Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Isabel Byon (00:00):
The New York State Office of Addiction Services and
Supports, or OASAS, providesthis podcast as a public service
.
Opinions expressed do notnecessarily reflect those of the
agency or state.
This is Addiction (00:12):
The Next Step.
Jerry Gretzinger (00:21):
Hey everybody, Jerry Gretzinger here, your
host for Addiction (00:23):
The Next Step, the podcast that's brought
to you by the New York StateOffice of Addiction Services and
Supports.
And you know we've talked aboutso many topics in our 75 plus
episodes and we have actuallyyet to touch on the one we're
going to talk about today.
And you know, really shame onus for not getting to it sooner,
because it's so important andsometimes a difficult thing to
(00:46):
even think about.
Wrap your head around.
You know, what we're talkingabout is something that deals
with pregnant women who areliving with substance use
disorders.
And you know, obviously you canthink about that and it can be
a heartbreaking thing to evenconsider.
You know an expectant momliving with substance use
disorder wondering, you know,how will that may that impact
(01:06):
their unborn child and what canbe done to assist them both.
Well, today we're going to betalking to someone who's
answering some of thosequestions and trying to provide
supports and services for them,and that's Dr Leah Habersham.
She's the director of theBridge Program at Mount Sinai
and, Leah, thanks so much forsitting down with us today on
the podcast.
Leah Habersham (01:24):
Yeah, thank you for having me.
Jerry Gretzinger (01:26):
So you know I mentioned and we'll talk about
this first you know, just evenconsidering, you know this whole
idea, we know it's a reality,right?
There are women with substanceuse disorder who are with child,
who are going to give birth,and there's the concerns about
how does that substance usedisorder affect their child,
affect the mother, and that'ssomething that kind of drives
(01:46):
what you're doing.
Leah Habersham (01:48):
Yes, definitely.
It's a problem that oftentimesneither side who normally cares
for this population knows how tomanage exactly, and so the OB's
tend to not have that trainingof how to manage substance use
disorders.
And then the addictionspecialists tend to not have
(02:09):
that training of how to managethe substance use disorder when
it's occurring in a pregnantpatient, and so it oftentimes
leads to a gap in knowledge andcare.
Jerry Gretzinger (02:26):
Yeah.
So let's talk first about, likesome of those, some of the
concerns that are raised rightwhen we know about a woman who's
expecting a child and is livingwith substance use disorder,
what are the health, what arethe safety concerns that we look
at, you know, when it comestime to delivering that child,
or even during the pregnancy.
Leah Habersham (02:40):
Yeah.
So I mean there's lots ofconcerns, especially the ones
that we have regardless ofwhether the woman is pregnant or
not, overdose, things like that.
But then with pregnancyspecifically, growth restriction
is one, the chance of the babyhaving the possibility of
(03:03):
neonatal opioid withdrawalsyndrome is another.
Lots of different things thatcan happen, especially with the
fact that we don't knowoftentimes what is in the
substance and that can lead tofurther issues later.
And then the other thing iseven getting access to treatment
, access to care.
(03:23):
This seems to be a big problemonce moms are ready to get into
treatment finding providers thatare willing to treat them,
finding programs that arewilling to accept them in that
pregnant state.
Jerry Gretzinger (03:35):
Now you mentioned neonatal opioid
withdrawal syndrome, right.
So are we talking mostly aboutopioids?
Are there other substances thatan expectant mother could be
using that can have that sort ofan effect on the unborn child,
or again on both of them in thatparticular situation?
Leah Habersham (03:55):
Yeah, so neonatal abstinence syndrome is
the more broad term.
N eonatal opioid withdrawalsyndrome is specific to opioids.
So neonatal abstinence syndromecan occur with a variety of
substances like SSRIs, whichhave nothing to do with
substance use disorders, as wellas benzodiazepines, but then
(04:18):
also opioid use.
Opioids can also lead toneonatal abstinence syndrome,
but when we speak specificallyabout that due to opioids, we
call it N-O-W-S.
Jerry Gretzinger (04:32):
So how does your program?
How do you become aware of anexpectant mom with substance use
disorder, like?
At what point do you find outabout it?
Do you find and I'm surethere's a variety of ways that
you find out and can startproviding services or support.
But is it typically like themom who comes forward and says
you know I'm pregnant, I usesubstances, I want to figure out
(04:55):
what's right for me and my baby.
Is it someone who's a physician, a care provider, who comes
forward and says what can we doto assist them?
Tell me that process.
