AOD Use and Mental Health Disparities during Pregnancy and Postpartum

Victoria H. Coleman, Ph.D. & Michael L. Dennis, Ph.D.

Chestnut Health Systems, Bloomington, IL

Introduction

Pregnancy is recognized as presenting significant biological, psychological, and social stressors in a woman’s life (Goebert, Morland, Frattarelli, Onoye, & Matsu, 2007; Huizink, Mulder, Robles de Medina, Visser, & Buitelaar, 2004). Typically, alcohol and other drug (AOD) use decreases during pregnancy (SAMHSA, 2008), however certain populations exhibit relatively higher rates of AOD use during this time. Illicit drug use during pregnancy has been found to vary by race/ethnicity, with American Indians, individuals of two or more races, and African-Americans reporting the highest rates of current use during pregnancy in 2007 (SAMHSA, 2008). Pregnant adolescents (aged 15-17) reported a higher rate of current illicit drug use (22.6%) than non-pregnant adolescents (13.3%), which is a trend that is reversed for women aged 18-44 (SAMHSA, 2008). It is widely known that substance use during pregnancy can contribute to perinatal complications and poor neonatal outcomes (Havens, Simmons, Shannon, & Hansen, in press), thus identifying any disparity in substance abuse treatment received is of the utmost importance. Substance abuse treatment is believed to be more effective during pregnancy given the motivation for a mother to change for the sake of her unborn child (Jones, 2004).

Purpose of the Study The purpose of this study is to examine Global Appraisal of Individual Needs (GAIN; Dennis et al., 2003) data collected from pregnant adults and adolescents upon entry into substance abuse treatment, in an effort to identify any disparity in treatment received that exists across groups by race/ethnicity, then in a second analysis by age, after controlling for baseline differences, mental health and substance problem severity, and pattern of multi-morbidity.

Data Set Used

GAIN Instruments & Scales

The GAIN is a collection of comprehensive biopsychosocial assessments used in substance abuse treatment.

Staff-administered in about 60-90 minutes Yield DSM/ICD diagnoses and ASAM information Strong history of psychometric integrity

Measures at Intake: Substance Problems Scale (SPSy),Internal Mental Distress Scale (IMDS), Behavioral ComplexityScale (BCS), General Crime Scale (GCS), General VictimizationScale (GVS)

Acknowledgement - Analysis of the GAIN data reported in this presentation was supported by Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT) under Contracts 207-98-7047, 277-00-6500, 270-03-00006, and 270-07-0191 using data provided by 10 grantees. The opinions expressed here belong to the author and are not official positions of the government. For more information, please contact Victoria H. Coleman, Ph.D. * Chestnut Health Systems * 448 Wylie Drive * Normal, IL 61761 * 309-451-7797 *vhcoleman@chestnut.org

Trained and certified GAIN administrators collectedintake data from treatment clients at 10 sites during a one-on-one interview. Individual sites sent data to a central datamanagement system at Chestnut Health Systems. Demographic profiles were created to determine groupdifferences. To help control for spurious results, Whitefemales’ responses were weighted via propensity scorespredicting membership in the minority race groups, thusproducing 3 paired groups with equal sample sizes. The propensity score was based on age, lifetimevictimization, past year substance use-related problems,past year internalizing mental distress, past yearexternalizing behavior problems, and the pattern of multi-morbidity.

Methods

Definitions Need of mental health treatment defined as: high on IMDS (scale score > 23), high on BCS (scale score > 18), or endorsing suicidal thoughts.

Need of substance abuse treatment defined as any past year dependence or abuse.

Need of legal intervention defined as: high on GCS (scale score > 3).

Disparity defined as low treatment received in the past 90 days, given treatment need.

Total N=4509 females presenting to treatment. Pregnant sample N=328 (7%)

Sample Demographics

African-American Hispanic Mixed

n=75 n=46 n=50Age (mean yrs.) 25 17 16Single parent hh 56.2% 42.1% 41.3%Current criminal justice system involvement 55.3% 76.6% 78.0%High severity victimization (past year) 51.3%* 66.0% 78.0%Weekly any drug use 55.3% 53.3% 62.0%Weekly alcohol use 17.1% 17.0% 10.0%Weekly tobacco use 70.7% 44.7%* 64.0%Any past year substance dependence 56.0% 56.5%* 66.0%Any past year abuse 22.7% 23.9% 24.0%Any co-occurring MH disorder 64.5%* 78.7% 88.0%

*Significant difference from reference group, p<.05

Results

The figures below display significant disparity in substance abuse treatment received when comparing a minority group with the majority group, after weighting. Specifically, pregnant African-American and Mixed females were significantly more likely to have had no substance abuse treatment received in the past 90 days, despite having a need for treatment. No other disparity in the areas of mental health treatment received or legal intervention were found with these two groups, and no disparity was found with the Hispanic group for any substance, mental, or legal treatment received.

Figure 1: Substance Abuse Treatment Disparity (AA, White)

Figure 2: Substance Abuse Treatment Disparity (Mixed, White)

86.2%

5.2% 8.6%16.1%

25.8%

58.1%

0%10%20%

30%40%50%60%70%

80%90%

100%

Low Moderate High

Past 90 day treatment acquisition

Per

cen

tag

e o

f w

om

en w

ith

pas

t yr

su

bst

ance

dep

/ab

use

African-American

White

90.9%

9.1%0.0%

14.6%24.4%

61.0%

0%10%20%

30%40%50%60%70%

80%90%

100%

Low Moderate High

Past 90 day treatment acquisition

Per

cen

tag

e o

f w

om

en w

ith

pas

t yr

su

bst

ance

dep

/ab

use

Mixed

White

n=58 n=62

χ2(2)=11.69, p<.01

n=41 n=44

χ2(2)=13.77, p<.01

When analyzing by age, there is significant difference in need, with adolescents needing treatment more than adults. Though need is greater, no disparity was apparent in treatment received by age.

Data used in this study is from a collection of 10 adolescent and adult treatment studies. All data reported is intake data collected with GAIN instruments.

The dataset was limited to cases for which pregnancystatus was available.

Adolescents Adultsn=224 n=104

Age, mean yrs.(SD) 16 (1.2) 28 (7.1)Current criminal justice system involvement* 72.8% 50.0%High severity victimization (past year) 69.6% 63.5%Victimized in past 90 days 25.6% 17.6%Weekly any drug use 50.5% 61.2%Weekly alcohol use 12.9% 17.5%Weekly tobacco use*** 60.1% 80.6%Weekly marijuana use*** 35.7% 16.3%Any past year substance dependence** 57.3% 76.0%Any past year abuse 21.8% 16.3%Any co-occurring MH disorder** 80.8% 65.4%

*Significant difference at p<.05**Significant difference at p<.01***Significant difference at p<.001

Weighted by race

Unweighted by age

Summary and Implications When matched on age and clinical severity, pregnant African-Americanand Mixed women are not receiving the substance abuse treatment that theyneed, as compared with pregnant White women. Targeted interventions for pregnant African-American and Mixed femalesare indicated. Pregnant adolescents have greater need for treatment than adults, thoughdisparity in treatment received was not observed.

Adolescents (n=224) Adults (n=104)Substance treatment need 79.1% 92.3%

Mental health treatment need 8.0% 1.9%Legal intervention need 39.2% 3.8%

References Available from author on separate sheet.Due to the significant difference by age in substance severity, mental

distress, and pattern of multi-morbidity, weighting could not be utilized in age analyses.