Introduction

Family structures have become more complex across different societies in the world including the American society. The traditional nuclear families are changing to families consisting of single parents, multigenerational, foster, or even stepfamilies. If a member of a family abuses substances, the impact on families may differ depending on the type of the family structure. An increasing number of literature points out that drug abuse can cause distinct effects on the structures of the family. The children of drug abusers tend to act as surrogate spouses for their parents. Children whose parents are drug addicts, for example, may deny reality and this may deteriorate their psychological health. As a result, such children tend to act in a manner which is not appropriate and proportional to their age. The consumption of drugs has become an increasing healthcare problem for different societies as its intense use continues causing an increase in the number of undesirable social vices and events, such as domestic violence and divorce among individuals who should provide full care to their children. Although no study gives accurate figures about the use of drugs during pregnancy, evidence has shown that women tend to underreport their use of drugs. The complications arising from the use of drugs do not only affect the pregnant women but also extend to their fetus, who tend to show restarted or slowed developments during their early years. Drug addiction by pregnant women may cause most of the drugs to cross the hematoencephalic and placental barriers, thereby, causing damage to the brain as well as the central nervous system of the fetus thereby resulting in cognitive defects, abstinence syndromes, and deformities. Prenatal drug abuse is a major problem which may lead to negative developmental issues among children, but it is possible to prevent and treat the issue through such interventions as milieu teaching and culturally appropriate healthcare services.

History of the Problem

Drug addiction among pregnant women has been a major societal problem for a long time. Drug use in the United States is not a new phenomenon; almost two thirds of the population addicted to opium and morphine at the end of the 19^th century was women. The use of legal opiate in America has a history which spans across 300 years while cocaine has been used since 1870 (Varner et al., 2014).  Starting from 1960s, the use of drugs during pregnancy attracted the attention of the nation, since public began to understand the possible harm of drugs to the unborn child. Within the first 15 years after Chuck Yaegar shattered a sound barrier, several other events combined to break placental barrier, as people believed that the fetus was well protected and was not vulnerable to any harm. During this period, arguments for placental barrier faced a lot of criticism (Varner et al., 2014). When rubella, a condition caused by the use of diethylstilbestrol and thalidomide drugs, broke out, further public attention shifted from the belief that the fetus was exclusively protected against drugs abuse during pregnancy. In 1962, it was proven that the use of thalidomide caused rare sets of deformities such as limb malformations and over 8000 children were already affected (Varner et al., 2014). By late 1960s and early 1970s, the research confirmed that the use of diethylstilbestrol (DES) by women during pregnancy led to a rare adenocarcinoma of the vagina. Consequently, both illicit and licit drugs were suspected as the possible causes of such problems.

As the United States government set the measures to cope with these challenges during the 1970s, a series of studies in France and in the United States were conducted to determine how fetal alcohol syndrome could affect the fetus. The research studied such major effects as dimorphic features, central nervous system problems, development delays, and growth retardation. During the 1970s, research was published, which indicated the impacts of opiates on children born of addicted mothers. The research findings initiated the increase in opium withdrawal of pregnant women. During the 1980s, the use of substances among pregnant women drew more attention of public health debates as the price of cocaine significantly dropped and more smokeable forms became readily available to people. During this period, the House of Representatives of the United States defined the use of cocaine as a crisis.

The identification of the prenatal exposure to drug is an important activity in understanding the nature as well as the magnitude of the problem. Proper identification is also an essential component of determining the psychological and medical intervention appropriate for the patients. The methods of identifying prenatal exposure to drug abuse are varied, but the most common ones include self-administered questionnaires, interviews, urine testing of the mothers, intake history, and testing of infant hair and meconium. According to Varner et al. (2014), the use of self-reported history presents an inexpensive and the most practical identification method which can be used to recognize the prenatal exposure to drug abuse. Also, it represents the only method from which information regarding the timing of a drug during pregnancy can be obtained. However, the verification of such information may be difficult to obtain. Studies have shown that over 30 percent of women engage in alcohol consumption at some point during their pregnancy. Varner et al. (2014) stated that while it was difficult to determine the safe level of alcohol consumption during pregnancy, the heavier a woman drank during her pregnancy the higher the chances of causing damage to their babies were.

Effects of the Problem on the Society and Family

Children born exposed to drugs such as cocaine usually experience poor developmental outcomes especially with regards to their language development. According to the research by Hurault‐Delarue et al., (2016), children born cocaine-exposed are at great risk of experiencing developmental delay. The use of drugs by mothers leads to the disruption of critical caregiver-child interaction elements, such as maternal linguistic style, linguistic stimulation, and maternal responsiveness. Children who were pre-exposed to cocaine, unlike those who were never exposed to the drugs, showed clear deficits in their language development capabilities. The literature specifically outlines the roles of caregivers in helping children to develop language capabilities. Children who experience better health outcomes have more responsive caregivers who provide language rich models and are more encouraging. However, caregivers who abuse cocaine have been characterized as less responsive, less encouraging, and highly disengaged. Furthermore, cocaine abuse is closely associated with less optimal maternal behavior during the interactions with a child. Therefore, if proper development of language and cognitive abilities in children require proper social interactions, environment feedback, and persistent as literature suggests, then the inconsistent and unstable environment provided by cocaine abusing caregivers cannot promote proper language development among children.

