Substance Abuse, Mental Illness, and Trauma Clinical Needs of Pregnant Women in Treatment

Background and Purpose: Substance abuse, mental illness, and trauma in pregnancy are associated with adverse outcomes for mother and child. Yet little is known about the clinical treatment needs of pregnant women with co-occurring substance abuse and mental health disorders and trauma and the benefits of integrated treatment for this population. Pregnancy may increase risk through increased vulnerability to mental illness, stress-induced health risk behaviors, and exposure to violence. Alternately, pregnancy may be protective, generating increased motivation and support for health behavior change and access to treatment. We addressed this research gap by comparing pregnant versus non-pregnant women’s clinical profiles (substance abuse, mental illness, and trauma symptoms) at treatment entry, the role of recent interpersonal abuse, and trajectories of change in treatment.

Methods: We conducted secondary analysis of data from the Substance Abuse and Mental Health Service Administration’s Women with Co-occurring Disorders and Violence Study, a longitudinal, quasi-experimental study evaluating the treatment outcomes of integrated treatment versus usual care for 2,729 women, seeking or in treatment for co-occurring disorders and trauma, at 9 sites across the United States. Analyses compared means and frequencies of baseline scores between 205 pregnant and 2,524 non-pregnant women. We used multiple regression models to explore the role of recent interpersonal abuse in the relationship between pregnancy and clinical profiles, controlling for covariates of age, income, race, employment, child abuse, homelessness, marital status, and residential treatment status. To examine whether the trajectories of Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and Posttraumatic Stress Diagnostic Scale (PDS) differ between pregnant and non-pregnant women, we used generalized estimating equation (GEE) models to analyze baseline and 12 month follow-up data with a subsample of 145 pregnant women who were non-pregnant at 12 month follow-up and 1,670 women who were never pregnant during the study controlling for treatment condition and sociodemographic covariates.

Results: Pregnant women had better clinical profiles at treatment entry on ASI-Alcohol, BSI, and PDS but not ASI-Drug. Among pregnant women, recent interpersonal abuse was associated with worse mental illness and trauma symptoms but not substance abuse. Pregnant women’s ASI-Alcohol scores decreased more slowly over 12 months than non-pregnant women in both treatment conditions. The ASI-Drug score decreased quicker among pregnant women for usual care only. We found no difference in the rate of change over time between pregnant and non-pregnant women on mental health and trauma symptoms.

Conclusions and Implications: Pregnant women may have different treatment needs and respond differently to integrated treatment than non-pregnant women. Pregnancy may be protective at treatment entry. Pregnant women had better clinical profiles and, among pregnant women, recent interpersonal abuse was not associated with worse substance abuse severity at treatment entry. Pregnant women are potentially in a better position for change at treatment entry. However, pregnant women in integrated treatment improved more slowly than pregnant women in usual care. Future research should evaluate the mechanisms associated with rate of improvement for pregnant women in treatment and sustained change in the postpartum.