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Competency 4: Prevention

Addiction Disorders in Women

Appropriate Preconception Planning Methods

Prepregnancy counseling is critical for all women of childbearing age and is important in preventing FASD.11 Many women drink in the early stages of pregnancy, before they know that they are pregnant. In addition, about half of all pregnancies are unplanned.12 Women need to be encouraged to plan their pregnancies and to abstain from alcohol use before and during pregnancy.11

Male doctor

Addiction professionals can help by talking to their clients about the dangers of alcohol use during pregnancy. Discussing plans for pregnancy is also important to promote a healthy, alcohol-free pregnancy. Women with alcohol problems may need assistance with family planning to avoid pregnancy while they are drinking. Motivational interviewing plus a contraception counseling session can decrease the risk of an alcohol-exposed pregnancy in women in high-risk settings.13

Issues to discuss during preconception counseling include:

  • The various methods of contraception and the attitudes of the woman, her significant others, and her community regarding their use. The addiction counselor might need to refer the client to family planning resources and to follow up with the client
  • The impact of alcohol and other drug use during pregnancy on the woman and the fetus.
  • The teratogenic impact of prescribed medications, such as Antabuse and various anticonvulsants. Again, a referral might be needed, since most addiction professionals are not trained in pharmacology.
  • Alternative medications with reduced or no teratogenic potential for such common problems as seizure disorder. An obstetrician or geneticist can recommend such medications.

Clients who temporarily require medications such as Antabuse, or those who choose to postpone childbearing, may want an effective, reversible form of contraception. Women who use substances and who have a history of irregular menses and involuntary infertility need to know that sobriety or the successful initiation of a recovery program may result in a resumption of ovulation and an increased risk of unplanned pregnancy.14 Such clients need referrals to appropriate specialists. Addiction professionals need to be familiar with available specialists in their area.

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