March 1, 2025 • 49 mins
This episode of Beyond Substance explores the complex and often misunderstood topic of substance use disorder during pregnancy and beyond. Hosts Dean Babcock talks with expert Dr. Camila Arnado and Jodi Miller talks with Ashna Clark.
Segment 1: Co-Host Dean Babcock talks with Dr. Camila Arnaudo. Dr. Arnaudo shares her journey as an addiction psychiatrist, her insights on the complexities of substance use among pregnant individuals, and the evolving trends in substance use. The discussion emphasizes the importance of understanding the risks involved and the need for supportive care for pregnant individuals facing substance use disorders. This conversation delves into the complexities of substance use during and after pregnancy, highlighting the critical postpartum period where risks of relapse and overdose increase.
Segment 2: In our personal story, Co-Host Jodi Miller welcomes Ashna Clark. Ashna shares her profound journey through addiction, motherhood, and recovery. She reflects on her challenging childhood, early pregnancies, and the difficult decisions she made, including giving her first child up for adoption. Ashna discusses her struggles with substance abuse, the turning points that led her to seek help, and the importance of community support in her recovery. Now a child advocate, she emphasizes the significance of being a present and loving mother, while also offering hope and encouragement to others facing similar challenges.
Takeaways
Chapters
00:00 Introduction to Substance Use Disorder and Pregnancy
03:08 Understanding the Statistics and Challenges
06:01 Expert Insights from Dr. Camila Arnado
12:12 The Complexities of Substance Use During Pregnancy
17:50 The Postpartum Period: Risks and Realities
23:59 Stigma and Barriers to Seeking Help
30:00 Ashna Clark's Journey: A Personal Story of Recovery
42:03 Hope and Support: Building a New Life
45:52 Conclusion and Future Discussions
Segment 1: Co-Host Dean Babcock talks with Dr. Camila Arnaudo. Dr. Arnaudo shares her journey as an addiction psychiatrist, her insights on the complexities of substance use among pregnant individuals, and the evolving trends in substance use. The discussion emphasizes the importance of understanding the risks involved and the need for supportive care for pregnant individuals facing substance use disorders. This conversation delves into the complexities of substance use during and after pregnancy, highlighting the critical postpartum period where risks of relapse and overdose increase.
Segment 2: In our personal story, Co-Host Jodi Miller welcomes Ashna Clark. Ashna shares her profound journey through addiction, motherhood, and recovery. She reflects on her challenging childhood, early pregnancies, and the difficult decisions she made, including giving her first child up for adoption. Ashna discusses her struggles with substance abuse, the turning points that led her to seek help, and the importance of community support in her recovery. Now a child advocate, she emphasizes the significance of being a present and loving mother, while also offering hope and encouragement to others facing similar challenges.
Takeaways
- There are significant barriers to treatment for pregnant women with substance use disorders.
- The postpartum period presents unique challenges and risks for mothers in recovery.
- Stigma and fear of judgment prevent many from seeking help.
- Mothers often love their children deeply, despite their struggles with addiction.
- The relationship between mother and baby can motivate recovery efforts.
- Compassionate care is essential in treating substance use disorders during pregnancy.
Chapters
00:00 Introduction to Substance Use Disorder and Pregnancy
03:08 Understanding the Statistics and Challenges
06:01 Expert Insights from Dr. Camila Arnado
12:12 The Complexities of Substance Use During Pregnancy
17:50 The Postpartum Period: Risks and Realities
23:59 Stigma and Barriers to Seeking Help
30:00 Ashna Clark's Journey: A Personal Story of Recovery
42:03 Hope and Support: Building a New Life
45:52 Conclusion and Future Discussions
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
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Stories connect human beings to human beings.
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As we realize that our experiences are uniquely our own.
And yet somehow, apart of the bigger picture.
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These are the stories from a community that is building hope through recovery by going beyond substance.
(00:28):
[Music]
Hello, I'm Dean Babcock.
And I'm Jodi Miller.
We're the host here on the Beyond Substance Podcast.
Today works boring a topic that is often deeply personal and misunderstood.
Substance used to disorder during pregnancy and beyond.
It's a subject that is filled with challenges, stigma, and most importantly hope.
(00:52):
Absolutely, Dean, in this episode we're featuring two incredible conversations that shed light on these challenges from very different but equally powerful perspectives.
I'll be talking with Dr. Camila Arnauto, an addiction psychiatrist whose insights into substance use during pregnancy and the postpartum period highlight the complexities of care and the importance of compassion and treatment.
(01:20):
And I'll be introducing you to Ashna Clark, a mother whose story of addiction, loss, and recovery reminds us of the strength and resilience it takes to build a new life while helping others do the same.
From expert perspectives to deeply personal journeys, this episode brings together the knowledge and the empathy needed to address substance use during some of life's most vulnerable moments.
(01:49):
So rather you're here to better understand the science, the stories, or the solutions, we believe this episode will inspire you with new ways to think about recovery and hope.
So let's start as always with Angela Shamblin, taking a look at the numbers.
(02:12):
In 2022, National Survey on Drug Use reported that about 10% of pregnant women admitted to using legal drugs while pregnant. Drug use during pregnancy can increase risks to not only its developing baby but to the mother.
Between 2018 and 2021, overdose mortality increased substantially for women who are pregnant or postpartum. Across almost all examined age, racial, ethnic, educational, and marital status groups.
(02:39):
Troubled for women in the 35 to 44 age group and shockingly over 60% of these deaths happen outside of healthcare settings.
Even though treatment for pregnant women with substance use issues is available, many face barriers like stigma, discrimination, and a lack of access to services and resources.
The American College of Obstetricians and Gynecologists recommends that pregnant women get medication to help with substance use as it can improve health outcomes by reducing drug use and risky behaviors.
(03:08):
However, more than half of US states, including Indiana, consider substance use during pregnancy to be child abuse and require reporting to child protective services, even if the woman is using prescribed medication for opioid use disorder.
Indiana does have an exception for the proper use of prescribed medications, however.
That's it for the data segment. Back to you, Dean.
(03:29):
So now that we've looked at the numbers, let's get started with our guests.
As we said in our introduction, when Jodi and I were chatting, today we're going to be focusing on pregnancy and substance use disorder
(03:54):
and the challenges, complications, successes, or whatever, with that particular segment of our population.
And today I have the pleasure of chatting with Dr. Camilla Arnauto, who I've known for a number of years, actually.
And I know she is very, very passionate when she talks and works with individuals who may be pregnant and have a substance use disorder.
(04:18):
So as we get started, Dr. Arnauto, if you could start today by introducing yourself to our audience, including your background and history, and if you could also touch bases on how you became interested in helping people who have substance use disorders.
I'm Camilla Arnauto, and as you alluded to, I'm an addiction psychiatrist, and I'm very, yeah, my passion, my life's work really is around working with pregnant and postpartum people.
(04:47):
With substance use disorder and also general psychiatric conditions.
I've been a psychiatrist for about 20 years and became interested in working with people in the period, after I actually had my own first child about 15 years ago now,
and experienced some postpartum depression and anxiety that really surprised me, and just made me realize what a sort of challenging period it was, but also so much opportunity to use my own lived experience to help other people and to really try to understand and reassure people that even though it feels really scary and insurmountable,
(05:32):
it's something that with help and with time, people can feel better.
And then in terms of substance use disorder, my medical school was involved more Maryland during a previous heroin epidemic, let's call it.
And then I also trained in Boston where there was not the same kind of substance use disorder, but it was always very present during my residency.
(05:55):
So I always sort of had it as something that I was aware made a big impact on people's lives, but what really turned my interest to it was going to a labor of love conference here in Indiana and
I was also a nurse practitioner actually was talking about people breastfeeding while on some box and how much that helped with withdrawal in the postpartum period, and I just got so interested by this idea because it wasn't the medicine, it was the relationship between the postpartum person and the baby and the skin to skin and all that, and it just made me think of how meaningful it must be for the person who is in recovery who is trying to parent
(06:37):
to have this role or this ability to help their baby that had nothing to actually do with the medicine, but had to do with that connection.
And I have been trying to do paranatal work for a while already in terms of general psychiatric illness and that just really made me think, I really actually want to work in addictions like this is a really exciting idea of like this diatic, you know, mother baby relationship.
(07:06):
And that's kind of like how I got interested in it, then I had another like chance encounter with Andy Chambers who was my fellowship director and he really encouraged me to do a fellowship rather than just try to learn as I went and that I was in 2015 and the rest is history.
Could you help our listeners understand a little bit about the nature of substance use during pregnancy?
(07:32):
I think what's happening in the US and probably in the world is that there are more and more women, you know, being exposed to substances and falling into an addiction to two substances.
And even people who don't have addictions who are simply, you know, using alcohol tobacco, you know, various substances in a more like sporadic fashion, they will become pregnant.
