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Drug dependence also referred to as drug addiction or drug habituation, is the state of physical, emotional, and extrasensory reliance on any drug. The dependency usually occurs due to the administration of the drug to the individual repeatedly which causes an individual to feel like they need the drug. When the individual withdraws from the drug or attempts to then physical perturbation occurs. The existing paper will investigate how accessible and effective prenatal care is to drug dependent teenagers. According to Monitoring the Future, a study of the behaviors and attitudes of young adults and students funded through NIH (National Institutes of Health) and the NIDA (National Institute on Drug Abuse), illicit drug use has increased steadily over the years amongst young adults. According to the study, 33. 4% of young adults in high school and college use any illicit drugs, 29. 3% use marijuana, and 41. 7% consume alcohol. 60% of pregnant teens have reported using multiple substances before, during, and after pregnancy. Of those teens aged 12-17 who are/were pregnant, 18. 3% use illicit drugs and those aged 18-25 have an illicit drug use of 9. 0%. The major complication with drug-dependent pregnant teens is getting them into the proper treatment so that the baby can be healthy and the mother’s life is preserved as well.
Public health professionals seek ways to appropriately implement the policy so these women can seek help and as well as different approaches to utilize for prevention of drug use while pregnant and from relapse after. One of the most pressing epidemics nationally is teenage pregnancy. According to the CDC (Centers for Disease Control and Prevention), teens between 15 and 19 held a birth rate of 22. 3 per 1, 000. In 2015 teenagers in the United States gave birth to 229, 715 babies. The birth rate for blacks was 9%, Hispanics 8%, and whites 8% (CDC). In 2016 the majority of teen pregnancies occurred between 18 and 19-year-olds. This accounted for 74% of all teen births. However, the birth rate has spiked within the year and the birth rate in 2016 amongst Hispanics was 31. 9%, blacks 29. 3%, and 14. 3% for whites, for teens aged 15-19. As we can see from these rates the birth rate has spiked immensely within just a year meaning we need to practice pregnancy prevention. Most of the teens who have been pregnant or are pregnant live in poor socioeconomic conditions. The families that these teens come from may have poor income, poor education, family history of teen pregnancy, and live in poor communities that may have high violence rates. These rates, although lower than previous years, are still markedly high in comparison to other industrialized countries. Pregnancies amongst teens are already high-risk situations, however, those involving drug and alcohol use increase severity of complication and prevalence.
A study conducted in 2002 by Julie Quinlivan and Sharon Evans reviewed the impact of drug use on teenage pregnancy outcomes. The pair was studying the effects of illicit drug use on co-morbidity, delivery, and birth outcomes. The use of drugs during and before pregnancy increased the incidence of preterm labor amongst this group and the cases of NAS. What the duo came to find was that 40% of the participants in the study ceased use of drugs upon knowledge of their pregnancy or immediately before attempting to become pregnant. The researchers were also shocked to find that of these girls, aged 15-19, 90% of the pregnancies were planned and they planned the pregnancy as a means to kick their habits and stop the use of illicit drugs. Although, many mothers ceased use of illicit drugs after conception around 20% of the participants admitted to using illicit drugs throughout the pregnancy. The patients had all come from similar backgrounds, which could be a determinant for why teens have such high pregnancy rates and drug use. Majority of the population used reported being socially isolated, having poor mental health, history of family violence, and poor environment. These environments foster the use of drugs so that they may escape from the poor conditions they are exposed to on a day to day basis. It was also noted that 8-10% of the cohort contracted chlamydia which could potentially harm the fetus. Based on the results from the study public health professionals need to be able to provide safe spaces for psychosocial development and good antenatal care in order for poor birth outcomes to be reduced amongst teen mothers.
Substance abuse has many side effects and can cause many complications in pregnancies amongst women, especially the still-developing bodies of pregnant teens and their babies. Some of the complications that they are at risk for are intrauterine fetal demise, miscarriage, preterm birth, intrauterine growth restriction, placental abruption, fetal intraventricular hemorrhage, other developmental effects and risks, and most important neonatal abstinence syndrome. Neonatal abstinence syndrome (NAS) is a series of conditions that occur when an infant withdraws from drugs that they were exposed to while developing in the womb. NAS is usually onset by opioids, antidepressants, benzodiazepines, and other drugs. Intrauterine growth restriction otherwise referred to as IUGR occurs when the fetus weighs below the 10th percentile and it covers two types. Primary IUGR occurs when the fetal organs are reduced in size and secondary IUGR occurs when the head and brain is a normal size but the body is smaller. Intrauterine fetal demise simply refers to stillbirth or the death of a child in the uterus.
