The Czech Republic Annual Report 2010 Drug ... - Drogy-info.cz

12 Drug Users with Children
The aim of this Selected Issue is to provide information about the prevalence of pregnant drug users and those users
who are parents of minor children and trends and characteristics pertaining to them, as well as describing specific
services designed for such users and their children in the Czech Republic. First and foremost, this chapter deals with
addictive substances other than alcohol and those that are illegal.
A pregnant drug user refers to a woman who has used drugs during her pregnancy. For the purposes of this
Selected Issue, a drug-using parent means every user who is the parent of a child under 18 years of age,
irrespective of whether they currently have custody of the child or whether the child has been temporarily placed in
the care of an institution or another person until they are deprived of parental rights or make the child available for
adoption. In theory, a child is deemed to be every person up to the age of 18, but, in practice and in relation to the
issue under consideration, children of pre-school and school age will be the main age groups referred to.
At a certain stage of their drug careers, some drug users give birth to children, which raises a number of fundamental
questions about the future life of such children and their health, safety, and rights. It is common practice that such
pregnancies tend to be unintended or unwanted, and often the woman only discovers that she is pregnant after
some delay. As a result, mothers carry on using drugs and living in unsuitable socio-economic and hygienic
conditions while already pregnant. Following the delivery, newborns may suffer from withdrawal-related problems,
which are addressed by specialised healthcare facilities. Drug-using mothers rarely have a good social background
to which they could resort with a child after birth. Moreover, their ambiguous attitude to their further drug use
complicates their ability to take proper care of the child, which frequently results in interventions on the part of the
authorities involved in the social and legal protection of children because of concerns that the child’s favourable
development may be endangered or disturbed. Some of these children subsequently need to be placed in
alternative care. Similar problems also occur when children live with parents who use drugs or in a drug-using
environment. Drug-using parents with children are provided with support and treatment by both governmental and
non-governmental specialised professional agencies.
12.1 Size of the Problem
Studies investigating the effects and consequences of pregnant women’s and parents’ drug use on the physical and
psychological development of the child mainly fall within the domain of medicine, with a particular focus on the target
group of pregnant women in relation to the development of the foetus. The degree of the impact of drug use during
pregnancy largely depends on whether the use has involved experimentation, irregular use, or addiction. Occasional
users who are aware of the harmful effects of drug use usually abstain during pregnancy. Problem drug users and
drug addicts are not able to discontinue their substance abuse; pregnant women often postpone or neglect prenatal
care. Studies and practical experience provide enough evidence that parents’ drug use affects the child’s further
development. However, the environment in which children grow up during the early years of their lives, with all its
health and psychosocial consequences, plays a significant and often crucial role.
The use of all types of drugs, including alcohol, marijuana, nicotine, and barbiturates and other pills, may have
dangerous effects on the course of a pregnancy. The main reason is that, by crossing the placenta, the drug enters
the body of the foetus and endangers its healthy development. Similarly, in a breastfeeding woman, drugs may enter
the child’s body with the mother’s milk (Vavřinková and Binder, 2007a).
The studies on the occurrence of neonatal abstinence syndrome (NAS) and other conditions in newborns confirm
that the onset and the intensity of symptoms depend on the type of drug, dose, and the time of last use. Evidence
shows that withdrawal symptoms are likely to subside rapidly in the children of mothers using heroin, while
withdrawal from substitution medication manifests itself later and lasts longer. NAS develops in 50–90% of the
children of mothers who used opiates (both illegal drugs and substitution medication) during pregnancy and
interferes in a number of organs and regulatory systems (Stará et al. 2009). Alcohol is the most common cause of
congenital mental retardation, and even small doses are associated with a higher risk of birth anomalies and lower
intellect (Čihař, 2009).
One of the key objectives of postnatal care for drug-using women is the rehabilitation of their family. It has been
shown that the success of such rehabilitation is conditioned by ensuring the primary contact between the mother and
the child after birth and, where possible, by support from the broader family. The postnatal adaptation of drugdependent
parents’ children may be short (with a varying course of NAS). However, it has been suggested that the
use of addictive substances during pregnancy has long-term effects which may later manifest themselves in children
as hyperactivity, difficulty in concentrating, irritability, speech disorders, slowness, or ADHD. As part of a study
carried out at the Children’s Centre in Prague (formerly a so-called nursery home), the present psychomotor
development, the maturation of the CNS, and health risks in the children of 200 mothers with a history of drug use
page 148