Leah Habersham (05:04):
Yeah, oftentimes it's not the patient themselves
, I say the majority of timesit's another provider in the
community, sometimes within ourown health system or within
another program that houseswomen who are pregnant, who are
aware of our program, and thenwe'll link them to our services.
Jerry Gretzinger (05:25):
And so at that point, once they've been linked
to services, sort of what's theprocess then?
I mean, are the moms usuallyreceptive to that service being
offered?
And what happens at that point?
Is it trying to help moms, sortof like back off from the
substance use or to be healthierthrough it, like what's the
next step, I guess?
Leah Habersham (05:44):
So once they're linked with our program, we link
them with our social worker,who's specific to the bridge, we
have a peer and then they meetwith myself and so we encourage
harm reduction.
So most moms are usuallywanting to stop using substances
(06:07):
.
They're not already onmedication for opioid use
disorder or whatever their usedisorder is.
If there's an FDA approvedmedication, I can start them on
that, and it's usually abouttrying to help moms to stop use
if they currently have use, ifthat's what they want, if that's
their goal.
I've had most patients that'stheir goal.
(06:30):
There are a few patients whodon't intend to stop and so I
still provide care to them justthe same, and just it's about
education and getting them tothe prenatal care and the
addiction care that they need.
Jerry Gretzinger (06:45):
And so the folks who are working with them
will work with them straightthrough delivering the child and
, I would imagine, continuingafterwards as well.
Leah Habersham (06:56):
Yeah, so my program it's an integrated OBGYN
and addiction program, so Itreat women throughout the
lifespan, it's not just specificto pregnancy.
So even after they deliver, Ihave patients that still
continue on with me,particularly if I'm providing
their addiction care.
So they'll still continue withme even postpartum.
Jerry Gretzinger (07:17):
And you know, go ahead Sorry.
Leah Habersham (07:19):
No, I was just going to say.
And then on continuing onbeyond the postpartum period.
Jerry Gretzinger (07:24):
And you know, unfortunately this word winds up
being wrapped up into so manydifferent.
You know scenarios, but stigma.
I'm sure one of the things thatis a challenge for moms to come
forward and seek or acceptservices like these is the
stigma that they're afraid maybe associated with it.
Leah Habersham (07:42):
For sure, and so that's something that we try to
address with this program,right, because everyone that
we're treating here has anaddiction, and so it's not
really an issue here, it's thenorm for our program, and so we
really try to destigmatize, weoffer trauma-informed care, and
(08:06):
that's really our focus and whatmakes this program unique and
necessary, I think.
Jerry Gretzinger (08:13):
So talk to us too, about you know.
You have people who.
How long has this program beenrunning, by the way?
Leah Habersham (08:19):
Since September of 2022.
Jerry Gretzinger (08:21):
All right, All right.
So we've got a few years in andI'm assuming you must have had
some really you know goodstories that have come out of
the work that you're doing andyou've seen, seen moms come in
and been able to deliver a childand see that joy of new life
and perhaps the mom's enjoying anew life of their own after
going through treatment.
Leah Habersham (08:39):
Yeah, yeah, for sure.
We actually have a patient whostarted with us early in
pregnancy.
She continued on with uspostpartum and is now actually a
peer for the program.
I have another patient who justcompleted her CASAC and is
going on to, you know, helpothers who are in similar
(09:02):
situations to herself.
So we have had several successstories that, you know, really
warm my heart and really make mefeel like we're doing the best
work possible.
Jerry Gretzinger (09:13):
Yeah, no, that's great.
It's good to hear that thoseoutcomes are possible and are
happening.
You talked before about youknow there's not enough
crossover, really right, peoplewho are working in substance use
disorder may not always havethe knowledge of an OBGYN, and
then the reverse also applies.
What kind of work's being doneto sort of to bridge those gaps,
(09:34):
so that people are aware thatyou know there are services
available for women in thisposition and how to connect them
with them?
Leah Habersham (09:42):
Yeah, I get invites a lot to do talks at
different places, and so I thinkit's education as tea.
We're giving talks within theOB community, within the
addiction community, and so it'sgetting the word out that there
is this specialized care.
That's one way.
There's also the New York CityCouncil, I know, is looking at a
(10:06):
bill that will increaseeducation and awareness for
providers in general of thismaternal population as well as
the broader community.
And so I think all of that isreally needed.
I hope it passes.
But all of that is reallyneeded in order to address this
problem, in order to get peopleto know that there is help out
(10:29):
there and that recovery ispossible, even the population,
and it's so needed.
We need more education really.
