Contents INTRODUCTION 1 EFFECTS OF THE DIFFERENT SUBSTANCES ON THE FETUS 2 Marijuana (also known as weed, pot or grass): 2 Cocaine: 2 Alcoholism 3 LAW AND SUBSTANCE ABUSE MOTHERS 4 THEORIES OF SUBSTANCE ABUSE 6 Biological Theories 6 Genetic Factors 6 Metabolic Imbalance 7 THEORECTICAL PERSPECTIVE 8 MANAGEMENT AND TREATMENT 10 SOLUTION TO PROBLEM 11 EXPECTED RESULTS/TIMEFRAME 12 CONCLUSION 13 REFERENCES 14 PICTURES ILLUSTRATING PREGNANT SUBSTANCE ABUSE WOMEN AND FETUS 15

INTRODUCTION
Social problems exist at the door step of every community it has been in existence decades ago and still lives on today. Social problems can be defined as an issue that relates to society’s perception of an individual’s personal life and their behaviour is considered to be out of the norm. Substance abuse has vast becoming an epidemic in today’s society and it is considered as a social problem. Substance abuse is one thing but to see pregnant women abusing these endangering substances is another issue. People use drugs for many different reasons but for a pregnant woman to use drugs she may be mentally ill or depressed. Substance abuse may not have a serious or long-lasting effect on you but the same is not always true for a foetus. Mothers that abuse substances give birth to "drug babies." These children have serious developmental problems.
Researches show that using substances legal or illegal during pregnancy has a direct impact on the foetus, whether smoking, consumption of alcohol, or ingesting caffeine. If you use marijuana or cocaine, your foetus also feels the impact of these dangerous drugs. If you are addicted to heroin, you are risking the health of your unborn baby. The use of drugs during pregnancy also increases the chance of birth defects, premature babies, underweight babies, and stillborn births. Consumption of illegal substances is not safe for the unborn baby or for the mother. Studies have shown that consumption of drugs and substances during pregnancy can also result in miscarriage, even maternal death.

EFFECTS OF THE DIFFERENT SUBSTANCES ON THE FETUS
Marijuana (also known as weed, pot or grass): * Marijuana crosses the placenta to your baby and like cigarette smoke, contains toxins that keep your baby from getting the proper supply of oxygen that he or she needs to properly develop. Marijuana in pregnancy is said to be inconclusive because many women who smoke marijuana also use tobacco and alcohol. Smoking marijuana increases the levels of carbon monoxide and carbon dioxide in the blood, and this reduces the oxygen supply to the baby. Pregnant mother that smoke marijuana increases their chances of miscarriage, low birth weight, premature births, developmental delays, and behavioural and learning problems.
Cocaine:
* According to the Organization of Teratology Information Services (OTIS), the use of cocaine during the early stages of pregnancy can lead to miscarriage and later stages, cocaine use can cause placenta abruption. Placental abruption may lead to severe bleeding, preterm birth, and foetal death. OTIS also conveys that the risks of birth defects are greater when the mother use cocaine frequently. According to the American Congress of Obstetricians and Gynaecology (ACOG), women who use cocaine during their pregnancy have a 25 % increased chance of premature labour. Babies born to cocaine abuse mothers in the early stages of pregnancy tend to be smaller and babies exposed to cocaine later in pregnancy may be born dependent and suffer from withdrawal.

Alcoholism * Alcohol consumption during pregnancy causes birth defects called Foetal Alcohol Spectrum Disorders, or FASDs. The March of Dimes website states that up to 40,000 babies are born with a FASD each year. Addiction to Alcohol should be treated very early in the pregnancy since the baby develops the most during the first trimester. Alcohol withdrawal symptoms that are mild as tremor and agitation last a short

