Maternal Substance Use Disorder

A Look at Provider Stigma, Attitudes, and Beliefs

Authors

  • Kristin Trainor BSU

DOI:

https://doi.org/10.18060/24282

Keywords:

Stigma, NAS, Drug use, Pregnancy, Attitudes

Abstract

Pregnant women with substance use disorder (SUD) can face varying degrees of negative interactions with healthcare providers, including judgment of the individual’s value and involvement in their infant’s care. This research explored potential stigma and attitudes among medical providers within a maternal/fetal healthcare setting towards women with maternal SUD. An electronic survey was administered to 117 health care providers, including social workers, who work with pregnant women in an urban, Midwest, healthcare facility. Attitudes and stigma differed significantly based on the health care providers’ discipline. Healthcare providers who viewed SUD as a disease had a more positive perception of mothers with SUD. By building professional awareness, creating policy change, increasing education, and continuing research regarding maternal SUD, social workers have an opportunity to develop responsive support programs for healthcare workers and promote overall change within the healthcare setting.

References

Bhuvaneswar, C., Chang, G., Epstein, L., & Stern, T. (2008). Cocaine and opioid use during pregnancy: Prevalence and management. Psychiatrist Today, 10(1), 59-65. https://doi.org/10.4088/PCC.v10n0110

Bland, E., Oppenheimer, L., Brisson-Carroll, G., Morel, C., Holmes, P., & Gruslin, A. (2001). Influence of an education program on medical students’ attitudes to substance use disorder in pregnancy. American Journal of Drug and Alcohol Abuse, 27(3), 483-490. https://doi.org/10.1081/ADA-100104513

Boone, M., & McMichael, B. (2021). State-created fetal harm. The Georgetown Law Journal, 109(3), 475-522. https://www.law.georgetown.edu/georgetown-law-journal/wp-content/uploads/sites/26/2021/03/Boone_McMichael_State-Created-Fetal-Harm.pdf

Bowie, B. (2005). Intervention to improve interactions between drug-abusing mothers and their drug-exposed infants: A review of the research literature. Journal of Addictions Nursing, 15, 153-161. https://doi.org/10.1080/10884600490888349

Burke, S. (2016). Doctors applaud the end of Tennessee’s Fetal Assault Law. Associated press. https://apnews.com/08ce8448799148bf852babadc33d1aef

Busenbark, M. (2016). Strategies to care for babies born drug dependent. Children’s Hospital Today, Children’s Hospital Association. https://www.childrenshospitals.org/Newsroom/Childrens-Hospitals-Today/Issue-Archive/Issues/Spring-2016/Articles/Caring-for-Babies-Born-Drug-Dependent

Carnes, M., Devine, P. G., Isaac, C., Manwell, L. B., Ford, C. E., Byars-Winston, A., Fine, E., & Sheridan, J. (2012). Promoting institutional change through bias literacy. Journal of Diversity in Higher Education, 5(2), 63-77. https://doi.org/10.1037/a0028128

Centers for Disease Control and Prevention. (2019). Pregnancy-related deaths: Saving women’s lives before, during, and after pregnancy. Pregnancy-related Deaths | VitalSigns | CDC

Chapman, E. N., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine, 28(11), 1504-1510. https://doi.org/10.1007/s11606-013-2441-1

Chiandetti, A., Hernandez, G., Mercadal-Hally, M., Alvarez., Andreu-Fernandez, V., Navarro-Tapia, E., Bastons-Compta, A., & Garcia-Algar, O. (2017). Prevalence of prenatal exposure to substances of abuse: Questionnaire versus biomarkers. Reproductive Health, 14, 1-12. https://doi.org/10.1186/s12978-017-0385-3

Collier, A. Y., & Molina, R. L. (2019). Maternal mortality in the United States: Updates on trends, causes, and solutions. NeoReviews, 20(10), e561-e574. https://doi.org/10.1542/neo.20-10-e561

Corrigan, P., Kerr, A., & Knudsen, L. (2005a). The stigma of mental illness: Explanatory models and methods for change. Applied & Preventative Psychology, 11, 179-199. https://doi.org/10.1016/j.appsy.2005.07.001

Corrigan, P., Kuwabara, S. A, & O’Shaughnessy, J. (2009). The public stigma of mental illness and drug addiction: Findings from a stratified random sample. Journal of Social Work, 9, 139-147. https://doi.org/10.1177/1468017308101818

