine Abuse During Pregnancy: Translating Research to Clinical Practice

“…When punitive policies are put in place (often with good intentions, hoping they will motivate pregnant cocaine-abusing women to stop using drugs), they often backfire. With pregnant women fearing detection, such policies can deter them from seeking prenatal care, which is likely to increase the risks of negative outcomes [58,59].…”

Permanency planning and social service systems: A comparison of two families with prenatally substance exposed infants

“…Comorbid mental health disorders, domestic violence, histories of trauma, poor parenting skills, unaddressed medical needs, limited vocational and educational experiences, few social supports, and poverty are factors associated with women who use substances (Clark, 2001;Hans, 1999;Kissin, Svikis, Morgan, & Haug, 2001;Ondersma, Simpson, Brestan, & Ward, 2000;Semidei et al, 2001). Two-dimensional approaches to the multifaceted needs of families affected by substance use are being increasingly replaced by treatment programs that have the depth to integrate the process of recovery with the undertaking of parental responsibilities (Brindis, Berkowitz, Clayson, & Lamb, 1997;Chavkin, Paone, Friedmann, & Wilets, 1993;Clayson, Berkowitz, & Brindis, 1995;Howell, Heiser, & Harrington, 1999;Lester, Freier, Boukydis, Affleck, & Boris, 1996;Luthar & Walsh, 1995;Magura, Laudet, Kang, & Whitney, 1999;Marsh, D'Aunno, & Smith, 2000;Wobie, Eyler, Conlon, Clarke, & Behnke, 1997).…”