Commentary: Addressing Fetal Alcohol Spectrum Disorders in Addiction Treatment
Addiction treatment professionals can play a vital role in
preventing the leading known cause of intellectual disabilities, birth
defects and neurobehavioral disorders in the world, Fetal Alcohol
Spectrum Disorders (FASD).
Each year 125,000 American newborns are prenatally exposed to heavy
or binge alcohol consumption, 20 times the number exposed to
methamphetamine and inhalants. Alcohol is a teratogen—a substance known
to be toxic to developing babies. Of the most common substances of
abuse, including marijuana, cocaine and heroin, alcohol produces by far
the most serious neurobehavioral effects in the offspring of
substance-using women.
FASD is not typically included in addiction treatment curriculum. One
problem is that there is not a code for it in the DSM manual of mental
health disorders, and as a result, psychiatrists and psychologists are
not informed about FASD.
FASD may also be an unexamined cause for high recidivism in addiction treatment. There are several reasons why this may be:
• Women may have used alcohol and drugs while pregnant and be afraid to discuss in group;
• Women may have children with undiagnosed FASD, and may not be educated on appropriate parenting techniques; and
• Clients themselves may have been prenatally exposed to alcohol and
have unidentified learning and behavioral disorders as a result.
Preventing FASD in Addiction Treatment
If a woman drinks while she is pregnant, there is a risk for having a
child with FASD regardless of ethnicity, education or socio-economic
status. A woman does not have to be an alcoholic to have a child with
effects; however, women that suffer with alcoholism are at the highest
risk. Women who use other drugs are also at high risk for having a child
with FASD, since many use alcohol as well. Women who drink should be
counseled about using effective contraception to avoid pregnancy.
Since FASD is preventable, all clients and their families receiving
addiction treatment should be educated on the hazards of drinking while
pregnant. Men may not cause FASD directly, but they have a very
important role in prevention. They can encourage and support women not
to drink while pregnant, or at risk for pregnancy.
Treatment is an appropriate time to learn about FASD. If clients
realize that some of their children may have effects from prenatal
alcohol exposure, a counselor is there to provide them with support and
resources. Treatment professionals should provide opportunities for
women to discuss many of the difficult issues around mothering and
parenting. They can provide women with language to talk to their
pediatricians and other health care providers about possible exposures
to ensure that the children are receiving assessments and appropriate
services.
Recognizing FASD in Clients
People with FASD often go unnoticed as having a brain disorder because
the majority of individuals have borderline intelligence or above. This
is a lifelong disability and the cognitive, behavioral, emotional and
social difficulties can each appear across a continuum of severity, from
mild to profound. They may experience a daily fluctuation of attention
and focus. Many will struggle with understanding cause and effect
relationships or the ability to predict future behaviors. Individuals
are typically naïve and are easily led into situations. They may have
problems in judgment, memory and social skills, but because they have
strong expressive language skills they appear higher functioning than
they are. It is not uncommon for a client with FASD to be unsuccessful
and sometimes terminated from treatment. These individuals need
structure, support and understanding. If counselors better understood
the typical behavioral profile of a client with FASD, and how to modify
treatment, treatment outcomes could improve.
Recognizing that a person “can’t” perform, rather than “won’t”
perform, immediately changes the dynamic in a service relationship. By
recognizing the disability of FASD and modifying systems of care, we can
improve outcomes for clients. Adults often need lifelong transitional
and behavioral support.
Below are suggestions for improving treatment for individuals with FASD:
• Train staff to modify treatment plans and treatment;
• Plan for long-term treatment and aftercare options;
• Include the entire family in treatment;
• Assist clients with housing, vocational, educational, day-care, respite, recreational and other services;
• Assist clients with Supplemental Security Income, public
assistance, food stamps, Medicaid/Medicare and other disability
programs;
• Counselors should consider the possibility of past victimization in these clients;
• Counselors should know best treatment practices and recommendations for clients with FASD; and
• Addiction treatment agencies should pursue assessments and
diagnosis for clients (and/or children of clients) when they suspect a
person has FASD.
There is much that can be done to address FASD in addiction
treatment. The National Organization on Fetal Alcohol Syndrome (NOFAS),
founded in 1990 as a voice for individuals, families and caregivers
living with FASD, disseminates information and resources, provides
referrals to specialists, and offers a 22-unit certification program for
addiction professionals (
www.nofas.org).
Kathleen Tavenner Mitchell, MHS, LCADC
Kathleen T. Mitchell is currently the Vice President and
International Spokesperson for the National Organization on Fetal
Alcohol Syndrome and a noted speaker/author on Fetal Alcohol Spectrum
Disorders (FASD) and Women and Addictions. She founded the Circle of Hope (COH), an international peer mentoring network for women who have used substances while pregnant.
