Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

442 IV. SPECIAL POPULATIONSin miscarriage, low birthweight, and sudden infant death syndrome. Unfortunately,many young women believe that cocaine facilitates a quick and lesspainful delivery, whereas it actually produces obstetric complications that causedamage to the newborn, as well as birth defects secondary to its deleteriouseffects on fetal circulation. Pregnant heroin addicts are customarily treated withmethadone as a maintenance drug rather than detoxification to abstinence, as asafer regimen for the fetus. With good prenatal care, such patients can bebrought to term and experience normal deliveries. However, their infantsrequire treatment for neonatal opiate withdrawal (U.S. Department of Healthand Human Services, 1993).Whether or not birth defects occur, untreated substance abuse/dependencein a new mother will interfere with maternal–infant bonding, parenting,and family life. Thus, pregnancy is a critical time for case findingand intervention. Among the approximately 4 million pregnancies in theUnited States annually, approximately 12% of women smoke (Ibrahim, Floyd,Merritt, & De Couble, 2000), 23% use alcoholic beverages, and 4.4% useother substances (Substance Abuse and Mental Health Services Administration,2002).GENETIC INFLUENCESA great deal of research has been devoted to the effort to differentiate geneticfrom environmental factors in the etiology of alcoholism, as well as other drugdependencies. Almost all implicate a combination of nature and nurture(Kendler, Walters, & Neale, 1995). Of interest here is that some studies showdifferent patterns of alcoholism heredity for men and women (Prescott, Aggen,& Kendler, 1999).Studies of possible genetic markers in children of alcoholics have largelybeen confined to males, or to a small number of women. Daughters of alcoholicparents have also been found to have more positive and pleasant mood reactionsto a single dose of alprazolam, suggesting that they may be at greater riskfor abuse of this drug. Regarding the heritability of drug use disorders, there isindication that genetic influences are stronger for males than for females, whileenvironmental factors are more evident in females than in males (Blume &Zilberman, 2004; Zilberman & Blume, 2004).In addition, some research suggests that there is a genetic link betweenalcoholism in male relatives and major depressive disease in women, in a combinationof genetic and environmental causation (Cadoret et al., 1996). Astudy in female twin pairs suggests separate heredity but common environmentalrisk factors for comorbid alcoholism and major depression in women(Kendler, Heath, Neale, Kessler, & Eaves, 1993).