C. Pregnant Women and Relapse Prevention and Safety Plans

1. Pregnant Women and Substance Use

Since 1994, SAMHSA has designated pregnant women as a federal priority population in substance use disorder treatment services. In Texas, a pregnant woman who is financially eligible and clinically appropriate must be admitted to HHSC-funded treatment services within 48 hours of the woman's request for service. Additionally, SAMHSA requires states to spend five percent of the states' overall budget on specialized female programs for pregnant and parenting women.

Neonatal abstinence syndrome (NAS) is a treatable condition that newborns may experience as a result of prenatal exposure to certain substances, most often opioids. Neonatal Opioid Withdrawal Syndrome (NOWS) is a related term that refers to the symptoms that infants may experience as a result of exposure to opioids specifically.[129] Pregnant women using opioids should not discontinue opioid use due to the risk of maternal return to use, overdose, withdrawals, and fetal demise. The American College of Obstetricians and Gynecologists (ACOG) and Substance Abuse and Mental Health Services Administration (SAMHSA) recommend Medication Assisted Treatment (MAT) as a best practice in managing an opioid use disorder in pregnancy.[130] Tapering of MAT dosing during pregnancy is also associated with more frequent return to use. Prior to birth, engaging pregnant women with opioid and other substance use disorders in substance use treatment and other services as a component of prenatal care can also mitigate or prevent negative birth outcomes associated with NAS and NOWS.[131]

Every health region in Texas has an Outreach, Screening, Assessment and Referral (OSAR) Center which can assist any Texas resident with finding appropriate treatment and community resources. To find local resources and additional assistance, please visit the HHSC OSAR webpage.[132] Individuals can also locate substance use services in their area by visiting the substance use service locator map.[133]

Special Issue: “Return to use” is the recommended term to avoid shame and stigma associated with the term “relapse,” however “relapse” and “relapse prevention” are still commonly used terms.

2. Relapse Prevention

Parents in DFPS cases who have difficulty with substance use may relapse or return to use. However, with the right support and appropriate level of intervention, it is possible to achieve successful reunification with a parent who has addressed or is addressing their substance use. At this time, there are no standardized resources statewide. DFPS uses state funded and community resources that use individualized treatment approaches to meet the needs of parents and families. DFPS policy states the following in relevant part regarding relapse prevention planning:

•   Relapse is a return to a pattern of substance use after a period of non-use.

•   In the relapse safety plan, the client, along with a trusted support system, plans to ensure the safety of the child or children, in case relapse becomes an issue.

•   Court orders supersede any actions that the client requests in the relapse safety plan.

•   A relapse safety plan can be developed at any stage of service.

Please see Developing a Safety Plan in Case a Client Relapses (CPS Policy Handbook § 1982.2) for more information.