(07:57):
You know, most pregnancies in the US are unplanned, so many people there, you know, they're just using drugs using drugs and alcohol during this stage, the ages when people can become pregnant, that is the time when it's more more likely for people who can become pregnant to be using.
So they will be using the substances as they would either do to an addiction or do to just sporadic use and they'll find themselves pregnant.
(08:23):
I think at that moment they have to try to make a choice about whether to try to stop or, you know, to try to continue.
And the majority of people, they stop.
You know, they see pregnancy as a time when they have more than just themselves to consider.
And that is very motivating and so most people actually stop using substances.
But the people that I take care of are people who've tried to stop and they just haven't been able to because it for them it has become, you know, a disorder or a behavior that is not so easily changed.
(08:56):
They need extra support.
So I think it just makes sense because of the timing of when people get pregnant and how much use is occurring in that age.
Even with our people with substance use disorder, we see a drop in the use whether they're in treatment or not while they're pregnant.
You know, people will even say things like when they, for example, if they're using stimulants, they'll make, let's say they might use some methamphetamine and they might feel that the baby kicks more.
(09:24):
Right? Because the baby is feeling that stimulant, that stimulant effect as well, that that is very upsetting for them.
That when they realize like, I'm using the drug and I'm literally feeling the baby kick more that they say that, that will discourage them from using like as both you and I know with, with substance use when you can really tie the effect more closely, you know, the negative effect more closely for people that helps them to modify that behavior.
(09:51):
Even though it's continued use despite negative consequences, you know, the closer the negative consequences for the person, the more so that they're able to change that behavior.
We think about things like anabuse, you know, disulfur, where if you drink, you get sick right away, that does actually even decrease cravings for people because the consequences right there.
It's not like, oh, if I used to day, I might get arrested tomorrow or something might happen in a few months. It's easier to, to unlink those two consequences.
(10:21):
But when you're, when you're having that immediate effect of like, I use some methamphetamine and I feel the baby kicking more, that really helps people to say, like, oh, I'm not going to do this.
I, I can't overcome my addiction, my drive to use the changes in my brain that have happened because of my use. I am able to like use my frontal lobe and my decision making executive powers to like stop myself from using because I right away, I feel an effect on my fetus.
(10:51):
Sometimes people talk about this concept of self-medicating, okay, or that this is about stress relief or whatever. Do you have any thoughts that you'd like to share about that?
And some people who I take care of who are still using when they're pregnant, you know, they often started drug use quite young, like in their early teens, they even have some that have started when they were, you know, nine, 10 years old.
(11:12):
I try to think with them or imagine what, what prompted them to start in the majority of pregnant people who use drugs have a trauma history.
And the majority of them have other psychiatric illnesses in addition to their psychiatric illness related to their addiction, many have depression, anxiety, maybe PTSD, many have ADHD, you know, many women are not diagnosed with that.
(11:37):
And so I think, I think early on in their use, I don't disagree with the idea that, you know, they possibly did, let's say, use some of these medicines to relieve some anxiety or to feel more numb.
When trauma is happening to them to try to like not have it be in the front of their mind when when people are hurting them.
(11:59):
Or maybe they're using some of the stimulants to help, you know, just focus or be in relationships like we know ADHD is way more complex than just not getting your schoolwork done.
It impacts your relationships, your ability to listen to your friends.
In addition, things like ADHD may, may make you like more likely to take risks if it's untreated.
So I think I don't disagree with the concept that when people first started using the drugs, there may be some way in which they were using it to cope with different things.
(12:30):
But I think by the time that I see them, what's happened is now the use is more of a compulsion, right? They're using because their brain is now telling them that they need to use to survive or that the drug is sort of like, I don't want to call it their best friend, but it's the thing that is the most constant in their life.
Because so many other things have fallen away when your use has gotten to the point where I'm usually taking care of people.
(12:56):
I don't necessarily disagree with that as an initial part, but I think it gets very confusing when we're seeing people.
Another point that I can add, something that I've noticed for many people that I work with is, for example, with opioid use disorder, where we may use medications for opioid use disorder like Bipinorphine or Methodos.
(13:17):
Many times when we initiate them on these medicines and it takes away the cravings for the opioids and they're not needing to seek them out or use them compulsively, they feel better from the withdrawal perspective and they're not craving.
They can have a more organized life, but they often feel quite a lot of despair and depression and anxiety right after they get on these medicines because they're not numb in the same way.
(13:47):
And now many emotions that were sort of like tampered down by the substances are more present for them.
So I don't think that the drugs, the opioids that they were like treating the anxiety or the depression, but they were putting a big lid and they were making it, you know, so the people weren't caring so much.
You know, we know that opioids, one of the things that they do, they don't necessarily decrease pain so much as they make you just not be so upset about the pain, not care as much about the pain.
(14:16):
And it does the same thing for the emotions. So I think the concept of self medication, it can get a little tricky for people, but those are the ways in which I think it is sort of accurate.
You mentioned opia and you've talked also about methamphetamines. Could you share what are the different types of drugs that we're seeing today or either trans or things that you've seen change in the time that you have practiced.
(14:45):
What I've noticed the most is the increase in the cannabis, you know, as the, as many states in the United States, you know, make that more accessible and less less illegal.
We see more and more people using cannabis during pregnancy.
Many are using small amounts, but others are using quite a lot and they're using very potent things like the waxes and the oils and the dabbing and so forth.
(15:14):
What about alcohol?
I'm getting all red people can't see if they're only listening to the recording, but I'm getting all red because we often forget about that and that's very dangerous to forget about because people switched to it.
Right people who use other drugs will switch to alcohol because it's not illegal. And the focus for many people who use drugs, you know, is that they don't want to lose custody.
(15:38):
But they do want to parent at least the ones that I take care of and so they they fear Department of Child Services or someone coming in to remove their child.
And so they think of alcohol as perhaps safer because it's legal and you know, they're not going to get arrested for it.
But unfortunately in terms of the developing brain, alcohol is very dangerous and just like I forgot right here as we were talking, we often forget to ask people who are using other drugs about alcohol.
(16:07):
Because we're so focused on the opioids or so focused on the benzodiazepines.
It's a good reminder to all of us to make sure we're asking people about every single thing.
Like if you're using chaotically and you're getting arrested, obviously you're not getting ideal care if you're imprisoned in any way.
And if you're trying to avoid the Department of Child Services and detection, many of our pregnant people, they just don't show up till really late, late in their pregnancy.
(16:34):
They're trying to kick it on their own and show up when they have nothing in their system or they're, you know, they're just trying to be as little noticed and trying to sort of evade all that so that they're not detected.
And overall, I think the general person on the street would probably say, you know, there are associated harms with using during the course of pregnancy.
(17:01):
And I also don't want us to forget that those lifestyle and behavioral types of things that just aren't only involved during the course of a nine month pregnancy, but in the postpartum and early parenting period.
That may have negative consequences for babies and children.
(17:23):
I'm really glad you're mentioning the postpartum period because that is actually the period that I'm actually most interested in in terms of how we can help people.
I think during pregnancy, like we said, there's the immediate consequence of feeling your action impacting the fetus.
But once the fetus is outside your body, you know, many people, they are so motivated by that. They don't need anything else sometimes to stay sober.
(17:48):
It's really like that plus the doctor, they come to us, they are feeling motivated, they're not quote unquote messing up, but as they would call it.
But once you deliver and, you know, you separate the consequence, the consequence is not in your body anymore. It's outside the body.
And the people who unfortunately, like maybe didn't weren't able to do all the work to add coping skills and to make all the connections that they needed.
(18:11):
And even once that are doing well during pregnancy, we find a lot of people resume use by just thinking like, well, I'm so tired in the postpartum period.
What if I just use a little bit of meth to get a little bit of energy? Then I could take care of the baby. Then I could do my shopping or like the patient might say, like, I had all this trauma.
Now I have this baby who's crying, it really triggers things for me. I'm just going to use a little bit of opioids because then I can be numb and I can take better care of the baby without being so stressed.
(18:39):
And then, you know, we know that that can progress quickly to quite a lot of use.
And so I like to say, I have a talk that I give and it's called like pregnancy at time of opportunity and peril.
Because the postpartum period is like a high risk of death for a person who can be pregnant, then never having been pregnant.
(19:01):
Okay? So she have a woman who uses drugs who never gets pregnant in the same time period. There are studies on this.
They are more likely to die from an overdose in the postpartum period than had you never been pregnant.
So even though the pregnancy itself is lower risk for overdose and people are using less drugs, the postpartum period is higher risk for overdose than had been never been pregnant.
(19:28):
So that, I mean, that's a really scary thought because many people think, oh, when you're pregnant, this is when you're going to stop.
Even the pregnant person themselves, they say, I'll never use again. My baby is going to fix it all for me. But as many of us who've been postpartum like myself, you know, I was not depressed and anxious before and I was in the postpartum period.
