Factors Influencing Treatment Outcomes for Pregnant and Post-Partum Women in Methadone Treatment Program

Background and Purpose: Substance abuse treatment for pregnant women with opioid use disorder is complex, and there are many factors that can complicate treatment. Little is known about what environmental factors contribute to treatment outcomes for opioid-dependent mothers, such as relapse or loss of custody of a child.

 The purpose of this study is to explore specific biopsychosocial factors that influence treatment outcomes for pregnant and post-partum women receiving methadone treatment, and whether this ultimately impacts the removal of the child by protective services.

Methods: The sample includes 70 women who received methadone treatment for opioid use disorder. All participants were post-partum and received methadone treatment during and after their pregnancy. Information was gathered from biopsychosocial assessments, and included 16 factors in areas of substance abuse and treatment history, mental health, and social support. Treatment outcomes were described in terms of maternal relapse, continuity of treatment after delivery, stabilization of methadone dose after delivery, and the involvement of child protective services due to relapse. Logistic regression was used to predict the removal of the child from their mother. Correlates between these factors and treatment outcomes were explored, as well as adherence to treatment and the mother’s coping strategies.

Results: Post-partum relapse occurred to 70% of the participants and 70% demonstrated the use of coping strategies to prevent relapse. Correlation analysis showed that higher scores of adherence to treatment were significantly associated with a lower risk for child removal (r = .52, p < .001) and higher scores in coping ability were correlated with lower risk for removal ( r = .57, p < .001). The prior removal of a child proved to be the main factor that increased the risk of removal of the youngest child. Participants who had previously been involved with child protective services were extremely likely to have their infant removed in the event of relapse. Even though a new mother reported the presence of a strong support system, she was still over 10 times more likely to have her child removed if there was relapse. Overall, it was the mothers who were both adherent to treatment and had family support that were least likely to have their child removed.

Conclusion and Implications: The findings indicate that, although rates of relapse are high, engagement in treatment, use of coping skills, and family support were associated with positive treatment outcomes. These findings can be crucial in child welfare and substance abuse treatment settings where child protective services interact with and oversee the mother’s ability to parent their children. Knowing how likely a mother is to have her subsequent children removed after a prior removal can inform the services that follow an initial removal of a child. Overall, this study will make contributions to the field of substance abuse and social work by further exploring the theoretical understanding of substance abuse recovery for pregnant and post-partum women in methadone treatment.