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KAP KEYS Based on TIP 2
Pregnant, Substance-Using Women



        CSAT’s
Knowledge Application Program


KAP Keys
For Clinicians

Based on TIP 2
Pregnant, Substance-
Using Women



U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov

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KAP KEYS Based on TIP 2
Pregnant, Substance-Using Women



These KAP Keys were developed to accompany the Treatment
Improvement Protocol (TIP) Series published by the Center for
Substance Abuse Treatment (CSAT), Substance Abuse and
Mental Health Services Administration. These KAP Keys are
based entirely on TIP 2 and are designed to meet the needs of
the busy clinician for concise, easily accessed "how-to" infor
mation.
For more information on the topics in these KAP Keys, readers
are referred to TIP 2.
Introduction



TIP 5, Improving Treatment for Drug-Exposed Infants (1993)
 BKD110
TIP 25, Substance Abuse Treatment and Domestic Violence
 (1997) BKD239
TIP 27, Comprehensive Case Management for Substance
 Abuse Treatment (1998) BKD251
TIP 36, Substance Abuse Treatment for Persons With Child
Abuse and Neglect Issues (2000) BKD343
Other Treatment Improvement Protocols (TIPs)
that are relevant to these KAP Keys:

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Procedures for the First
Prenatal Visit
1

KAP KEYS Based on TIP 2
Pregnant, Substance-Using Women

• Detailed health history, including alcohol and illicit drug use
and psychosocial assessments

• Comprehensive physical examination, focusing on the multi
ple medical problems of this population

• Family psychosocial, medical, alcohol and illicit drug use his
tory

• Health, psychosocial, alcohol and illicit drug use history of
the baby's father

• Routine prenatal panel, plus other laboratory tests, including
urine and/or blood toxicology screening, tuberculin test with
an antigen panel, and baseline sonogram

• Optional tests as needed, including screening for human T-
cell lymphotropic virus (HTLV)-I and hepatitis C

• Attention to areas of special concern in substance-using
women

• Attention to medical complications encountered in pregnancy

• Referrals to an alcohol or illicit drug treatment program,
nutritional counseling, social services, and other counseling

• Additional referrals as needed

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Point of Entry: Substance
Abuse Treatment
2

KAP KEYS Based on TIP 2
Pregnant, Substance-Using Women


Alcohol
• Setting: Inpatient, under medical supervision
• Follow admission procedures
• Monitor for signs and symptoms of alcohol withdrawal syn
drome (use medical caution)
• Antabuse: contraindicated (use medical caution)
• Inpatient substance abuse treatment whenever possible
• Outpatient substance abuse treatment with special focus on
pregnancy issues and drug use
• Encourage and monitor continued prenatal care

Cocaine
• Setting: Inpatient is most effective
• Follow admission procedures
• Medication contraindicated, except in cases of extreme agi
tation (use medical caution)
• Inpatient substance abuse treatment whenever possible
• Outpatient substance abuse treatment if necessary, with
special focus on pregnancy issues and drug use
• Encourage and monitor continued prenatal care

Sedative-Hypnotics
• Setting: Inpatient, under medical supervision
• Follow admission procedures
• Monitor for severe symptoms: seizures, delirium (use med
ical caution)
• Determine risk/benefit ratio when considering use of med
ications (use medical caution)
• Encourage and monitor continued prenatal care

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Point of Entry: Prenatal Care 3



Postpartum
• Encourage continued participation in substance abuse treat
ment
• Encourage and educate about family planning
• Permit breastfeeding in methadone-maintained mothers
• Initiate preventive health maintenance program
• Provide for child care and parenting education
• Conduct postpartum followup
• Additions for HIV-positive women
- Conduct postpartum followup
- Breastfeeding contraindicated
- Encourage continued participation with HIV specialist 
for medical followup for mother and infant

- Educate mother regarding special needs of infant

- Encourage and educate about family planning

Neonatal
• Obtain urine and/or blood toxicologies
• Monitor for effects of drugs on the infant
• Treat appropriately, depending on drug
• Review case with mother and educate her regarding special
care of infant
• Encourage involvement of father of baby or significant other,
and family members
• Additions for HIV-positive women
- Ensure special pediatric followup
KAP KEYS Based on TIP 2
Pregnant, Substance-Using Women

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Training Areas 4



Training for medical staff, alcohol and illicit drug treatment
providers, and others serving pregnant, substance-using
women and their children should address these topics:
• Diagnosis and treatment
- Medical guidelines
- Treatment readiness in substance-using women
- Assessment instruments

- Dual diagnosis

- Women with positive toxicology screens in alcohol and 
illicit drug treatment programs

- Followup care

• Population-specific issues
- Child abuse and neglect
- Noncompliant patients

- Gender-specific treatment
- Sociocultural sensitivity

- Incest, adult and child sexual abuse
- Domestic violence

- Habilitation and rehabilitation

- Child development

• Staff development
- Multidisciplinary team approach
- Staff development and burnout

A collection of sample assessment instruments is available as
a package from SAMHSA's National Clearinghouse for Alcohol
and Drug Information (NCADI), P.O. Box 2345, Rockville, MD
20852, 1-800-729-6686.
"Assessment Instruments for Programs Serving Pregnant,
Substance Abusing Women." Available from SAMHSA/CSAT
Web site at: www.csat.samhsa.gov. Fee: $1.00
KAP KEYS Based on TIP 2
Pregnant, Substance-Using Women

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Ordering Information
         TIP 2
Pregnant, Substance-Using Women



Easy Ways to Obtain Free Copies 
of All TIP Products

1. Call SAMHSA's National Clearinghouse for Alcohol and
Drug Information (NCADI) at 800-729-6686, 
TDD (hearing impaired) 800-487-4889.
2. Visit CSAT's Website at www.csat.samhsa.gov



Do not reproduce or distribute this publication for a fee with
out specific, written authorization from the Office of
Communications, Substance Abuse and Mental Health
Services Administration, U.S. Department of Health and
Human Services.



DHHS Publication No. (SMA) 01-3552
Printed 2001