Research Update

Alcohol Use and Pregnancy: An Important Canadian Public Health and Social Issue

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8.3 Outreach

Because of the numerous barriers faced by pregnant women to obtain help for their drinking, outreach activities are needed to identify and intervene with those unable to quit drinking on their own, as well as those seeking help from non-substance abuse services. Clearly, attention to substance use issues by pregnant woman as early as possible is important. But if individuals are not able or interested in attending to their health issues, outreach can be effective in initiating this process. Outreach efforts can reduce known barriers such as fear and low self-esteem, while increasing readiness to address alcohol use issues, demystifying what is available and what is involved in the various levels of care.^225,226

Drop-in centres, community centres and transition houses or shelters for women and mothers are in a strong position to raise substance use issues with women in a sensitive, respectful manner. A study of women entering transition houses in British Columbia found a general reduction in substance use when they were followed up three months after leaving the house.²²⁷ In fact, in Canada, much of the substance abuse “treatment” for pregnant women that does occur is through these types of services (i.e. outside the formal treatment sector).²²⁸ On-call outreach workers trained in substance abuse counselling (particularly the Transtheoretical or Stages of Change Model) can extend outreach further (e.g. to homes, schools and streets). By providing emergency response, counselling and possibly referral, these workers can increase access to care for pregnant substance-using women who are harder to reach.²²⁹ It has been suggested that outreach work also needs to involve collaboration with referral sites, education of community agencies and advertisement of programs.^230,231

In a small non-experimental study of women with serious substance use and mental health issues, Corrarino and colleagues found home visits by nurses to be effective. Ninety percent of the women in the study entered treatment and all had full-term babies. The authors suggested that nurses, by fostering trusting non-judgmental relationships, were able to “push open” the window of opportunity that pregnancy provides to move women to the point of being ready to change.²³³

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