Substance abuse treatment outcomes in women with Fetal Alcohol Spectrum Disorder
Aims: There is little literature describing substance use treatment participation or completion rates for adults with neurocognitive impairments, including Fetal Alcohol Spectrum Disorders (FASD). This paper examines inpatient and outpatient substance abuse treatment outcomes among women with diagnosed or suspected FASD compared to women without prenatal alcohol exposure (PAE).
Design: Three-group observational study.
Setting: A three-year case management intervention program in Washington State for high-risk women who abuse alcohol and/or drugs during pregnancy.
Participants: Group 1: No PAE (N = 463); Group 2: Diagnosed with FASD (FAS, ARND, fetal alcohol effects, or static encephalopathy) by a qualified physician (N = 25; 14 included in hypothesis testing); Group 3: Suspected FASD (all reported PAE and displayed behaviors consistent with a clinical diagnosis of FASD) (N = 61).
Measures: Addiction Severity Index and biannual assessment of substance abuse treatment received and alcohol and drug use.
Findings: Women with diagnosed/suspected FASD were less likely than those without PAE to attend and complete inpatient and outpatient treatment. Women with diagnosed/suspected FASD who completed treatment were twice as likely to do so within a structured residential setting compared to a less structured outpatient setting.
Conclusions: Program structure in substance abuse treatment is important for people with FASD because of brain-based impairments. Outpatient treatment participation requires intact executive function skills (e.g., planning, organizing, sequencing), while structured inpatient treatment is not as challenging because it requires less independent decision-making. We suggest routine intake screening, referral protocols for follow-up diagnostic assessment, maximizing program structure to the extent possible, and modified therapeutic approaches to accommodate disabilities.
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