Drinking History
Treatment
Withdrawal
Stabalization
Case Management
Service Delivery

Treatment of the Pregnant Problem Drinker

One of the most well-recognised treatment protocols for pregnant problem drinking women comes from the the US Department of Health and Human Services series on Treatment Improvement Protocols (TIP) Series 2.  Initially published in 1993 this TIP was reprinted in 1995.

The foreword of this protocol states "One of the best opportunities we have to approach and intervene with the substance-using woman is when she is pregnant.  The child's birth may give her a powerful motive to seek treatment for her addiction.  Early intervention efforts during the pre-natal period increase the likelihood that she will successfully recover from alcohol and other drug use".

The TIP recognises the complex needs of this treatment population both during and after pregnancy. For the purposes of this website the focus will be on the detox and medical and social care during pregnancy.

The pregnant, substance-using woman requires a continuum of care that includes a broad range of support services provided over an extended period of time. This continuum of care should reflect the complexity of her multiple roles as a person in recovery, parent, partner, and frequently, single head of a household. Ideally, support services should be provided as long as the woman and her family need and can benefit from them, potentially until her last child reaches adulthood. In reality, support services may be available for a period of a few months to several years.

The case management function is essential for the recovery and well-being of the substance-using woman and her family. Virtually any agency can provide case management services, although the lead agency typically assigns an appropriate staff person to this role, such as a social worker or nurse. The case manager assists the patient in accessing services, and monitors her participation and progress in using health care, alcohol and other drug treatment, and other social services.

The multiple services coordinated by the case manager are generally provided by a variety of agencies. Many of these services are initiated during or even prior to pregnancy and should continue after delivery for as long as they are appropriate. The consortium of service providers may change over time, depending on the family's individual circumstances and resources.

The case manager should be aware that differences in philosophies may exist between health and social service agencies and the alcohol and other drug treatment field. Behaviours that health and social service agencies view as helping and supportive are often viewed as co-dependent behaviours by the treatment field. As agencies work together on behalf of patients, they too must recognize and handle complex and legitimate differences in philosophies and practices.