(19:50):
I'm not a person who uses drugs. So that wasn't, you know, what I went towards, but someone who then becomes depressed and anxious in the past, they've, you know, that's how they've dealt.
So I said most people who are become pregnant and use drugs, 70% have a risk of having had depression before that gets triggered off and then we're off to the races, you know, as you well know, Dean, the main way to treat addiction is nothing to do with medication.
(20:18):
It's connection to other people, you know, it's becoming more connected to people and less connected to the substance.
What happens in the United States in the postpartum period is a lot of isolation for people, you know, and so it's a very dangerous time.
Exactly. And we also know in the case of pregnant people that may have an opioid use disorder after that period of abstinence during the course of the pregnancy, people's tolerance may go down and they may return to using the same amount they were using before.
(20:53):
But now they find themselves in an overdose situation.
I'm on the maternal mortality review committee and we look at some of these cases and you do see people that were doing well and it looks from, we don't know for sure, but it looks like it's a one time use is just, yeah, people don't know what's in the drug supply anymore, right?
(21:14):
Like when you're using you become very savvy to what's out there and when you're not using anymore, you just don't know as well. You're not, you're not in the know and one time can just get you, especially with these fentanyls, car fentanyls, with these xylazine that's in the, in the drug supply now.
And then the other thing that we see are the mixed overdoses, right? The people that are using the stimulants plus the sedatives together, they're just doing a number on their hearts.
(21:42):
And as you said, they were, they were not using anything and their body is just shocked to death basically it's a terrible, it's really a terrible and scary phenomenon.
I'd like us to shift if we could to this notion that sometimes pregnant people are reluctant to seek care and get involved in care.
(22:05):
Can you share your thoughts on kind of what helps drive that fear?
And the fear and the stigma, not just the stigma outside of the person, but the self stigma that someone sort of develops, I think we could call it over the time course of their substance use, right?
The pharmacy will treat them differently, the emergency room, doctors, people will say, well, you shouldn't be doing this.
(22:30):
Like as we know, scared straight just is one of the worst techniques that exists and I try to be really thoughtful when I'm talking to people about the risks of the substance is even alcohol, etc.
And to try to do it in a way where it's not about scared straight, but it's like we're on the same team and here's what we're trying to prevent.
(22:51):
And honestly say I have never taken care of someone who I think does not care about their baby that I've never had that experience I always find that they care, but that doesn't mean you can immediately stop, right?
It's an illness for a reason changes have happened to your brain.
I can think of a recent experience right was meeting with someone who is pregnant and who's on people, nor feeing and struggling with other substance use and she's not been completely open with me with everything she's used and we've seen through some drug screens that there's some things in there that she wasn't talking to us about and you know, I had to address that with her and someone could say well she's lying to you she doesn't care.
(23:33):
And I think much more it's like she's trying to show the best face to me that she can so that I'll continue providing you know meds that are really helpful she's not using any opioids the people nor fee is helping.
And of course she's afraid of losing that if she's open about everything and then in in fact by not telling me that is actually putting that at more risk because it makes it more dangerous for me to you know to provide the medicine.
(23:56):
So we had to have a really open talk about that and she was you know she was upset she was crying she was an angry at all with me which everyone in the office predicted she was going to get mad and yell at me.
That didn't happen at all you know she was crying she was embarrassed and she was angry of course that she got like sort of found out or outed in this way but I don't know what the outcome will be you know of how this discussion will impact things but she agreed to do more intensive treatment.
(24:24):
I think the main thing that stops people from coming is fear of DCS and stigma and then the other things that stop people from coming are just real life things like having to work other appointments the cost of treatment you know prior experience of it not helping.
We know high quality substance use treatment in our country is not enough so many people have tried less than full treatment and it hasn't been helpful and so they just they're hopeless about it helping.
(24:55):
I think those are some of the main reasons that I see with why people don't don't see treatment.
And I've always been working with this population I try to help people understand you know these are patients that love their babies and many times they have other children people have so much loss you talk about the older children so many of them haven't been able to parent those older children and they've done studies on this they did a beautiful study where they interviewed 15 women who lost their kids to the system.
(25:26):
And the kind of grief that they described the way they felt about the losses it you know even if the though the children were still living and many of them could still have some contact but it was as if it was similar to what people describe when they had lost the child to death you know the impact of those losses is really significant and it really does increase the risk that people will continue using.
(25:52):
So we have to think about the losses in the trauma I mean the trauma in this population is just it's just staggering what people have been through your passion for this population I have always perceived as infectious.
These are treatable illnesses these are illnesses in their treatable and we have we have a lot of tools medications therapy support groups peer recovery you know there's so many things that we can we can leverage to help people so when I meet people for the first time that are going through this and even subsequent times like as hard as it is like I do feel a lot of hope for them because through all this throw these hardships they've made it to the office you know it's not very easy to get an appointment with you.
(26:38):
It's easy to get an appointment with me to get there and to be there so I feel like well they've overcome a lot to be here and that makes me hopeful that they tried so hard to get there I know that means they they have a fighting spirit and they have a chance and and I'm excited to do this work and be there with them and figure out what are the pieces of the puzzle they'll be able to put together that's going to help this person to get to what their next goal is.
(27:04):
[Music]
Addiction and motherhood two worlds that seem impossible to reconcile yet for so many women they collide in ways that redefine their lives.
(27:30):
On today's episode we're sharing Ashna Clark's incredible journey.
Ashna's childhood was shaped by challenges many of us might find hard to imagine growing up with a single mother who struggled with mental illness and substance use.
She learned early that alcohol was a way to cope.
(27:52):
It was a lesson she carried into her teen years a period defined by instability and hardship.
I did end up leaving my childhood home at 14 by that age I knew that what I was living in wasn't right I knew it was toxic I didn't want to be around it so I moved in with my boyfriend at 14 which was yet another toxic situation.
(28:20):
When I was 16 and I was living with my boyfriend I was also living with his mother and a shooting accident had actually happened and he had shot off most of his left hand.
And so at the same time that he had this accident I had found out I was pregnant.
Well during that accident for him that's when they prescribed him opiates to cope with the pain and that was when he really spiraled in his addiction which for me to cope for that.
(28:49):
I spiraled in my own addiction and so I was actually smoking weed the whole pregnancy for my son.
Pregnant and calchopping with her boyfriend she was confronted with a daunting reality of bringing a child into a world she wasn't prepared for.
I remember the feeling of finding out that I was pregnant because I was super excited that okay everything that my mother had done wrong I was going to do right with this baby.
(29:13):
And just in a child like my set I was thinking this was my little baby doll and this is where I'm going to do everything right and I'm going to love it so much and that's going to be enough.
And I felt like I could not go to get prenatal care or go to a doctor's office because I knew that once they were going to have you you know give them a screen.
(29:35):
And it's usually just even show that your pregnant but that fear of they're going to have this idea about me they're going to report this is not that fear led me to not receiving any prenatal care for any of my children except for my my first born.
Had I not had that fear of what these doctors and what these people are going to think of me I think if that had been different than I probably could have received the help a lot sooner.
(30:02):
During the time that I was pregnant and watching the father of my child.
Like spiral further into his addiction I realized how alone I really was and I kept every day worrying about okay so I feel super super alone I have no one who I can lean on I have no idea what I'm doing how am I going to support this thing that is a living being and you know make sure that it's going to survive and have all of its needs and my.
(30:31):
And it was a really daunting feeling at that age to wonder how my boy someone who can't even provide for themselves how am I going to provide for this baby that I already love so much and haven't even met yet.
I remember giving birth to him.
(30:52):
While I was at the hospital my father my child he was passed out due to being high and he missed the entire birth and.
In that moment really passionate a heartbreaking choice to give her son the life she couldn't provide.
(31:13):
And so I did end up giving him a production.
But that decision didn't lead to immediate change instead it marked the beginning of a journey that would take years to find its footing.
(31:38):
And 17 Ashna left Indiana for Nebraska to reconnect with her strange father.
But instead of stability she found herself drawn deeper into addiction this time alongside him.
I stayed with him for a little bit he was addicted to Smith and Femines my sobriety then at that point was just because I had looked so it was maybe only a few months long.
(32:05):
I then had actually gotten high with my dad and that's when things started to spiral again for me for a couple years up until about the age of 24 is when I was really kind of spiraling myself with the alcohol in the methamphetamines.
And then I met a guy who was really into fitness and all this kind of stuff.
(32:27):
So what I ended up doing was jumping on that bandwagon with him. And so I dropped the methamphetamines I was just drinking on the weekends type thing I was doing the kitchen catering business and everything was okay for a while.
But with what I have the disease that I have the alcohol on the weekends slowly changed to alcohol in the evenings and the weekends and then it was alcohol all day.
(32:52):
And I was still functioning addict at that time I was still doing the kitchen catering thing it was still working well for me and then up until it wasn't I was starting to show up to work drunk.
I started taking Xanx to try to win myself off of alcohol which is not a thing.
