B. Substance Use Among Women

Substance use disorders in women tend to be multi-faceted and highly correlated with co-morbid mental health conditions such as depression, anxiety, and eating disorders. Additionally, substance use disorders in women are strongly correlated with childhood personal violence and histories of trauma. Consequences of substance use for women include physical complications, the risk of losing custody of children under their care, and exposure to partner violence. Women develop physiological complications from substance use, especially alcohol, in a shorter time and with lower consumption than men. Additionally, reproductive consequences for pregnant women may include fetal alcohol spectrum disorders, long-term cognitive deficits, low birth weight, or miscarriage.[223].

According to a 2009 Substance Abuse and Mental Health Services Administration (SAMHSA) publication, pregnant women may be reluctant to seek prenatal care due to fear of losing custody of the infant or other children. Most mothers who are in substance use disorder treatment feel a strong connection with their children and want to be good mothers. Most of these mothers want to maintain or regain custody of their children and become “caring and competent parents.” Women who believe they have not cared for their children adequately or who believe that they are perceived as having neglected their children carry enormous guilt. Therefore, for many women, maintaining caring relationships with their children is sufficient motivation to keep them in treatment. Unfortunately, they often have inadequate role models in their own lives or lack the information, skills, or economic resources that could make motherhood less difficult.[224]

In its 2018 biennial report, the Texas Maternal Mortality and Morbidity Task Force found that between 2012 - 2015 drug overdose (typically opioids) was the leading cause of maternal mortality for women, typically occurring after 60 days post-partum.[225]