KAP KEYS Based on TIP 2 

Pregnant, Substance-Using Women 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

CSAT’s 

Knowledge Application Program 

KAP Keys
 For Clinicians 

Based on TIP 2 

Pregnant, SubstanceUsing Women 
KAP KEYS Based on TIP 2 

Pregnant, Substance-Using Women 

Introduction 

These KAP Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and 

Mental Health Services Administration. These KAP Keys are 

based entirely on TIP 2 and are designed to meet the needs of 

the busy clinician for concise, easily accessed "how-to" information. 

For more information on the topics in these KAP Keys, readers 

are referred to TIP 2. 

Other Treatment Improvement Protocols (TIPs) 

that are relevant to these KAP Keys: 

TIP 5, Improving Treatment for Drug-Exposed Infants (1993) 

BKD110 

TIP 25, Substance Abuse Treatment and Domestic Violence 

(1997) BKD239 

TIP 27, Comprehensive Case Management for Substance 

Abuse Treatment (1998) BKD251 

TIP 36, Substance Abuse Treatment for Persons With Child 

Abuse and Neglect Issues (2000) BKD343 
Procedures for the First 

Prenatal Visit 

KAP KEYS Based on TIP 2 

Pregnant, Substance-Using Women 

1 

• Detailed health history, including alcohol and illicit drug use 

and psychosocial assessments 

• Comprehensive physical examination, focusing on the multiple medical problems of this population 

• Family psychosocial, medical, alcohol and illicit drug use history 

• Health, psychosocial, alcohol and illicit drug use history of 

the baby's father 

• Routine prenatal panel, plus other laboratory tests, including 

urine and/or blood toxicology screening, tuberculin test with 

an antigen panel, and baseline sonogram 

• Optional tests as needed, including screening for human Tcell lymphotropic virus (HTLV)-I and hepatitis C 

• Attention to areas of special concern in substance-using 

women 

• Attention to medical complications encountered in pregnancy 

• Referrals to an alcohol or illicit drug treatment program, 

nutritional counseling, social services, and other counseling 

• Additional referrals as needed 
KAP KEYS Based on TIP 2 

Pregnant, Substance-Using Women 

Point of Entry: Substance 

Abuse Treatment 

2 

Alcohol 

• Setting: Inpatient, under medical supervision 

• Follow admission procedures 

• Monitor for signs and symptoms of alcohol withdrawal syndrome (use medical caution) 

• Antabuse: contraindicated (use medical caution) 

• Inpatient substance abuse treatment whenever possible 

• Outpatient substance abuse treatment with special focus on 

pregnancy issues and drug use 

• Encourage and monitor continued prenatal care 

Cocaine 

• Setting: Inpatient is most effective 

• Follow admission procedures 

• Medication contraindicated, except in cases of extreme agitation (use medical caution) 

• Inpatient substance abuse treatment whenever possible 

• Outpatient substance abuse treatment if necessary, with 

special focus on pregnancy issues and drug use 

• Encourage and monitor continued prenatal care 

Sedative-Hypnotics 

• Setting: Inpatient, under medical supervision 

• Follow admission procedures 

• Monitor for severe symptoms: seizures, delirium (use medical caution) 

• Determine risk/benefit ratio when considering use of medications (use medical caution) 

• Encourage and monitor continued prenatal care 
KAP KEYS Based on TIP 2 

Pregnant, Substance-Using Women 

Point of Entry: Prenatal Care 3 

Postpartum 

• Encourage continued participation in substance abuse treatment 

• Encourage and educate about family planning 

• Permit breastfeeding in methadone-maintained mothers 

• Initiate preventive health maintenance program 

• Provide for child care and parenting education 

• Conduct postpartum followup 

• Additions for HIV-positive women 

- Conduct postpartum followup 

- Breastfeeding contraindicated 

- Encourage continued participation with HIV specialist 

for medical followup for mother and infant 

- Educate mother regarding special needs of infant 

- Encourage and educate about family planning 

Neonatal 

• Obtain urine and/or blood toxicologies 

• Monitor for effects of drugs on the infant 

• Treat appropriately, depending on drug 

• Review case with mother and educate her regarding special 

care of infant 

• Encourage involvement of father of baby or significant other, 

and family members 

• Additions for HIV-positive women 

- Ensure special pediatric followup 
KAP KEYS Based on TIP 2 

Pregnant, Substance-Using Women 

Training Areas 4 

Training for medical staff, alcohol and illicit drug treatment 

providers, and others serving pregnant, substance-using 

women and their children should address these topics: 

• Diagnosis and treatment 

- Medical guidelines 

- Treatment readiness in substance-using women 

- Assessment instruments 

- Dual diagnosis 

- Women with positive toxicology screens in alcohol and 

illicit drug treatment programs
 

- Followup care
 

• Population-specific issues 

- Child abuse and neglect 

- Noncompliant patients 

- Gender-specific treatment 

- Sociocultural sensitivity 

- Incest, adult and child sexual abuse 

- Domestic violence 

- Habilitation and rehabilitation 

- Child development 

• Staff development 

- Multidisciplinary team approach 

- Staff development and burnout 

A collection of sample assessment instruments is available as 

a package from SAMHSA's National Clearinghouse for Alcohol 

and Drug Information (NCADI), P.O. Box 2345, Rockville, MD 

20852, 1-800-729-6686. 

"Assessment Instruments for Programs Serving Pregnant, 

Substance Abusing Women." Available from SAMHSA/CSAT 

Web site at: www.csat.samhsa.gov. Fee: $1.00 
Ordering Information
 

TIP 2 

Pregnant, Substance-Using Women 

Easy Ways to Obtain Free Copies 

of All TIP Products 

1. Call SAMHSA's National Clearinghouse for Alcohol and 

Drug Information (NCADI) at 800-729-6686, 

TDD (hearing impaired) 800-487-4889. 

2. Visit CSAT's Website at www.csat.samhsa.gov 

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of 

Communications, Substance Abuse and Mental Health 

Services Administration, U.S. Department of Health and 

Human Services. 

DHHS Publication No. (SMA) 01-3552 

Printed 2001