Jerry Gretzinger (10:38):
Yeah, that's absolutely true, and I guess
that's one of the reasons why wedo this podcast right we want
to make sure we're helping getthe word out.
We're very happy to have beenable to help share the word
about this program that you'reinvolved with and a lot of good
work that you've done andhopefully a lot more good work
ahead.
If people have questions, theyhave they're looking for more
information.
You know, obviously you saidmost times it's another provider
(11:02):
who says oh, I know someone whocould benefit, but if somebody
is out there and hears this andsays I'm in that position, what
can I do to learn more?
Where should they go?
What should they do?
Leah Habersham (11:12):
MountSinai.
org.
You can look up the bridgeprogram on Mount Sinai, and then
also we have an email addresswhich is thebridge@mountsinai.
org.
Jerry Gretzinger (11:23):
Great, okay, excellent.
And you know, if somebody isn't, like you know, local to Mount
Sinai, I'm assuming there haveto be like referrals to other
programs around the state thatcan be made and, you know, get
people the help they're lookingfor, regardless of you know what
corner of New York Statethey're in.
Leah Habersham (11:38):
Definitely.
Yeah, there are all kinds ofprograms I am happy to connect
people.
Jerry Gretzinger (11:46):
Great.
Perfect, and I know you gavesome email addresses and
websites there.
We'll put links to those in thenotes for the podcast as well.
Dr Leah, thank you so much forchatting with us today about
this.
Like I said, we've done 75episodes, haven't talked about
this, but obviously this isdefinitely something that's
important to focus on and we'reglad that you're focusing on it.
Leah Habersham (12:04):
Thank you so much,
Jerry Gretzinger (12:06):
All right.
We'll have to have you back atsome point when you've got more
of those success stories toshare with us.
Leah Habersham (12:11):
Happy to do so.
Jerry Gretzinger (12:12):
Great, all right, take care and hey, listen
.
Thank you so much for joiningus for this episode of
Addiction (12:16):
The Next Step, brought to you by the New York
State Offices of AddictionServices and Supports.
You can always go to ourwebsite, oasas.
ny.
gov, o-a-s-a-s, dot N-Y, dot,G-O-V.
And you've also got our HopeLine.
It's always a resource877-8-HOPE-NY.
Until we talk to you next time.
I'm Jerry Gretzinger, be well.
The New York State Office of Addiction Services and
Supports, or OASAS, providesthis podcast as a public service
.
Opinions expressed do notnecessarily reflect those of the
agency or state.
This is Addiction (00:12):
The Next Step.
Jerry Gretzinger (00:21):
Hey everybody, Jerry Gretzinger here, your
host for Addiction (00:23):
The Next Step, the podcast that's brought
to you by the New York StateOffice of Addiction Services and
Supports.
And you know we've talked aboutso many topics in our 75 plus
episodes and we have actuallyyet to touch on the one we're
going to talk about today.
And you know, really shame onus for not getting to it sooner,
because it's so important andsometimes a difficult thing to
(00:46):
even think about.
Wrap your head around.
You know, what we're talkingabout is something that deals
with pregnant women who areliving with substance use
disorders.
And you know, obviously you canthink about that and it can be
a heartbreaking thing to evenconsider.
You know an expectant momliving with substance use
disorder wondering, you know,how will that may that impact
(01:06):
their unborn child and what canbe done to assist them both.
Well, today we're going to betalking to someone who's
answering some of thosequestions and trying to provide
supports and services for them,and that's Dr Leah Habersham.
She's the director of theBridge Program at Mount Sinai
and, Leah, thanks so much forsitting down with us today on
the podcast.
Leah Habersham (01:24):
Yeah, thank you for having me.
Jerry Gretzinger (01:26):
So you know I mentioned and we'll talk about
this first you know, just evenconsidering, you know this whole
idea, we know it's a reality,right?
There are women with substanceuse disorder who are with child,
who are going to give birth,and there's the concerns about
how does that substance usedisorder affect their child,
affect the mother, and that'ssomething that kind of drives
(01:46):
what you're doing.
Leah Habersham (01:48):
Yes, definitely.
It's a problem that oftentimesneither side who normally cares
for this population knows how tomanage exactly, and so the OB's
tend to not have that trainingof how to manage substance use
disorders.
And then the addictionspecialists tend to not have
(02:09):
that training of how to managethe substance use disorder when
it's occurring in a pregnantpatient, and so it oftentimes
leads to a gap in knowledge andcare.
Jerry Gretzinger (02:26):
Yeah.