And then I ended up losing my job for smelling like alcohol and slaring my words at work. And a job that was very good to me provided well for me.
(33:23):
I had my own apartment in my own car all the things that I was going to be so proud of for when my son was to reach out to me one day.
All the things I built up to show him like look mom did not give you up for just nothing you know like this is everything I did so that we one day you could come back to me.
All of that I ended up losing because of my drinking so.
(33:48):
There were moments of clarity. Ashna tried to build a life but the grip of addiction was unrelenting and by her late twenties she had lost everything including her sense of self worth.
It was a Facebook call that brought a glimmer of hope her first born son now twelve reached out for Ashna this was a sign an opportunity to start over but as she returned to Indiana the challenges of addiction follow her.
(34:24):
So I packed my car full of everything I had I called up his father and I said hey I'm going to be moving back can I stay with you for a little bit until I can get on my feet.
And nine hour drive it took me about sixteen hours because at that time I was really still heavy in the alcohol.
I could not go more than a couple hours without starting to have these keys and I moved in with the father my son and he yet again showed me that he was into methamphetamines I quit drinking the day that I started doing math.
(35:03):
Unfortunately what had happened right before that was my son had called me for one of our phone calls you know it we don't even talking for about a week.
I called to let him know that I was back in Indiana I don't remember the conversation because I was drunk and because of that all communication with him was stopped.
(35:26):
And so at that moment I felt like I had nothing else to lose and so I started doing methamphetamines.
Despite her best intentions addiction continued to a road her life pregnant again she found herself in an abandoned house heating refried beans over candlelight.
(35:48):
It was a moment of reckoning a realization that she needed help.
I just remember thinking if I give birth to my son right now nobody's ever going to find me like I could die in this band of giving birth to my son and no one's ever going to know.
And in that moment that terrified me and so I have reached out to my sister who I had not spoken to in about sixteen years from when I had left in the first place.
(36:18):
And I let her know that I was in a really tough situation and I needed needed help in that surprise the maintenance pregnant.
I have an addiction I have a problem and asked if I could go live with her.
She agreed and I was sober for about three months.
I'm long enough for me to give birth to my son of course he didn't have anything in his system because I had just stopped you know right before.
(36:46):
So there wasn't like a DCS case to step in and I felt safe at my sisters until that it started to come back of you know I'm really kind of bored.
So I think I want to try something else.
And so I thought okay well I can be mommy and get high and no one will be any wiser you know.
And it's a whole attic thinking like that obsession is so hard.
(37:10):
When you don't know that there is another way that obsession takes hold and so every day that I'm sitting there holding my son I'm like you know I bet you this would feel you better if I was high.
And so three months after my son was born I reached out to some of the people that I used to get high with.
And one day one of them came to pick me up and I was just gonna go down to hang out for a couple hours and I never went back to my sisters.
(37:37):
I had my son there with me and even in that moment I thought that I was the best mom ever I thought it was a ball day playing with my son during the day up all night cleaning up the house up all day playing with my son up all night cleaning the house.
And I thought in my head that that was me being a good mom because you know he had his basic needs met and I was still doing all this other stuff and that just wasn't the case.
(38:05):
Even as she tried to find stability addictions poll was strong.
The day before my son was to turn one I got knock on the door and it was the cops they were coming in to look for the guy I was with at that time he had a multitude of warrants that I was not aware of but they came in looking for him they found me in my son because of the conditions at the house because of you know all the other sub drugs.
(38:34):
My son was removed the day before his first birthday and I remember sitting in the back of the cop car and I felt like my soul had died that day like I was already it took about 10 years for me to feel like previously with giving my first born out for adoption it took about 10 years for me to feel like that whole was starting to close up a little bit and then sitting in the back of that cop car knowing that it was going to be.
(39:03):
I was going to be months before I could see my son again I just felt like I died and that was the moment that I thought okay it's now or never you need you need to change.
And you would think being in the back of the cop car losing your second child you know that that would be enough and even still it wasn't.
(39:26):
I was jailed to an empty house the guy was with at the time he ended up leaving with all my stuff and I just kind of crumbled I stayed in that house for a little while just kind of soaking in the emptiness and just realizing like all the things that I had done that led me up to this moment and how was I going to fix it.
(39:53):
My solution at that time was still to get high and so that happened for about maybe about two years until I got pregnant with my daughter.
And similar situation happens where I am in jail with her seven months pregnant for a violation on probation for a dirty drug screen.
(40:16):
It wasn't until she faced the devastating removal of her son and the prospect of giving birth in jail that she found the strength to surrender sitting there in that jail that time that was when something hit me and I was like you were going to have three children and not raising a single one.
(40:38):
All you've ever wanted to do in your life was to care for something the way that you felt like your mother should care for you. And so in that moment I was like it is it's truly now or never I refuse to lose another child because I can't get myself together.
And so that was the moment that I really surrendered and I was like if there is a God please help me.
(41:02):
That chance led her to heart rock recovery a program designed for pregnant women and mothers seeking a new path for ashtah it was more than just a program.
It was a lifeline.
So I was 32 weeks I might have been 33 weeks and so heart rock accepts you if you are pregnant or if you have a child and you were trying to reunite with your child.
(41:29):
And you're someone who suffers from substance use disorder. There is an application online the steps are you apply you get a phone interview and then after that you're put on a wait list which typically is a long wait list things change all the time.
I was told that I was third on the wait list and in a matter of a week I was in the house.
I have a really good support system here and living in communal living especially with moms and babies it's a different kind of atmosphere like I had sisters you know and I kind of lost contact with them but being here it's like a different kind of sisterhood and then my daughter has all these little baby sister and brothers you know.
(42:10):
And she just to watch her bond with other women here and watch her bond with other children and then maybe able to have that same bond.
There's a sense of family here that I was searching for my whole life that I never about you know never knew that I needed and wanted but coming here I have found that and I know communal living can seem terrifying to some people like why would I want to be with all these different people on this mat.
(42:36):
But the thing about it is I would have wanted any other way I mean why would I want to I've already felt alone my whole life why would I want to now go through this whole new thing of being sober and being completely in my feelings now and why would I want to do that alone I want to do that with other people who finally understand how I feel and who are feeling the same thing.
(42:58):
There are still struggles there are still moments you know where I get frustrated recent one is when I hit my one year sobriety.
It was also at the same time that the no contact order with my four year old had ended so I ended up getting a turn and I am currently in the custody battle for him.
(43:19):
So and there's struggles with that because there's a lot that I'm going to have to face I you know there's a lot of accountability that I have to take on my end because I did hand the people who have a broken child and you know I have to take responsibility for that and it's been through the program and been through the support and the honesty of you know everyone here at heart rock that I'm able to now see that and can take that and hold that with what I'm supposed to.
(43:49):
Today Ashina is thriving as the child advocate at heart rock she uses her experiences to guide other mothers helping them find their voices and rebuild their lives.
I currently am the child advocate at heart rock so I am the voice for the children but I also walk beside the mothers and so it's a really unique opportunity for me because where I feel like I had failed my sons.
(44:17):
And I wasn't I was someone who should have been their voice and I wasn't I am now in a position where I'm able to guide other women into being that voice for their children and it's it's been a really special opportunity to feel like I'm fulfilling a part of me that I had failed with my sons.
(44:38):
Ashina's vision for the future is simple yet profound to raise her children with the love and stability she wants long for.
It's a dream she's working toward every day fueled by resilience and hope.
So my true vision of my future is me in my own apartment and with both my son and my daughter and you know just kind of enjoying that life of watching my children be able to grow up together and be able to grow up together.
(45:07):
And watch them be happy and I would still be at heart rock working as the child advocate.
I just in this position I have such a calling for that I never realized I wanted or needed and I just my future is me being the mom that I always wanted to be.
(45:28):
And that's a big motivator for me.
Ashina's journey reminds us that recovery is not a straight line but it is possible her courage to face her past fight for her future and support others along the way is a true testament to the strength of the human spirit.
(45:50):
To all the mothers out there who are struggling Ashina's story is proof you are not alone and there is always a way forward. Please reach out for help. We are here for you.
You know having a history of working with pregnant women who have substance disorders disorders. You know that stigma piece is so kind of far reaching and keeps people out of care and I remember I had a program in the 90s you know and I was always kind of amazed by the misunderstanding of that population and misunderstanding of them as the clients as mothers.
(46:39):
You know motherhood is such an instinctual kind of dynamic and that mothers automatically love their children for the most part although I'm sure there may be exceptions but I think that's really kind of the that's kind of the overall kind of rule rather than the exception.
And the whole idea that you know people think that they don't love those children and they don't love those babies is always been such an enigma to me and my my experiences told me they absolutely love those babies and and want the best but it is a very powerful demonstration of just how powerful an addiction can be.
(47:24):
That takes over and that that kind of drives the behavior in it and I think that's so misunderstood.
