Social Determinants of Methadone in Pregnancy: Violence, Social Capital, and Mental Health

Abstract

Mothering and methadone can occur together with the right resources and support. Methadone mothers need to be seen in the context of their social risks and environment. Societal attitudes, social capital, and other contextual variables can be changed through policy. The purpose of this article is to describe the contextual risks experienced by drug abusing mothers in order to direct further research and policy changes that protect their children. Research has focused on biological or genetic determinants, but now social risks and environmental factors are shaping current literature about substance abuse in pregnancy. Significant risk factors, taken from the literature, are detailed, such as intimate partner violence and mental health co-morbidities. Racial differences and the effect of place on pregnant substance abusers are also discussed. Policy recommendations address the barriers substance abusing women face in their journey toward a healthy pregnancy.

Contributions of psychology to research, treatment, and care of pregnant women with opioid use disorder.

“…Historically, research on OUD in pregnancy focused on biomedical factors. Social, psychological, and environmental risk factors are increasingly recognized as determinants of health and of OUD in pregnancy (Alexander, 2013; Meyer, Isaacs, El-Shahawy, Burlew, & Wechsberg, 2019). In addition to the intervention research elaborated above, psychologists can spearhead research to learn about factors that precipitate OUD in pregnant women, research to clarify the contribution of psychosocial factors to treatment and health outcomes of this population, and research to identify and increase understanding of women’s needs.…”

“…A majority of pregnant women with OUD earn less than $20,000 per year and are unemployed (Martin et al, 2015; Metz, Brown, Martins, & Palamar, 2018). Further, OUD during pregnancy can be precipitated or exacerbated by psychosocial factors and circumstances including intimate partner violence, psychopathology, and homelessness (Alexander, 2013). These characteristics are important details to consider in creating interventions to prevent and treat OUD in this population.…”

Conceptualizing integrated service delivery for pregnant and parenting women with substance use issues: defining key factors and processes

“…They elaborated further that women who are unable to secure basic needs (e.g., food, shelter) or who experience ongoing threats to their safety (e.g., intimate partner violence) may be less likely to engage in or benefit from services targeting otherseemingly less urgent issues -such as substance use or parenting. Alexander (2013) states that "mothers experiencing drug addiction need to be seen in the context of their social determinants and environment" (p. 747). She aptly stated that "starting with a desire to find a cure before determining why people use [drugs] will always fail to produce a solution" (p.748), and cautions against focusing exclusively on "fixing the behaviour" at the expense of identifying and preventing factors that shape it.…”

Dietary Intake Among Opioid- and Alcohol-Using Pregnant Women

“…Inadequate dietary intake during pregnancy is a risk factor for adverse pregnancy outcomes, such as neural tube defects, intrauterine growth restriction, preterm delivery, and low birth weight (Abu-Saad & Fraser, 2010). Women with substance use disorders may be at a high risk for poor dietary intake during pregnancy due to a number of reasons, including inconsistent eating patterns, unstable housing situations, food insecurity, high rates of co-existing psychiatric disorders and tobacco use, unemployment and consequent poor socioeconomic status, inadequate social support, and a history of sexual or physical abuse and partner violence (Alexander, 2013; Best et al, 1998; Himmelgreen et al, 1998). In addition, substance abuse has been linked to addictive eating patterns and binge eating behaviors associated with excessive consumption of sweets and carbohydrates, and decreased intake of nutrient-dense foods (Grilo, White, & Masheb, 2009; Holderness, Brooks-Gunn, & Warren, 1994; Pelchat, 2002; Saeland et al, 2011; Tomedi, Bogen, Hanusa, Wisner, & Bodnar, 2012; Zador, Wall, & Webster, 1996).…”