Corrigan, P., Markowitz, F., & Watson, A. (2004). Structural levels of mental illness stigma and discrimination. Schizophrenia Bulletin, 30(3), 481-489. https://doi.org/10.1093/oxfordjournals.schbul.a007096

Corrigan, P., Watson, A., Heyman, M., Warpinski, A., Garcia, G., Slopen, N., & Hall, L. (2005b). Structural stigma in the state legislature. Psychiatric Services, 56(5), 557-563. https://doi.org/10.1176/appi.ps.56.5.557

Crawford, C., Sias, L., & Goodwin, L. (2015). Treating pregnant women with substance abuse issues in an obgyn clinic: Barriers to treatment. Vistas, 2015, 1-8. https://www.counseling.org/docs/default-source/vistas/treating-pregnant-women-with-substance-abuse-issues-in-an-obgyn-clinic-barriers-to-treatment.pdf?sfvrsn=a417f2c_8

Criminal Law. (2020). Criminalization of pregnancy - eighth circuit upholds manslaughter charge against pregnant woman for death of baby based on prenatal drug use. Harvard Law Review, 133(3), 1087-1094. https://harvardlawreview.org/wp-content/uploads/2020/01/1087-1094_Online.pdf

Darlington, C. K., Compton, P. A., & Hutson, S. P. (2021). Revisiting the Fetal Assault Law in Tennessee: Implications and the way forward. Policy, Politics & Nursing Practice, 22(2), 93-104. https://doi.org/10.1177/1527154421989994

De Bortoli, L., Coles, J., & Dolan, M. (2014). Linking illicit substance misuse during pregnancy and child abuse: What is the quality of the evidence? Child and Family Social Work, 19, 136-148. https://doi.org/10.1111/cfs.12002

Dryden, C., Young, D., Hepburn, M., & Mactier, H. (2009). Maternal methadone use in pregnancy: Factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. Obstetrics and Gynecology, 116(5), 665-671. https://doi.org/10.1111/j.1471-0528.2008.02073.x

Daui Wei Ling, C. (2011). MANOVA: Type 1 error rate analysis. Digital Commons, California Polytechnic State University. https://digitalcommons.calpoly.edu/statsp/19/

Faherty, L. J., Kranz, A. M., Russell-Fritch, J., Patrick, S. W., Cantor, J., & Stein, B. D. (2019). Association of punitive and reporting state policies related to substance use in pregnancy with rates of neonatal abstinence syndrome. JAMA Network Open, 2(11), 1-12. https://doi.org/10.1001/jamanetworkopen.2019.14078

Fonti, S., Davis, D., & Ferguson, S. (2016). The attitudes of health care professionals towards women using illicit substances in pregnancy: A cross-sectional study. Women Birth, 4, 1-6. https://doi.org/10.1016/j.wombi.2016.01.001

Frank, L. E., & Nagel, S. K. (2017). Addiction and moralization: The role of the underlying model of addiction. Neuroethics, 10(1), 129-139. https://doi.org/10.1007/s12152-017-9307-x

French, A., Macedo, M., Poulsen, J., Waterson, T. & Yu, A. (n.d.). Multivariate analysis of variance. https://utah.instructure.com/files/7975618/download?download_frd=1

Frimpong, J. A., Helleringer, S., Awoonor-Williams, J. K., Yeji, F., & Phillips, J. F. (2011). Does supervision improve health worker productivity? Evidence from the upper east region of Ghana. Tropical Medicine & International Health, 16(10), 1225-1233. https://doi.org/10.1111/j.1365-3156.2011.02824.x

Garg, M., Garrison, L., Leeman, L., Hamidovic, A., Borrego, M., Rayburn, W., & Bakhireva, L. (2016). Validity of self-reported drug use information among pregnant women. Maternal and Child Health Journal, 20(1), 41-47. https://doi.org/10.1007/s10995-015-1799-6

Goodman, D., Whalen, B., & Hodder, L. C. (2019). It's time to support, rather than punish, pregnant women with substance use disorder. JAMA Network Open, 2(11), 1-3. https://doi.org/10.1001/jamanetworkopen.2019.14135

Guttmacher Institute. (2021, December 2). Substance use during pregnancy. https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy.

