Whereas substance-related disorders are a public health problem with multiple risk factors and complex etiologies (e.g., genetics, traumatic experiences, environmental factors) (Khoury, Tang, Bradley, Cubells, & Ressler, 2010; NIDA, 2010; NIDA, 2011; NIDA, 2016);
Whereas the prevalence of pregnant adolescent girls and women who use illicit substances in the U.S. has remained essentially unchanged at 4.7 percent for the past five years (Center for Behavioral Health Statistics and Quality, 2016 SAMHSA, 2014);
Whereas several risk factors are associated with increased likelihood of substance use while pregnant including: adolescent girls and women younger than 25 (Center for Behavioral Health Statistics and Quality, 2016 ); in first or second trimester compared to the last trimester (Center for Behavioral Health Statistics and Quality, 2016 ); adolescent girls and women who meet criteria for possible psychopathology, including depressive, anxiety, and panic disorders, as well as PTSD (Havens, Simmons, Shannon & Hansen, 2009; Smith, Costello, & Yonkers, 2015). For example, pregnant women who abuse prescription opioids are more likely than non-users to have major depressive disorder (16 percent v. 8 percent), generalized anxiety disorder 18 percent v. 9 percent), PTSD (11 percent v. 4 percent), or panic disorder (6 percent v. 4 percent) (Smith, Costello, & Yonkers, 2015). Other possible risk factors include substance use by the biological father, being unmarried, childhood trauma, and delinquency (el Marroun et al., 2008; Young, Deardorff, Ozer, & Lahiff, 2011);
Whereas the use of illicit substances by pregnant adolescent girls and women can result in increases in premature birth, low birth weight, being small for gestational age, as well as behavioral and cognitive effects, including attention deficit disorders, language development, emotional reactivity, and externalizing (Derauf et al., 2016; El-Mohandes et al., 2003; Eze, et al., 2016; LaGasse, et al., 2012; Lester, Adreozzi, & Appiah, 2004);
Whereas there is a need for research identifying the rate of illicit drug use by pregnant adolescent girls and women who identify with a sexual minority group (Fredriksen-Goldsen et al., 2013); and a need for scientific literature identifying evidence based practices for pregnant adolescent girls and women who identify either with a sexual minority group;
Whereas there is a need for research identifying the rate of illicit drug use by pregnant adolescent girls and women who identify with a disability (National Council on Disability, 2012); and a need for scientific literature identifying evidence based practices for pregnant adolescent girls and women who identify with a disability (National Council on Disability, 2012);
Whereas there is a need for scientific literature assessing the interplay of the biological impact of illicit substance use on infant and child outcomes, including outcomes of behavioral dysregulation during early childhood and into adolescence as well as cognitive outcomes; as well as literature comparing these outcomes to other child risk and protective factors such as maternal mental health and stress, connectedness to parents/others, expectancy and motivation, parental supervision, and attitudes towards deviance (Fisher et al., 2011; Konijnenberg, Lund, & Melinder, 2015; Lester, Adreozzi, & Appiah, 2004);
Whereas prenatal care significantly improves birth outcomes for all pregnant adolescent girls, women, and their babies, it is especially helpful for pregnancies affected by substance use disorders (el-Mohandes et al., 2003; Lester, Andreozzi, & Appiah, 2004; Parrott & Daniels, 1996);
Whereas state support for substance abuse treatment for pregnant women is limited in that only 19 states have either created or funded specialized treatment programs; only 12 provide pregnant women with priority access to state-funded programs; and only four states prohibit state-funded programs from discriminating against pregnant women (Guttmacher Institute, 2016);
Whereas a 2017 SAMHSA report notes that only 13 percent of more than 13,000 treatment facilities in the United States offered specialized services to pregnant women and only 7.5 percent offered childcare services (Smith & Lapari, 2017);
Whereas the intersection of substance use and pregnancy is underrepresented in practice settings of psychologists (deAngelis, 2001) and in the psychological literature and research publications;
Whereas 18 states currently seek to punish women for using substances while pregnant by charging them with child abuse and/or neglect, reckless endangerment, assault, or homicide of the fetus (Angelotta & Weiss, 2016; Lester, Andreozzi, & Appiah, 2004). Such laws seldom account for standard medical protocols that involve prescription of methadone or an alternate opioid-like substance as part of medication assisted therapy that in itself may result in positive tests for the presence opioids, effectively making it a crime for pregnant women or girls to adhere to a prescribed medical regimen;
Whereas punitive approaches and stigmatization result in pregnant women with substance related disorders and HIV/AIDS which often co-occurs with substance abuse disorders being significantly less likely to seek substance use treatment and prenatal care due to fear of prosecution, fear of the removal of infants and other children from their custody, and reduced access to specialized treatment programs (Amaro, Larson, Zhang, Acevedo, Dai & Matsumoto, 2007, Lee, King, Duan & Amaro, 2015, Lester, Andreozzi, & Appiah, 2004; Sunil, Spears, Hook, Castillo, & Torres, 2010; Roberts & Pies, 2011), thereby undermining the health of the fetus such laws purport to protect;
