TORONTO — The number of pregnant women entering court-mandated substance abuse programs has increased in the years since the advent of the crack cocaine epidemic, Dr. Mishka Terplan said at the annual conference of the American Society of Addiction Medicine.
Among the more than 6 million women admitted for drug and alcohol abuse treatment between the years 1994 and 2005, about 220,000 were pregnant. By the end of that period, the annual number of pregnant women entering treatment via the criminal justice system had risen 30%, according to an analysis of data from the Treatment Episode Data Set.
In undertaking an analysis of women treated with “compassionate coercion,” for which Dr. Terplan was given the society's young investigator award, he presumed he would find disparities between pregnant women who enter treatment via the criminal justice system and those who enter treatment voluntarily.
The concept of coercive treatment is not new. Therapeutic prison farms were established by the U.S. Public Health Service in the 1930s, but criminal justice referrals for substance abuse in general have increased across all segments of the population in recent years. The proportional increase has been greater for women than men, and even greater for pregnant women. In a speech on the occasion of the unveiling of the 2006 National Drug Control Strategy, President Bush said, “Getting people into treatment will require us to create a new climate of compassionate coercion, which begins with family, friends, employers, and the community, and uses the criminal justice system.”
Dr. Terplan said that he expected to uncover disparities in terms of the unequal application of a system of social control, and that women of color, those who use hard drugs, those with psychiatric problems, and those with less education and of lower socioeconomic class would preferentially enter mandatory rather than voluntary treatment.
It turned out that black women were only half as likely to be referred through the criminal justice system as were white or Hispanic women, and women with psychiatric diagnoses other than substance abuse also were less likely to enter treatment via the criminal justice system. “This was probably because they are already hooked up with care for their mental illness,” he said.
Pregnant women who enter court-ordered treatment after an event such as an arrest for driving while intoxicated were likely to be in their 20s or 30s, and about half had at least a high school education.
“A whopping 87% were unemployed, 46% were receiving Medicaid, 41% said they had no insurance, and 6% said they had private insurance,” said Dr. Terplan of the department of obstetrics and gynecology, University of Chicago.
The analysis also showed that there had been a shift in the substances being abused over the time period of the study. Alcohol and cocaine were the primary substances reported in 1994, but by 2005 use of methamphetamine and marijuana were most likely to result in mandatory admission, with adjusted odds ratios of 1.9 and 1.5, respectively.
Another shift over time has been an increase in the number of Hispanic women entering court-ordered treatment. In 1994 they were 20% less likely than white women to enter treatment via the criminal justice system, but by 2005 they were just as likely to enter treatment via criminal justice as white women.
“No other group of mothers lays claim to the unspeakable in quite the same way as pregnant drug users,” he said. “Even when they make substantial strides during pregnancy to reduce the risk of drug use to their babies, the image of the ideal mythical mother looms over their shoulders and over the shoulders of people who have the power to determine their futures,” Dr. Terplan said.