Barriers to Screening Pregnant Women for Substance Abuse

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Title: Barriers to screening pregnant women for substance abuse Introduction: Drug and alcohol use in pregnancy poses a threat to the neonate’s development and the obstetric provider has an obligation to screen for substance use. Substance use in pregnancy can place the developing fetus at risk for in-utero opioid dependence, fetal-alcohol syndrome, preterm labor, and other consequences of maternal alcohol, tobacco, and illicit drug use.(6) Within the past three years La Crosse County has seen a marked increase in the amount of heroin use.(7) The American College of Obstetricians and Gynecologist (ACOG) has clearly documented how instrumental the Obstetrician can be in screening patients for alcohol, tobacco, and illicit drug use. (1,12) The standpoint of ACOG, is that drug screening should be implemented in a non-judgmental fashion which will not deter the woman from seeking prenatal care. (12) In doing so the Obstetrician can facilitate a healthy trustful relationship with their patient in which the patient feels safe to discuss their substance abuse and seek help without fear of litigation.(12) Many methods of screening have been implemented including neonatal sampling of hair and meconium, maternal urine screening, and maternal self-reports.(11) In considering wide-spread feasibility, self-report measures have been commonly used, some more known and validated methods include the 4 P’s plus and TWEAK. (4,5,13) In the clinic visit, the Obstetrician may also implement a brief motivational interview to assess the patients willingness to change. The Treatment and Intervention Protocol recommends the FRAMES Approach where the providers give feedback, responsibility, advice, menus of change options, empathy, and empowers t... ... middle of paper ... ...lin, and Kevin Grumbach. "Screening and Intervention for Intimate Partner Abuse Practices and Attitudes of Primary Care Physicians." The Journal of American Medical Association 282.5 (1999): 468-474. JAMA. Web. 25 Nov. 2013. 20. Gassman RA. Medical specialization, profession, and mediating beliefs that predict stated likelihood of alcohol screening and brief intervention: Targeting educational interventions. J Subst Abuse. 2003;24(3):141–156. 21. Miner KJ, Holtan N, Braddock M, Cooper H, Kloehn D. Barriers to screening and counseling pregnant women for alcohol use. Minn Med. 1996;79:43–47. 22. Davis, PM, TL Carr, and CB La. "Needs assessment and current practice of alcohol risk assessment of pregnant women and women of childbearing age by primary health care professionals.."Canadian Journal of Clinical Pharmacology 15.2 (2008): Web. 25 Nov. 2013.
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