So let's talk first about, likesome of those, some of the
concerns that are raised rightwhen we know about a woman who's
expecting a child and is livingwith substance use disorder,
what are the health, what arethe safety concerns that we look
at, you know, when it comestime to delivering that child,
or even during the pregnancy.
Leah Habersham (02:40):
Yeah.
So I mean there's lots ofconcerns, especially the ones
that we have regardless ofwhether the woman is pregnant or
not, overdose, things like that.
But then with pregnancyspecifically, growth restriction
is one, the chance of the babyhaving the possibility of
(03:03):
neonatal opioid withdrawalsyndrome is another.
Lots of different things thatcan happen, especially with the
fact that we don't knowoftentimes what is in the
substance and that can lead tofurther issues later.
And then the other thing iseven getting access to treatment
, access to care.
(03:23):
This seems to be a big problemonce moms are ready to get into
treatment finding providers thatare willing to treat them,
finding programs that arewilling to accept them in that
pregnant state.
Jerry Gretzinger (03:35):
Now you mentioned neonatal opioid
withdrawal syndrome, right.
So are we talking mostly aboutopioids?
Are there other substances thatan expectant mother could be
using that can have that sort ofan effect on the unborn child,
or again on both of them in thatparticular situation?
Leah Habersham (03:55):
Yeah, so neonatal abstinence syndrome is
the more broad term.
N eonatal opioid withdrawalsyndrome is specific to opioids.
So neonatal abstinence syndromecan occur with a variety of
substances like SSRIs, whichhave nothing to do with
substance use disorders, as wellas benzodiazepines, but then
(04:18):
also opioid use.
Opioids can also lead toneonatal abstinence syndrome,
but when we speak specificallyabout that due to opioids, we
call it N-O-W-S.
Jerry Gretzinger (04:32):
So how does your program?
How do you become aware of anexpectant mom with substance use
disorder, like?
At what point do you find outabout it?
Do you find and I'm surethere's a variety of ways that
you find out and can startproviding services or support.
But is it typically like themom who comes forward and says
you know I'm pregnant, I usesubstances, I want to figure out
(04:55):
what's right for me and my baby.
Is it someone who's a physician, a care provider, who comes
forward and says what can we doto assist them?
Tell me that process.
Leah Habersham (05:04):
Yeah, oftentimes it's not the patient themselves
, I say the majority of timesit's another provider in the
community, sometimes within ourown health system or within
another program that houseswomen who are pregnant, who are
aware of our program, and thenwe'll link them to our services.
Jerry Gretzinger (05:25):
And so at that point, once they've been linked
to services, sort of what's theprocess then?
I mean, are the moms usuallyreceptive to that service being
offered?
And what happens at that point?
Is it trying to help moms, sortof like back off from the
substance use or to be healthierthrough it, like what's the
next step, I guess?
Leah Habersham (05:44):
So once they're linked with our program, we link
them with our social worker,who's specific to the bridge, we
have a peer and then they meetwith myself and so we encourage
harm reduction.
So most moms are usuallywanting to stop using substances
(06:07):
.
They're not already onmedication for opioid use
disorder or whatever their usedisorder is.
If there's an FDA approvedmedication, I can start them on
that, and it's usually abouttrying to help moms to stop use
if they currently have use, ifthat's what they want, if that's
their goal.
I've had most patients that'stheir goal.
(06:30):
There are a few patients whodon't intend to stop and so I
still provide care to them justthe same, and just it's about
education and getting them tothe prenatal care and the
addiction care that they need.
Jerry Gretzinger (06:45):
And so the folks who are working with them
will work with them straightthrough delivering the child and
, I would imagine, continuingafterwards as well.
Leah Habersham (06:56):
Yeah, so my program it's an integrated OBGYN
and addiction program, so Itreat women throughout the
lifespan, it's not just specificto pregnancy.
So even after they deliver, Ihave patients that still
continue on with me,particularly if I'm providing
their addiction care.
So they'll still continue withme even postpartum.
Jerry Gretzinger (07:17):
And you know, go ahead Sorry.
Leah Habersham (07:19):
No, I was just going to say.
And then on continuing onbeyond the postpartum period.
Jerry Gretzinger (07:24):
And you know, unfortunately this word winds up
being wrapped up into so manydifferent.
You know scenarios, but stigma.
I'm sure one of the things thatis a challenge for moms to come
forward and seek or acceptservices like these is the
stigma that they're afraid maybe associated with it.
