It’s Time to Talk About Maternal Substance Use
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By Kallen Thorton and Joy Burkhard
The intersection of maternal mental health and maternal substance use is multi-layered and complex, but just the knowledge of how common these behavioral health conditions are can decrease stigma. That’s why this year TheBlueDotProject.org, host of the U.S. maternal mental health awareness campaign is talking about substance use. It’s time.
Substance use disorders affect millions of people every year and substance use among women is increasing. Like many other diseases, substance use disorders are both preventable and treatable. However, people who suffer from these disorders are forced to navigate an often unwelcoming and fragmented health care system and a profound degree of stigma when seeking support, education, and treatment.
Why People Use Substances
The most common reason people use substances like alcohol, marijuana, and other drugs is that they change the way we feel. Sometimes people use substances to create or enhance a feeling they want to have, and sometimes people use substances to take away feelings they don’t want to have. The initial decision to use a substance is often viewed as a choice. Keep in mind that many things that are thought to be individual choices (like tobacco use or regular consumption of ‘fast food’ for example) can be heavily influenced by factors outside of a person’s control. These factors are called the social determinants of health (SDOH) and have to do with the conditions and environments in which people are born, learn, work, and raise their families.
Access to safe housing, transportation, and medical care, as well as systemic racism, discrimination, and exposure to violence are a few of the many examples of these outside factors that influence health behaviors and outcomes.
There are risk factors that increase a person’s likelihood of developing a substance use disorder. It’s important to know that many people who struggle with addiction have experienced trauma, and that experiences of trauma set the foundation for the development of many chronic diseases and behavioral health conditions, including depression, substance use disorders, heart disease, lung disease, and many others.1 The risk of trauma and its long-term health impacts is especially high for women, who are more likely than their male counterparts to have experienced childhood abuse at the hands of someone they knew and trusted, and are more likely to experience abuse and violence in subsequent adult relationships. In addition, our society places an enormous burden on new parents, who face inadequate parental leave policies, lack of access to affordable quality childcare, and in many states, health insurance that wanes during the highest-risk time of their postpartum journey. Substance use and continuation of use can be seen as an individual’s best attempt to cope with the tremendous toll that trauma and toxic stress take on one’s emotional, psychological and physical well-being.
Substance Use and Stigma
For a myriad of reasons and influenced by many factors, a person may begin using a substance and over time (notably shorter periods of time for women), our brains and bodies can even begin to rely on a substance to feel ‘normal’, which is referred to as ‘dependence’. By then, substance use has become less of a choice and more of a survival impulse. If we lessen or suddenly stop using a substance we are dependent upon, we may feel physically and emotionally very sick, which is referred to as ‘withdrawal.’ This can be dangerous and is not recommended for pregnant people without medical supervision and support.
Stigma, which results in predjudicial attitudes about and discriminatory practices against people with behavioral health conditions, is one of the greatest barriers to treatment, particularly for mothers/parents and those who are pregnant.
Due to cultural beliefs and gender expectations, mothers/parents who struggle with substance misuse and addiction are among those most profoundly harmed by stigma. Risk of harm compounds and increases when moms/parents hold intersecting identities, characteristics, or conditions that are stigmatized by society. For example, a parent of color, who identifies as LGBTQ+ and has both a disability and a substance use disorder, faces more stigma than does a parent who benefits from the privilege society affords for being white, heterosexual, and able-bodied while struggling with a substance use disorder. Overall, parents (and their children) pay a high physical, mental, emotional, social, and economic price due to the stigma around addiction that is woven throughout our healthcare, legal, and social systems.
Examples of Barriers that Perpetuate Stigma include:
A health care system that doesn’t proactively educate patients about substance use risk, protective factors and available treatment.
Obstetricians and other providers fail to universally screen for (and subsequently treat) substance use disorder among pregnant and parenting people.
When someone becomes pregnant, the focus shifts from the person who is struggling with a substance use disorder to a child who may be impacted by a substance use disorder. This conflicts with the fact that investing in and taking good care of the woman/pregnant person is integral to infant & child mental health and well-being.
Laws that penalize those who are pregnant and parenting experiencing substance use disorders prevent them from receiving the care they deserve and increase the likelihood of poor health outcomes.
Perpetuation of the narrative that parents who struggle with substance use are “selfish”, “immoral”, or “don’t deserve” their children. Instead, we should recognize that they are parenting while suffering from a chronic and treatable disease and deserve treatment and support.
Misinformation or mislabeling, ie., “medication for opioid use disorder shouldn’t be used while pregnant or breastfeeding because the baby will be born addicted” (inaccurate– medication for opioid use disorder is the gold standard of treatment for pregnant and breastfeeding individuals with opioid use disorder and though babies can have signs of withdrawal, babies aren’t able to be “addicted” per the DSM definition of addiction, and are able to thrive when their parents get needed treatment.
Substance Use Impacts All of Us in Some Way
Pause and think for a moment about your own experiences related to substance use. It is very likely that you have friends and loved ones who have struggled with substance use or addiction, and you may have had seasons of your life in which you personally struggled or are struggling.
This May We are Raising Awareness
Join us this May to raise awareness.
Learn more at https://www.thebluedotproject.org/mmhweek2022
Resources
If you or someone you know is struggling, please remember you are not alone and support is available. Don’t ever forget that people can and do recover every day.
National Institute for Drug [and Substance] Addition
This website includes resources for families, providers, and individuals who are suffering.
Online Sobriety Support Groups
Treatment Locator Hotline/Web Locator
March of Dimes, Stories and Resources about Maternal Addiction and Stigma
More Facts about Maternal Substance Use and Maternal Mental Health
Research and Program Resources
Incorporating Equity into Peer Recovery Services: Examples and Considerations (webinar recording)