environmental challenges, including poverty or deprivation, homelessness, inability to afford or access dental or medical care, unemployment, a lack of vocational skills, interpersonal violence, and ineffective parenting skills. As such, brief screening instruments, followed by assessment and treatment when needed, are urgently needed for front-line substance abuse treatment staff to quickly and easily administer, to interpret the results, and to refer their clients for further assessment for mental health treatment (Lincoln et al., 2006).

Although the rates of depression in parents who treated for substance use disorders are elusive, several promising programs that screen, assess, and treat depression in pregnant and parenting women who are also being treated for substance use disorders are highlighted below.

Specific to pregnant women, the Center for Addiction and Pregnancy, located in Baltimore City on the campus of the Johns Hopkins Bayview Medical Center, is a comprehensive care model (Jansson et al., 1996, 2007). The center provides treatment for substance use disorders while concurrently providing obstetrical, medical, and other psychiatric care to mothers and pediatric care to the children of patients. As a part of the center’s comprehensive screening battery, a screen for mental health issues is included. Given the need to minimize paperwork and demands on patients and staff, a study comparing the utility of the Addiction Severity Index (ASI) to the BDI was conducted to see which instrument predicted mood disorders in this pregnant drug-dependent population. The ASI psychiatric severity rating by the interviewer was found to have better sensitivity and specificity than the BDI for predicting mood disorders (Chisolm et al., in press). The ASI, which is a required intake tool for substance abuse treatment programs in many states, is now used for screening patients for the need for further psychiatric assessment by the center psychiatrist. The center’s research has also found that when using the Structured Clinical Interview for DSM Disorders, diagnosed depression in the absence of anxiety is especially prevalent (54 percent) in pregnant, drug-dependent patients (Fitzsimons et al., 2007).

Two promising programs described in Chapter 6 treat mental health, interpersonal violence, and substance use disorders in mothers and families. The first model is the Boston Consortium of Services for Families in Recovery Model, which under the Boston Public Health Commission has an active collaborative system of services for women with substance use disorders as well as mental health and trauma issues (Amaro et al., 2005). The system, which routinely screens all new patients for mental health disorders, found that 88 percent of patients reported experiencing mental health symptoms in the month before treatment entry (Lincoln et al., 2006). The other model is part of PROTOTYPES, which also provides services for women with substance use disorders as well as a variety of mental illnesses and trauma issues (Brown, Rechberger, and Bjelajec, 2005).



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