Substance Abuse and or Addiction Diagnosis Treatment and or Prevention Essay

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Substance Addiction


Substance Addiction in Pregnancy and Treatment


Audiences: adolescent girls and women, healthcare providers, principals and leaders of youth, women's and other community and church organizations and halfway homes for women

Information and Education Campaign for the Prevention of Substance Addiction in Women, specifically Neonatal Abstinence Syndrome or NAS

To briefly inform or update the target audiences about the current treatment of substance addiction among pregnant women, specifically NAS

To inform them about NAS, its nature, incidence, prevalence, prevention, screening and treatment

To motivate adolescent girls in these audiences against illicit substance use

To extend assistance to former or present substance-using pregnant women to obtain screening, treatment of, or prevention of, NAS

Visual Aids -- photos and/or videos of adolescent girls taking illicit substances during parties or in other settings; pregnant girls and women in random situations; ultrasound images of defective fetuses or embryos; infants or young children with NAS symptoms. These visual aids shall accompany appropriate texts in this presentation.


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A careful diagnosis, appropriate case management, and successful treatment depend on the extent and nature of a woman's substance use disorder and life complications (NLM, 2012). These begin with the screening and assessment, which are matched with the appropriate treatment. Standardized screening and assessing instruments and interviews will obtain important information. Other factors associated with at-risk substance abuse among pregnant women, included moderate to server depression, living alone or with young children, or with someone who uses alcohol or drugs.

Neonatal Abstinence Syndrome or NAS

TOPIC: Essay on Substance Abuse and or Addiction Diagnosis Treatment and or Prevention Assignment

This is a post-natal drug withdrawal condition, which primarily results from the mother's opiate use (Patrick, 2012). But because it is a complex disorder, it is more carefully defined as a mix of strikingly similar behavioral and physiological signs and symptoms (Hamdan, 2012). Its two recognized major types are prenatal NAS and postnatal NAS. Prenatal NAS is due to maternal substance use, which results in withdrawal symptoms in the infant. Postnatal NAS occurs when medications, such as fentanyl or morphine for pain in the newborn, are discontinued. Drug abuse during pregnancy and psychomotor behavior in newborns on account of withdrawal from opiate and polydrug withdrawal is at present a clinical and social problem. Records show that about 3% of the 4.1 million women of child-bearing age who abuse drugs are inclined to persist on the practice during pregnancy. The most frequently associated drugs with NAS are opiates and narcotics and other drugs, including barbiturates, cocaine, nicotine, antihistamine, marijuana and diazepam (Hamdan). From 2000-2009, there was a large increase in the incidence of NAS and maternal opiate use in the United, along with an increase in NAS-related hospital costs (Patrick).

Infants with NAS exhibit CNS dysfunction; metabolic, vasomotor and respiratory disturbances, genitor-urinary disorders, and alcohol-specific symptoms (Hamdan, 2012). They also show irritability, tremors, seizures and abdominal distention. They likewise exhibit symptoms from lysergic acid because of polydrug abuse, nicotine and caffeine withdrawal symptoms. Some of these symptoms persist for weeks or even months. Scoring systems used to assess NAS severity include those developed by Finnegan, Ostrea, Lipsitz, Rivers and the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Of these, the Finnegan scoring system is the most widely used in its original and modified forms. The best care that can be given affected infants is placement in a unit with experienced practitioners who can detect problems, evaluate constantly and perform appropriate interventions promptly (Hamdan).

Johnson and his team (2003) reported that the few appropriately designed randomized trials opioids as the most effective for NAS from uterine exposure to diamorphine or methadone. Recently, however, infants have been increasingly subjected to polydrug exposure for which no adequate treatment has been determined. Those infants may need several months of treatment and suffer from a lot of consequences after they are discharged (Johnson et al.).

A randomized study on opioids morphine, methadone and pethidine for children needing pain relief after surgery showed side effects of respiratory depression (Johnston et al., 2012). This was due to a decreased sensitivity of the brainstem chemo-receptors. Opioids can also induce nausea and vomiting because of this chemo-receptor stimulation in the medulla. Paregoric is no longer recommended for its potentially toxic additive substances. Clonidine produces agonist action. Chloral hydrate causes gastrointestinal irritation. Chlorpromazine may develop cerebellar dysfunction and blood problems. Diazepam produces a number of adverse effects and withdrawal triggers jitters and hypertonia. And phenobarbitone has low therapeutic effect (Johnson et al.).

