Substance use during pregnancy and parenting can lead to harmful consequences for both mother and child. One of the most commonly used substances during pregnancy is methamphetamine, which also has high relapse rates. [1] It can lead to pregnancy complications, and parents who use meth often struggle with the stressors that come along with raising children. [2]
This isn’t about intentional neglect. Women who use meth are typically loving mothers and are deeply concerned about the welfare of their children. [3] A recent study describes an effective intervention aimed specifically at meth-using mothers, which allows them to use their pregnancy as motivation to stop using meth and other substances. [4] Here’s everything you need to know.
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Understanding methamphetamine use in pregnant and parenting women
Meth use is associated with high rates of unplanned pregnancy, partly because it increases sexual behavior and may reduce inhibitions or personal restraint. [5] It affects the serotonin, norepinephrine, and dopamine systems in the brain, which control pleasure and reward, among other functions. [6]
Serotonin and norepinephrine are also heavily involved in fetal development, including controlling amniotic fluid and fetal circulation.[1] Some studies suggest that meth use during pregnancy may lead to conditions such as preeclampsia, which can be fatal, although other studies did not replicate these findings. [1][7] There is a consistent relationship between meth use and low birth weight or premature birth, but this trend can be affected by stopping meth use at any point during the pregnancy. [1]
Problems arising from meth use during pregnancy aren’t solely due to the chemical effects of the drug. Women who use meth are more likely to have a mental health condition, experience poverty, and be a single parent. [7] They also usually have fewer prenatal medical visits and less medical care. [1]
Parenting is inherently stressful, and parents who use meth may struggle to cope with certain parenting duties. Studies show that they have particular difficulty creating a safe, consistent, emotionally supportive environment for their children, instead often appearing chaotic or suffering from withdrawal, including showing signs of depression and paranoia. [2][8]
Overview of the MAMADAM methamphetamine-specific treatment program
The recent study published in Nature looked at the effectiveness of a program originally developed in Germany known as MAMADAM. This comes from the German phrase “Mama, denk an mich,” which means “Mommy, think of me.” [9] The MAMADAM program is designed to reduce barriers to effective healthcare and provide support for meth users during pregnancy and parenting.[7]
MAMADAM brings together psychiatric, obstetrics, and pediatric medical professionals, as well as child welfare services, community SUD support, childcare options, and help with transportation. Evidence suggests that mothers who are separated from their children have higher rates of relapse, so the program also aims to help mothers retain custody of their children where it is safe to do so. [4] Most patients were treated on an outpatient basis, though inpatient services were available, and the average treatment lasted for 8 months.
The MAMADAM program relies on shared decision-making, using motivational interviewing to help patients develop their individual care plans. Simple adjustments, such as calling patients who miss appointments and building long-term relationships through consistent staff, were shown to improve retention. MAMADAM includes a relapse prevention program, using group motivational interviewing, cognitive behavioral therapy (CBT), and education. Social services staff support housing and employment.
MAMADAM also includes random drug screening, which is designed to improve engagement with treatment. [7]
Key findings: Sustained abstinence outcomes
This study spoke to people approximately 4.5 years after they had completed the MAMADAM program to understand how their substance use had changed. Around one-third of the original group took part in this follow-up, and the study explicitly excluded tobacco when asking about substance use. [4]
Most programs designed to help people stop using meth find that around 40% of people are still abstinent from that drug after a year. The researchers found that all of the women had achieved a significant period of abstinence following MAMADAM, with 64% not using meth at all and 41% remaining abstinent from all addictive substances for the full 4.5 years. The most common substances used by those who didn’t stay fully abstinent were methamphetamines and alcohol. Relapse rates were predicted to be higher in people who didn’t take part in this follow-up study, but these are still promising results.
They also looked at factors that made women more likely to relapse. These included:
- Longer history of use.
- Having more young children.
- Being separated from a child before the program.
Challenges in sustaining abstinence
To understand why this program is so effective, we need to understand why it can be so difficult to stop using methamphetamines. To do that, we need to consider why people take meth in the first place and why it is difficult to stop.