I agree 100% with that Dean it's it's really it's really sad to me and just even the work that I do in the jail with women program you know most of the women are mothers you know they've lost their children so many of them and and people don't understand that you know how would that become before your
(47:53):
your children and but you know like you said it's just the power of the addiction.
And you know I've also thought about this a lot which is sometimes certainly in the health care system in particular we throw up little barriers and we don't understand that you know sometimes our behavior like if you miss an appointment you have to call back in and you know we close your charts if you miss so many appointments and I think when it comes to you.
(48:22):
And I think when it comes to this population that we need to keep in mind that this is very high risk for both the moms and for the babies and all of our actions really should be geared toward how do I help this mom keep her next appointment and keep her engaged in care and that to me is kind of the bottom line we should do everything we can to keep them in care.
(48:50):
Yeah I mean I think it's just so important to not stigmatize this population it was a great conversation I had with Ashna and I learned a lot about just her story which was very powerful so I think this this is going to help a lot of people have a better understanding so thanks for our guest for their willingness and participation.
(49:13):
In our next episode we'll be talking about drug trends and how the drug supply has changed over the years and currently what's out there and take a closer look at that with the very kind of renowned researcher who really kind of looks at drug trends in Indiana.
Thanks everyone and see you next time.
(49:35):
If you feel you need assistance please reach out to a counselor or other healthcare provider, supportive loved one or contact resources in the community such as 211 where you can be connected to assistance or talk with a peer or counselor.
Beyond Substance is hosted by Dean Babcock and Jody Miller.
(49:56):
A look at the numbers segment is hosted by Angela Shamblin. Beyond Substance is produced by Angela Shamblin and the executive producer is Shawn P Neal.
#AdvoCast #ShawnPNeal #SubstanceUseDisorder #Pregnancy #Recovery #Addiction #SUD
(50:26):
[Music]
(00:04):
Stories connect human beings to human beings.
[Music]
As we realize that our experiences are uniquely our own.
And yet somehow, apart of the bigger picture.
[Music]
These are the stories from a community that is building hope through recovery by going beyond substance.
(00:28):
[Music]
Hello, I'm Dean Babcock.
And I'm Jodi Miller.
We're the host here on the Beyond Substance Podcast.
Today works boring a topic that is often deeply personal and misunderstood.
Substance used to disorder during pregnancy and beyond.
It's a subject that is filled with challenges, stigma, and most importantly hope.
(00:52):
Absolutely, Dean, in this episode we're featuring two incredible conversations that shed light on these challenges from very different but equally powerful perspectives.
I'll be talking with Dr. Camila Arnauto, an addiction psychiatrist whose insights into substance use during pregnancy and the postpartum period highlight the complexities of care and the importance of compassion and treatment.
(01:20):
And I'll be introducing you to Ashna Clark, a mother whose story of addiction, loss, and recovery reminds us of the strength and resilience it takes to build a new life while helping others do the same.
From expert perspectives to deeply personal journeys, this episode brings together the knowledge and the empathy needed to address substance use during some of life's most vulnerable moments.
(01:49):
So rather you're here to better understand the science, the stories, or the solutions, we believe this episode will inspire you with new ways to think about recovery and hope.
So let's start as always with Angela Shamblin, taking a look at the numbers.
(02:12):
In 2022, National Survey on Drug Use reported that about 10% of pregnant women admitted to using legal drugs while pregnant. Drug use during pregnancy can increase risks to not only its developing baby but to the mother.
Between 2018 and 2021, overdose mortality increased substantially for women who are pregnant or postpartum. Across almost all examined age, racial, ethnic, educational, and marital status groups.
(02:39):
Troubled for women in the 35 to 44 age group and shockingly over 60% of these deaths happen outside of healthcare settings.
Even though treatment for pregnant women with substance use issues is available, many face barriers like stigma, discrimination, and a lack of access to services and resources.
The American College of Obstetricians and Gynecologists recommends that pregnant women get medication to help with substance use as it can improve health outcomes by reducing drug use and risky behaviors.
(03:08):
However, more than half of US states, including Indiana, consider substance use during pregnancy to be child abuse and require reporting to child protective services, even if the woman is using prescribed medication for opioid use disorder.
Indiana does have an exception for the proper use of prescribed medications, however.
That's it for the data segment. Back to you, Dean.
(03:29):
So now that we've looked at the numbers, let's get started with our guests.
As we said in our introduction, when Jodi and I were chatting, today we're going to be focusing on pregnancy and substance use disorder
(03:54):
and the challenges, complications, successes, or whatever, with that particular segment of our population.
And today I have the pleasure of chatting with Dr. Camilla Arnauto, who I've known for a number of years, actually.
And I know she is very, very passionate when she talks and works with individuals who may be pregnant and have a substance use disorder.
(04:18):
So as we get started, Dr. Arnauto, if you could start today by introducing yourself to our audience, including your background and history, and if you could also touch bases on how you became interested in helping people who have substance use disorders.
I'm Camilla Arnauto, and as you alluded to, I'm an addiction psychiatrist, and I'm very, yeah, my passion, my life's work really is around working with pregnant and postpartum people.
(04:47):
With substance use disorder and also general psychiatric conditions.
I've been a psychiatrist for about 20 years and became interested in working with people in the period, after I actually had my own first child about 15 years ago now,
and experienced some postpartum depression and anxiety that really surprised me, and just made me realize what a sort of challenging period it was, but also so much opportunity to use my own lived experience to help other people and to really try to understand and reassure people that even though it feels really scary and insurmountable,
(05:32):
it's something that with help and with time, people can feel better.
And then in terms of substance use disorder, my medical school was involved more Maryland during a previous heroin epidemic, let's call it.
And then I also trained in Boston where there was not the same kind of substance use disorder, but it was always very present during my residency.
(05:55):
So I always sort of had it as something that I was aware made a big impact on people's lives, but what really turned my interest to it was going to a labor of love conference here in Indiana and
I was also a nurse practitioner actually was talking about people breastfeeding while on some box and how much that helped with withdrawal in the postpartum period, and I just got so interested by this idea because it wasn't the medicine, it was the relationship between the postpartum person and the baby and the skin to skin and all that, and it just made me think of how meaningful it must be for the person who is in recovery who is trying to parent
(06:37):
to have this role or this ability to help their baby that had nothing to actually do with the medicine, but had to do with that connection.
And I have been trying to do paranatal work for a while already in terms of general psychiatric illness and that just really made me think, I really actually want to work in addictions like this is a really exciting idea of like this diatic, you know, mother baby relationship.
(07:06):
And that's kind of like how I got interested in it, then I had another like chance encounter with Andy Chambers who was my fellowship director and he really encouraged me to do a fellowship rather than just try to learn as I went and that I was in 2015 and the rest is history.
Could you help our listeners understand a little bit about the nature of substance use during pregnancy?
(07:32):
I think what's happening in the US and probably in the world is that there are more and more women, you know, being exposed to substances and falling into an addiction to two substances.
And even people who don't have addictions who are simply, you know, using alcohol tobacco, you know, various substances in a more like sporadic fashion, they will become pregnant.
(07:57):
You know, most pregnancies in the US are unplanned, so many people there, you know, they're just using drugs using drugs and alcohol during this stage, the ages when people can become pregnant, that is the time when it's more more likely for people who can become pregnant to be using.
So they will be using the substances as they would either do to an addiction or do to just sporadic use and they'll find themselves pregnant.
(08:23):
I think at that moment they have to try to make a choice about whether to try to stop or, you know, to try to continue.
And the majority of people, they stop.
You know, they see pregnancy as a time when they have more than just themselves to consider.
And that is very motivating and so most people actually stop using substances.
But the people that I take care of are people who've tried to stop and they just haven't been able to because it for them it has become, you know, a disorder or a behavior that is not so easily changed.
(08:56):
They need extra support.
So I think it just makes sense because of the timing of when people get pregnant and how much use is occurring in that age.
Even with our people with substance use disorder, we see a drop in the use whether they're in treatment or not while they're pregnant.
You know, people will even say things like when they, for example, if they're using stimulants, they'll make, let's say they might use some methamphetamine and they might feel that the baby kicks more.
(09:24):
Right? Because the baby is feeling that stimulant, that stimulant effect as well, that that is very upsetting for them.
That when they realize like, I'm using the drug and I'm literally feeling the baby kick more that they say that, that will discourage them from using like as both you and I know with, with substance use when you can really tie the effect more closely, you know, the negative effect more closely for people that helps them to modify that behavior.
(09:51):
Even though it's continued use despite negative consequences, you know, the closer the negative consequences for the person, the more so that they're able to change that behavior.
We think about things like anabuse, you know, disulfur, where if you drink, you get sick right away, that does actually even decrease cravings for people because the consequences right there.
It's not like, oh, if I used to day, I might get arrested tomorrow or something might happen in a few months. It's easier to, to unlink those two consequences.
