The long term effects of drug abuse on the unborn fetus of a pregnant mother - Dissertation Example

? The long term effects of drug abuse on the unborn fetus of a pregnant mother Tom-Louis W. Gray Sr. Argosy College of Business Ed. D. in Organizational Leadership Abstract Drug abuse has emerged as a common problem in recent decades that has affected various spheres of life including pregnant women. Prenatal and neonatal development has been shown to be affected negatively due to drug abuse. It is no secret that drug abuse during pregnancy causes a host of physical and mental disabilities in children that persist with them throughout their lives. This paper aims to look into Axis II type problems caused by drug abuse by pregnant mothers in order to see how drug abuse affects the child’s long term development. It is believed that drug abuse by pregnant mothers causes maladaptive behaviors stemming from Axis II diagnosis including (but not limited to) bipolar disorders, borderline personality disorders, schizophrenia, conduct disorders, antisocial and learning disorders. Introduction Substance abuse is linked to a number of different physical and mental defects in the offspring of abusers. A large volume of research exists on the phenomenon and its various dimensions. The physical and mental disabilities endowed to the fetus of substance abusers are complex and have thus been categorized into various systems for closer examination. This research will largely be concerned with a systematic study of long term effects on the fetuses of substance abusers based on Axis II diagnosis alone. A large amount of rich material both of a qualitative and quantitative nature exists for the current research area. The current research will rely on the examination of existing literature since it has both quantitative findings and quantitative findings. This will allow the current research to utilize qualitative methods in order to derive qualitative findings that are supported by quantitative results. The current research could have been geared for a pure mixed methods research but the shortage of time and resources precludes any such methods. In order to investigate fetuses that are born from substance abusing mothers, a large sample set and an adequate amount of time is required. The typical time required for such research would be at least a few years since the born child would only display Axis II disorders when they reach their early learning years. However, the shortage of time and the lack of access to a large sample set ready to participate in quantitative research require that the current research be geared towards qualitative methods alone. As mentioned before, the provision of both qualitative and quantitative results also supports the contention that a comprehensive literature review would suffice for the current research. Background to Drug Abuse during Pregnancy Drug abuse refers to the consumption of drugs without direct medical advice or supervision. It is widely believed that drug abuse relates to the recreational abuse of mood altering substances but the use of any drugs for performance enhancement is also essentially drug abuse. Based on this classification, drug abuse involves drugs that are mood altering, performance enhancing as well as psychoactive in character. The use of any forms of drugs, whether legal or illegal, is considered as drug abuse as long as there is no medical justification for their use (Ksir & Ray, 2002). Another major feature of drug abuse is the dependence created by drug use. Drug abusers or substance abusers require continuous consumption of the subject drug in order to satisfy their body’s urges. The number of drugs being abused around the world is too large to be discussed within the framework of this research alone. However, the most common feature displayed by all used drugs is the tendency of the user to rely excessively on the subject drug for mood altering or performance enhancement purposes (Barrett, Meisner, & Stewart, 2008). The dependency of the drug abuser on the drugs causes the greatest problems during pregnancy because the drug abuser is unable to quit using drugs. Consequently, the adverse effects of drug abuse are transferred from mother to child since most mothers are unable to quit drug abuse during their pregnancy (Mosby, 2005). Drug abuse typically entails the use and abuse of multiple substances most of which are strongly addictive in character. Typical pregnant drug abusers confront another major problem because of this phenomenon – even if a pregnant drug abuser stops taking or reduces taking one form of drug, there are always other drugs that they are still abusing. Pregnant drug abusers require more attention than other forms of drug abusers since drug use has to be stopped altogether and immediately unlike the phased withdrawal plans for other kinds of drug abusers (Moore, et al., 2010). The overall mix of drugs abused by pregnant women tends to entail most drugs abused by other kinds of drug abusers. More commonly, drug abuse in pregnant women relates to the abuse of alcohol, cocaine, opiates, amphetamines, cannabis and marijuana. The greatest danger to the unborn fetus arises from the abuse of alcohol followed by smoking and the abuse of opiates and amphetamines. Previous research on the issue of drug abuse in pregnant women clearly finds that alcohol is the most dangerous to the fetus and that drug abuse is typically accompanied by tobacco smoking (Ryan, Ehrlich, & Finnegan, 1987). Here it needs to be kept in mind that tobacco smoking may be addictive, but it does not alter mood or enhance performance, so smoking tobacco cannot be classified as drug abuse as per