Drug-abusing moms and babies – victims of stigma

A pregnant woman’s substance abuse problem is not a criminal one. It is a mental health problem that needs to be treated and prevented like any other health problem such as hypertension. Dismissing the similarities between these two health problems is a symptom of the stigma associated with drug use.

By Barry Lester

The frightening prevalence of drug use among employed men and women in this country was the focus of a report issued last August by the federal government. Deep inside that report was another alarming figure: During the past year, more than 320,000 pregnant women either binged on alcohol or used illicit drugs.

Our ignorance and inconsistency in dealing with the issue accompany the recurring problem of drug and alcohol abuse by pregnant women. In 1992, for instance, a South Carolina court sent Cornelia Whitner, who had used cocaine while pregnant, to jail for eight years because she violated state laws regarding child abuse and neglect. According to the court, she should have known that cocaine use would result in the birth of a damaged baby. Therefore she had to be punished. On the other hand, a Wisconsin appeals court threw out a case against Deborah Zimmerman, who was accused of trying to drink her fetus to death. The court ruled that she could not be charged with attempted murder because a fetus is not a human being.

The image of an infant exposed to cocaine is one of a brain-damaged baby born prematurely, trembling and screaming through withdrawal. These infants and those exposed to alcohol, according to popular beliefs, are destined to fail in school and in life, and become wards of society.

The public’s concern for the welfare of the child is often expressed as anger at the mother. As a result, policy-makers tend to punish these women with jail sentences or removal of their children.

But a pregnant woman’s substance abuse problem is not a criminal one. It is a mental health problem that needs to be treated and prevented like any other health problem such as hypertension or diabetes. Society disregards the similarity between cocaine use and hypertension because the inability to control one’s blood pressure is seen as an involuntary act.

Dismissing the similarities between these two health problems is a symptom of the stigma associated with drug use.

Research shows that treatment for drug addictions is effective. In fact, treatment works for drug addictions as well as it does for medical conditions such as hypertension and diabetes. But the stigma associated with drug use drives women away from seeking treatment for fear of detection, incarceration and child removal. Of all people, women like Whitner and Zimmerman and their babies need health care treatment.

The federal government spends more than $350 million annually on services for drug-exposed children in school. If that were spent on early intervention, we could prevent the children’s deficits from occurring.

But to do this, we first have to accept that substance abuse by pregnant women is similar to other health problems. We can no more abandon an addict at the first sign of relapse than we would abandon a hypertensive for forgetting to take blood pressure medication.

The first step is to treat both the drug user and the societal stigma associated with drug use. Without that, the chances of recovery for the drug-addicted mother or the drug-exposed baby are not likely to improve.

Barry Lester, professor of psychiatry and pediatrics at the Brown University School of Medicine, directs the Infant Development Center at Women and Infants’ Hospital. His work is funded by the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program.