Language competency is an important element in cognitive, learning, and social development. A longitudinal study by Haabrekke et al. (2015) explores how the use of substances and maternal intrusiveness when they interact with the children can affect language development. The authors found a significant difference between the expressive language development capabilities of children born to drug abusers than children born to non-abusers. The aim of this research was to show the factors which alongside drug abuse can lead to failure of proper language development among children. The authors indicated that the intrusiveness of mothers with regards to their interaction with the children could negatively affect proper language development abilities.

Second, children born under the effect of the psychotropic drugs experience the deficits in normal neurodevelopment professionals. The effects of psychotropic drugs on pregnant women have been a primordial concern for healthcare professionals. There is also evidence that exposure to psychotropic drugs and antidepressants leads to motor retardation. Hurault‐Delarue et al. (2016) conducted a study and observed psychomotor development abnormalities from children whose mothers used psychotropic drugs such as epileptics, neuroleptics, and anti-depressants. Also, the study indicated that the risk of psychomotor development abnormality was low in children born from women treated by anxiolytics during their pregnancy. Although the influence of psychotropic drugs on the developmental delay is hard to establish, there have been several hypothesis trying to explain the pharmacological mechanisms. According to Hurault‐Delarue et al. (2016), women whose uterus is exposed to serotonin reuptake inhibitors have shown numerous changes in the psychological and behavioral abnormalities of the central nervous system. Studies by Hurault‐Delarue et al. (2016) have shown that when utero is exposed to antidepressants, the subsequent effects on the psychomotor development majorly depend on the interactions between environmental, genetics, and drug factors. Recent studies have also implicated dopamine in motor learning. Furthermore, anti-epileptic drugs have shown influence on human fetus as they trigger apoptosis of cells in their central nervous system thereby causing a disturbance of the brain histogenesis which could lead to abnormalities in their psychomotor development.

Third, it has been observed that postnatal withdrawal is usually common among children whose mothers used teratogenic substances which affected their intrauterine brain development. After investigating the interplay of the different domains and the levels of attenuation functioning in prenatally exposed and non-prenatally exposed children, Jaeger, Suchan, Schölmerich, Schneider, and Gawehn (2015) found that the exposed children recorded higher levels of attenuation deficit hyperactivity symptoms prevalence.

Children born to women engage in moderate to severe consumption of alcohol during their pregnancy face the risk of developing a Fetal Alcohol Spectrum Disorder. A Fetal Alcohol Spectrum Syndrome is a classification which includes disorders such as the Fetal Alcohol Effects (FAE), Fetal Alcohol Syndrome (FAS), and Alcohol-related Neurodevelopmental Disorder (ARND). A Fetal Alcohol Spectrum Disorder has symptoms which include smaller than normal head circumference, physical deformities, facial abnormalities, and cognitive delays as well as poor fine motor skills. According to Jaeger et al. (2015), children who have Fetal Alcohol Syndrome may face difficulties as they enter into adulthood with major problems in their memory and learning capabilities as well as poor concentration. Such children may find it challenging going to school and even if they want jobs they may find it difficult to withhold their responsibilities. Alcohol-related neurodevelopment disorder may also face emotional and behavioral issues which although may not lead to physical deformities, but may experience reduced cognitive function.

Multicultural Aspects of the Problem

There are no doubts that pregnancy is embedded in different cultural contexts.

Gender appropriate and culturally responsive health care can improve the situation of pregnant women who are drug addicts. There are many culturally and linguistically diverse factors which determine when a woman should seek prenatal care during their pregnancy. According to Varner et al. (2014), culture is an important factor in determining the way a woman perceives and prepares for her birthing experience. Every culture has its values, beliefs and practices related to how women handle their pregnancy and birthing process.

It is commonly agreed that drug addiction can be determined by racial stereotypes. The racial stereotypes have been advanced such that it is believed that pregnant women from certain ethnic or racial background are more likely to become drug addicts than others. According to a survey on drugs use and health conducted in 2011 by the National Survey, drug addiction among Asian women was the lowest among all the different racial and ethnic cultures in the United States. Drug among the Asian population was recorded as 3.8% (U.S. Department of Health and Human Services, 2013). According to the same study, the next lowest level of drug addiction was observed among the Hispanic population. The Hispanic population recorded a rate of 8.4 percent. The third lowest level ethnic group which abused drugs was the white people who recorded a rate of 8.7 percent (U.S. Department of Health and Human Services, 2013). The African Americans used drugs at a rate of 10 percent while the Pacific Islanders and the Native Hawaiians used drugs at a rate of 11 percent. The second highest ethnic group which recorded drugs abuse was the Alaska and American Indian natives who set the drug use at a rate of 13.4 percent (U.S. Department of Health and Human Services, 2013). Finally, a 13.5 percent rate of drug use was recorded among persons of two or more races, thereby becoming the group with the highest likelihood of abusing drugs.

