The controversy of substance abuse during pregnancy has initiated speculation regarding matters of consequences specifically, treatment vs. punishment. There has been incredible speculation as well as various questions asked regarding this matter.
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Should the mother be held accountable for her actions and face the consequences or should she be given the right to appropriate treatment? In the United States there are a wide range of different stances on this issue such as a severely illicit viewpoint to where the mother should be faced with harsh punishments because of the effects dealt to the fetus to one that really emphasizes the concern of the mother’s mental health and the importance of getting treatment that copes with this issue. It is hoped that by raising awareness on these issues, policy enforcers throughout the United States will consider the approach that views both the mother and fetus as humanely as possible.
The complexities of dealing with this issue are not easily overcome. There are essentially pros and cons that stem from both perspectives however, mother’s facing substance abuse during pregnancy especially those who are addicted should be obligated to get professional treatment to help herself as well as her fetus as opposed to being looked down upon as a criminal who disregards human life because that just may not be the case.
Statistically, about 12% of the adult population in the United States suffers from some form of substance abuse. This number boosts to 28% if we include substance or mental health disorders which often times than not are inseparable from one another. What’s being done to punish women for facing this crisis of substance abuse during pregnancy far surpasses what’s being done to combat punishment and focus on the treatment regarding the mother and the fetus. As NCBI states The cost of society of drug use including crime, health care and reduced work productivity was estimated at over 300 billion dollars annually (NCBI 1). This is far more that was spent on the treatment of substance abuse which the total expenditure was only 13 billion dollars annually in 2005. This disparity between both consequences shows that there could be far more spending for treatment programs for women facing this problem.
In addition, maternal prenatal substance abuse has always been around. Although some people may believe that the fetus must be protected and is severely invulnerable we must also engage in the mother’s wellbeing and health as well. Getting treatment and help from this substance abuse crisis can result in a tremendous increase in the amount of women not facing substance abuse. By punishing them, they are not being exposed to a positive environment in which they can grow from and will result in only negative consequences. Firstly, if women are punished they are not being put in a position to cope with their problem and try and disengage in substance abuse. The punishment will only want them to continue using illicit and licit drugs. Secondly, women who are punished often face cruel stress which can lead to problematic outcomes for the fetus which can be irreversible.
This starts with policymakers within and throughout the United States. One way to combat this epidemic of substance abuse during pregnancy would be behavioral interventions. In Hendree E Jones’ article Drug Addiction during Pregnancy: Advances in Maternal Treatment and Understanding Child Outcomes, she makes note that Drug use occurs in the absence of other positive reinforces. Thus, drug use can be eliminated by increasing the density of non-drug positive reinforces and decreasing the positive reinforces attained from substance use (Jones 127). One example of behavioral intervention would be contingency management which essentially is a system that conveys reinforcing rewards that are rectifiable for goods and services or punishing consequences that are contingent on behavior such as providing a negative drug test. Jones also states This intervention has been subsequently used in a variety of addicted populations including nicotine, heroin, and poly-drug users. In 85% of reports published, this type of intervention produced significant changes in target behaviors (Jones 127-128).
Another use of contingency management to help treat women who face substance abuse during pregnancy is the therapeutic workplace. Women who show results of an absence of drugs earn rewards for work related performance. In the article Evidence-Based Drug Treatment Practice and the Child Welfare System: The Example of Methadone it makes note of the outcomes of this management program and states Over 3 years, therapeutic-work-place participants significantly increased cocaine abstinence relative to controls (54% and 28%) and opioid abstinence relative to controls (60% vs. 37%) (Lundgren 77). This demonstrates that contingency management can be an alternative to resulting to punishment for these women. This type of treatment is an incentive based program that can develop women to become substance free by eliminating those negative variables and incorporating positive variables in which women has some incentive to actually do well and try and help themselves.
Instead of punishing women for using substances while pregnant, taking into considerations of what was previously mentioned could be a viable alternative. Some counterarguments to be made about this epidemic include the crime of fetal abuse and the delivery of drugs through the umbilical cord. Women are often being committed of crime or jailed, as well as losing custody of their children. Although this may be true, most women are far more capable of being great parents to their children if the appropriate treatment and care for these women are incorporated in their daily lives and this starts with the help of our policy makers and social workers who.
As Arlene Bowers Andrews states in her novel Searching for Solutions to Alcohol and Other Drug Abuse during Pregnancy: Ethics, Values, and Constitutional Principles, she makes note that Women have long been disadvantaged in the provision of health care, particularly addictions treatment and obstetrical care (Andrews 57). The novel also mentions a statement provided by the NASW (National Association of Social Workers) Code of Ethics in which they state The social worker should act to ensure that all persons have access to the resources, services, and opportunities which they require.[and should act to expand choice and opportunity for all persons, with special regard for disadvantaged or oppressed groups and persons (NASW 10). Social workers play a critical role in the advancement of care for women facing substance abuse during pregnancy. And the best way to advocate for this is by organizing all-inclusive care for their clients.
With the epidemic of substance abuse during pregnancy, many would think the mother should be held accountable for her actions of fetal abuse and delivering irregular substances to the fetus. This opportunity should be taken as a way to encompass social values and while doing so implementing treatment programs such as contingency management that would result in a desired professional and safe environment for mothers who are willingly open to acknowledge their problem. By increasing the amount of non-drug reinforces that are positive and decreasing the reinforces that are positive stemming from substance abuse we can observe women to be less dependent upon substance abuse as a positive reinforcement and instead rely more upon things that are much less detriment to the health of the mother and the fetus such as prescribed medication and therapy and getting augmented treatment with professionals.
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