Women-Centered Drug Treatment Services and Need in the United States, 2002–2009

Objectives. We examined options and need for women-centered substance use disorder treatment in the United States between 2002 and 2009.Methods. We obtained characteristics of facilities from the National Survey of Substance Abuse Treatment Services and treatment need data from the National Survey on Drug Use and Health. We also examined differences in provision of women-centered programs by urbanization level in data from the National Center for Health Statistics 2006 Rural-Urban County Continuum.Results. Of the 13 000 facilities surveyed annually, the proportion offering women-centered services declined from 43% in 2002 to 40% in 2009 (P < .001). Urban location, state population size, and Medicaid payment predicted provision of such services as trauma-related and domestic violence counseling, child care, and housing assistance (all, P < .001). Prevalence of women with unmet need ranged from 81% to 95% across states.Conclusions. Change in availability of women-centered drug treatment services was minimal from 2002 to 2009, even though need for treatment was high in all states.Substance use is common among women of reproductive age in the United States. According to the 2012 National Survey on Drug Use and Health, 10.7% of nonpregnant women aged 15 to 44 years and 5.9% of pregnant women reported current (past 30 days) illicit drug use.1 Among pregnant women, illicit drug use decreases as age increases and as a pregnancy progresses.2 However, of women aged 18 years and older who met criteria for needing substance use disorder treatment, only 11.2% received treatment.1 In addition, 84.2% of women who were classified as needing treatment (met criteria for abuse or dependence or received specialty substance use treatment) did not receive it and did not perceive a need for it.3 Clearly, a disparity exists between women who may benefit from such treatment and those who actually receive it.Women with substance use disorders face unique barriers when seeking and receiving treatment. Women are less likely than men to seek treatment for substance use disorders, often citing fear of social stigma, involvement in violent relationships, and lack of adequate child care during treatment.4,5 Although the prevalence of intimate partner violence among women in the general population ranges from 10% to 30%, estimates for substance-using women are between 25% and 60%.4 This population also has increased barriers to obtaining treatment that stem from high rates of coexisting mental health issues, such as posttraumatic stress disorders and depression.4In the early 1980s, increased media coverage of crack babies led to increased federal focus and subsequent funding for women-centered substance use treatment.6,7 In 1988, the Anti-Drug Abuse Act allotted 10% of federal war on drugs funds to women-centered treatment programs, with an emphasis on programs targeted at pregnant and postpartum women.8 In recent decades, interest in researching, designing, and implementing gender-specific treatment has increased, and outcomes for substance-using women have improved.9 Studies have found that women in programs that offer services tailored to their unique needs have higher retention rates (or lower dropout rates), show reductions in substance use, and report fewer barriers to care.6,7,9–12We examined the temporal and geographic trends in the availability of women-centered drug treatment services in the United States. In addition, we aimed to assess the disparity between treatment need and service availability for women with substance use disorders.     

Effect of criminal justice mandate on drug treatment completion in women

Background: Drug and alcohol abuse among women is a growing problem in the United States. Drug treatment is an effective way to manage the psychological, biological, financial, and social cost of drug abuse. Prior research has identified criminal justice referrals or coercion as a predictor of treatment completion among men but questions remain about the same effect in women. Objectives: This study uses the Treatment Episodes Datasets Discharge 2006–2008 (TEDS-D) to explore the association between coercion and treatment completion among women. Methods: Analysis compared primary treatment episodes of coerced women to those who entered treatment voluntarily. A logistic model of the odds of treatment success was performed controlling for race/ethnicity, age, education, employment, primary substance of abuse, number of substances reported at admission, referral source, treatment setting, and treatment duration. Results: 582?671 primary treatment episodes were analyzed comparing women with coercion referrals (n?=?196?660) to those who entered treatment voluntarily (n?=?390?054). Results of multivariable logistic modeling showed that coerced women had better odds of completion or transfer than women who entered voluntarily. However, this association was modified by treatment setting with better odds in ambulatory (OR?=?1.49 [1.47, 1.51]) than in inpatient (OR?=?1.06 [1.03, 1.10]) and worst outcomes in detoxification (OR?=?0.89 [0.84, 0.96]). Conclusion: These results dispute the broad effectiveness of legal mandates across all drug treatment settings among women. They show the need for further recognition of female-specific characteristics that can affect motivation and treatment success to better inform healthcare and judicial policies on drug treatment services for women.     

The relationship between pregnancy intention and alcohol use behavior: An analysis of PRAMS data

This study examined the relationship between pregnancy intention and change in perinatal alcohol use between 3 months prior to pregnancy and the last 3 months of pregnancy from a large national sample of women in the United States, the 2004–2008 Pregnancy Risk Assessment Monitoring System (PRAMS). The study sample consisted of 95,728 women who reported any alcohol drinking in 3 months prior to pregnancy. There was no relationship between pregnancy intention and cessation or reduction in alcohol use. Those whose pregnancies were unwanted were significantly more likely to report binge drinking during pregnancy compared to women with intended/mistimed pregnancies (AOR 1.55 [95% CI: 1.20, 1.99]). These findings suggest that interventions targeting binge drinking, perhaps particularly among women who drink in the 3 months prior to pregnancy and who do not want to become pregnant, are needed.     

Naltrexone in the treatment of opioid‐dependent pregnant women: the case for a considered and measured approach to research

The present paper considers naltrexone to treat opioid dependence during pregnancy. The public health problem of opioid dependence and its treatment during pregnancy is reviewed first. Next, the naltrexone and opioid dependence treatment literature is summarized, with overviews of the pre‐clinical and clinical research on prenatal naltrexone exposure. Finally, considerations and recommendations for future medication research for the treatment of opioid dependence in pregnant women are provided. The efficacy of long‐acting injectable naltrexone relative to placebo, its blockade of opioid agonist euphoric effects, its lack of abuse and tolerance development and its modest adverse effect profile make it a potential medication for opioid‐dependent pregnant women. However, it is not without seriously concerning potential drawbacks, including the difficulty surrounding medication induction that may lead to vulnerability with regard to relapse, physical dependence re‐establishment, increased risk behaviors, treatment dropout and resulting opioid overdose. Before embarking on future research with this medication, the benefits and risks for the mother–embryo/fetus/child dyad should be weighed carefully. Should future research be conducted, a multi‐level commitment to proactive ethical research is needed to reach the ultimate goal of improving the lives of women and children affected by opioid dependence.     

Über die intestinale Form der Lymphogranulomatose

Ohne Zusammenfassung     

Abnormal cerebral cortical neurons in a child with maternal PKU syndrome

A child born to a phenylketonuric (PKU) woman not on dietary treatment was microcephalic and had congenital heart and other physical anomalies consistent with the maternal PKU syndrome. After a repeat cardiac catherization at 3 months of age, he suffered an embolic left cerebral infarct and seizures. He was found by his mother dead in bed at 4 months of age; general autopsy revealed Klebsiella sepsis and pneumonia. Neuropathologic studies of the right cerebral hemisphere showed neuronal loss of the third cortical layer; Golgi studies revealed persistently immature cortical pyramidal cell somata and dendritic spines. This is the first report of specific neuronal abnormalities in a child with the maternal PKU syndrome and may, in part, account for the clinical features of microcephaly, mental retardation, and seizures seen in affected children.     

Addiction and Depression: Unmet Treatment Needs Among Reproductive Age Women

Maternal and Child Health Journal - To describe the current unmet major depression and substance use disorder (SUD) treatment needs among reproductive age women Data from the 2007 to 2014 National...