According to the research by Warner, Roussos-Ross, and Behnke (2014), it was concluded that most efforts of state police departments across the united states reflected implicit racial bias as race was found to unconsciously impact the perception of who and what constitute state drug problem. Cultural images play an important role in determining drug abusers and impacting the perception of the potential drug offenders and users in the population. However, if recent studies are anything to go by, such perceptions and efforts may leave out certain racial groups who are highly susceptible to drug abuse. According to Fellner (2009), despite the fact that drug use among the black Americans and whites are disproportionately the same, the black Americans are 13 times more likely to be suspected and detained than the whites. This view also translates in the case of women who abuse drugs. The pregnant black Americans are more likely to be suspected of abusing drugs and be given greater attention than the whites. The implication of this stereotype and reasoning is that most pregnant white Americans who abuse drugs tend to get lower attention concerning their use of drugs.

Treatment Options

There are many language intervention strategies which have proven to be successful at improving the language development capabilities of children who experience language issues. These intervention strategies have majorly shifted from didactic and behaviorally oriented interactions to more socially and naturalistic play sessions. Furthermore, the intervention strategies have shifted to incorporating the needs and preferences of children rather than being based on a continuum of being least intrusive and most intrusive. According to Warner et al. (2014), milieu teaching is an important intervention strategy and it may be effective in handling children with delays in language development. The milieu teaching combines more specific and smaller techniques including mand-model procedures, incidental teaching, and time delay. This is an elicitation procedure which provides opportunities for learning by following the child’s lead, and providing natural consequences, prompting the behaviors through specific verbalizations and environmental arrangements, and embeds teaching into regular interactions.

The milieu teaching has also proven to be effective with a population including children who experience intellectual disabilities as well as children who are identified as late talkers. Early intervention of milieu teaching for the disadvantaged children has shown that they can improve the language outcomes. Prenatally exposed children showed higher incidence and risk of hyper-activity, inattenuation, and increased impulsiveness during their early development periods.

The primary goal of managing substance use during pregnancy period is abstinence. According to Ross, Graham, Money, and Stanwood (2015), participation of women in prenatal care alone is enough to improve the outcome of drug abuse during pregnancy thereby preventing the chances of developmental failures for children born out of such mothers. Although children exposed to substance use by their mothers may still have good outcomes, Christensen et al. (2013) suggested that early interventions could help prevent and further lessen the future neurodevelopmental problems. Some common problems to treatment include poor social support systems as well as the failure to identify substance abusers. Other problems to early intervention during prenatal care include inadequate financial resources and increased fear for loss of custody

The use of safe medical detox is the treatment option for drug addict pregnant women. Drug and alcohol addiction usually come with physical dependence which implies that if the use of these substances is suddenly stopped, life threatening difficulties may occur, for example, the fetus may be at risk of fetal distress, preterm labor, and even fetal death. As a result, it has been obtained that the use of medical detox can provide a conducing environment where pregnant women can receive appropriate and safe care as they work on stopping the use of harmful substances such as alcohol and drug. Detox may lead to weaning off the drug and slowly tapering the amount the patient receives until a time when they are no longer given. In instances such as addiction to opium, the patients may receive a replacement such as the methadone. However, there is a multitude of risks associated with the use of detox treatment. Sometimes the medical professional may outweigh the risks which the fetus faces and whether their mothers can endure cessation of substance abuse without causing serious harm to the baby.

During addiction treatment, it is also important to provide mental care. According to Behnke, Smith, Committee on Substance Abuse, and Committee on Fetus and Newborn (2013), the mental treatment may be provided either as an individual or a group therapy session. The group session may occur in the presence and participation of other pregnant women but with particular focus on the issues of this population. During such group sessions, women can collaboratively work so that they can learn appropriate parenting techniques as well as other healthy stress coping strategies. Such therapies may also delve into what may have caused the women to abuse drugs and in turn help them learn the ways they can use to practice healthy habits. During such sessions, women may also be undertaken through intensive counseling which teaches them how to handle medical concerns and child birth pain both during pregnancy and childbirth.

Reflection of Class Content

Throughout the course, we have learned about the prenatal drug abuse and how it can lead to the developmental issues in fetus and babies. During the discussions, all members agreed that prenatal exposure to drugs such as methamphetamine, alcohol, and cocaine could affect the behaviors and development of fetuses and babies. We also found out that children exposed to cocaine tended to be deliquescent and aggressive than children not exposed to it. What we learned from this course was that pregnant women should abstain from drug use as much as possible and that cultural issues must always be taken into consideration while delivering health services to pregnant women who were drug addicts.