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Journal of Dual Diagnosis
research and practice in substance abuse comorbidity
Volume 11, 2015 - Issue 3-4
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CLINICAL FORUM

A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

, CNM DNP MPH, , LICSW MLADC LCS, , MD PhD, , MD PhD & , MD

REFERENCES

  • ACOG Committee on Health Care for Underserved Women and American Society of Addiction Medicine. (2012). ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. Obstetrics & Gynecology, 119(5), 1070–1076. doi:10.1097/AOG.0b013e318256496e
  • Akerman, S.C., Brunette, M.F., Green, A.I., Goodman, D.J., Blunt, H.B., & Heil, S.H. (2015). Treating tobacco use disorder in pregnant women on opioid medication assisted therapy: A systematic review. Journal of Substance Abuse Treatment, 52, 40–47.
  • Amaro, H., McGraw, S., Larson, M.J., Lopez, L., Nieves, R., & Marshall, B. (2005). Boston Consortium of Services for Families in Recovery. Alcoholism Treatment Quarterly, 22(3–4), 95–119. doi:10.1300/j020v22n03_06
  • American College of Obstetricians and Gynecologists (ACOG). (2008). Use of psychiatric medications during pregnancy and lactation. ACOG practice bulletin no. 92. Obstetrics & Gynecology, 111, 1001–1020.
  • Arch, J.J., Dimidjian, S., & Chessick, C. (2012). Are exposure-based cognitive behavioral therapies safe during pregnancy? Archives of Women's Mental Health, 15(6), 445–457. doi:10.1007/s00737-012-0308-9
  • Ashley, O.S., Marsden, M.E., & Brady, T.M. (2003). Effectiveness of substance abuse treatment programming for women: A review. The American Journal of Drug and Alcohol Abuse, 29(1), 19–53. doi:10.1081/ada-120018838
  • Batki, S.L., Gruber, V.A., Bradley, J.M., Bradley, M., & Delucchi, K. (2002). A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users. Drug and Alcohol Dependence, 66(3), 283–293. doi:10.1016/s0376-8716(01)00208-3
  • Beck, C.T. (2004). Post-traumatic stress disorder due to childbirth. Nursing Research, 53(4), 216–224. doi:10.1097/00006199-200407000-00004
  • Bell, S.A., & Seng, J. (2013). Childhood maltreatment history, posttraumatic relational sequelae, and prenatal care utilization. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(4), 404–415. doi:10.1111/1552-6909.12223
  • Benningfield, M.M., Arria, A.M., Kaltenbach, K., Heil, S.H., Stine, S.M., Coyle, M.G., … Martin, P.R. (2010). Co-occurring psychiatric symptoms are associated with increased psychological, social, and medical impairment in opioid dependent pregnant women. The American Journal on Addictions, 19(5), 416–421. doi:10.1111/j.1521-0391.2010.00064.x
  • Bernshaw, N.J. (2002). Website review: American Academy of Pediatrics, Committee on Drugs: The Transfer of drugs and other chemicals into human milk. Journal of Human Lactation, 18(1), 81–82. doi:10.1177/089033440201800130
  • Brown, V.B., Najavits, L.M., Cadiz, S., Finkelstein, N., Heckman, J.P., & Rechberger, E. (2007). Implementing an evidence-based practice: Seeking Safety group. Journal of Psychoactive Drugs, 39(3), 231–240. doi:10.1080/02791072.2007.10400609
  • Bruce, R.D., Altice, F.L., Gourevitch, M.N., & Friedland, G.H. (2006). Pharmacokinetic drug interactions between opioid agonist therapy and antiretroviral medications. JAIDS Journal of Acquired Immune Deficiency Syndromes, 41(5), 563–572. doi:10.1097/01.qai.0000219769.89679.ec
  • Burns, A., O’Mahen, H., Baxter, H., Bennert, K., Wiles, N., Ramchandani, P., … Evans, J. (2013). A pilot randomised controlled trial of cognitive behavioural therapy for antenatal depression. BMC Psychiatry, 13(1), 33. doi:10.1186/1471-244x-13-33
  • Center for Substance Abuse Treatment. (2005). Medication-assisted treatment for opioid addiction in opioid treatment programs, Treatment Improvement Protocol (TIP) Series Vol. No. 43. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64164/
  • Classen, C., Koopman, C., Nevillmanning, K., & Spiegel, D. (2001). A preliminary report comparing trauma-focused and present-focused group therapy against a wait-listed condition among childhood sexual abuse survivors with PTSD. Journal of Aggression, Maltreatment & Trauma, 4(2), 265–288. doi:10.1300/j146v04n02_12
