Perinatal Substance Use Care: Listening, Trust, and Treatment

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Cara Poland explore the unique challenges of perinatal substance use care. They discuss the impact of stigma, the importance of compassionate care, and the use of medications for addiction treatment in pregnancy. Additionally, they address polysubstance use, physiological changes during pregnancy, and the critical postpartum period, sharing insights from their clinical experience and emphasizing a patient-centered, non-judgmental approach to improve treatment outcomes for mothers.

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Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. 

Expert

Cara Poland, MD, MEd, FACP, DFASAM 

Dr. Cara Poland is ASAM’s Vice President, is board-certified in Addiction Medicine, and is a faculty member at Michigan State University. In 2018, Dr. Poland identified the need to strengthen our country’s Addiction Medicine workforce. Dr. Poland leads MI CARES, which trains physician-level addiction specialists in Michigan and across the country. The program also teaches physicians-in-training, resident physicians, social work students, social work practitioners, APRNs, and PAs. Her didactic program involves purposeful education to train healthcare providers to treat persons with SUDs in a kind, compassionate, destigmatized way. Dr. Poland has a special interest in treating pregnant people and their families living with a substance use disorder. 

📖 Show Segments

• 00:05 - Introduction 
• 00:15 - New York Times Excerpt 
• 03:07 - Substance Use and Overdose Risk During Pregnancy
• 04:07 - Addressing Stigma in Addiction Treatment
• 19:18 - Effective Support Systems for Pregnant People with Addiction
• 13:56 - Medication for Opioid Use Disorder During Pregnancy
• 18:00 - Postpartum Care and Overdose Risk
• 27:06 - Polysubstance Use and Alcohol Use Disorder
• 33:38 - Key Takeaways
• 35:10 - Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Recognize Pregnancy as a Motivator for Change: Pregnancy can inspire individuals to seek help and begin recovery. Leveraging this motivation through empowering, respectful care can improve outcomes for both parent and baby. 
• Understand Vulnerability in Substance Use: Addressing underlying vulnerabilities that often contribute to substance use, such as trauma, mental health conditions, and social factors, through compassionate care is essential to supporting recovery.  
• Foster Trust by Reducing Stigma: Creating nonjudgmental healthcare environments, along with respectful, supportive patient-provider relationships, encourages engagement and improves treatment outcomes. 
• Promote Evidence-Based Treatment During Pregnancy: Medications for opioid and alcohol use disorders are safe and effective during pregnancy. Addressing misinformation and normalizing these treatments can help improve access and reduce harm. 
• Normalize Return to Use as Part of Recovery: Recovery is rarely linear. Approaching return to use with empathy, as a step in the process, encourages long-term engagement and helps reduce shame. 
• Deliver Empathic, Individualized Care: Active listening, empathy, and individualized care planning help build trust, deepen understanding, and guide effective, patient-centered interventions. 
• Implement Team-Based Support: Pregnant individuals with substance use disorders often face complex medical, social, and behavioral health challenges. Coordinated, interdisciplinary care is essential for addressing these needs holistically. 

🔗 Resources