previous definitions of drug abuse in this paper. However, it also needs to be kept in mind that certain drugs can only be consumed when combined with tobacco smoking such as smoking marijuana, weed or cannabis. Hence, smoking can be seen as a peripheral mechanism that supports drug abuse and so can be classified as being present if drug abuse is present. For the purposes of this paper, it will be assumed that drug abuse is accompanied by tobacco smoking. Based on this assumption, the negative consequences of tobacco smoking will be considered in tandem with the negative effects of drug abuse on the fetus’ long term development. Axis II Disorders Classification Drug abuse related defects in fetus relate largely to physical abnormalities such as fetal alcohol syndrome (FAS) and mental abnormalities that may lead to developmental disorders. The mental defects and disorders have been classified by the American Psychiatric Association (APA) through the Diagnostic and Statistical Manual of Mental Disorders (DSM) which categorizes mental disorders into five broad classifications. These classifications are meant to organize psychiatric disturbances as per their consequences on human behavior. The current research is concerned only with Axis II type mental abnormalities that result from drug abuse during pregnancy on the fetus. The Axis II classification scheme deals with issues related to mental retardation and problems of personality disorders alone as per the latest version of DSM-IV (Dalal & Sivakumar, 2009). The categorization in the Axis II system deals with common personality disorders such as schizophrenic behavior, paranoia, social incompatibility, avoidant behavior, borderline personality disorder, narcissist behavior, obsessive compulsive disorder (OCD), dependency disorders as well as hampered intellectual abilities (Maser & Patterson, 2002). Drug abuse in pregnancy produces a number of physical and mental defects in fetuses but this research will be concerned with Axis II type mental disorders alone. Axis II Disorders in Children resulting from Drug Abuse during Pregnancy Alcohol One of the more commonly abused substances during pregnancy is alcohol. When compared to other abused substances, alcohol is more dangerous in terms of the short term and long term effects on the unborn fetus. The physical and mental damage caused to the unborn fetus by alcohol consumption on the part of the mother is collectively known as the fetal alcohol syndrome (FAS). The overall span of damage by alcohol consumption is so large that it is highly recommended not to consume alcohol during pregnancy (Stratton, Howe, & Battaglia, 1996). The chief difference between alcohol and other forms of drugs is the transmission mechanism. Unlike other drugs that take time to assimilate into the blood stream, alcohol passes directly into the blood stream from the stomach walls. This allows alcohol to easily cross the placental barrier in order to access the fetus. Once alcohol accesses the fetus, it tends to damage the fetus’ facial features, physical formation as well as brain growth. Alcohol typically attacks brain growth in the fetus and tends to damage the formed neurons. In turn, the damage to neurons at such an early age leads to stunted mental growth once the child is delivered. It is common for children of alcoholic mothers to be experiencing psychological stress as well as behavioral problems especially in the context of social relationships (Ulleland, 1972) (Streissguth A. , 1997). As mentioned before, typically alcohol is one of the substances being abused by substance abusing mothers so it is relatively hard to leave during pregnancy. Research indicates that between ten and fifteen percent of all pregnant women consume alcohol regularly during pregnancy (Havens, Simmons, Shannon, & Hansen, 2008). On the other hand, another thirty percent of all pregnant women in the United States consume alcohol occasionally during their pregnancy (Ethen, Ramadhani, & Scheuerle, 2008). This is indicative of the fact that alcohol use is common among half of all pregnant women in the United States which represents an alarming proportion given alcohol’s negative effects on the fetus. The negative effects of alcohol consumption on the fetus’ brain development are essential to understanding the development of Axis II type disorders later in the child’s life. Fetus affected by alcohol face the greatest damage to the central nervous system (CNS) which is typically irrecoverable. In the case of the fetus, the brain as well as the subsystems is still developing including brain cells. Prenatal alcohol exposure leads to permanent damage to brain cells as they are developing leading to restricted subsystem growth in the brain. It is common for such children to face cognitive problems as well as functional limitations in life as they develop. The most common problems experienced by such as children include a weak memory, problems in concentrating, attention deficit disorders, and lack of effective reasoning skills as well as reckless behavior (Guerri, 2002). Other research also indicates that such children may be more prone to drug addiction as well as deviant behavior caused by mental health problems (Streissguth, Barr, Kogan, & Bookstein, 1996). The development of the fetus’ brain is an ongoing process throughout the pregnancy so consuming alcohol at any time during the pregnancy can carry the chance of permanent brain damage to the fetus. The phenomenon of alcohol consumption and the associated problems with the fetus’ brain development are widespread throughout nations where alcohol is legalized. It is estimated that industrialized nations face fetal alcohol syndrome