LAW AND SUBSTANCE ABUSE MOTHERS

There are currently no law that holds prenatal substance abuse as a criminal act of child abuse and neglect. In Trinidad and Tobago and world-wide, governments have expanded their civil child-welfare requirements that include substance abuse during pregnancy as grounds for terminating parental rights in relation to child abuse and neglect. In Trinidad and Tobago this is enforced in the Domestic violence act and children act.
The laws that address prenatal substance abuse in some US States and other countries are as follows: * Iowa, Minnesota, and North Dakota’s health care providers are required to test for and report prenatal drug exposure. Kentucky health care providers are only required to test. * Alaska, Arizona, Illinois, Louisiana, Massachusetts, Michigan, Montana, Oklahoma, Utah, Rhode Island and Virginia’s, health care providers are required to report prenatal drug exposure. Reporting and testing can be evidence used in child welfare proceedings. * Many states and countries consider prenatal substance abuse as part of their child welfare laws. Therefore prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. These states include: Arkansas, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Minnesota, Nevada, Rhode Island, South Carolina, South Dakota, Texas, Virginia, and Wisconsin. * Some states have policies that enforce admission to an inpatient treatment program for pregnant women who use drugs. These states include: Minnesota, South Dakota, and Wisconsin. * In 2004, Texas made it a felony to smoke marijuana while pregnant, resulting in a prison sentence of 2-20 years. * In Trinidad and Tobago there is the domestic violence centre which assists in the rehabilitation of pregnant substance abused women.

THEORIES OF SUBSTANCE ABUSE
The following theories would assist in explaining and understanding phenomena of substance abuse.

Biological Theories
Biological theories are specific physical mechanisms in individuals that may influence them either to experiment with dangerous substances or to abuse them once they are exposed to them. The environment plays a vital role in the influence of substance abuse. Two theories that give an explanation of this are genetic theories and the theory of metabolic imbalance.
Genetic Factors
It was stated that the genetic makeup of individuals predisposes them toward drug abuse and alcoholism. A gene or combination of genes Influences the specific biological mechanisms relevant to substance abuse such as being able to achieve a certain level of intoxication when using drugs, becoming ill at low doses as opposed to much higher doses, lowering or not lowering anxiety levels when under the influence, or having the capacity to metabolize chemical substances in the body. Any and all these factors could vary from one individual to another or from one racial or national group to another, and could influence continued use. This “genetic loading,” in combination with environmental and personality factors, could make for a significantly higher level of substance abuse.

Metabolic Imbalance
This theory argues that metabolic imbalance is a possible factor in at least one type of substance abuse that is narcotic addiction. Developed by physicians Vincent Dole and Marie Nyswander (1965, 1980; Dole, 1980), this theory tells us that heroin addicts suffer from a metabolic disease or disorder, much as diabetics.

THEORECTICAL PERSPECTIVE
Base on my research I can safely say that there is no one theory that explains drug use and abuse in pregnant women. It is the perspective of the Feminist theory that society has a duty to aid pregnant women since they are the centre of the world (Mothers). They support the notion that society has a duty to accommodate special needs of pregnant women and the state must protect the foetus from its mother. They recognize that there are obstacles in the lives of every pregnant woman such obstacles maybe addiction, lack of education and poverty. They believe that society needs to be more aware of the circumstances surrounding these women using drugs so that they would be less discriminative and more incline to aid.

The perspective of social conflict theory on the other hand explains that substance abuse is primarily a problem of structural inequality and class conflict. While substance abuse is generally omnipresent throughout society, social conflict theory argues that minorities, the lower class and other marginalized groups are more likely to immensely suffer negative consequences as a result of substance abuse.

Essentially, the psychological theory explains that drug use and abuse begins because of the unconscious motivations within all of us. So a pregnant woman may not be aware of these motivations, not even when they manifest themselves. There are unconscious conflicts and motivations that reside within us as well as our reactions to early events in our lives that move a person toward drug use and abuse. The motivations for drug use are within us, and we are not aware of them, nor are we aware that those are the reasons we have chosen to turn to drugs. In this case, the person may be weak or without self-esteem or even see themselves in the opposite manner, as all-important. Drug users and abusers in the psychological theory find it incredibly difficult to find some sort of balance in their lives. When they struggle to find that balance and that state of really being okay with themselves, it is easy to resort to drugs of any sort to help restore that balance or peace. Drugs become the way of escaping the pain of being unable to find that balance. Drugs become the way they stop feeling badly about themselves. Of course, these things only last short-term, which is why the user must continue to use. Thus begins the cycle of addiction. They continue to use these drugs to stop feeling badly about themselves, and to cope with mental issues that they may be thoroughly unaware that they even have.