Haffajee, R. L., Faherty, L. J., & Zivin, K. (2021). Pregnant women with substance use disorders: The harm associated with punitive approaches. New England Journal of Medicine, 384(25), 2364-2367. https://doi.org/10.1056/NEJMp2101051

Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. American Journal of Public Health, 105(12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903

Hatzenbuehler, M. (2016). Structural stigma: Research evidence and implications for psychological science. American Psychologist, 71(8), 742-751. https://doi.org/10.1037/amp0000068

Hatzenbuehler, M., Phelan, J., & Link, B. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813-821. https://doi.org/10.2105/AJPH.2012.301069

Horvath, T., Misra, K., & Epner, A. (n.d.). Disease model of addiction and recovery implications. AMHC. https://www.gracepointwellness.org/1408-addictions/article/48343-disease-model-of-addiction-and-recovery-implications

Howell, E. M., & Chasnoff, I. J. (1999). Perinatal substance abuse treatment: Findings from focus groups with clients and providers. Journal of Substance Abuse Treatment, 17(1-2), 139-148. https://doi.org/10.1016/S0740-5472(98)00069-5

Hudak, M. L., Tan, R. C., (2012). Committee on drugs, committee on fetus and newborn, & American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics, 129(2), e540–e560. https://doi.org/10.1542/peds.2011-3212

Indiana Department of Health. (2020). Indiana Maternal Mortality Review Committee: 2020 annual report. https://www.in.gov/health/cfr/files/Maternal-Mortality-Report_December-2020-Final.pdf

Koppel, S (2016). Evidence-based drug crime policy: Moving beyond the moral/medical dichotomy to a multi-level model of addiction. Journal of Civil Legal Science, 5(175), 1-5. https://doi.org/10.4172/2169-0170.1000175

Latuskie, K. A., Andrews, N. C., Motz, M., Leibson, T., Austin, Z., Ito, S., & Pepler, D. J. (2019). Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study. Women and Birth, 32(1), e57-e64. https://doi.org/10.1016/j.wombi.2018.04.001

Lawrence, R., Rasinski, K., Yoon, J., & Curlin, F. (2013). Physicians’ belief about the nature of addiction: A survey of primary care physicians and psychiatrists. American Journal on Addictions, 2, 255-260. https://doi.org/10.1111/j.1521-0391.2012.00332.x

Lemaitre, R. (2011, December 5). Obama drug policy: Reforming the criminal justice system [Blog]. Office of National Drug Council and Policy. https://obamawhitehouse.archives.gov/blog/2011/12/05/obama-drug-policy-reforming-criminal-justice-system

Link, B., & Hatzenbuehler, M. L. (2016). Stigma as an unrecognized determinant of population health: Research and policy implications. Journal of Health Politics, Policy & Law, 41(4), 653-673. https://doi.org/10.1215/03616878-3620869

Little, M., Shah, R., Vermeulen, M., Gorman, A., Dzendoletas, D., Ray, J. G. (2005). Adverse perinatal outcomes associated with homelessness and substance use in pregnancy. Canadian Medical Association Journal, 173(6), 615-618. https://doi.org/10.1503/cmaj.050406

Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systemic review and meta-analysis. Social Science & Medicine, 71, 2150-2161. https://doi.org/10.1016/j.socscimed.2010.09.030

Livingston, J. D., Milne, T., Fang, M., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorder: A systemic review. Addiction, 107, 39-50. https://doi.org/10.1111/j.1360-0443.2011.03601.x

Logan, B., Brown, M., & Hayes, M. (2013). Neonatal abstinence syndrome: Treatment and pediatric outcomes. Clinical Obstetrics & Gynecology, 56(1), 186-192. https://doi.org/10.1097/GRF.0b013e31827feea4

Lollar, C. E. (2017). Criminalizing pregnancy. Indiana Law Journal, 92(3), 947-1005. https://www.repository.law.indiana.edu/cgi/viewcontent.cgi?article=11252&context=ilj

MacVicar, S., & Kelly, L. (2019). Systemic mixed- study review of nonpharmacological management of neonatal abstinence syndrome. Birth, 46(3), 428-438. https://doi.org/10.1111/birt.12427

Marangoni, S., & Felix de Oliveria, M. (2015). Women users of drug abuse during pregnancy: Characterization of a series of cases. Acta Scientiarium; Health Sciences, 37(1), 53-61. https://doi.org/10.4025/actascihealthsci.v37i1.16754