for every two children out of one thousand live births (Sampson, Streissguth, Bookstein, Little, Clarren, & Dehaene, 1997). In the United States alone, fetal alcohol syndrome affects one percent of all new born children (Astley, 2004). It is not uncommon for problems caused by FAS to be considered as behavioral problems in children although the actual underlying cause is the damage to the central nervous system. The common domain of problems caused by central nervous system damage comprise of functional disabilities that in turn lead to behavioral problems as well as mental health problems. Children with prenatal alcohol exposure end up with cognitive difficulties, attention span disorders, lowered achievement levels, a lack of adaptive behavior, problems in dealing with language, lowered memory retention, poor motor skills, under integrated sensory skills as well as social communication dilemmas (Malbin, 2002). The lack of proper cognition and motor skills means that these children are typically ostracized from an early age since they are slow at interacting with other children around them. The early isolation from society as well as a chance of abuse at the hands of a drug abusing mother means that these children develop behavioral problems at an early age that require resolution. As these children mature with age, their social interactions undergo skewed patterns leading to social isolation, violence and little chance for integration into wider society. There is little doubt that children affected by prenatal alcohol exposure end up with social problems given the undeveloped and damaged state of their central nervous system. Methamphetamine Methamphetamine has grown in popularity as a commonly abused drug by people of all ages for the last two decades. The relative simplicity of manufacturing methamphetamine and its relative cheapness make it a popular drug for abuse since most people are able to afford the drug with ease. The low cost of methamphetamine and its availability throughout the United States have made it the second most popular drug after marijuana that is abused by pregnant women (McGuinness & Pollack, 2008). However, the long term affects of methamphetamine on the fetus have not been scrutinized as widely as other substances such as alcohol. In addition, the negative effects of methamphetamine on the development of children affected by prenatal methamphetamine exposure (PME) have not been studied widely as yet leaving large areas for research (Smith, LaGasse, Derauf, & Grant, The Infant Development, Environment, and Lifestyle Study: Effects of Prenatal Methamphetamine Exposure, Polydrug Exposure, and Poverty on Intrauterine Growth, 2006). Methamphetamine is a relatively new drug compared to older substances such as alcohol and marijuana so it comes as no surprise that PME has not been attended in detail as yet. The need to study the effects of methamphetamine use on prenatal development has become essential given the drug’s quick rise to one of the most abused substances in the United States especially in the rural Midwest and Southern United States (Smith, LaGasse, Derauf, & Grant, The Infant Development, Environment, and Lifestyle Study: Effects of Prenatal Methamphetamine Exposure, Polydrug Exposure, and Poverty on Intrauterine Growth, 2006). Previously conducted research on PME indicates that methamphetamine abuse during pregnancy tends to affect fetal growth negatively by leading to physical developmental disabilities as well as mental development problems. One of the more common problems associated with PME is damage to the fetus’ visual growth. It is also common to observe abnormal brain growth resulting in abnormal behavior in children exposed to PME. Children affected by PME are known to exhibit hyperactivity, lower memory retention, unwanted stress levels as well as social behavior issues. A chief problem that accentuates PME compared to other drugs is the retention potential of methamphetamine in the human body. Methamphetamine displays one of the longest retention periods inside the human body especially when it is compared to either marijuana or alcohol. Other then retention, methamphetamine tends to stay active inside the human body which means that any pregnant woman using methamphetamine is potentially storing the drug for long term release in the body. Even after the drug abuser is done with drug use, methamphetamine is still present inside the human body in enough quantity to negatively affect fetal growth. Methamphetamine is also distinguished from other drugs given its ability to imitate the behavior of neurotransmitters in the brain which provides it with relatively simple access to the human brain (Smith, et al., 2008). Current research into PME indicates that children exposed to methamphetamine tend to display limited cognition, lowered motor responses, emotional difficulties as well as language barriers that lead to social isolation at an early age. However, the areas of depression, paranoia or schizophrenic behavior have yet not been connected conclusively to PME since research is still underway in these areas (Hackathorn, 2010). On the other hand, there is conclusive proof to support the idea that children exposed to PME suffer from sleep disturbances along with some degree of behavioral problems at an early age. The possible cause for such changes is attributed to methamphetamine’s ability to stay for long periods in the human body and its ability to imitate the behavior of the brain’s neurotransmitters (LaGasse, Wouldes, Newman, & Smith, 2011). Another notable aspect is the ability of methamphetamine to affect visual perception. Research has shown that PME exposed born children