Pregnant Substance Abusers Prefer Integrated Treatment


MIAMI — Women with problematic substance use during pregnancy prefer integrated treatment over separate obstetric and substance-use care, according to a presentation at the annual conference of the American Society of Addiction Medicine.

The investigators found that women attending one of two integrated programs reported feeling less stigmatization about their substance abuse. They also liked the care they received from consistent providers.

In contrast, those who received isolated substance abuse treatment at a traditional center and obstetric care at a general hospital were less satisfied. Those women reported harsh and punitive treatment from hospital staff that made them feel marginalized, Dr. Lisa G. Lefebvre said during an interview at a poster session.

“Because our program is fairly new … we wanted to get an idea of what women thought,” said Dr. Lefebvre, an addiction medicine consultant with the department of family and community medicine, University of Toronto. Patients tour the maternity ward in advance, and everyone on the staff is trained to be sensitive to their substance use “The women like this [integrated] model,” she said. “They have one doctor who treats pregnancy and everything you'd do for addiction.”

In 2005, researchers used focus groups in Toronto to assess satisfaction among women attending one of two integrated programs—the Toronto Center for Substance Use in Pregnancy or the Herzl Family Practice Centre. Transcripts of these sessions were coded for recurring themes.

The researchers compared the subjects' satisfaction with that of women recruited from the obstetrics department at a general hospital in 1995. Women in the latter group also attended a community substance use treatment center—the Centre for Addiction and Mental Health's addictions program in Toronto.

Women who attended separate programs were less likely to report a good birth experience or to know their obstetrician at delivery. “They had great addiction care but missed obstetric appointments,” Dr. Lefebvre said. Is it possible that the stigma of substance use was worse in 1995? “Even in 2005, when they ended up in another facility, they felt stigma.”

Clinicians in the integrated program encouraged the pregnant women to report themselves to child protection services. Surprisingly, many patients used the services as a resource, Dr. Lefebvre commented.

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