Addressing substance abuse in obstetrics and gynecology

Substance abuse has far-reaching and long-lasting implications not only for women, but for their children and families as well. Substance abuse disorders are related to a host of biopsychosocial problems including severe medical and obstetric complications, poverty and unemployment, relational and parenting problems, domestic violence, and child abuse. Despite the seriousness of the problem, because substance abuse has typically been considered a male disorder, it is one of the most commonly missed diagnoses among women. Further complicating matters is that women are significantly more likely to present veiled symptoms to their primary care physicians than to seek appropriate substance abuse treatment. Given this, it is incumbent on today’s obstetrician/gynecologists to help uncover this often secret, but significant problem among women. Recommendations are made regarding the assessment and treatment of women with substance-related disorders. Obstetrician/gynecologists are encouraged to make substance abuse assessment, using standardized screening measures (such as the TWEAK questionnaire) as well as open-ended dialogues, a part of their routine exams. Obstetrician/gynecologists can play a vital role not only in the initial diagnosis of substance-related disorders but also in encouraging patients to take steps towards sobriety and to seek appropriate treatment when indicated.