aged around one year tend to have poorer motor skills as a result of visual weaknesses as well as spatial recognition disabilities. The results of the research indicate that there is a possibility that visual weakness and spatial recognition disabilities may persist as these children develop leading to poorer visual capabilities in the future. It has also been suggested that such children may be forced out of activities demanding keen motor skills such as sports since their visual weaknesses prevent precise and fine motor control (Smith, LaGasse, Derauf, Newman, & Shah, 2011). This could in turn lead to social isolation since these children may be forced out of socializing activities such as sports. Further research on the issue has shown that newborns with PME tend to be irritated easily and tend to eat poorly compared to children their own age. Moreover, the irritability of such children tends to linger for years leading to uncontrolled aggression, fits of anger and rage as well as impulsive behavior (Risch, 2008). It is expected that as these children grow on, their behavior would reflect hyperactivity as well as attention deficit disorders. In turn these phenomenons could be expected to support learning disabilities and generally irritable moods along with mood swings leading to maladaptive behavior on the part of children with PME. Research carried out on children born with PME in Sweden indicated such children displayed generally aggressive behavior as well as severe learning disabilities compared to their peers. Children born with PME were observed till fourteen years of age in Sweden to determine the range of effects of PME on the child’s development and growth. It was found that children from methamphetamine abusing mothers displayed excessively aggressive behavior at eight years of age. This in turn triggered social adjustment problems for such children leading to greater social isolation and reinforcement of such behavior. Moreover, it was also discovered that the amount of aggression displayed by children with PME depended on the total amount of methamphetamine that they were exposed to during pregnancy (Wouldes, LaGasse, Sheridan, & Lester, 2004). As these children aged into their teenage years, it was observed that their cognitive abilities including language development and mathematical skills were limited in comparison to their peers. Statistical testing showed that children with PME displayed lower cognition compared to other children their own age (Wouldes, LaGasse, Sheridan, & Lester, 2004). Cannabis Cannabis represents one of the most controversial drugs in terms of its consequences. On the one hand, research indicates that cannabis use leads to permanent brain damage while on the other hand research indicates that cannabis use leads to brain augmentation. There is as yet a lack of conclusive scientific evidence to support one claim against the other and research on the issue is ongoing. Previous research concentrated on studying the effects of cannabis on prenatal and neonatal development of fetus exposed to cannabis. Testing and results of a study consisting of Jamaican mothers indicated that neonatal children aged one month showed better results for reflexes and autonomic stability for mothers who had been using cannabis (Hayes, Lampart, Dreher, & Morgan, 1991). In contrast before this period, neonatal comparisons of newborns exposed to cannabis and newborns not exposed to cannabis failed to show any significant differences. Given these results, it could be concluded that cannabis use tends to favor neonatal development but other evidence needs to be examined before such a conclusion can be issued. More recent research on the issue has indicated that cannabis use may not actually support neonatal development as speculated. In contrast to the results of the previously reported study, more recent research links up tobacco smoking with cannabis use. It has been suggested that cannabis or marijuana use cannot occur unless it is accompanied by tobacco smoking. Research from this perspective suggests that children exposed to cannabis during pregnancy tend to suffer permanent cognitive defects as well as attention deficit problems leading to social estrangement at an early age. Research conducted utilized two groups – one with fetuses exposed to cannabis and the other without any cannabis exposure during pregnancy. Results from the study indicated that children being exposed to cannabis during pregnancy had a much higher chance of developing permanent cognitive disabilities that would affect their language learning and other allied skills (Huizink & Mulder, 2006). Moreover, it was also made apparent that the use of cannabis during pregnancy led to offspring that suffered from hyperactivity. The onset of hyperactivity related to cannabis use during pregnancy only seemed to develop in children as they aged further. The onset of hyperactivity in such children also leads to the conclusion that these children suffer from low concentration spans and problems such as attention deficit disorders. Continuous hyperactivity and low concentration spans means that these children are mostly ostracized by children their age given the socially unacceptable behavior exhibited by these children (Fried, Watkinson, & Gray, 2003). It must also be mentioned that the two related studies ensured that other factors that affected child development such as social background, parental care, access to health services etc. were similar or the same for both groups being studied. In addition, there is new research to support the contention that endocannabinoid molecules have a definitive role to play in the creation of links between