A randomized, open-label, active-control study on the effectiveness of sublingual buprenorphine showed that it is a feasible and apparently safe treatment of NAS when administered sublingually (Kraft, 2003). The study involved 13 term infants who received 13.2-39 mug/kg per day in 3 divided doses and standard care oral neonatal opium solution. They were divided into the neonatal-opium-solution and the buprenorphine groups. A modified Finnegan scoring system was used to determine doses. More than 98% of plasma concentrations from undetectable to about 0.60 ng/mL resulted. The average length of treatment for the neonatal-opium-solution group was 38 days while that in the buprenorphine was 27 days. Moreover, treatment with buprenorphine was well tolerated. In utero exposure to drugs of abuse can develop NAS and to prolonged hospitalization. Buprenorphine is used to treat adult detoxification and maintenance (Kraft).

A second cohort of 24 term infants with NAS needing treatment were given either oral morphine or bupronorphine sublingually in divided doses (Brauser, 2012). The study was conducted at the Thomas Jefferson University Hospital where the infants were admitted. Results showed that the length of treatment of infants who received bruprenorphine was 23 days as compared with those who received morphine at 38. Their average hospital stay was 32 for those treated with bruprenorphine and 42 for morphine. Morphine has been the most commonly used agent for NAS but it entails prolonged treatment (Brauser).

Dr. Ashral H. Hamdan noted positive characteristics of buprenorphine, which makes it a favored treatment for NAS (Brauser, 2012). Among these are a "ceiling effect" for respiratory depression and the lack of cardiovascular liability as in the methadone. As such, buprenorphine has a "lower risk of abuse, addiction and side effects" like full opioid agonists. It can be beneficial for outpatient treatment. However, its effectiveness, ease and safety on newborns are still unknown (Brauser).

Kraft and his team (2010) listed the goals of NAS treatment as shortened hospital stay, shortened time of exposure to opiates, lower hospital expenditures, and improved parenting through maternal-infant bonding and reduced maternal guilt. Present challenges in the use of buprenorphine in newborns include the lack of pediatric indication, no good PK data, sublingual administration, metabolic ontogeny and the still-unknown potency of nonbuprenorphine. At present, there is need to demonstrate that sublingual buprenorphine for NAS is safe, tolerable and feasible. It must show comparative efficacy in terms of the length of treatment and hospital stay. And there is need to explore its pharmacokinetics (Kraft et al.).

Currently, buprenorphine appears to be safe and more effective than morphine (Kraft et al., 2010). That efficacy, however, still needs to be tested and confirmed in a blinded clinical trial. When it proves effective, it may be expanded for outpatient use. Future trends at this time call for more research on clonidine and buprenorphine, pharmacogenetics, polysubstance abuse treatment, dose optimization, and more research (Kraft et al.).

Johnson and Leff (1999) observe that most studies on children of abusers and other drug abusers are not longitudinal. Thus, there is little that will help determine genuine deficits or developmental delay or predict them in early disorders or behavioral deviations. It was suggested in 1974 that there could be different groups of children of substance abusers and that they are not a single and uniform entity. These children affect and respond differently to similar experiences on account of individual differences as well as temperaments, intelligence and environmental resources (Johnson & Leff).

Fisher and his team (2011), however, found that prenatal exposure to substances of abuse and early adversity can incline such children towards high-risk behaviors. The direction or trajectory may have an underlying neurodevelopmental basis and follow that path from parental substance exposure when combined with early adversity. The researchers assessed neurobehavioral disinhibition via behavioral dysregulation and poor executive function composite measures. Data were taken from 1,073 participants from birth to adolescence. Their latent growth modeling analyses showed stable and significant individual differences in behavioral dysregulation and mean decline with individual differences in executive function difficulties. Prenatal drug use laid the path for the emergence and growth of neurobehavioral disinhibition through adolescence. Prenatal drug use in combination with early adversity showed unique effects on the growth in behavioral dysregulation. Early adversity uniquely and strongly predicted executive function difficulties. Further research is strongly recommended before the findings influence policy. Further research should be in the form of additional replication studies with expanded scopes on similar outcomes among young people of prenatal substance exposure and early adversity (Fisher et al.).

Conclusion and Call to Action

Adolescent girls and women with substance use disorders are invited to consult with… [END OF PREVIEW] . . . READ MORE

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Substance Abuse and or Addiction Diagnosis Treatment and or Prevention.  (2012, December 10).  Retrieved September 26, 2021, from

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