  • Cloitre, M., Koenen, K.C., Cohen, L.R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067–1074. doi:10.1037//0022-006x.70.5.1067
  • Cohen, L.R., & Hien, D.A. (2006). Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatric Services, 57(1), 100–106. doi:10.1176/appi.ps.57.1.100
  • Concheiro, M., Jones, H.E., Johnson, R.E., Choo, R., Shakleya, D.M., & Huestis, M.A. (2010). Maternal buprenorphine dose, placenta buprenorphine, and metabolite concentrations and neonatal outcomes. Therapeutic Drug Monitoring, 32(2), 206–215. doi:10.1097/FTD.0b013e3181d0bd68
  • Conners, N.A., Grant, A., Crone, C.C., & Whiteside-Mansell, L. (2006). Substance abuse treatment for mothers: Treatment outcomes and the impact of length of stay. Journal of Substance Abuse Treatment, 31(4), 447–456. doi:10.1016/j.jsat.2006.06.001
  • Covington, S.S., Burke, C., Keaton, S., & Norcott, C. (2008). Evaluation of a trauma-informed and gender-responsive intervention for women in drug treatment. Journal of Psychoactive Drugs, Suppl 5, 387–398.
  • de Castro, A., Jones, H.E., Johnson, R.E., Gray, T.R., Shakleya, D.M., & Huestis, M.A. (2011). Maternal methadone dose, placental methadone concentrations, and neonatal outcomes. Clinical Chemistry, 57(3), 449–458. doi:10.1373/clinchem.2010.154864
  • Diav-Citrin, O., & Ornoy, A. (2012). Selective serotonin reuptake inhibitors in human pregnancy: To treat or not to treat? Obstetrics and Gynecology International, 2012, 1–12. doi:10.1155/2012/698947
  • Dunn, K.E., Sigmon, S.C., Strain, E.C., Heil, S.H., & Higgins, S.T. (2011). The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: A review. Drug and Alcohol Dependence, 119(1–2), 1–9. doi:10.1016/j.drugalcdep.2011.05.033
  • Elkader, A., & Sproule, B. (2005). Buprenorphine. Clinical Pharmacokinetics, 44(7), 661–680. doi:10.2165/00003088-200544070-00001
  • Feske, U. (2008). Treating low-income and minority women with posttraumatic stress disorder: A pilot study comparing prolonged exposure and treatment as usual conducted by community therapists. Journal of Interpersonal Violence, 23(8), 1027–1040. doi:10.1177/0886260507313967
  • Ford, J.D., Steinberg, K.L., & Zhang, W. (2011). A randomized clinical trial comparing affect regulation and social problem-solving psychotherapies for mothers with victimization-related PTSD. Behavior Therapy, 42(4), 560–578. doi:10.1016/j.beth.2010.12.005
  • Goler, N.C., Armstrong, M.A., Osejo, V.M., Hung, Y.-Y., Haimowitz, M., & Caughey, A.B. (2012). Early start. Obstetrics & Gynecology, 119(1), 102–110. doi:10.1097/aog.0b013e31823d427d
  • Goler, N.C., Armstrong, M.A., Taillac, C.J., & Osejo, V.M. (2008). Substance abuse treatment linked with prenatal visits improves perinatal outcomes: A new standard. Journal of Perinatology, 28(9), 597–603. doi:10.1038/jp.2008.70
  • Gowing, L., Farrell, M.F., Ali, R., & White, J.M. (2014). Alpha2-adrenergic agonists for the management of opioid withdrawal. Cochrane Database of Systematic Reviews, 3, CD002024. doi:10.1002/14651858.CD002024.pub4
  • Grant, T., Ernst, C.C., Pagalilauan, G., & Streissguth, A. (2003). Postprogram follow-up effects of paraprofessional intervention with high-risk women who abused alcohol and drugs during pregnancy. Journal of Community Psychology, 31(3), 211–222. doi:10.1002/jcop.10048
  • Greenfield, L., Burgdorf, K., Chen, X., Porowski, A., Roberts, T., & Herrell, J. (2004). Effectiveness of long‐term residential substance abuse treatment for women: Findings from three national studies. The American Journal of Drug and Alcohol Abuse, 30(3), 537–550. doi:10.1081/ada-200032290
  • Handmaker, N.S., Miller, W.R., & Manicke, M. (1999). Findings of a pilot study of motivational interviewing with pregnant drinkers. Journal of Studies on Alcohol, 60(2), 285–287. doi:10.15288/jsa.1999.60.285
  • Harris, M., Anglin, J., & Community Connections (Washington, D.C.). (1998). Trauma recovery and empowerment: A clinician's guide for working with women in groups. New York, NY: Free Press.
