Substance Abuse During Pregnancy
Foreword Substance Abuse During Pregnancy
William F. Rayburn, MD, MBA Consulting Editor
In 2003, Dr Michael Bogenschutz and I guest-edited an issue of Obstetrics and Gynecology Clinics of North America pertaining to “substance use disorders and women’s health.” That undertaking was in response to the misuse of illegal and controlled drugs, alcohol, and tobacco that became a more widely recognized national health problem. Although more frequent in men, substance use disorders (abuse and dependence) remained common in women, with overall lifetime prevalence estimated at nearly one in five women, excluding nicotine dependence. In that issue, we asked the authors to characterize how substance misuse affected women and men differently. Substance-dependent women tended to suffer more severe medical and interpersonal consequences than men, and their dependence progressed more rapidly. Women with substance use disorders were reported to demonstrate different patterns of comorbid psychiatric illnesses, which in some cases played a role in the cause of their substance use disorder. Multiple barriers to effective diagnosis and treatment of substance use disorders were reported, including stigmatization of substance-using women, fear of loss of child custody, treatment programs designed for men, and a paucity of treatments, pharmacologic as well as psychosocial, that have been empirically validated in women. Hopefully, these barriers have improved for all women, particularly those of reproductive age. Yet substance use continues to remain a major social and medical problem and women’s substance use patterns are increasingly more similar to men’s. The gap is narrowing, making this topic even more relevant now. For this reason, I chose to pursue an update issue of our Obstetrics and Gynecology Clinics of North America after more than a decade, which focused solely on ramifications of substance use and pregnancy. As physicians for women’s health care, obstetricians play important, often frontline, roles in addressing substance use disorders. These roles may include screening patients for contraception and pregnancy, providing preventive education about substance use, advising patients about social and support groups, practicing Obstet Gynecol Clin N Am 41 (2014) xi–xii http://dx.doi.org/10.1016/j.ogc.2014.02.012 obgyn.theclinics.com 0889-8545/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
xii
Foreword
safe prescription writing, undertaking fetal surveillance, and facilitating referrals for comanagement. It is my pleasure to coedit this issue with the talents of Dr Hilary Smith Connery, a very capable psychiatrist trained in addiction medicine. Together, we attempted to provide relevant information to offer strategies for busy clinicians about providing more optimal and often interdisciplinary care of pregnant women with substance use problems. Our experienced and well-qualified team of authors hopes that practical evidence-based information provided herein will aid in the development and implementation of diagnostic and treatment programs for our needy patients and their families before and after the delivery of their babies. William F. Rayburn, MD, MBA Department of Obstetrics and Gynecology Continuing Medical Education and Professional Development University of New Mexico School of Medicine MSC10 5580, 1 University of New Mexico Albuquerque, NM 87131-0001, USA E-mail address: [email protected]
Foreword Substance Abuse During Pregnancy
William F. Rayburn, MD, MBA Consulting Editor
In 2003, Dr Michael Bogenschutz and I guest-edited an issue of Obstetrics and Gynecology Clinics of North America pertaining to “substance use disorders and women’s health.” That undertaking was in response to the misuse of illegal and controlled drugs, alcohol, and tobacco that became a more widely recognized national health problem. Although more frequent in men, substance use disorders (abuse and dependence) remained common in women, with overall lifetime prevalence estimated at nearly one in five women, excluding nicotine dependence. In that issue, we asked the authors to characterize how substance misuse affected women and men differently. Substance-dependent women tended to suffer more severe medical and interpersonal consequences than men, and their dependence progressed more rapidly. Women with substance use disorders were reported to demonstrate different patterns of comorbid psychiatric illnesses, which in some cases played a role in the cause of their substance use disorder. Multiple barriers to effective diagnosis and treatment of substance use disorders were reported, including stigmatization of substance-using women, fear of loss of child custody, treatment programs designed for men, and a paucity of treatments, pharmacologic as well as psychosocial, that have been empirically validated in women. Hopefully, these barriers have improved for all women, particularly those of reproductive age. Yet substance use continues to remain a major social and medical problem and women’s substance use patterns are increasingly more similar to men’s. The gap is narrowing, making this topic even more relevant now. For this reason, I chose to pursue an update issue of our Obstetrics and Gynecology Clinics of North America after more than a decade, which focused solely on ramifications of substance use and pregnancy. As physicians for women’s health care, obstetricians play important, often frontline, roles in addressing substance use disorders. These roles may include screening patients for contraception and pregnancy, providing preventive education about substance use, advising patients about social and support groups, practicing Obstet Gynecol Clin N Am 41 (2014) xi–xii http://dx.doi.org/10.1016/j.ogc.2014.02.012 obgyn.theclinics.com 0889-8545/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
xii
Foreword
safe prescription writing, undertaking fetal surveillance, and facilitating referrals for comanagement. It is my pleasure to coedit this issue with the talents of Dr Hilary Smith Connery, a very capable psychiatrist trained in addiction medicine. Together, we attempted to provide relevant information to offer strategies for busy clinicians about providing more optimal and often interdisciplinary care of pregnant women with substance use problems. Our experienced and well-qualified team of authors hopes that practical evidence-based information provided herein will aid in the development and implementation of diagnostic and treatment programs for our needy patients and their families before and after the delivery of their babies. William F. Rayburn, MD, MBA Department of Obstetrics and Gynecology Continuing Medical Education and Professional Development University of New Mexico School of Medicine MSC10 5580, 1 University of New Mexico Albuquerque, NM 87131-0001, USA E-mail address: [email protected]