People start taking methamphetamines for many reasons, but two of the most common ones are to deal with stressful life events and to help them relax and enjoy themselves. [10] These can become cyclical, as meth use may lead to more stressful life events and the creation of a social network that revolves around meth use.
People who use meth describe 6 main barriers to stopping, three of which are internal/personal factors, and three of which are external or social. The internal factors are feelings of powerlessness, having a false sense of control over their meth use, and not wanting to face the side effects of withdrawal. The external factors are living in an environment that enables drug use, unsupportive reactions from friends and family, and the lack of effective programs to help them stop. [11] Where programs to support them were theoretically available, people looking to quit described them as being rigid, unresponsive, and not meeting their needs. Many had highly specific criteria for joining, which were difficult to meet.
Why was the MAMADAM program so effective?
Methamphetamines are extremely addictive, and this is reflected in the relatively high relapse rate. Most programs find that around 61% of people have relapsed within the first year, and 25% of those who remained abstinent for 12 months will relapse before reaching 5 years. [12] In some cases, nearly 70% of people relapsed during the program itself. [11]
One of the most effective ways to improve abstinence rates is to have a motivating factor. People who have experienced a serious adverse experience related to their meth use (such as a major health problem or a violent encounter) have significantly higher abstinence levels because of their motivation. [12] The MAMADAM program uses pregnancy and the concern women have for their children as a powerful motivating factor.
MAMADAM is a comprehensive, integrated program designed to remove barriers, without strict criteria for enrollment. It works with women to improve all aspects of their lives, including housing, employment, childcare, and parenting skills. The women in this program didn’t have to navigate multiple different systems to access this help, as it was all provided through working with their assigned workers. This helped to overcome the external challenges to achieving abstinence.
MAMADAM also prioritizes empowering women to stop using addictive substances and become better parents, rather than stigmatizing them. Importantly, women felt supported in keeping their children with them, rather than at risk of having them taken away. This enabled them to engage with the services confidently and safely. By respecting their autonomy and offering constructive help, the MAMADAM program was able to reduce internal challenges to quitting as well.
Implications for treatment and policy
Drawing from the success of the MAMADAM program, researchers identified several factors that may be key to helping reduce methamphetamine use. [4]
- Pregnancy and parenthood are powerful motivating factors to encourage people to pursue abstinence. Finding other opportunities for effective interventions could be beneficial.
- Reducing poverty and economic stress allows individuals to avoid situations that would usually encourage substance use. Improving housing security has been especially effective. [7] This kind of support is best delivered through a single, integrated program like MAMADAM.
- Relapse is more common in the earlier stages of abstinence, typically around the first 3 months. [13] Sustained programs offer support throughout this high-risk period, reducing the risk of relapse.
- Programs need to be flexible enough to meet the needs of patients and remove barriers to abstinence. This includes making childcare provisions, meeting other mental health needs, and encouraging a sense of autonomy.
Resources for pregnant and parenting women seeking help
Women with SUD need extra support during pregnancy, such as additional prenatal care, mental health services, or treatment for their substance use. They may also require legal assistance. [14] In most cases, a doctor, nurse, midwife, or OBGYN is your most valuable resource and can help you find organizations to help, but this isn’t always enough.
Here are some organizations you can contact for additional help and support.
- The National Harm Reduction Coalition has a toolkit for helping people with SUD navigate pregnancy.
- The National Maternal Mental Health Hotline provides trained counselors who can help you find resources. It’s available 24/7 on 1-833-TLC-MAMA (1-833-852-6262).
- SAMHSA provides a database of substance abuse treatment providers and a referral helpline if you need more advice.
- The 988 Suicide and Crisis Lifeline is a 24/7 confidential helpline for anyone experiencing distress or mental health crises. Call or text 988, or use their online chat.
- Pregnancy Justice offers legal assistance to those at risk of criminal prosecution for their drug use during pregnancy
Final thoughts
Pregnancy and parenthood can be stressful, particularly for people who struggle with substance use. Providing interventions designed to treat substance use during pregnancy helps improve outcomes for parents and children.
