DRUGS, PREGNANCY A BAD MIX

WORKSHOPS TO TEACH HOW TO RECOGNIZE ABUSE

If the doctors had known what to look for, they might have recognized that
Elsie was smoking crack and snorting cocaine while pregnant with three of
her seven children.

And if foster parents had known what to expect, they might have found more
effective ways to care for those children once they were taken from Elsie's
custody.

Women such as Elsie, a 39-year-old New Britain woman who asked that her last
name be withheld to protect her family's privacy, are the reason why New
Britain General Hospital is sponsoring a three-day series of workshops
starting Monday on drug abuse and pregnancy for clinicians, child care
providers and the public.

Almost 19 percent of pregnant women surveyed recently by the National
Institute on Drug Abuse reported drinking alcohol while pregnant, while 5.5
percent of pregnant women reported continuing to use illegal drugs. More
than 20 percent reported smoking cigarettes.

But too often, substance abuse is not recognized by health care providers
until after the baby is born.

This, of course, is often by design on the part of mothers who fear that
admitting to a drug or alcohol problem during pregnancy will result in
having the baby taken away.

But Dr. Ira Chasnoff, an author and national expert on substance abuse by
pregnant women, says doctors and other health care providers can help
addicts bear and take home healthier infants by confronting the problem
early.

Chasnoff, a pediatrics professor at the University of Illinois College of
Medicine in Chicago, will lead the workshops in New Britain aimed at helping
physicians recognize the signs of substance abuse and offering suggestions
on ways to intervene.

Now, women who are suspected of abusing drugs may be given urine tests as
part of routine pre-natal visits. But women such as Elsie are savvy, often
stopping their drug use for a few days or weeks prior to prenatal visits.
After a clean urine test, the addicts will return to drugs.

Beyond sporadic urine tests, there is no standard intervention until a baby
is delivered. At the hospital, doctors who suspect that a newborn has been
exposed to drugs might order a test for the mother. But again, this method
is rife with prejudice and flaws, Chasnoff said.

In a 1990 study published in the New England Journal of Medicine, Chasnoff
found that black women were 10 times as likely as white women to be tested
for drugs after giving birth, and poor women were also more likely to be
tested, although the rate of illicit drug use among pregnant women was about
the same regardless of race and socio- economic status.

A more effective approach, Chasnoff contends, would be to look for clues and
interview all pregnant women about their alcohol and drug- use practices.
When he speaks to obstetricians Wednesday, Chasnoff will offer suggestions
about how to recognize an abuser.

The most obvious clue, he said, is admission by the pregnant patient that
she is smoking cigarettes and using a small amount of alcohol. That patient,
Chasnoff said, is 100 times more likely to be abusing drugs and alcohol than
one who says she does not smoke or has quit.

If substance abuse is overlooked in the prenatal care system, chances are
its effects will continue to be felt in the foster-care system, where 80
percent of children are in custody because of drug abuse in the family,
Chasnoff said.

Children of substance abusers appear to have more emotional, behavioral and
learning problems than do children from homes where drug abuse is not a
problem, although debate continues about whether the actual chemical
exposure or the home environment contributes to the problem.

Nonetheless, problems exist. And at a community forum Monday night aimed at
foster parents, teachers and others who deal with children, Chasnoff will
offer suggestions about teaching and caring for the children of abusers.

At that event, Chasnoff also plans to offer some explanation for why women
continue using drugs during pregnancy, despite the dangers. Drug-addicted
women often suffer from clinical depression and have a history of domestic
violence or incest, he said.

Elsie, who sought treatment in 1996 after her third baby in a row was taken
into foster care, could be a poster woman for Chasnoff's lectures.

She was raised by an alcoholic father and a timid mother in New York's tough
South Bronx and says she was sexually abused by members of her family. She
had her first child at 13 and two more by the time she was 19. All of those
children were raised by relatives.

In 1988, Elsie moved to New Britain, hoping the change of scene would help
her quit drinking and smoking marijuana. Instead, her drug use escalated and
she became addicted to crack and cocaine.

While on drugs, she had three more children, including a girl who now
suffers from attention deficit hyperactivity disorder -- a learning
disability often associated with cocaine-exposed children.

She said she hid her drug abuse during all of her pregnancies, and was found
out only when doctors tested her in the hospital.

Elsie said she sought help after winding up homeless and beaten up on the
streets of New Britain. She has since completed two years of treatment and
has been reunited with her children. A fourth baby was born a year ago --
the first one she had while free of drugs.

But while Elsie believes that substance-abusing women need help, she is
skeptical about the role doctors can play in their recovery. She said even
the threat of losing her children was not enough to convince her to seek
help.

"I had to hit bottom, and I hit bottom really bad," Elsie said. "If they
would have told me `you need help,' I would have said, `no, you need help.'
"

Checked-by: Don Beck