Seeking Care in Crisis

26 years old Rowan* has been using heroin and fentanyl since age 10. Opioids were not something she just stumbled upon; her mother used opioids throughout her childhood. One day, Rowan took a pregnancy test and realized she was pregnant. She spiraled: How can she take care of a baby? What if she has already hurt the baby due to her opioid use? What if her baby is taken away from her? She went to her local hospital for help. The nurse would not look at her and asked how she could use drugs while pregnant. Rowan felt humiliated and left the hospital without treatment. Unfortunately, this is not an isolated incident. Many people face similar situations when seeking addiction treatment while pregnant. Outcomes improve for mothers and their infants when they are met with compassion and evidence-based treatment.

The Law as a Barrier

Seeking treatment for addiction is not simple for pregnant women. Stigma, fear of judgement, and the threat of criminalization are powerful barriers to accessing treatment. Disclosing substance use during pregnancy can trigger child protection involvement or even criminal prosecution in some jurisdictions. In the US states of Alabama and South Carolina, prenatal drug exposure is considered grounds for criminal charges. By contrast, the states of Washington and Vermont emphasize harm reduction and voluntary treatment. In jurisdictions where substance use during pregnancy is criminalized, mandatory child welfare reporting laws often escalate clinical encounters into punitive interventions. These policies can often deter future treatment engagement.

Treatment Matters for Mothers and Babies

Legal risk is just one layer of a deeper problem. Most addiction treatments fail to meet the intersecting needs of pregnant women. Integrated treatments combine addiction treatment, prenatal care, mental health support, and parenting resources to replace fragmented services. However, access still remains limited and there is a persistent stigma that those who use substances during pregnancy are unfit to parent. This isolates pregnant women, deters help-seeking, and perpetuates substance use and marginalization.  The resulting medical risks can have long-term health impacts for mothers and their infants, such as preterm birth, low birth weight, and neonatal abstinence syndrome. Skipping prenatal care altogether increases infant mortality risk.

Strategies for the Road to Recovery

Integrated treatments are associated with fewer complications during birth and fewer preterm births. Over the long-term, integrated treatment also improves children’s emotional and behavioral functioning. Recovery is possible and can be life-changing for both mothers and infants when supported by evidence-based care and treatment. Medication-assisted treatment (MAT) is generally safe during pregnancy, reducing cravings, relapse, and neonatal abstinence syndrome symptom severity. However, stigma and misinformation keep many from accessing MAT. In addition to MAT, psychotherapy plays a crucial role in supporting recovery by addressing the underlying thoughts, emotions, and behaviors linked to substance use. For example, Cognitive Behavioral Therapy (CBT) helps individuals identify and reframe maladaptive thoughts and behaviors contributing to substance use. Similarly, Motivational Interviewing (MI) encourages self-reflection, especially for those facing fear and stigma. Contingency Management is another technique, which uses small rewards to encourage abstinence and treatment engagement. All these harm reduction strategies meet people where they are and offer tools to reduce harm, including supervised detox centers and access to overdose medications.

Support Networks to Heal

Recovery from addiction during pregnancy often depends on the presence of a support network. An illustrative example is the program “Families in Recovery Program” in the Canadian province of British Columbia. It uses hospital-based residential treatment integrating perinatal care and addiction services. The program is delivered by an interdisciplinary team and provides trauma-informed, family-centered care tailored to the specific needs of each patient. It offers wraparound support, including access to safe housing, on-site childcare, transportation, and employment training. This program ensures mothers can recover and stay with their infants, which improves maternal-infant bonding and treatment engagement. In addition to trauma-informed counselling and peer support, partners or family members may be involved in recovery planning to foster long-term stability.

Role of Cultural Safety in Treatments

Access to programs like Families in Recovery is limited. Structural barriers, geographic location, systemic discrimination, and inadequate funding disproportionately affect racialized and economically marginalized communities. This can be seen in Indigenous communities in Canada, who face persistent gaps in access to culturally appropriate mental health services during pregnancy. Expanding access to integrated, community-based models of care is important to make sure mothers can recover and remain with their infants. Cultural safety is a necessary step as well. This includes involving community leaders in treatment development and integrating traditional healing practices. It also means offering services in preferred languages and ensuring staff receive comprehensive training in cultural competence and anti-oppression practices.

Impact of Punitive Versus Supportive Measures

Mandatory reporting requirements and criminal penalties have not been shown to reduce substance use, but instead create barriers to prenatal and postpartum care. Punitive approaches to substance use during pregnancy erode trust in healthcare providers and can deter treatment access. In contrast, supportive,  integrated models are associated with higher rates of maternal engagement, reduced substance use outcomes, and improved infant and mother mental health. For instance, Ontario’s adoption of integrated treatments has shown promising results. Engagement with this program is high, with little evidence of disparities based on demographic characteristics (e.g., age, income). Participants also report more positive experiences in treatment compared to those in standard care. These findings reinforce the value of integrated treatment for substance use in pregnancy.

*name changed for privacy reasons

please note, while this text uses the term “pregnant women”, it is intended to include all pregnant persons, including transgender men, non-binary individuals, and others who may not identify as women but can become pregnant.