Fetal intraventricular hemorrhage is the excessive bleeding inside or around the ventricles or cavities of an organ. All of these are very extreme cases and can be prevented in order to ensure that babies born to drug-dependent teens are healthy through improved intervention and prevention. There are several approaches to helping pregnant teenagers who rely on drugs. Opioids are one of the major causes of drug dependency amongst teens and poor birth outcomes for their children. Opioid detoxification is one of the many methods that can be utilized to help teens reduce their drug dependency. Opioid detoxification occurs when an individual abstains from the use of the said drug. Public health professionals would prefer that women consider opioid detoxification and abstain from drug use throughout the term of the pregnancy, however, this comes with a lot of risks. The department of obstetrics and gynecology at the University of Tennessee Medical Center conducted a study where they assessed the effects that detoxification had on newborns in teens who suffer from opioid addiction. It has been shown that detoxification can cause fetal distress, fetal demise, and preterm birth. The pressure to abstain from drugs can also cause an extreme amount of stress which can also result in said birth outcomes. The goal is to ensure that these teens do not relapse. In order to assess other methods of detoxification that will result in positive birth outcomes, a retrospective analysis was conducted.
Bell J. et al shared shocking results. The patients were tested using four different methods of detoxification. These methods included acute detoxification, inpatient detoxification with intense outpatient follow up, inpatient detoxification without intense follow up, and slow outpatient detoxification with buprenorphine. The results found showed that of those who participated approximately three hundred successfully detoxed with no negative birth outcomes, however, 94 patients delivered babies that suffered from NAS. The results exemplify to public health and medical professionals that detoxification can be a key approach in helping drug-dependent teens as long as the patients are still being monitored and followed-up after birth. The goal next is to be able to make these teens feel more comfortable seeking help instead of being discouraged so that they can ensure the baby is born healthy. The first steps in making teens feel more comfortable seeking help for their drug dependency is for health professionals to be as supportive and sensitive as they can to those individuals and their needs. Gabriele Fischer et al found that in order for treatment to be successful that one has to be able to offer assessment, triage, referral services, and coordination with health professionals for their case.
A study conducted in 2006 by Grella et al showed that psychosocial, or the social factors that influence behavior and thought, support is one of the biggest factors in a teen user seeking treatment. These counseling sessions in order to be effective would need to be overseen by a healthcare professional, outreach professional, and financial providers. The healthcare professional would be in charge of the patient’s case and that the team who is working with that patient is properly educated and trained on dealing with young adults who rely on drugs. The outreach professional would be responsible for home visits and ensuring and being a support crutch for the woman. There will also be a support to help those mothers with financial need unmet to meet those needs and find outside resources who can assist with such. The earlier that one seeks treatment the more likely that they have a healthy pregnancy and establish better physical, mental, emotional, environmental, and financial situations for themselves and their families. Maintenance therapy or medication-assisted therapy is one of the most effective ways to reduce dependency on drug use. This therapy involves drug replacement to those drug-dependent individuals. The two drugs that are proven to be most successful for this form of treatment are methadone and buprenorphine. Individuals who have undergone drug replacement and maintenance therapy have shown immense improvement with their drug habits and work towards improving health. In 2014, the National Survey on Drug Use and Health 7. 7 million girls aged 12 and older qualified to receive maintenance therapy for substance abuse, however, only 1. 4 million of them received treatment.
In order for maintenance therapy to be more accessible, we need to create more treatment facilities and educate health facilities on the importance of this form of treatment in reducing poor birth outcomes in drug-dependent teens. Another very effective approach to reducing the use of drugs amongst pregnant teens is cognitive behavioral therapy and community reinforcement through 12-step programs and other forms of group support. This involves peer-facilitated groups that could offer the young mom support in order to abstain or reduce the amount of drug use for better health outcomes of their child especially for those who expect to breastfeed. These programs could use cognitive behavioral therapy in order to help the teens identify what their triggers are and ways to cope so that they can reduce the possibility of relapse and how to effectively and efficiently deal with these triggers. These groups can be teen girl support groups, teen mom support groups, family/social support groups, or even recreational. In order for access to care for pregnant teens who have a drug dependency to change the care provided has to be more sensitive to the needs of these still-developing young women and help them work on their drug use and in turn, make sure the health of the baby is positive. Federal and state laws also need to improve so that drug-dependent teens, especially those who are pregnant, have better access to substance abuse treatment without financing and accessibility being a huge barrier to why they do not receive help.
Many teens do not seek help for fear that they will be reported to child services or the police for drug use s we need to figure out ways to make teens more trusting in our facilities by committing to outreach and ensuring that they help them with transportation and social support.
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