  • Hinton, D.E., Hofmann, S.G., Rivera, E., Otto, M.W., & Pollack, M.H. (2011). Culturally adapted CBT (CA-CBT) for Latino women with treatment-resistant PTSD: A pilot study comparing CA-CBT to applied muscle relaxation. Behaviour Research and Therapy, 49(4), 275–280. doi:10.1016/j.brat.2011.01.005
  • Hofmann, S.G., Asnaani, A., Vonk, I.J., Sawyer, A.T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. doi:10.1007/s10608-012-9476-1
  • Hudak, M.L., & Tan, R.C. (2012). Neonatal drug withdrawal. Pediatrics, 129(2), e540–e560. doi:10.1542/peds.2011-3212
  • Jansson, L.M., DiPietro, J., & Elko, A. (2005). Fetal response to maternal methadone administration. American Journal of Obstetrics and Gynecology, 193(3), 611–617. doi:10.1016/j.ajog.2005.02.075
  • Jansson, L.M., Svikis, D.S., & Beilenson, P. (2003). Effectiveness of child case management services for offspring of drug-dependent women. Substance Use & Misuse, 38(14), 1933–1952. doi:10.1081/ja-120025120
  • Jeffreys, M.D. (2015). Atypical antipsychotics and anticonvulsants in the treatment of PTSD: Treatment options that include cognitive behavioral therapies. In N. C. Bernardy & M. J. Friedman (eds.), A practical guide to PTSD treatment: Pharmacological and psychotherapeutic approaches (pp. 89–99). Washington, DC: American Psychological Association.
  • Johnson, D.M., Zlotnick, C., & Perez, S. (2011). Cognitive behavioral treatment of PTSD in residents of battered women's shelters: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 79(4), 542–551. doi:10.1037/a0023822
  • Jones, H.E., Deppen, K., Hudak, M.L., Leffert, L., McClelland, C., Sahin, L., … Creanga, A.A. (2014). Clinical care for opioid-using pregnant and postpartum women: The role of obstetric providers. American Journal of Obstetrics and Gynecology, 210(4), 302–310. doi:10.1016/j.ajog.2013.10.010
  • Jones, H.E., Finnegan, L.P., & Kaltenbach, K. (2012). Methadone and buprenorphine for the management of opioid dependence in pregnancy. Drugs, 72(6), 747–757. doi:10.2165/11632820-000000000-00000
  • Jones, H.E., Haug, N., Silverman, K., Stitzer, M., & Svikis, D. (2001). The effectiveness of incentives in enhancing treatment attendance and drug abstinence in methadone-maintained pregnant women. Drug and Alcohol Dependence, 61(3), 297–306.
  • Jones, H.E., Kaltenbach, K., Heil, S.H., Stine, S.M., Coyle, M.G., Arria, A.M., … Fischer, G. (2010). Neonatal abstinence syndrome after methadone or buprenorphine exposure. The New England Journal of Medicine, 363(24), 2320–2331. doi:10.1056/nejmoa1005359
  • Jones, H.E., O’Grady, K.E., Malfi, D., & Tuten, M. (2008). Methadone maintenance vs. methadone taper during pregnancy: Maternal and neonatal outcomes. The American Journal on Addictions, 17(5), 372–386. doi:10.1080/10550490802266276
  • Jones, H.E., Svikis, D., Rosado, J., Tuten, M., & Kulstad, J.L. (2004). What if they do not want treatment? Lessons learned from intervention studies of non-treatment-seeking, drug-using pregnant women. The American Journal on Addictions, 13(4), 342–357. doi:10.1080/10550490490483008
  • Kaltenbach, K., Berghella, V., & Finnegan, L. (1998). Opioid dependence during pregnancy. Obstetrics and Gynecology Clinics of North America, 25(1), 139–151. doi:10.1016/s0889-8545(05)70362-4
  • Kessler, R.C. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048. doi:10.1001/archpsyc.1995.03950240066012
  • Kosten, T.R., & O’Connor, P.G. (2003). Management of drug and alcohol withdrawal. The New England Journal of Medicine, 348(18), 1786–1795. doi:10.1056/nejmra020617
  • Lefebvre, L., Midmer, D., Boyd, J.A., Ordean, A., Graves, L., Kahan, M., & Pantea, L. (2010). Participant perception of an integrated program for substance abuse in pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 39(1), 46–52.
