Good Idea? Bad Idea? Integrating Family Planning & Substance Use Disorder Treatment Services
Treatment for substance use disorder is delivered to a substantial number of female clients who are of child-bearing age. During the course of treatment, the reproductive healthcare needs of clients such as contraception are often not addressed at all, or are handled by using referrals to off-site services.
However, is this what providers and clients think is the best option for supporting recovery?
WHAT PROBLEM DOES THIS STUDY ADDRESS?
Unmet reproductive healthcare needs among women with substance use disorders can cause a range of poor health outcomes at birth.
Women constitute a substantial proportion of substance use disorder treatment admissions in the US totaling about one-third annually.
Approximately 90% of pregnancies among opioid-using women are unintended compared to 51% among the general population.
Reproductive health services that are offered during substance use disorder treatment may reduce unplanned pregnancies and substance-exposed pregnancies and improve the quality of life for women in or seeking recovery.
However, not much information is available regarding the knowledge, beliefs and attitudes of substance use disorder treatment staff regarding family planning, or the integration of reproductive health services. The main goal of this study was to describe the staff and clients’ knowledge-base of reproductive health information. In addition, the researchers sought to determine the level of support for the integration of family planning services into substance use disorder treatment.
HOW WAS THIS STUDY CONDUCTED?
This qualitative study was conducted in three substance use disorder treatment centers in Baltimore, MD from 2013-2014. Two treatment centers were residential programs for women with young children, & the third was an outpatient medicated-assisted treatment program. Data was collected through 6 focus groups with female clients which resulted in a sample size of 41 with an average age of 36 years. 3 staff focus groups resulted in a sample size of 23.
There were 9 in-depth interviews targeted at higher level staff such as physicians, nurse practitioners and managers, registered nurses, and clinical and program directors. The data was then coded for themes and commonalities through multiple coding iterations. This research design enabled the authors to assess the staff and clients’ knowledge-base of reproductive health information and determine the level of support for the integration of family planning services.
WHAT DID THIS STUDY FIND?
Clients’ statements showed they had knowledge about contraceptive options, side effects, and benefits. None of the clients verbalized disapproval of the idea of contraception, and most showed support for women using birth control. Clients expressed contraceptive preferences based off their need for disease prevention and family planning.
Treatment & Family Planning
Many clients expressed that their decisions and attitudes around family planning were influenced by substance use disorder treatment through making them more conscientious regarding taking care of their overall health and the role it can play in supporting recovery. Clients reported that easy access to contraception should be routine, and it should be perceived as a part of a healthy lifestyle change they make during their recovery.
Gaps in Clients Knowledge
There were numerous misconceptions and doubts about contraception and its side effects within participants statements. Many clients’ decisions about contraception were related to the belief that they could not get pregnant while they were actively using substances.
Client’s Access to Contraception & Family Planning While in Treatment
Barriers to accessing contraception and family planning services while in treatment included: (1) not being asked at intake about family planning, (2) unable to get prescriptions filled, (3) long delays between getting permission to make an appointment with an outside provider and getting an appointment, (4) challenges in following through with referrals made to outside providers, and (5) unaware if they could speak with their staff and healthcare professionals at their treatment center about these issues.
Interest in Services & Education
The majority of clients reported that they would feel comfortable receiving services in their treatment centers, and would even prefer onsite services. Some participants suggested that counselors could deliver family planning education, referring to high levels of trust in their counselors.
Provider Attitudes & Beliefs
Several providers said that they were hesitant to invade on personal choices by “stepping on clients’ toes”. Providers also expressed that family planning issues are outside of treatment programs’ priorities. Almost all providers stated that their jobs were to focus on addiction-specific issues, not on family planning. Despite their hesitations, largely, staff felt that offering family planning services on site would benefit their clients.
WHY IS THIS STUDY IMPORTANT?
This qualitative study has several implications for the potential of integrating family planning services into programs designed to treat substance use disorder.
Female clients receiving substance use disorder treatment are indeed interested in using contraception for the purpose of family planning & disease prevention.
Clients have experienced barriers to accessing reproductive services while in residential treatment which can result in disruptions in healthcare and unintended pregnancies.
Regarding on-site versus offsite referrals for family planning needs, the clients preferred onsite. The staff also made several contributions in describing the potential to address reproductive healthcare and educational needs at an addiction focused treatment center. Time constraints and conflicting priorities were discussed including a desire to not overstep patients’ personal, and staffs’ professional, boundaries when working with clients.
Overall, providers indicated that family planning and education were important and should be provided at treatment centers. The staff also felt that reproductive healthcare services should be received onsite at the treatment center, though highlighted several obstacles to implementation, including time limitations and varying staff levels of comfort with the topic.
- This is an exploratory qualitative study. Thus, while highly informative, it is premature to provide definitive advice around program policies. However, this study has contributed to the early knowledge-base of client and staff perspectives on addressing family planning in substance use disorder treatment as a way of improving overall health to support recovery.
This qualitative study has generated unique data on provider and client perspectives on the interests and barriers to addressing reproductive healthcare in substance use disorder treatment. The next steps are to use the qualitative responses to inform a quantitative study, and determine the effect of integrated healthcare on long-term recovery.
In addition, the authors advise that family planning interventions should be mindful of any misconception that all women should be able to choose if and when to have children throughout their lifetime.
- For individuals & families seeking recovery: At this point, the groundwork is just being laid for the potential of reproductive services to be fully integrated into substance use disorder treatment centers as a standard of care. You may find these services are offered to varying degrees depending on where you seek treatment. Nonetheless, talk with your providers about initiating reproductive healthcare or minimize disruptions to ongoing healthcare routines (e.g., annual exams) to maximize your quality of life in recovery from alcohol or other drugs.
- For Scientists: This study has uncovered some important information regarding the interest and potential of delivering reproductive health services in substance use disorder treatment programs. Both clients and staff agreed that on-site services would be a better option than off-site referrals however the staff expressed reservations regarding competing priorities and level of comfort with the topic. More work needs to done to determine if the health of substance use disorder patients is improved with integrated reproductive care and what supports are needed to make the transition.
- For Policy makers: This initial qualitative study has found that both providers and clients agree that reproductive healthcare services should be integration into substance use disorder treatment centers. Primary care has already received some lines of funding for integration into substance use disorder treatment; however, family planning is lacking. Consider prioritizing policies and research to better understand the potential impact of integrated reproductive healthcare services and the barriers that may arise.
- For Treatment professionals and treatment systems: The reproductive health of female clients is often not addressed during the course of intake or treatment for substance use disorder. Be aware that opioid-using women are more likely to have four or more pregnancies in their lifetime and five times more likely than the general population to have a history of an abortion which may, in part, reflect a lack of access to reproductive healthcare. As part of a comprehensive plan for recovery, consider taking assessment of your client’s family planning preferences and facilitate access if the issue is raised.
Robinowitz, N., Muqueeth, S., Scheibler, J., Salisbury-Afshar, E., Terplan, M. (2016). Family planning in substance use disorder treatment centers: Opportunities and challenges. Substance Use & Misuse, 51(11), 1477-1483. http://dx.doi.org/10.1080/10826084.2016.1188944