PROGRAM TARGETS SUBSTANCE ABUSE BY PREGNANT WOMEN

Forty percent of some 850 pregnant women who were seen in prenatal clinics
at Earl K. Long Medical Center in the past year screened positive for use
of alcohol, tobacco or illicit drugs during pregnancy.
"Of those, 63 percent had used alcohol or tobacco and 37 percent had used
illicit drugs," said Jan Kasofsky, executive director of Capital Area Human
Services District.

Some of those women were occasional drinkers, though others were identified
as having significant substance abuse problems, she said. Some were
directed to education programs where they learned that "no alcohol is safe
during pregnancy," and others were referred to treatment programs.

CAHSD has prioritized substance abuse by pregnant women and is revamping
its treatment programs to target that population, Kasofsky said. "We
already had in place programs ranging from education to residential
treatment. But, in the next week or two, we will open an intensive
outpatient treatment program for pregnant women at Family Road. Treatment
approaches are different for women, and this program will target pregnant
women specifically. Child care will also be provided, removing one of the
barriers that keeps women from getting treatment."

Consumption of alcohol during pregnancy is the No. 1 preventable cause of
mental retardation in children, she said. "If we can save these kids and
keep families together, then we'll be fulfilling our mission."

Kasofsky was one of a number of local, state and national speakers to
address a Women and Substance Abuse Treatment Conference, "Healing Pathways
for Women: Disease, Treatment and Recovery." The conference was sponsored
here last week by CAHSD.

Keynote speakers included Dr. Ira J. Chasnoff, president of The Children's
Research Triangle and a professor at the University of Illinois College of
Medicine in Chicago, Ill.; Martha A. Jessup, a fellow at the Institute for
Health Policy Studies at the University of California in San Francisco,
Calif.; and Rokelle Lerner, an international consultant on families and
chemical dependency.

The use of alcohol, tobacco and illicit drugs during pregnancy is a major
public health concern, Chasnoff said.

In a recent national survey of some 1,200 pregnant women, more than 54
percent said they had used alcohol or tobacco during their pregnancies, and
3 percent said they had used an illicit drug.

An estimated 2 million children are born in this country each year exposed
to substances that can affect fetal brain development.

A recent survey of obstetricians revealed that the majority still tell
their patients it's OK to drink alcohol, Chasnoff said. That means
physicians haven't been educated about the long-term effects of prenatal
substance abuse on the development and behavior of the exposed child.

Leonard was a child whose mother abused alcohol and drugs while she was
pregnant, he said. When he was 5 years old, Leonard and his 2-year-old
brother were abandoned by their mother and placed in foster care. Between
the ages of 5 and 12, Leonard was placed unsuccessfully in 17 different
foster homes. At 12, he went to live in a group home.

"Leonard came to my attention when, at the age of 17, he was getting ready
to leave the state's custody. He had an IQ of 68 and the facial features of
fetal alcohol syndrome. He had stab wounds and tattoos and was a member of
a gang. When I asked him to draw a picture of himself, he drew his face in
pretty good detail, but his body was in a fetal position and, across the
front, he wrote 'feed me.' It was too late for Leonard but that's why we do
this work -- to save the Leonards and to stop the cycle," Chasnoff said.

While in Baton Rouge, Chasnoff addressed groups of physicians and consumers
about prenatal substance abuse. He recommended that physicians incorporate
a simple screening tool in taking medical histories of pregnant women.

"In the month before you knew you were pregnant, how many cigarettes did
you smoke and how many drinks did you consume?" are the key questions to
ask, he said. Positive responses indicate the need for further assessment,
and it is critical to have a referral system in place for those women who
need treatment.

Chasnoff said he definitely favors voluntary screening over mandatory urine
toxicology tests for pregnant women. The U.S. Supreme Court has ruled that
urine toxicologies can not be performed in pregnant women without their
permission for therapeutic reasons, he said.

To read more about Chasnoff's research on prenatal substance abuse with the
Children's Research Triangle, visit the Web site: http://www.childstudy.org.

WOMEN AND TOBACCO

It's 2003 now and tobacco should be lumped in with alcohol and drugs when
it comes to looking at the potential harm pregnant women can expose their
unborn children to, Jessup said.

One in five American women smokes and one in eight pregnant women smokes,
according to statistics quoted by Jessup.

Some women in lower socioeconomic levels believe that smoking during
pregnancy is good because their babies will be born smaller or earlier,
thus ensuring an easier delivery, she said. What they don't realize is that
smoking during pregnancy has been linked to low birth weight, sudden infant
death syndrome, prematurity and other problems during pregnancy and delivery.

Children exposed to tobacco smoke experience higher rates of asthma,
pneumonia, heart disease, ear infections, colds, flu and allergies.

The U.S. Supreme Court has also ruled against attempts to incarcerate
pregnant women who smoke, in effect stating that the habit should be viewed
and treated as an addiction rather than prenatal child abuse.

Some obstetricians have limited their practices to nonsmokers, a trend that
Jessup said she finds "disturbing" and fraught with legal and ethical
dilemmas. Instead, she said, physicians should counsel their patients and
refer them to treatment.

If ever there was a "teachable moment" between doctors and patients, it is
when a woman is told she is pregnant and that her actions will influence
the course of her unborn child's life from that point on. That's a strong
motivation to stop smoking, she said.

Order from chaos

Anything that takes too large a share of your life can be viewed as an
addiction, and the transition between using and recovery can be both a time
of chaos and great opportunity, Lerner said.

Some of the major themes that people in transition have to deal with are
shame, abandonment, vulnerability, deprivation, mistrust and survival.
Moving from a state of surviving to a state of thriving means the
individual comes to believe "I am not responsible for what happened to me,
but I am responsible for making sure it never happens again."

Some individuals get stuck in their addictions partly because of "invisible
loyalties," she said. If you do something good for yourself and feel
guilty, if you feel like you're betraying someone by getting healthier, or
if you know what you need to do and can't do it, you may need to look at
those underlying issues, she said.

Letting go is one of the first steps in the healing process of recovery,
Lerner said. "The miracle of recovery means you will feel alive again, free
from fear, with peace of mind, increased energy and creativity and a
feeling of purpose, meaning and value in life."