  • Maina, A., Arrotta, M., Cicogna, L., Donvito, V., Mischinelli, M., Todros, T., & Rivolo, S. (2014). Transdermal clonidine in the treatment of severe hyperemesis. A pilot randomised control trial: CLONEMESI. BJOG, 121(12), 1556–1562. doi:10.1111/1471-0528.12757
  • Mattick, R.P., Kimber, J., Breen, C., & Davoli, M. (2008). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, Apr 16(2), CD002207. doi:10.1002/14651858.CD002207.pub3
  • McCarthy, J.J., Leamon, M.H., Parr, M.S., & Anania, B. (2005). High-dose methadone maintenance in pregnancy: Maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, 193(3), 606–610. doi:10.1016/j.ajog.2005.03.072
  • McCarthy, J.J., Leamon, M.H., Willits, N.H., & Salo, R. (2015). The effect of methadone dose regimen on neonatal abstinence syndrome. Journal of Addiction Medicine, 9(2), 105–110. doi:10.1097/adm.0000000000000099
  • McComish, J.F., Greenberg, R., Ager, J., Essenmacher, L., Orgain, L.S., & Bacik, W.J. (2003). Family-focused substance abuse treatment: A program evaluation. Journal of Psychoactive Drugs, 35(3), 321–331. doi:10.1080/02791072.2003.10400015
  • McDonagh, A., Friedman, M., McHugo, G., Ford, J., Sengupta, A., Mueser, K., … Descamps, M. (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73(3), 515–524. doi:10.1037/0022-006x.73.3.515
  • McHugo, G.J., & Fallot, R.D. (2011). Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of Dual Diagnosis, 7(4), 280–284. doi:10.1080/15504263.2011.620451
  • Miller, D. (2002). Addictions and trauma recovery: An integrated approach. Psychiatric Quarterly, 73(2), 157–170.
  • Morland, L., Goebert, D., Onoye, J., Frattarelli, L., Derauf, C., Herbst, M., … Friedman, M. (2007). Posttraumatic stress disorder and pregnancy health: Preliminary update and implications. Psychosomatics, 48(4), 304–308. doi:10.1176/appi.psy.48.4.304
  • Najavits, L.M., Gallop, R.J., & Weiss, R.D. (2006). Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. The Journal of Behavioral Health Services & Research, 33(4), 453–463. doi:10.1007/s11414-006-9034-2
  • Najavits, L.M., Weiss, R.D., & Liese, B.S. (1996). Group cognitive-behavioral therapy for women with PTSD and substance use disorder. Journal of Substance Abuse Treatment, 13(1), 13–22.
  • Najavits, L.M., Weiss, R.D., & Shaw, S.R. (1997). The link between substance abuse and posttraumatic stress disorder in women: A research review. The American Journal on Addictions, 6(4), 273–283. doi:10.3109/10550499709005058
  • Nanovskaya, T.N., Deshmukh, S., Brooks, M., & Ahmed, M.S. (2002). Transplacental transfer and metabolism of buprenorphine. Journal of Pharmacology and Experimental Therapeutics, 300(1), 26–33.
  • Nanovskaya, T.N., Nekhayeva, I.A., Hankins, G.D. V., & Ahmed, M.S. (2008). Transfer of methadone across the dually perfused preterm human placental lobule. American Journal of Obstetrics and Gynecology, 198(1), 126.e121–126.e124. doi:10.1016/j.ajog.2007.06.073
  • Oberlander, T.F., Misri, S., Fitzgerald, C.E., Kostaras, X., Rurak, D., & Riggs, W. (2004). Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. The Journal of Clinical Psychiatry, 65(2), 230–237. doi:10.4088/jcp.v65n0214
  • Orsillo, S.M, Raja, S., & Hammond, C. (2002). Gender issues in PTSD with comorbid mental health disorders. Gender and PTSD, 207–231.