Whereas laws to discourage use and reduce crime through punishment, the arrest, incarceration, or termination of parental rights of pregnant adolescent girls and women leads to a lower availability of viable specialized treatment services in justice facilities, loss of welfare benefits, and dissolution of family bonds, which in turn encourage a return to drug use, increased criminal activity and re-incarceration, and exacerbates individual and community health problems (Allard, 2002; Van Olphen, Eliason, Freudenberg, & Barnes, 2009);
Whereas evidence demonstrates that women of color and their newborns are significantly more likely than other perinatal and peripartum women to be assessed as high risk and screened for drug use (Ellsworth, Stevens, & D’Angio, 2010; Kunins, Bellin, Chazotte, Du, & Arnsten, 2007), suggesting substance use testing guidelines are implemented unevenly;
Therefore be it resolved that the American Psychological Association affirms that substance-related disorders manifest as behavioral and biomedical health problems, and recommends providing rehabilitative services rather than criminalizing pregnant women and girls’ substance use and prioritizing substance use treatment services for pregnant women (see Guidance to States: Treatment Standards for Women with Substance Disorders, NASADAD, 2008).
Be it further resolved that the American Psychological Association opposes mandatory or nonconsensual drug testing of infants, adolescent girls, and women in the course of the provision of perinatal and supportive services, except for (a) the purposes of collecting confidential epidemiological surveillance data and (b) that which is necessary solely to determine treatment; and the American Psychological Association clarifies that drug testing should be conducted with the opportunity to participate in voluntary, evidence-based substance use treatment; and that the American Psychological Association opposes withholding of benefits based on drug testing.
Be it further resolved that the American Psychological Association affirms that laws, regulations, and policies relevant to healthcare professionals’, including psychologists, interactions with substance using girls and women should be framed to encourage women and girls’ help seeking and attaining prenatal and substance use treatment services and support the provider-patient relationship rather than requiring healthcare professionals to police pregnant adolescent girls’ and women’s behaviors (Lester, Andreozzi, & Appiah, 2004; Sunil, Spears, Hook, Castillo, & Torres, 2010; Roberts & Pies, 2011).
Be it further resolved that the American Psychological Association recommends additional state and federal funds be allocated for research toward developing, implementing, and evaluating innovative and effective gender-specific health promotion (strategies to support behavioral health and resilience) and substance use prevention (interventions to prevent or reduce risk of using substances and prevention and treatment of HIV/AIDS) with respect to pregnant and peripartum adolescent girls and adult women across minority groups (race, ethnicity, sexual orientation, ability, socioeconomic status, and religion).
Be it further resolved that the American Psychological Association urges governmental, both federal and state, and private entities to increase current funding and efforts toward developing, implementing, evaluating, and increasing the availability of gender-specific treatment programs for pregnant and parenting adolescent girls and women with substance-related disorders that include evidence-based components of child care, prenatal care, women-only programs, supplemental services and workshops that address women-focused topics, mental health programming, and comprehensive programming (Ashley, Marsden & Brady, 2003).
Be it further resolved that the American Psychological Association recommends enhancement of current health and human services professional education and training programs for medical, psychological, and behavioral health professionals to include an understanding of substance use and substance related disorders as well as the co-occurrence of HIV/AIDS in the lives of women of reproductive age, and especially in pregnant and parenting adolescent girls and women.
Be it further resolved that the American Psychological Association recommends psychologists collaborate with other health and education disciplines to take an interdisciplinary approach that will best address the needs of women of reproductive age who are using substances, and especially adolescent girls and women who are pregnant and are parents.
Be it further resolved that the American Psychological Association encourages psychologists to conduct research on the interplay of biology and environment in sequelae of maternal substance use during pregnancy and on treatment effectiveness.
Be it further resolved that the American Psychological Association supports and promotes the publication of psychological research on the effects of substance use during pregnancy on pregnant adolescent girls and women, and the effective treatments of substance related disorders during pregnancy, in research publications including its own journals.