nerve cells when fetal brains are developing (Berghuis, Rajnicek, & Morozov, 2007). This idea was also supported by research on mice that indicated that endocannabinoids aid in the directional development of the brain of fetal mice (Minkel, 2007). Based on these results, it has been suggested that elevated levels of endocannabinoids in the fetal brain would allow for greater brain development though it is still not clear if an excess could trigger permanent damages to the fetal brain. Given the current state of research on this issue, it is safe to say that cannabis use affects the neonatal brain positively as far as motor responses are concerned but it fails to show any major developments after that. On the other hand, it is clear through research that cannabis use leads to long term problems in children exposed to cannabis during pregnancy. The more common problems involve excessive aggression, permanent cognition disabilities and overall social incompatibility which lie in line with findings on other drugs that fetuses are exposed to. For the moment, it would be safe to declare that cannabis use has more negative consequences on fetal development in the longer run than positive outcomes. Cocaine Cocaine represents the top end of the drug chain given that it is relatively expensive and is consumed by few people on a regular basis. Over the years, cocaine exposure for fetuses has undergone massive transformation after scientific research. Initially, a few decades ago, it was widely believed that cocaine use led to highly negative developments for fetuses. It was opined that cocaine use would cause severe physical and mental disabilities in children with prenatal cocaine exposure (PCE) but there was a lack of scientific evidence to support such a cause. Over time, there has been little evidence to support the idea that PCE causes major damage to fetal development. Current research on the issue of PCE indicates that children with such exposure do not suffer the more common drug abuse related problems such as physical and mental disability. Moreover, research indicates that children with PCE show no major differences from children with no PCE over the early years of childhood (Lamy & Thibaut, 2010). Moreover, other research focusing on children aged six years or less failed to show any major problems in cognition, language development, and social adjustment etc. for children with PCE. The measurements carried out for comparison consisted of statistical testing of children with PCE and children without PCE which indicates that the results of this study are reliable (Ackerman, Riggins, & Black, 2010). However, it cannot be concluded that cocaine use during pregnancy is safe for the child. Research indicates that children with PCE tend to display greater attention deficit disorders than other children their age. Moreover, PCE tends to affect children negatively by causing premature births as well as other birth related complications though these tend to fall outside the scope of the current research. At the current point in time, it is widely believed that PCE effects on fetuses are somewhere between the negative consequences of FAS and tobacco smoking on fetuses (Goldberg, 2009). Change Management and Conflict Management In order to avoid the pervasive negative consequences of drug abuse during pregnancy, effective change management is required to limit the role of drugs during pregnancy. The use and abuse of drugs presents the chance that a pregnant mother is at inherent conflict with her main objective which is delivering a healthy child. Effective change management is required in order to deal with both the inherent conflict and to deal with negative consequences to the fetus. A number of different models and theories have been postulated in regards to change management as per drug abuse. However, not all models of change management for drug abuse could be declared as perfect since certain shortcomings are present in all such models. This paper will concentrate on three different change management models namely the social learning model, the disease model and the Shafer’s pattern of drug use model. Social Learning Model The social learning model is developed around the core idea that drug use is a functional activity carried out by members of society. The activity of drug use as both positive or intended as well as negative or unintended consequences for the drug user. The massive damage to the fetus during pregnancy can be considered as the unintended consequences of drug use. The other major idea propagated by the social learning model is that drug use and abuse are learned from the society by individuals. This learning can also be unlearned by the subject individual given the right circumstances and support in society. Given these basic assumptions, it is notable that social settings play an important role in the social learning model. Moreover, another major result of the social learning model is that the subject drug user could also be taught to limit drug use if the drug user seems to be unable to leave drugs outright altogether (Marlatt & Donovan, 2005). If the social learning model is looked into critically, it becomes apparent that drug learning is compared to a learned activity such as things taught in school. Moreover, the model contends centrally that any forms of learning can be reversed. However, this may not be true for a large variety of things. For example, people who learn to ride a bike can remount and use a bike any time later in their life. No matter what one does, it is not possible to unlearn certain parts of being human. People rush to drugs in order to deal with their inadequacies such as rising