If a woman taking opioids wants to quit badly enough, she can. It’s just a matter of willpower and self-discipline.
Take a closer look: Twelve-Step programs, like Narcotics Anonymous, are often viewed by the general public as the best approach to treat SUD. Although behavioral therapies can help people reflect on past experiences and develop skills to respond to challenges moving forward, they cannot always remove the physical and psychological dependencies that result from changes to the brain caused by substance use.
Experts recommend also using FDA-approved medications that help detoxify or wean the body off high doses of alcohol or opioids and then help maintain withdrawal over a longer period. This is known as medication-assisted treatment, or MAT. In particular, opioid agonists (methadone and buprenorphine) have been a standard treatment for opioid use disorder in pregnancy since the 1970s (ACOG, 2017).
Medication-assisted treatment has been shown to
• improve a person’s chances for survival,
• increase the odds of someone staying in treatment,
• decrease illicit drug use and other criminal activity,
• increase a person’s ability to gain and keep employment, and
• improve birth outcomes among women who have substance use disorders and are pregnant (SAMHSA, 2020).
Take a closer look: You might believe that someone addicted to illicit drugs is “worse” than someone addicted to prescription drugs because they choose to try the drugs for fun or experimentation rather than being prescribed drugs for health reasons. These beliefs may influence how health professionals treat people who use prescription drugs better than people addicted to illicit drugs.
While the decision to try illicit drugs for the first time is usually a personal choice, the addiction to those substances that can result is not. These drugs alter the way our brains work and create physical and psychological dependence, which can make it difficult to quit, even if a person is actively choosing to stop (Addiction Center).
Becoming addicted to illicit drugs like heroin or cocaine is worse than becoming addicted to drugs prescribed by a doctor, because illicit drug use is a choice.
Some people are more prone to substance use disorder because they have an addictive personality. Once an addict, always an addict.
Take a closer look: You may have heard someone say, “she became addicted because she has no impulse control.” But really, addiction and substance use disorders (SUDs) can affect anyone. It’s not a personality trait, it’s a brain disorder that can be treated.
In fact, no evidence supports the idea that a specific personality type predicts or causes SUDs. In some cases, personality traits like social isolation or manipulation of others may be related to SUDs. In other cases, these traits may emerge as a result of substance-induced changes in the brain. Just because such traits and addiction are often related does not mean that these traits cause SUDs.
We do know that other factors can directly increase the risk of SUDs developing, such as childhood trauma and genetics. But simplifying addiction as a personality trait that can’t be changed can create feelings of self-blame or hopelessness among people who think they have an “addictive personality.” This feeling that addiction to substances and relapse is unavoidable may prevent them from seeking treatment and support (Healthline).
If a woman’s mental health problem—such as prenatal or postpartum depression—is treated through therapy, then her substance use disorder will also go away.
Take a closer look: Mental health issues and substance use problems often occur in people at the same time. About 1 in 2 people with alcohol use disorder experience anxiety disorders (Anker, 2019) and about 2 in 3 people with opioid use disorder have at least one mental illness (Jones & McCance-Katz, 2019). But it is important to realize that substance use disorders (SUDs) and mental health issues are not one in the same, and one does not cause the other.
The best treatment for someone who has a mental health issue and a substance use disorder is an integrated approach, where both conditions are treated at the same time with coordination by a treatment team (HelpGuide.org). Even if a woman has successfully treated her depression through the use of antidepressants and counseling, she may still struggle with substance use until specific treatment methods, such as detoxification and withdrawal management, are incorporated to address physical and psychological dependence.
Oversimplifying our beliefs about treatment and thinking that therapy alone can cure a SUD can create stigma around people seeking medication and other treatments that are proven to be effective.
It is difficult for me to trust people with substance use disorder to do a job, task, or favor for me.
Take a closer look: Society perpetuates stereotypes of people with substance use disorders as lazy, irresponsible, sneaky, and weak. Removing these labels and our related preconceptions about a person with a substance use disorder is a critical step to reducing stigma and discriminatory actions.
Similar to treating diabetes or asthma, substance use disorder is a chronic health condition that can be treated and managed, leading to long-term recovery. Not hiring or working with someone because of their current or past experiences with substance use disorder is discrimination.
Once a woman’s treatment team deems that employment is appropriate, then the structure, social connections, and opportunity to become financially stable can help support long-term recovery and the ability for a woman to care for her family (Laudet, 2012). In fact, one of the four major dimensions that support recovery is purpose—“conducting meaningful daily activities and having the independence, income, and resources to participate in society” (SAMHSA, 2019).
Women who drink alcohol or use drugs while pregnant should not be allowed to keep their baby.
Take a closer look: The decision to put a baby in out-of-home care is not one that should be made lightly, nor should it be a standardized protocol. Each situation should be examined by professionals with care and kindness. In many cases, the system can be highly punitive, which makes pregnant women and mothers fearful and less likely to seek treatment (Stone, 2015). A federal statute called the Child Abuse Prevention and Treatment Act (CAPTA) requires that healthcare providers notify child protective services of any infants identified as being affected by substance use or withdrawal symptoms or fetal alcohol spectrum disorders (Administration for Children and Families, 2020). However, this statute also requires that healthcare providers work with the patient to identify the treatment needs of the mother (or other caregiver) and baby and to develop plans of “safe care” for the infants (Child Welfare Information Gateway, 2019).
The American College of Obstetricians and Gynecologists (ACOG) recommends that states implement the Family First Prevention Services Act, which “expand[s] access to treatment services for vulnerable families while helping them stay together and heal”(ACOG, 2018). Outpatient programs can provide women with access to behavioral therapy; medications for substance use disorder (SUD) treatment; and support services, such as transportation and childcare. These programs can also help women obtain social services while they live at home with their baby and create a more stable structure and routine.
Women who ask their doctors for medication, such as methadone, to treat their opioid use disorder are probably going to sell it or use it to get high.
Take a closer look: It is true that people can take higher doses or intravenously inject opioid treatment medications, such as methadone and buprenorphine, to produce a high. Also, they could choose to sell the drugs illegally. But most experts agree that the benefits outweigh these risks.
Assuming that people treated with medications are automatically going to abuse or sell them generates stigma around medications for opioid use disorder and may actually limit the number of facilities that offer this treatment.
When taken at the right dose, methadone doesn't produce a high. The goal of medication-assisted treatment, or MAT, is to help stabilize a person’s physical and psychological health so they can focus on other treatments, including counseling and behavioral therapies.
Medication is not a crutch. It’s a treatment tool, similar to insulin being used to treat diabetes.
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