Addiction severity, psychopathology and treatment compliance in cocaine-dependent mothers

A retrospective chart review of clinical assessments encompassing psychiatric diagnosis, addiction severity and psychosocial functioning of cocaine-dependent pregnant or postpartum women during inpatient treatment was obtained. Predictive value of the elements of the assessment battery on aftercare compliance was determined.

The charts of forty-one cocaine-dependent pregnant or postpartum women treated for substance abuse were reviewed for addiction severity and aftercare compliance. Thirty of these patients were administered the Structured Clinical Interview for DSM-III-R (SCID I and II) and screened for history of victimization during inpatient treatment. All women were divided into two groups, aftercare treatment compliers (TCs) and aftercare treatment noncompliers (TNCs). TCs were those patients who attended at least one-half of the aftercare sessions.

TCs had significantly lower scores on the psychiatric (p < or = .05) and employment (p < or = .01) subscales of the ASI, indicating lesser problem severity. The total composite mean ASI score, although not statistically significant, was also lower for TCs. Of the thirty subjects that were administered the SCID-I and II, sixty-seven percent had an Axis I disorder. TNCs were significantly more likely to have an anxiety disorder (p < or = 0.05). Eighty percent of subjects had at least one Axis II disorder. TNCs were also significantly more likely to have any Axis II disorder (p < or = 0.05), and to have Cluster B and Cluster C personality disorders (p < or = 0.05). In addition, seventy-three percent of subjects reported victimization, with TNCs significantly more likely (p < or = 0.05) to have experienced childhood abuse.

In this sample of pregnant cocaine using women, the majority of women had current Axis I and II disorders as well as history of victimization. The results suggest that the ASI employment and psychiatric subscales may be predictive of aftercare compliance. The presence of certain Axis I and/or Axis II disorders also appear to be predictors of poor compliance. Treatment of pregnant substance using women must be designed to address issues of victimization as well as psychiatric disorders.