(10:21):
But when you're, when you're having that immediate effect of like, I use some methamphetamine and I feel the baby kicking more, that really helps people to say, like, oh, I'm not going to do this.
I, I can't overcome my addiction, my drive to use the changes in my brain that have happened because of my use. I am able to like use my frontal lobe and my decision making executive powers to like stop myself from using because I right away, I feel an effect on my fetus.
(10:51):
Sometimes people talk about this concept of self-medicating, okay, or that this is about stress relief or whatever. Do you have any thoughts that you'd like to share about that?
And some people who I take care of who are still using when they're pregnant, you know, they often started drug use quite young, like in their early teens, they even have some that have started when they were, you know, nine, 10 years old.
(11:12):
I try to think with them or imagine what, what prompted them to start in the majority of pregnant people who use drugs have a trauma history.
And the majority of them have other psychiatric illnesses in addition to their psychiatric illness related to their addiction, many have depression, anxiety, maybe PTSD, many have ADHD, you know, many women are not diagnosed with that.
(11:37):
And so I think, I think early on in their use, I don't disagree with the idea that, you know, they possibly did, let's say, use some of these medicines to relieve some anxiety or to feel more numb.
When trauma is happening to them to try to like not have it be in the front of their mind when when people are hurting them.
(11:59):
Or maybe they're using some of the stimulants to help, you know, just focus or be in relationships like we know ADHD is way more complex than just not getting your schoolwork done.
It impacts your relationships, your ability to listen to your friends.
In addition, things like ADHD may, may make you like more likely to take risks if it's untreated.
So I think I don't disagree with the concept that when people first started using the drugs, there may be some way in which they were using it to cope with different things.
(12:30):
But I think by the time that I see them, what's happened is now the use is more of a compulsion, right? They're using because their brain is now telling them that they need to use to survive or that the drug is sort of like, I don't want to call it their best friend, but it's the thing that is the most constant in their life.
Because so many other things have fallen away when your use has gotten to the point where I'm usually taking care of people.
(12:56):
I don't necessarily disagree with that as an initial part, but I think it gets very confusing when we're seeing people.
Another point that I can add, something that I've noticed for many people that I work with is, for example, with opioid use disorder, where we may use medications for opioid use disorder like Bipinorphine or Methodos.
(13:17):
Many times when we initiate them on these medicines and it takes away the cravings for the opioids and they're not needing to seek them out or use them compulsively, they feel better from the withdrawal perspective and they're not craving.
They can have a more organized life, but they often feel quite a lot of despair and depression and anxiety right after they get on these medicines because they're not numb in the same way.
(13:47):
And now many emotions that were sort of like tampered down by the substances are more present for them.
So I don't think that the drugs, the opioids that they were like treating the anxiety or the depression, but they were putting a big lid and they were making it, you know, so the people weren't caring so much.
You know, we know that opioids, one of the things that they do, they don't necessarily decrease pain so much as they make you just not be so upset about the pain, not care as much about the pain.
(14:16):
And it does the same thing for the emotions. So I think the concept of self medication, it can get a little tricky for people, but those are the ways in which I think it is sort of accurate.
You mentioned opia and you've talked also about methamphetamines. Could you share what are the different types of drugs that we're seeing today or either trans or things that you've seen change in the time that you have practiced.
(14:45):
What I've noticed the most is the increase in the cannabis, you know, as the, as many states in the United States, you know, make that more accessible and less less illegal.
We see more and more people using cannabis during pregnancy.
Many are using small amounts, but others are using quite a lot and they're using very potent things like the waxes and the oils and the dabbing and so forth.
(15:14):
What about alcohol?
I'm getting all red people can't see if they're only listening to the recording, but I'm getting all red because we often forget about that and that's very dangerous to forget about because people switched to it.
Right people who use other drugs will switch to alcohol because it's not illegal. And the focus for many people who use drugs, you know, is that they don't want to lose custody.
(15:38):
But they do want to parent at least the ones that I take care of and so they they fear Department of Child Services or someone coming in to remove their child.
And so they think of alcohol as perhaps safer because it's legal and you know, they're not going to get arrested for it.
But unfortunately in terms of the developing brain, alcohol is very dangerous and just like I forgot right here as we were talking, we often forget to ask people who are using other drugs about alcohol.
(16:07):
Because we're so focused on the opioids or so focused on the benzodiazepines.
It's a good reminder to all of us to make sure we're asking people about every single thing.
Like if you're using chaotically and you're getting arrested, obviously you're not getting ideal care if you're imprisoned in any way.
And if you're trying to avoid the Department of Child Services and detection, many of our pregnant people, they just don't show up till really late, late in their pregnancy.
(16:34):
They're trying to kick it on their own and show up when they have nothing in their system or they're, you know, they're just trying to be as little noticed and trying to sort of evade all that so that they're not detected.
And overall, I think the general person on the street would probably say, you know, there are associated harms with using during the course of pregnancy.
(17:01):
And I also don't want us to forget that those lifestyle and behavioral types of things that just aren't only involved during the course of a nine month pregnancy, but in the postpartum and early parenting period.
That may have negative consequences for babies and children.
(17:23):
I'm really glad you're mentioning the postpartum period because that is actually the period that I'm actually most interested in in terms of how we can help people.
I think during pregnancy, like we said, there's the immediate consequence of feeling your action impacting the fetus.
But once the fetus is outside your body, you know, many people, they are so motivated by that. They don't need anything else sometimes to stay sober.
(17:48):
It's really like that plus the doctor, they come to us, they are feeling motivated, they're not quote unquote messing up, but as they would call it.
But once you deliver and, you know, you separate the consequence, the consequence is not in your body anymore. It's outside the body.
And the people who unfortunately, like maybe didn't weren't able to do all the work to add coping skills and to make all the connections that they needed.
(18:11):
And even once that are doing well during pregnancy, we find a lot of people resume use by just thinking like, well, I'm so tired in the postpartum period.
What if I just use a little bit of meth to get a little bit of energy? Then I could take care of the baby. Then I could do my shopping or like the patient might say, like, I had all this trauma.
Now I have this baby who's crying, it really triggers things for me. I'm just going to use a little bit of opioids because then I can be numb and I can take better care of the baby without being so stressed.
(18:39):
And then, you know, we know that that can progress quickly to quite a lot of use.
And so I like to say, I have a talk that I give and it's called like pregnancy at time of opportunity and peril.
Because the postpartum period is like a high risk of death for a person who can be pregnant, then never having been pregnant.
(19:01):
Okay? So she have a woman who uses drugs who never gets pregnant in the same time period. There are studies on this.
They are more likely to die from an overdose in the postpartum period than had you never been pregnant.
So even though the pregnancy itself is lower risk for overdose and people are using less drugs, the postpartum period is higher risk for overdose than had been never been pregnant.
(19:28):
So that, I mean, that's a really scary thought because many people think, oh, when you're pregnant, this is when you're going to stop.
Even the pregnant person themselves, they say, I'll never use again. My baby is going to fix it all for me. But as many of us who've been postpartum like myself, you know, I was not depressed and anxious before and I was in the postpartum period.
(19:50):
I'm not a person who uses drugs. So that wasn't, you know, what I went towards, but someone who then becomes depressed and anxious in the past, they've, you know, that's how they've dealt.
So I said most people who are become pregnant and use drugs, 70% have a risk of having had depression before that gets triggered off and then we're off to the races, you know, as you well know, Dean, the main way to treat addiction is nothing to do with medication.
(20:18):
It's connection to other people, you know, it's becoming more connected to people and less connected to the substance.
What happens in the United States in the postpartum period is a lot of isolation for people, you know, and so it's a very dangerous time.
Exactly. And we also know in the case of pregnant people that may have an opioid use disorder after that period of abstinence during the course of the pregnancy, people's tolerance may go down and they may return to using the same amount they were using before.
(20:53):
But now they find themselves in an overdose situation.
I'm on the maternal mortality review committee and we look at some of these cases and you do see people that were doing well and it looks from, we don't know for sure, but it looks like it's a one time use is just, yeah, people don't know what's in the drug supply anymore, right?
(21:14):
Like when you're using you become very savvy to what's out there and when you're not using anymore, you just don't know as well. You're not, you're not in the know and one time can just get you, especially with these fentanyls, car fentanyls, with these xylazine that's in the, in the drug supply now.
And then the other thing that we see are the mixed overdoses, right? The people that are using the stimulants plus the sedatives together, they're just doing a number on their hearts.
(21:42):
And as you said, they were, they were not using anything and their body is just shocked to death basically it's a terrible, it's really a terrible and scary phenomenon.
I'd like us to shift if we could to this notion that sometimes pregnant people are reluctant to seek care and get involved in care.
(22:05):
Can you share your thoughts on kind of what helps drive that fear?
And the fear and the stigma, not just the stigma outside of the person, but the self stigma that someone sort of develops, I think we could call it over the time course of their substance use, right?