Mburu, G., Ayon, S., Mahinda, S., Khoshnood, K. (2020). Determinants of women’s drug use during pregnancy: Perspectives from a qualitative study. Maternal Child Health Journal, 24, 1170-1178. https://doi.org/10.1007/s10995-020-02910-w

McGlothen-Bell, K., Recto, P., McGrath, J. M., Brownell, E., & Cleveland, L. M. (2021). Recovering together: Mothers' experiences providing skin-to-skin care for their infants with NAS. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 21(1), 16-22. https://doi.org/10.1097/ANC.0000000000000819

McQueen, K., & Murphy-Oikonen, J. (2016). Neonatal abstinence syndrome. New England Journal of Medicine, 375, 2468-2479. https://doi.org/10.1056/NEJMra1600879

Melillo, G. (2020, June 13). Racial disparities persist in maternal morbidity, mortality and infant health. American Diabetes Association Scientific Sessions. https://www.ajmc.com/view/racial-disparities-persist-in-maternal-morbidity-mortality-and-infant-health

Meurk, C.S., Broom, A., Adams, J., Hall, W., & Lucke, J. (2014). Factors influencing women’s decisions to drink alcohol during pregnancy: Findings of a qualitative study with implications for health communication. BioMed Central Pregnancy Childbirth, 14, 1-9. https://doi.org/10.1186/1471-2393-14-246

Mitchell, M. M., Severtson, S. G., & Latimer, W. W. (2008). Pregnancy and race/ethnicity as predictors of motivation for drug treatment. American Journal Drug and Alcohol Abuse, 34(4), 397-404. https://doi.org/10.1080/00952990802082172

Murphy, T. (2021). Statistical design and analysis of experiments with R. Bookdown, Atlanta. https://tjmurphy.github.io/jabstb/

National Association of Social Workers. (2017). Code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

National Institute on Drug Abuse [NIDA]. (2011). Prenatal exposure to drugs of abuse— May 2011. https://radarcart.boisestate.edu/library/files/2017/07/prenatal_exposure_May-2011.pdf.

NIDA. (2014). Mental health. https://www.drugabuse.gov/related-topics/mental-health

NIDA. (2017). Dramatic increases in maternal opioid use and neonatal abstinence syndrome. https://archives.drugabuse.gov/trends-statistics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome.

NIDA. (2019). Dramatic increases in maternal opioid use and neonatal abstinence syndrome. https://www.drugabuse.gov/drug-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome

NIDA. (2020a). How effective is drug addiction treatment?. https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment

NIDA. (2020b). Substance use while pregnant and breastfeeding. https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding

Olejnik, S.F. (1984). Planning educational research: Determining the necessary sample

size. Journal of Experimental Education, 53 (1), 40-48.

Paris, R., Herriott, A. L., Maru, M., Hacking, S. E., & Sommer, A. R. (2020). Secrecy versus disclosure: Women with substance use disorders share experiences in help seeking during pregnancy. Maternal Child Health Journal, 24, 1396-1403. https://doi.org/10.1007/s10995-020-03006-1

Patrick, S., Schumacher, R., Benneyworth, B. D., Krans, E. E., McAllister, J. M., & Davis, M. M. (2012). Neonatal Abstinence Syndrome and associated health care expenditures: United States 2000-2009. American Medical Association, 307(18), 1934-1940. https://doi.org/10.1001/jama.2012.3951

Pickard H. (2017). Responsibility without blame for addiction. Neuroethics, 10(1), 169–180. https://doi.org/10.1007/s12152-016-9295-2

Pope, D. G., Price, J., & Wolfers, J. (2018). Awareness reduces racial bias. Management Science, 64(11), 4988-4995. https://doi.org/10.1287/mnsc.2017.2901

Prasad, M. (2014). When opiate abuse complicates pregnancy. Contemporary OB/GYN, 58(5), 28-37. https://www.contemporaryobgyn.net/view/when-opiate-abuse-complicates-pregnancy

Raeside, L. (2003). Attitudes of staff towards mothers affected by substance abuse. British Journal of Nursing, 12(5), 302-310. https://doi.org/10.12968/bjon.2003.12.5.11176

