Contents lists available at ScienceDirect Drug and Alcohol Dependence journal homepage: www.elsevier.com/locate/drugalcdep Full length article Treatment for substance use disorders in pregnant women: Motivators and barriers Zane Frazer*, Krystle McConnell, Lauren M. Jansson Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, United States ARTICLE INFO Keywords: Substance use disorder Pregnancy Addiction Stigma Neonatal abstinence syndrome Neonatal opioid withdrawal syndrome Medication Treatment Medication treatment ABSTRACT Background: Pregnancy is a unique opportunity to provide broad and necessary medical care for women- in- cluding treatment for Substance Use Disorders (SUD). The standard of care for SUD in pregnant women is treatment at a comprehensive care facility. There is little existing qualitative research exploring what brings pregnant women with SUD to treatment and what barriers to treatment exist for this population. This study explored women's self-reported reasons for pursuing treatment or hesitating to do so. Methods: This qualitative study used interviews to explore common factors that motivate pregnant women with SUD to seek comprehensive care during pregnancy and common hesitations/ barriers to treatment. The study population included 20 women in treatment at a comprehensive care facility for pregnant and parenting women at Johns Hopkins. Participants volunteered to do interviews which were recorded and transcribed for analysis. Results: Interviews revealed several major themes in motivators to seek treatment: readiness to stop using, concern for the baby's health, concern about custody of the baby or other children, wanting to escape violent environments or homelessness, and seeking structure. Barriers to treatment included fear of loss of custody, not wanting to be away from children/partner, concern about stigma or privacy, and lack of childcare and trans- portation. Conclusions: This study revealed common motivators to seek treatment and barriers to treatment for pregnant women with SUD. These themes may help direct future studies and guide efforts to increase access to crucial care in this vulnerable population. 1. Introduction Substance use disorder (SUD) in pregnant women is associated with many factors affecting health outcomes for mothers and children. Women with SUD are more likely to have comorbid psychiatric con- ditions, feelings of guilt and complications of pregnancy (Chou et al., 2018; McHugh et al., 2018). Infants born to women who use or misuse opioids and other substances during pregnancy are at risk for neuro- developmental and behavioral problems, and Neonatal Abstinence Syndrome (NAS), a constellation of withdrawal signs and symptoms that can be distressing for both mother and infant (Bakhireva et al., 2019, 2018) Pregnant women with SUD– disproportionately, poor women and women of color– are increasingly stigmatized and prose- cuted for their substance use, leading to financial, emotional and legal consequences in this population (Chou et al., 2018). The 2017 National Survey on Drug Use and Health (NSDUH, con- ducted by the Substance Abuse and Mental Health Services Administration) states that 8.5% of pregnant women reported recent (past month) use of illicit drugs, 7.1% reported past month marijuana use and 11.5% reported past month alcohol use (CBHSQ Data Review, 2012). These numbers have increased yearly since 2015 (from 4.7%, 3.4% and 9.3%, respectively). Nearly half (48%) of pregnant women who reported past-month illicit use of opioids reported concurrent al- cohol use, and it is estimated that roughly 30% of pregnancies in the U.S. are affected by in-utero alcohol exposure (Clemans-Cope et al., 2019). In 2016, almost 22,000 pregnant women began treatment for a SUD at a publicly funded facility in the US (Cochrain et al., 2018). Pregnancy is a unique window of access to medical care. Due to the risks of substance exposure in the perinatal period and the potential benefits of treatment during this time, pregnant women should be prioritized for treatment. Pregnant substance users are more likely to meet DSM IV criteria for SUD than non-pregnant substance users (given their continued use in the context of increased risk to self and to the fetus) and may be more motivated in recovery than non-pregnant women (Desai et al., 2014). However, pregnant women are significantly less likely to receive appropriate SUD treatment than their non- https://doi.org/10.1016/j.drugalcdep.2019.107652 Received 11 June 2019; Received in revised form 11 September 2019; Accepted 12 September 2019 ⁎ Corresponding author. E-mail addresses: Zfrazer1@jhmi.edu (Z. Frazer), Kgreen39@jhmi.edu (K. McConnell), LJansson@jhmi.edu (L.M. Jansson). Drug and Alcohol Dependence 205 (2019) 107652 Available online 22 October 2019 0376-8716/ © 2019 Elsevier B.V. All rights reserved. T