The pharmacy will treat them differently, the emergency room, doctors, people will say, well, you shouldn't be doing this.
(22:30):
Like as we know, scared straight just is one of the worst techniques that exists and I try to be really thoughtful when I'm talking to people about the risks of the substance is even alcohol, etc.
And to try to do it in a way where it's not about scared straight, but it's like we're on the same team and here's what we're trying to prevent.
(22:51):
And honestly say I have never taken care of someone who I think does not care about their baby that I've never had that experience I always find that they care, but that doesn't mean you can immediately stop, right?
It's an illness for a reason changes have happened to your brain.
I can think of a recent experience right was meeting with someone who is pregnant and who's on people, nor feeing and struggling with other substance use and she's not been completely open with me with everything she's used and we've seen through some drug screens that there's some things in there that she wasn't talking to us about and you know, I had to address that with her and someone could say well she's lying to you she doesn't care.
(23:33):
And I think much more it's like she's trying to show the best face to me that she can so that I'll continue providing you know meds that are really helpful she's not using any opioids the people nor fee is helping.
And of course she's afraid of losing that if she's open about everything and then in in fact by not telling me that is actually putting that at more risk because it makes it more dangerous for me to you know to provide the medicine.
(23:56):
So we had to have a really open talk about that and she was you know she was upset she was crying she was an angry at all with me which everyone in the office predicted she was going to get mad and yell at me.
That didn't happen at all you know she was crying she was embarrassed and she was angry of course that she got like sort of found out or outed in this way but I don't know what the outcome will be you know of how this discussion will impact things but she agreed to do more intensive treatment.
(24:24):
I think the main thing that stops people from coming is fear of DCS and stigma and then the other things that stop people from coming are just real life things like having to work other appointments the cost of treatment you know prior experience of it not helping.
We know high quality substance use treatment in our country is not enough so many people have tried less than full treatment and it hasn't been helpful and so they just they're hopeless about it helping.
(24:55):
I think those are some of the main reasons that I see with why people don't don't see treatment.
And I've always been working with this population I try to help people understand you know these are patients that love their babies and many times they have other children people have so much loss you talk about the older children so many of them haven't been able to parent those older children and they've done studies on this they did a beautiful study where they interviewed 15 women who lost their kids to the system.
(25:26):
And the kind of grief that they described the way they felt about the losses it you know even if the though the children were still living and many of them could still have some contact but it was as if it was similar to what people describe when they had lost the child to death you know the impact of those losses is really significant and it really does increase the risk that people will continue using.
(25:52):
So we have to think about the losses in the trauma I mean the trauma in this population is just it's just staggering what people have been through your passion for this population I have always perceived as infectious.
These are treatable illnesses these are illnesses in their treatable and we have we have a lot of tools medications therapy support groups peer recovery you know there's so many things that we can we can leverage to help people so when I meet people for the first time that are going through this and even subsequent times like as hard as it is like I do feel a lot of hope for them because through all this throw these hardships they've made it to the office you know it's not very easy to get an appointment with you.
(26:38):
It's easy to get an appointment with me to get there and to be there so I feel like well they've overcome a lot to be here and that makes me hopeful that they tried so hard to get there I know that means they they have a fighting spirit and they have a chance and and I'm excited to do this work and be there with them and figure out what are the pieces of the puzzle they'll be able to put together that's going to help this person to get to what their next goal is.
(27:04):
[Music]
Addiction and motherhood two worlds that seem impossible to reconcile yet for so many women they collide in ways that redefine their lives.
(27:30):
On today's episode we're sharing Ashna Clark's incredible journey.
Ashna's childhood was shaped by challenges many of us might find hard to imagine growing up with a single mother who struggled with mental illness and substance use.
She learned early that alcohol was a way to cope.
(27:52):
It was a lesson she carried into her teen years a period defined by instability and hardship.
I did end up leaving my childhood home at 14 by that age I knew that what I was living in wasn't right I knew it was toxic I didn't want to be around it so I moved in with my boyfriend at 14 which was yet another toxic situation.
(28:20):
When I was 16 and I was living with my boyfriend I was also living with his mother and a shooting accident had actually happened and he had shot off most of his left hand.
And so at the same time that he had this accident I had found out I was pregnant.
Well during that accident for him that's when they prescribed him opiates to cope with the pain and that was when he really spiraled in his addiction which for me to cope for that.
(28:49):
I spiraled in my own addiction and so I was actually smoking weed the whole pregnancy for my son.
Pregnant and calchopping with her boyfriend she was confronted with a daunting reality of bringing a child into a world she wasn't prepared for.
I remember the feeling of finding out that I was pregnant because I was super excited that okay everything that my mother had done wrong I was going to do right with this baby.
(29:13):
And just in a child like my set I was thinking this was my little baby doll and this is where I'm going to do everything right and I'm going to love it so much and that's going to be enough.
And I felt like I could not go to get prenatal care or go to a doctor's office because I knew that once they were going to have you you know give them a screen.
(29:35):
And it's usually just even show that your pregnant but that fear of they're going to have this idea about me they're going to report this is not that fear led me to not receiving any prenatal care for any of my children except for my my first born.
Had I not had that fear of what these doctors and what these people are going to think of me I think if that had been different than I probably could have received the help a lot sooner.
(30:02):
During the time that I was pregnant and watching the father of my child.
Like spiral further into his addiction I realized how alone I really was and I kept every day worrying about okay so I feel super super alone I have no one who I can lean on I have no idea what I'm doing how am I going to support this thing that is a living being and you know make sure that it's going to survive and have all of its needs and my.
(30:31):
And it was a really daunting feeling at that age to wonder how my boy someone who can't even provide for themselves how am I going to provide for this baby that I already love so much and haven't even met yet.
I remember giving birth to him.
(30:52):
While I was at the hospital my father my child he was passed out due to being high and he missed the entire birth and.
In that moment really passionate a heartbreaking choice to give her son the life she couldn't provide.
(31:13):
And so I did end up giving him a production.
But that decision didn't lead to immediate change instead it marked the beginning of a journey that would take years to find its footing.
(31:38):
And 17 Ashna left Indiana for Nebraska to reconnect with her strange father.
But instead of stability she found herself drawn deeper into addiction this time alongside him.
I stayed with him for a little bit he was addicted to Smith and Femines my sobriety then at that point was just because I had looked so it was maybe only a few months long.
(32:05):
I then had actually gotten high with my dad and that's when things started to spiral again for me for a couple years up until about the age of 24 is when I was really kind of spiraling myself with the alcohol in the methamphetamines.
And then I met a guy who was really into fitness and all this kind of stuff.
(32:27):
So what I ended up doing was jumping on that bandwagon with him. And so I dropped the methamphetamines I was just drinking on the weekends type thing I was doing the kitchen catering business and everything was okay for a while.
But with what I have the disease that I have the alcohol on the weekends slowly changed to alcohol in the evenings and the weekends and then it was alcohol all day.
(32:52):
And I was still functioning addict at that time I was still doing the kitchen catering thing it was still working well for me and then up until it wasn't I was starting to show up to work drunk.
I started taking Xanx to try to win myself off of alcohol which is not a thing.
And then I ended up losing my job for smelling like alcohol and slaring my words at work. And a job that was very good to me provided well for me.
(33:23):
I had my own apartment in my own car all the things that I was going to be so proud of for when my son was to reach out to me one day.
All the things I built up to show him like look mom did not give you up for just nothing you know like this is everything I did so that we one day you could come back to me.
All of that I ended up losing because of my drinking so.
(33:48):
There were moments of clarity. Ashna tried to build a life but the grip of addiction was unrelenting and by her late twenties she had lost everything including her sense of self worth.
It was a Facebook call that brought a glimmer of hope her first born son now twelve reached out for Ashna this was a sign an opportunity to start over but as she returned to Indiana the challenges of addiction follow her.
(34:24):
So I packed my car full of everything I had I called up his father and I said hey I'm going to be moving back can I stay with you for a little bit until I can get on my feet.
And nine hour drive it took me about sixteen hours because at that time I was really still heavy in the alcohol.
I could not go more than a couple hours without starting to have these keys and I moved in with the father my son and he yet again showed me that he was into methamphetamines I quit drinking the day that I started doing math.
(35:03):
Unfortunately what had happened right before that was my son had called me for one of our phone calls you know it we don't even talking for about a week.
I called to let him know that I was back in Indiana I don't remember the conversation because I was drunk and because of that all communication with him was stopped.
(35:26):
And so at that moment I felt like I had nothing else to lose and so I started doing methamphetamines.
Despite her best intentions addiction continued to a road her life pregnant again she found herself in an abandoned house heating refried beans over candlelight.
(35:48):
It was a moment of reckoning a realization that she needed help.
I just remember thinking if I give birth to my son right now nobody's ever going to find me like I could die in this band of giving birth to my son and no one's ever going to know.