Renbarger, K. M., Shieh, C., Moorman, M., Latham-Mintus, K., & Draucker, C. (2019). Health care encounters of pregnant and postpartum women with substance use disorders. Western Journal of Nursing Research, 42(8), 612-628. https://doi.org/10.1177/0193945919893372

Roberts, S., & Pies, C. (2010). Complex calculations: How drug use during pregnancy becomes a barrier to prenatal care. Journal of Maternal Child Health, 15, 333-341. https://doi.org/10.1007/s10995-010-0594-7

Schaler, J. A. (1991). Drugs and free will. Society, 28, 42-49. https://doi.org/10.1007/BF02695758

Selleck, C., & Redding, B. (1998). Knowledge and attitudes of registered nurses toward perinatal substance abuse. Journal of Obstetrics, Gynecology and Neonatal Nursing, 27(1), 70-77. https://doi.org/10.1111/j.1552-6909.1998.tb02593.x

Shadowen, C., Wheeler, R., & Terplan, M. (2021). Patient and provider knowledge of and attitudes toward medical conditions and medication during pregnancy. Addiction Science & Clinical Practice, 16(1), 22-22. https://doi.org/10.1186/s13722-021-00228-8

Silins, E., Conigrave, K. M., Rakvin, C., Dobbins, T., & Curry, K. (2007). The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers. Drug and Alcohol Review, 26, 191-200. https://doi.org/10.1080/09595230601184661

Stein, J. (2002). Manual for primary care providers: Effectively caring for active substance users. New York Academy of Pediatrics.

Stone, R. (2015). Pregnant women and substance use: Fear, stigma, and barriers to care. Health and Justice, 3(2), 1-15. https://doi.org/10.1186/s40352-015-0015-5

Stringer, K., Turan, B., McCormick, L., Durojaiye, M., Nyblade, L., Kempf, M., Lichenstein, B., & Turan, J. (2016). HIV-related stigma among health care providers in the Deep South. AIDS & Behavior, 20(1), 115-125. https://doi.org/10.1007/s10461-015-1256-y

Substance Abuse and Mental Health Services Administration (SAMHSA) (2016). A collaborative approach to the treatment of pregnant women with opioid use disorders. HHS Publication No. (SMA) 16-4978. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://ncsacw.samhsa.gov/files/Collaborative_Approach_508.pdf

Sukhera, J., Milne, A., Teunissen, P. W., Lingard, L., & Watling, C. (2018). Adaptive reinventing: implicit bias and the co-construction of social change. Advances in Health Sciences Education: Theory and Practice, 23(3), 587-599. https://doi.org/10.1007/s10459-018-9816-3

Sun, A. (2004). Principles for practice with substance-abusing pregnant women: A framework based on the five social work intervention roles. Social Work, 49(3), 383-394. https://doi.org/10.1093/sw/49.3.383

VanWormer, K. & Davis, D. (2018). Addiction treatment: A strengths assessment (4th ed.). Cengage.

Vogel, L. (2018). Newborns exposed to opioids need mothers more than NICU, say pediatricians. Canadian Medical Association Journal, 190(4), E123-E124. https://doi.org/10.1503/cmaj.109-5550

Whiteman, V., Salemi, J., Mulubrhan, Cain, M., Muktar, A., & Salihu, H. (2014). Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. Journal of Pregnancy, 2014, 1-8. https://doi.org/10.1155/2014/906723

Winstone, W., & Gervis, M. (2006). Countertransference and the self-aware sport psychologist: Attitudes and patterns of professional practice. Sport Psychologist, 20(4), 495-511. https://doi.org/10.1123/tsp.20.4.495

Wolfson, L., Schmidt, R. A., Stinson, J., & Poole, N. (2021). Examining barriers to harm reduction and child welfare services for pregnant women and mothers who use substances using a stigma action framework. Health & Social Care in the Community, 29(3), 589-601. https://doi.org/10.1111/hsc.13335

Woods, L. M., & Connelly, C. D. (2022). Opioid use treatment and recovery services during pregnancy. Journal of the American Psychiatric Nurses Association, 28(1), 58-67. https://doi.org/10.1177/10783903211033033

Worley, J. (2014). Identification and management of prescription drug abuse in pregnancy. Journal of Perinatal and Neonatal Nursing, 28(30), 196-203. https://doi.org/10.1097/JPN.0000000000000039

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Published

2022-06-14