stress levels. Even if a person unlearned drug use and abuse, it is highly likely that they could relearn it when faced with rising stress levels. In terms of pregnancy, the subject mother may end up with depression or anxiety due to biological as well as social factors such as lack of support from the father of the fetus. In such a case, the pregnant drug user who unlearned drug abuse will resort to drug abuse again in order to relieve stress. The long period of pregnancy precludes the effective use of the social learning model that fails to provide support after leaving drugs. Ineffective support after leaving drug abuse provides the possibility that a person may relapse into drug abuse after faced with previous triggers of drug abuse. Disease Model The disease model of drug use contends that there is a genetic predisposition to abuse drugs in the case of certain individuals. The model expounds that certain individuals may be inclined to use and abuse drugs since their body’s biochemical composition encourages them to consume drugs in order to feel more relaxed at easy. In the case of such individuals, a biochemical regime of treatment is recommended. The model relies on rather old lines of thinking and belief given the biochemical predisposition of certain individuals to abuse drugs. There is little scientific evidence to support the basic ideas of this model. However, the model is more effective than other models in dealing with drug abuse since the model tends to support the individual drug abuser throughout the entire regime of treatment (Rehm, Mathers, Popova, Thavorncharoensap, Teerawattananon, & Patra, 2009). Under the disease model of drug use, the individual is prescribed treatment measures including therapy and medicinal use in order to cure the individual. In certain cases, the individual drug abuser may be asked to lower the amount of drug intake in phases till an eventual withdrawal from drug use. The constant involvement of other individuals with the drug abuser ensures that the success rate is greater for this model when compared to other models of drug use change management. However, there are certain issues in the case of pregnant women that do not apply well to other drug abusers. For one thing, if treatment starts at the beginning of pregnancy, it is highly unlikely that the addiction would be over by the end of pregnancy since a slow and phased withdrawal is sought. Moreover, the drug abuser would be asked to lower the use of drugs over time but would not be required to leave drug use altogether so in the case of pregnancy the fetus would be exposed to drugs even if in lower quantities. Shafer’s Pattern of Drug Use Model Shafer’s framework for dealing with drug abuse depends largely on classifying the drug abuser into one of five prospective groups and to offer fitting treatment regimes. Shafer’s pattern expounds five different models of drug use that are: experimental; social or recreational; situational; intensive; compulsive. The majority of drug users tend to be described well within the first three categories but highly abusive individuals may be grouped into the last two categories. It has to be kept in mind that these groups do not necessarily coalesce into each other or lead to each other. Shafer’s model believes that the drug abuser must be classified into one group or the other before appropriate treatment can be provided. In the case of pregnant women, the user may be a part of any of these five groups and so would be offered intervention and change management accordingly. This ensures that there are greater chances for the drug user especially a pregnant drug user to lower their drug dependency and to minimize the amount of damage to the fetus. On the down side, certain quarters argue that Shafer’s model tends to over represent most drug abusers in the last two categories based on clinical samples alone without taking into account any social or other extrinsic factors (Tatarsky, 2008). Conclusion Based on the results of this study, it could be safely concluded that drug abuse tends to promote a number of different problems in fetal development that tend to negatively affect a child later on in life. Among other things, drug abuse in mothers tends to affect the child’s cognitive skills, concentration spans, language development, cause and effect reasoning, hyperactivity, anger management and control, attention deficit disorders etc. It goes without saying that drug abuse causes a multitude of problems for the child in both the prenatal and the neonatal development period. Although not all drugs cause neonatal effects but certain drugs such as methamphetamine tend to cause neonatal problems as well. Moreover, it must also be noted that most drugs cause problems in brain development and growth during the prenatal period which generally tends to affect the neurons. Restricted neuron activity tends to signal permanent mental disability that continues with the child throughout their entire life span to cause maladaptive behavior and a host of other related problems related to social relationships. In the case of pregnant women with drug abusing behavior, it is more than necessary to prevent drug use and abuse in order to limit damage to the drug user and the fetus. A number of different models are available for drug use change management including the social learning model, the disease model and Shafer’s pattern of drug use model. Each model offers certain advantages and disadvantages but it must be appreciated that Shafer’s model offers the greatest flexibility in offering the drug user methods to curtail and then stop drug use outright. 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