MANAGEMENT AND TREATMENT * Abstinence is said to be the major goal of the management and treatment of substance abuse during pregnancy. Researchers have found that participating in prenatal care alone can improve the outcome of the substance abuse pregnancy and that ceasing substance use during the pregnancy can further decrease perinatal morbidity. Most infants exposed to substances still have good outcomes, and early neonatal interventions can prevent or lessen future neurodevelopmental problems. Major obstacles to treatment include poor social support systems, failure to identify substance abusers during pregnancy, inadequate financial resources, and fear of custody loss with admission to problems of substance abuse. * There is a shortage of treatment programs for pregnant substance abuse women in the States and in the Caribbean. Research shows that in 1989, of 78 drug treatment facilities in New York City, 54% refused to treat pregnant women, 67% denied treatment to women on Medicaid, and 87% denied treatment to pregnant women addicted to crack cocaine. Finkelstein has documented the shortage of substance abuse treatment services available to women, specifically mothers and pregnant women. More recently, Breibart and associates in New York conducted a study to assess availability of substance abuse treatment programs for pregnant women in five U.S. cities, finding that only 80% of the programs surveyed accepted pregnant women; thus, barriers to treatment still remain. * Treatment options include formal counselling programs, self-help groups, women’s shelters, and halfway houses. It was stated that involuntary treatment should be considered when the substance abuser refuses to enter a treatment program and when her behaviour creates significant problems for herself and the foetus.
SOLUTION TO PROBLEM * Education and promotions on the effects of substance abuse and the unborn child should be stressed. * Health and the importance of family life should be highlighted. * Substance abuse is sometimes hereditary so family therapy and parenting skills should be encouraged. * Mental health issues should be made as a compulsory subject in schools. * In order to strengthened ties of support groups of substance abuser the community must be actively involved. * Abstinence messages must be reinforced and strongly encourage young women to delay sexual initiation. * A supportive environment must be created for women to seek and receive counselling for substance abuse, mental health issues and other personal / social problems without fear of exposure and or discrimination. * Trinidad and Tobago needs more up to date rehabilitations centre for pregnant women with issues such as substance abuse.

EXPECTED RESULTS/TIMEFRAME
Substance abuse during pregnancy has become a growing health issue because it not only affects our present generation of our country but also the future as well. It is very evident based on my findings that the occurrence of substance abuse among pregnant women of reproductive age has increased over the years but is expected to lessen within the next ten years.
The decreased is result of constant research, social scientific thinking and policies used to address this issue. Understanding the cause and effect like in the Feminist theory would lead to progress.

CONCLUSION
Someone who is thinking about getting pregnant and wants a healthy baby, then it's very vital that you avoid dangerous substances during pregnancy. Abusing substances such as marijuana, cocaine, methamphetamine, heroine and alcohol is not the only drugs that are harmful to foetal development. Popular used over-the-counter medicines, along with substance such as caffeine, can have lasting effects on an unborn child. Emphasis on adopting healthy lifestyles, including eating balanced meals, conflict management, and avoidance of alcohol, drugs, and other illicit substances must be stressed.
Substance abuse during pregnancy is often very difficult to detect, the health care provider should be more firm in acquiring details about the patient substance abuse history. This can be acquired at the patient first visit and follow questions at every other visit. If substance abuse is detected during pregnancy the health care provider would be able to assist with issues regarding management, treatment, and potential maternal, foetal, and other complications during pregnancy. It also provides the health care provider with an opportunity to make a meaningful intervention at a time when the woman may be most amenable to change. Various management and treatment options exist with the major goal of abstinence and should be therefore able to meet the needs and address the concerns of the individual. By increasing the awareness of substance abuse during pregnancy among the medical community, health care providers may better recognize and address this problem, thus improving the overall health of the population.

REFERENCES Retrieved April 12TH 2014 http://www.nice.org.uk/nicemedia/live http://www.crin.org/resources http://www.samhsa.gov/newsroom/advisories/ http://www.wikipedia.com

PICTURES ILLUSTRATING PREGNANT SUBSTANCE ABUSE WOMEN AND FETUS | | |