And in that moment that terrified me and so I have reached out to my sister who I had not spoken to in about sixteen years from when I had left in the first place.
(36:18):
And I let her know that I was in a really tough situation and I needed needed help in that surprise the maintenance pregnant.
I have an addiction I have a problem and asked if I could go live with her.
She agreed and I was sober for about three months.
I'm long enough for me to give birth to my son of course he didn't have anything in his system because I had just stopped you know right before.
(36:46):
So there wasn't like a DCS case to step in and I felt safe at my sisters until that it started to come back of you know I'm really kind of bored.
So I think I want to try something else.
And so I thought okay well I can be mommy and get high and no one will be any wiser you know.
And it's a whole attic thinking like that obsession is so hard.
(37:10):
When you don't know that there is another way that obsession takes hold and so every day that I'm sitting there holding my son I'm like you know I bet you this would feel you better if I was high.
And so three months after my son was born I reached out to some of the people that I used to get high with.
And one day one of them came to pick me up and I was just gonna go down to hang out for a couple hours and I never went back to my sisters.
(37:37):
I had my son there with me and even in that moment I thought that I was the best mom ever I thought it was a ball day playing with my son during the day up all night cleaning up the house up all day playing with my son up all night cleaning the house.
And I thought in my head that that was me being a good mom because you know he had his basic needs met and I was still doing all this other stuff and that just wasn't the case.
(38:05):
Even as she tried to find stability addictions poll was strong.
The day before my son was to turn one I got knock on the door and it was the cops they were coming in to look for the guy I was with at that time he had a multitude of warrants that I was not aware of but they came in looking for him they found me in my son because of the conditions at the house because of you know all the other sub drugs.
(38:34):
My son was removed the day before his first birthday and I remember sitting in the back of the cop car and I felt like my soul had died that day like I was already it took about 10 years for me to feel like previously with giving my first born out for adoption it took about 10 years for me to feel like that whole was starting to close up a little bit and then sitting in the back of that cop car knowing that it was going to be.
(39:03):
I was going to be months before I could see my son again I just felt like I died and that was the moment that I thought okay it's now or never you need you need to change.
And you would think being in the back of the cop car losing your second child you know that that would be enough and even still it wasn't.
(39:26):
I was jailed to an empty house the guy was with at the time he ended up leaving with all my stuff and I just kind of crumbled I stayed in that house for a little while just kind of soaking in the emptiness and just realizing like all the things that I had done that led me up to this moment and how was I going to fix it.
(39:53):
My solution at that time was still to get high and so that happened for about maybe about two years until I got pregnant with my daughter.
And similar situation happens where I am in jail with her seven months pregnant for a violation on probation for a dirty drug screen.
(40:16):
It wasn't until she faced the devastating removal of her son and the prospect of giving birth in jail that she found the strength to surrender sitting there in that jail that time that was when something hit me and I was like you were going to have three children and not raising a single one.
(40:38):
All you've ever wanted to do in your life was to care for something the way that you felt like your mother should care for you. And so in that moment I was like it is it's truly now or never I refuse to lose another child because I can't get myself together.
And so that was the moment that I really surrendered and I was like if there is a God please help me.
(41:02):
That chance led her to heart rock recovery a program designed for pregnant women and mothers seeking a new path for ashtah it was more than just a program.
It was a lifeline.
So I was 32 weeks I might have been 33 weeks and so heart rock accepts you if you are pregnant or if you have a child and you were trying to reunite with your child.
(41:29):
And you're someone who suffers from substance use disorder. There is an application online the steps are you apply you get a phone interview and then after that you're put on a wait list which typically is a long wait list things change all the time.
I was told that I was third on the wait list and in a matter of a week I was in the house.
I have a really good support system here and living in communal living especially with moms and babies it's a different kind of atmosphere like I had sisters you know and I kind of lost contact with them but being here it's like a different kind of sisterhood and then my daughter has all these little baby sister and brothers you know.
(42:10):
And she just to watch her bond with other women here and watch her bond with other children and then maybe able to have that same bond.
There's a sense of family here that I was searching for my whole life that I never about you know never knew that I needed and wanted but coming here I have found that and I know communal living can seem terrifying to some people like why would I want to be with all these different people on this mat.
(42:36):
But the thing about it is I would have wanted any other way I mean why would I want to I've already felt alone my whole life why would I want to now go through this whole new thing of being sober and being completely in my feelings now and why would I want to do that alone I want to do that with other people who finally understand how I feel and who are feeling the same thing.
(42:58):
There are still struggles there are still moments you know where I get frustrated recent one is when I hit my one year sobriety.
It was also at the same time that the no contact order with my four year old had ended so I ended up getting a turn and I am currently in the custody battle for him.
(43:19):
So and there's struggles with that because there's a lot that I'm going to have to face I you know there's a lot of accountability that I have to take on my end because I did hand the people who have a broken child and you know I have to take responsibility for that and it's been through the program and been through the support and the honesty of you know everyone here at heart rock that I'm able to now see that and can take that and hold that with what I'm supposed to.
(43:49):
Today Ashina is thriving as the child advocate at heart rock she uses her experiences to guide other mothers helping them find their voices and rebuild their lives.
I currently am the child advocate at heart rock so I am the voice for the children but I also walk beside the mothers and so it's a really unique opportunity for me because where I feel like I had failed my sons.
(44:17):
And I wasn't I was someone who should have been their voice and I wasn't I am now in a position where I'm able to guide other women into being that voice for their children and it's it's been a really special opportunity to feel like I'm fulfilling a part of me that I had failed with my sons.
(44:38):
Ashina's vision for the future is simple yet profound to raise her children with the love and stability she wants long for.
It's a dream she's working toward every day fueled by resilience and hope.
So my true vision of my future is me in my own apartment and with both my son and my daughter and you know just kind of enjoying that life of watching my children be able to grow up together and be able to grow up together.
(45:07):
And watch them be happy and I would still be at heart rock working as the child advocate.
I just in this position I have such a calling for that I never realized I wanted or needed and I just my future is me being the mom that I always wanted to be.
(45:28):
And that's a big motivator for me.
Ashina's journey reminds us that recovery is not a straight line but it is possible her courage to face her past fight for her future and support others along the way is a true testament to the strength of the human spirit.
(45:50):
To all the mothers out there who are struggling Ashina's story is proof you are not alone and there is always a way forward. Please reach out for help. We are here for you.
You know having a history of working with pregnant women who have substance disorders disorders. You know that stigma piece is so kind of far reaching and keeps people out of care and I remember I had a program in the 90s you know and I was always kind of amazed by the misunderstanding of that population and misunderstanding of them as the clients as mothers.
(46:39):
You know motherhood is such an instinctual kind of dynamic and that mothers automatically love their children for the most part although I'm sure there may be exceptions but I think that's really kind of the that's kind of the overall kind of rule rather than the exception.
And the whole idea that you know people think that they don't love those children and they don't love those babies is always been such an enigma to me and my my experiences told me they absolutely love those babies and and want the best but it is a very powerful demonstration of just how powerful an addiction can be.
(47:24):
That takes over and that that kind of drives the behavior in it and I think that's so misunderstood.
I agree 100% with that Dean it's it's really it's really sad to me and just even the work that I do in the jail with women program you know most of the women are mothers you know they've lost their children so many of them and and people don't understand that you know how would that become before your
(47:53):
your children and but you know like you said it's just the power of the addiction.
And you know I've also thought about this a lot which is sometimes certainly in the health care system in particular we throw up little barriers and we don't understand that you know sometimes our behavior like if you miss an appointment you have to call back in and you know we close your charts if you miss so many appointments and I think when it comes to you.
(48:22):
And I think when it comes to this population that we need to keep in mind that this is very high risk for both the moms and for the babies and all of our actions really should be geared toward how do I help this mom keep her next appointment and keep her engaged in care and that to me is kind of the bottom line we should do everything we can to keep them in care.
(48:50):
Yeah I mean I think it's just so important to not stigmatize this population it was a great conversation I had with Ashna and I learned a lot about just her story which was very powerful so I think this this is going to help a lot of people have a better understanding so thanks for our guest for their willingness and participation.
(49:13):
In our next episode we'll be talking about drug trends and how the drug supply has changed over the years and currently what's out there and take a closer look at that with the very kind of renowned researcher who really kind of looks at drug trends in Indiana.
Thanks everyone and see you next time.
(49:35):
If you feel you need assistance please reach out to a counselor or other healthcare provider, supportive loved one or contact resources in the community such as 211 where you can be connected to assistance or talk with a peer or counselor.
Beyond Substance is hosted by Dean Babcock and Jody Miller.
(49:56):
A look at the numbers segment is hosted by Angela Shamblin. Beyond Substance is produced by Angela Shamblin and the executive producer is Shawn P Neal.
#AdvoCast #ShawnPNeal #SubstanceUseDisorder #Pregnancy #Recovery #Addiction #SUD
(50:26):
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