Leah Habersham (07:42):
For sure, and so that's something that we try to
address with this program,right, because everyone that
we're treating here has anaddiction, and so it's not
really an issue here, it's thenorm for our program, and so we
really try to destigmatize, weoffer trauma-informed care, and
(08:06):
that's really our focus and whatmakes this program unique and
necessary, I think.
Jerry Gretzinger (08:13):
So talk to us too, about you know.
You have people who.
How long has this program beenrunning, by the way?
Leah Habersham (08:19):
Since September of 2022.
Jerry Gretzinger (08:21):
All right, All right.
So we've got a few years in andI'm assuming you must have had
some really you know goodstories that have come out of
the work that you're doing andyou've seen, seen moms come in
and been able to deliver a childand see that joy of new life
and perhaps the mom's enjoying anew life of their own after
going through treatment.
Leah Habersham (08:39):
Yeah, yeah, for sure.
We actually have a patient whostarted with us early in
pregnancy.
She continued on with uspostpartum and is now actually a
peer for the program.
I have another patient who justcompleted her CASAC and is
going on to, you know, helpothers who are in similar
(09:02):
situations to herself.
So we have had several successstories that, you know, really
warm my heart and really make mefeel like we're doing the best
work possible.
Jerry Gretzinger (09:13):
Yeah, no, that's great.
It's good to hear that thoseoutcomes are possible and are
happening.
You talked before about youknow there's not enough
crossover, really right, peoplewho are working in substance use
disorder may not always havethe knowledge of an OBGYN, and
then the reverse also applies.
What kind of work's being doneto sort of to bridge those gaps,
(09:34):
so that people are aware thatyou know there are services
available for women in thisposition and how to connect them
with them?
Leah Habersham (09:42):
Yeah, I get invites a lot to do talks at
different places, and so I thinkit's education as tea.
We're giving talks within theOB community, within the
addiction community, and so it'sgetting the word out that there
is this specialized care.
That's one way.
There's also the New York CityCouncil, I know, is looking at a
(10:06):
bill that will increaseeducation and awareness for
providers in general of thismaternal population as well as
the broader community.
And so I think all of that isreally needed.
I hope it passes.
But all of that is reallyneeded in order to address this
problem, in order to get peopleto know that there is help out
(10:29):
there and that recovery ispossible, even the population,
and it's so needed.
We need more education really.
Jerry Gretzinger (10:38):
Yeah, that's absolutely true, and I guess
that's one of the reasons why wedo this podcast right we want
to make sure we're helping getthe word out.
We're very happy to have beenable to help share the word
about this program that you'reinvolved with and a lot of good
work that you've done andhopefully a lot more good work
ahead.
If people have questions, theyhave they're looking for more
information.
You know, obviously you saidmost times it's another provider
(11:02):
who says oh, I know someone whocould benefit, but if somebody
is out there and hears this andsays I'm in that position, what
can I do to learn more?
Where should they go?
What should they do?
Leah Habersham (11:12):
MountSinai.
org.
You can look up the bridgeprogram on Mount Sinai, and then
also we have an email addresswhich is thebridge@mountsinai.
org.
Jerry Gretzinger (11:23):
Great, okay, excellent.
And you know, if somebody isn't, like you know, local to Mount
Sinai, I'm assuming there haveto be like referrals to other
programs around the state thatcan be made and, you know, get
people the help they're lookingfor, regardless of you know what
corner of New York Statethey're in.
Leah Habersham (11:38):
Definitely.
Yeah, there are all kinds ofprograms I am happy to connect
people.
Jerry Gretzinger (11:46):
Great.
Perfect, and I know you gavesome email addresses and
websites there.
We'll put links to those in thenotes for the podcast as well.
Dr Leah, thank you so much forchatting with us today about
this.
Like I said, we've done 75episodes, haven't talked about
this, but obviously this isdefinitely something that's
important to focus on and we'reglad that you're focusing on it.
Leah Habersham (12:04):
Thank you so much,
Jerry Gretzinger (12:06):
All right.
We'll have to have you back atsome point when you've got more
of those success stories toshare with us.
Leah Habersham (12:11):
Happy to do so.
Jerry Gretzinger (12:12):
Great, all right, take care and hey, listen
.
Thank you so much for joiningus for this episode of
Addiction (12:16):
The Next Step, brought to you by the New York
State Offices of AddictionServices and Supports.
You can always go to ourwebsite, oasas.
ny.
gov, o-a-s-a-s, dot N-Y, dot,G-O-V.
And you've also got our HopeLine.
It's always a resource877-8-HOPE-NY.
Until we talk to you next time.
I'm Jerry Gretzinger, be well.
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