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

Abstract

In the late-1980s and early-1990s, much attention in America was focused on cocaine abuse. In particular, the effects of prenatal cocaine use on mothers and infants were in the news spotlight. Risks of adverse effects prompted funding for novel treatment programs. More recently, media attention has shifted elsewhere, and specialized treatment resources have grown scarce. This redirection of funding is unfortunate, as social stigma and fear of legal consequences continue to encourage cocaine-abusing pregnant women to hide drug use and avoid prenatal care. The purpose of this article is to summarize the most prominent adverse maternal and fetal/infant effects associated with prenatal cocaine use; review treatment options, focusing on comprehensive care programs of the 1990s as well as recent research on evidence-based practices and their applicability to pregnant women; and highlight the population of prenatal cocaine-abusing women uninterested in treatment, with a focus on promising strategies to promote drug abstinence and other positive health behaviors.

Adolescents with prenatal cocaine exposure show subtle alterations in striatal surface morphology and frontal cortical volumes

“…Although several promising psychosocial prevention strategies for pregnant women addicted to cocaine have been identified [53], effective remediation strategies and treatments for prenatally exposed children remain to be developed. The improvement of such strategies will require that we gain a better understanding of the specific, localized and perhaps subtle neurological abnormalities resulting from prenatal cocaine exposure in order to facilitate the translation of research findings to clinical practice.…”

Substance Use in the Perinatal Period

“…The long-term effects of prenatal cocaine exposure on cognitive, motor, and language development have been inconsistent, with some studies reporting positive findings [124,125] and some studies finding small or no effects [126]. This inconsistency is likely related to the confounding effects of the postnatal environment, including dysfunctional parenting [16,17] and unstable and chaotic home environments, and frequent polysubstance use in the mother [127]. …”

“…As with smoking, CM is the most promising intervention for cocaine-using pregnant women [127]. In a recent randomized trial comparing CM to community reinforcement approach and twelve-step facilitation, CM was associated with significantly greater duration of cocaine abstinence, higher proportion of cocaine-negative urine tests, and higher proportion of documented abstinence across the study period [135].…”

Cuidado de mulheres usuárias de crack na gestação

“…• Dada a frequente associação de uso de múltiplas substâncias entre as usuárias de crack-cocaína, recomenda-se que o uso de uma substância como o tabaco e/ou álcool sirva de alerta para a investigação do uso de outras, como o crack (22)(23)37) ; • Ressalta-se a importância do uso de sistemas flexíveis de atendimento para essa população (25) ; • Estimula-se a utilização de recursos comunitários para o cuidado (25) ; • Identifica-se que a associação de diferentes estratégias de abordagem clínica dessa população, como a Terapia Cognitivo-Comportamental, os 12 passos e abordagens de reforço comunitário, tem melhores resultados, com redução do uso da droga e melhor adesão ao pré-natal (27)(28)32) .…”