  • Patrick, S.W., Schumacher, R.E., Benneyworth, B.D., Krans, E.E., McAllister, J.M., & Davis, M.M. (2012). Neonatal abstinence syndrome and associated health care expenditures. JAMA: The Journal of the American Medical Association, 307(18). doi:10.1001/jama.2012.3951
  • Porowski, A.W., Burgdorf, K., & Herrell, J.M. (2004). Effectiveness and sustainability of residential substance abuse treatment programs for pregnant and parenting women. Evaluation and Program Planning, 27(2), 191–198. doi:10.1016/j.evalprogplan.2004.01.008
  • Ray, S., & Stowe, Z.N. (2014). The use of antidepressant medication in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 71–83. doi:10.1016/j.bpobgyn.2013.09.005
  • Rogal, S.S., Poschman, K., Belanger, K., Howell, H.B., Smith, M.V., Medina, J., & Yonkers, K.A. (2007). Effects of posttraumatic stress disorder on pregnancy outcomes. Journal of Affective Disorders, 102(1–3), 137–143. doi:10.1016/j.jad.2007.01.003
  • Salasin, S.E. (2005). Evolution of women's trauma‐integrated services at the Substance Abuse and Mental Health Services Administration. Journal of Community Psychology, 33(4), 379–393.
  • Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality. (2014). The N-SSATS Report: Recovery Services Provided by Substance Abuse Treatment Facilities in the United States. Rockville, MD. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSSATS-SR175-RecoverySvcs-2014/NSSATS-SR175-RecoverySvcs-2014.htm
  • Schnurr, P.P., Friedman, M.J., Engel, C.C., Foa, E.B., Shea, M.T., Chow, B.K., … Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women. JAMA: The Journal of the American Medical Association, 297(8), 820. doi:10.1001/jama.297.8.820
  • Seng, J.S., Low, L.K., Sperlich, M., Ronis, D.L., & Liberzon, I. (2011). Post-traumatic stress disorder, child abuse history, birthweight and gestational age: A prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 118(11), 1329–1339. doi:10.1111/j.1471-0528.2011.03071.x
  • Simkin, P. (2011). Pain, suffering, and trauma in labor and prevention of subsequent posttraumatic stress disorder. The Journal of Perinatal Education, 20(3), 166–176. doi:10.1891/1058-1243.20.3.166
  • Sockol, L.E. (2015). A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. Journal of Affective Disorders, 177, 7–21. doi:10.1016/j.jad.2015.01.052
  • Steiner, M. (2012a). Prenatal exposure to antidepressants: How safe are they? AJP, 169(11), 1130–1132. doi:10.1176/appi.ajp.2012.12081126
  • Steiner, M. (2012b). Prenatal exposure to antidepressants: How safe are they? American Journal of Psychiatry, 169(11), 1130–1132. doi:10.1176/appi.ajp.2012.12081126
  • Strantz, I.H., & Welch, S.P. (1995). Postpartum women in outpatient drug abuse treatment: Correlates of retention/completion. Journal of Psychoactive Drugs, 27(4), 357–373. doi:10.1080/02791072.1995.10471701
  • Udechuku, A., Nguyen, T., Hill, R., & Szego, K. (2010). Antidepressants in pregnancy: A systematic review. The Australian and New Zealand Journal of Psychiatry, 44(11), 978–996. doi:10.3109/00048674.2010.507543
  • Umbricht-Schneiter, A., Ginn, D.H., Pabst, K.M., & Bigelow, G.E. (1994). Providing medical care to methadone clinic patients: Referral vs on-site care. American Journal of Public Health, 84(2), 207–210. doi:10.2105/ajph.84.2.207
  • Weissman, A.M., Levy, B.T., Hartz, A.J., Bentler, S., Donohue, M., Ellingrod, V.L., & Wisner, K.L. (2004). Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. The American Journal of Psychiatry, 161(6), 1066–1078. doi:10.1176/appi.ajp.161.6.1066
  • WHO. (2014). Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Retrieved from http://apps.who.int/iris/bitstream/10665/107130/1/9789241548731_eng.pdf
  • Yonkers, K.A., Smith, M.V., Forray, A., Epperson, C.N., Costello, D., Lin, H., & Belanger, K. (2014). Pregnant women with posttraumatic stress disorder and risk of preterm birth. JAMA Psychiatry, 71(8), 897. doi:10.1001/jamapsychiatry.2014.558

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