Isabel Byon: 0:00

The New York State Office of Addiction Services and Supports, or OASAS, provides this podcast as a public service. Opinions expressed do not necessarily reflect those of the agency or state. This is Addiction: The Next Step.

Jerry Gretzinger: 0:21

Hey everybody, Jerry Gretzinger here, your host for Addiction: The Next Step, the podcast that's brought to you by the New York State Office of Addiction Services and Supports.

Jerry Gretzinger: 0:30

And you know we've talked about so many topics in our 75 plus episodes and we have actually yet to touch on the one we're going to talk about today. And you know, really shame on us for not getting to it sooner, because it's so important and sometimes a difficult thing to even think about. Wrap your head around. You know, what we're talking about is something that deals with pregnant women who are living with substance use disorders. And you know, obviously you can think about that and it can be a heartbreaking thing to even consider. You know an expectant mom living with substance use disorder wondering, you know, how will that may that impact their unborn child and what can be done to assist them both. Well, today we're going to be talking to someone who's answering some of those questions and trying to provide supports and services for them, and that's Dr Leah Habersham. She's the director of the Bridge Program at Mount Sinai and, Leah, thanks so much for sitting down with us today on the podcast.

Leah Habersham: 1:24

Yeah, thank you for having me.

Jerry Gretzinger: 1:26

So you know I mentioned and we'll talk about this first you know, just even considering, you know this whole idea, we know it's a reality, right? There are women with substance use disorder who are with child, who are going to give birth, and there's the concerns about how does that substance use disorder affect their child, affect the mother, and that's something that kind of drives what you're doing.

Leah Habersham: 1:48

Yes, definitely. It's a problem that oftentimes neither side who normally cares for this population knows how to manage exactly, and so the OB's tend to not have that training of how to manage substance use disorders. And then the addiction specialists tend to not have that training of how to manage the substance use disorder when it's occurring in a pregnant patient, and so it oftentimes leads to a gap in knowledge and care.

Jerry Gretzinger: 2:26

Yeah. So let's talk first about, like some of those, some of the concerns that are raised right when we know about a woman who's expecting a child and is living with substance use disorder, what are the health, what are the safety concerns that we look at, you know, when it comes time to delivering that child, or even during the pregnancy.

Leah Habersham: 2:40

Yeah. So I mean there's lots of concerns, especially the ones that we have regardless of whether the woman is pregnant or not, overdose, things like that. But then with pregnancy specifically, growth restriction is one, the chance of the baby having the possibility of neonatal opioid withdrawal syndrome is another. Lots of different things that can happen, especially with the fact that we don't know oftentimes what is in the substance and that can lead to further issues later. And then the other thing is even getting access to treatment, access to care. This seems to be a big problem once moms are ready to get into treatment finding providers that are willing to treat them, finding programs that are willing to accept them in that pregnant state.

Jerry Gretzinger: 3:35

Now you mentioned neonatal opioid withdrawal syndrome, right. So are we talking mostly about opioids? Are there other substances that an expectant mother could be using that can have that sort of an effect on the unborn child, or again on both of them in that particular situation?

Leah Habersham: 3:55

Yeah, so neonatal abstinence syndrome is the more broad term. N eonatal opioid withdrawal syndrome is specific to opioids. So neonatal abstinence syndrome can occur with a variety of substances like SSRIs, which have nothing to do with substance use disorders, as well as benzodiazepines, but then also opioid use. Opioids can also lead to neonatal abstinence syndrome, but when we speak specifically about that due to opioids, we call it N-O-W-S.

Jerry Gretzinger: 4:32

So how does your program? How do you become aware of an expectant mom with substance use disorder, like? At what point do you find out about it? Do you find and I'm sure there's a variety of ways that you find out and can start providing services or support. But is it typically like the mom who comes forward and says you know I'm pregnant, I use substances, I want to figure out what's right for me and my baby. Is it someone who's a physician, a care provider, who comes forward and says what can we do to assist them? Tell me that process.

Leah Habersham: 5:04

Yeah, oftentimes it's not the patient themselves, I say the majority of times it's another provider in the community, sometimes within our own health system or within another program that houses women who are pregnant, who are aware of our program, and then we'll link them to our services.

Jerry Gretzinger: 5:25

And so at that point, once they've been linked to services, sort of what's the process then? I mean, are the moms usually receptive to that service being offered? And what happens at that point? Is it trying to help moms, sort of like back off from the substance use or to be healthier through it, like what's the next step, I guess?

Leah Habersham: 5:44

So once they're linked with our program, we link them with our social worker, who's specific to the bridge, we have a peer and then they meet with myself and so we encourage harm reduction. So most moms are usually wanting to stop using substances. They're not already on medication for opioid use disorder or whatever their use disorder is. If there's an FDA approved medication, I can start them on that, and it's usually about trying to help moms to stop use if they currently have use, if that's what they want, if that's their goal. I've had most patients that's their goal. There are a few patients who don't intend to stop and so I still provide care to them just the same, and just it's about education and getting them to the prenatal care and the addiction care that they need.

Jerry Gretzinger: 6:45

And so the folks who are working with them will work with them straight through delivering the child and, I would imagine, continuing afterwards as well.

Leah Habersham: 6:56

Yeah, so my program it's an integrated OBGYN and addiction program, so I treat women throughout the lifespan, it's not just specific to pregnancy. So even after they deliver, I have patients that still continue on with me, particularly if I'm providing their addiction care. So they'll still continue with me even postpartum.

Jerry Gretzinger: 7:17

And you know, go ahead Sorry.

Leah Habersham: 7:19

No, I was just going to say. And then on continuing on beyond the postpartum period.

Jerry Gretzinger: 7:24

And you know, unfortunately this word winds up being wrapped up into so many different. You know scenarios, but stigma. I'm sure one of the things that is a challenge for moms to come forward and seek or accept services like these is the stigma that they're afraid may be associated with it.

Leah Habersham: 7:42

For sure, and so that's something that we try to address with this program, right, because everyone that we're treating here has an addiction, and so it's not really an issue here, it's the norm for our program, and so we really try to destigmatize, we offer trauma-informed care, and that's really our focus and what makes this program unique and necessary, I think.

Jerry Gretzinger: 8:13

So talk to us too, about you know. You have people who. How long has this program been running, by the way?

Leah Habersham: 8:19

Since September of 2022.

Jerry Gretzinger: 8:21

All right, All right. So we've got a few years in and I'm assuming you must have had some really you know good stories that have come out of the work that you're doing and you've seen, seen moms come in and been able to deliver a child and see that joy of new life and perhaps the mom's enjoying a new life of their own after going through treatment.

Leah Habersham: 8:39

Yeah, yeah, for sure. We actually have a patient who started with us early in pregnancy. She continued on with us postpartum and is now actually a peer for the program. I have another patient who just completed her CASAC and is going on to, you know, help others who are in similar situations to herself. So we have had several success stories that, you know, really warm my heart and really make me feel like we're doing the best work possible.

Jerry Gretzinger: 9:13

Yeah, no, that's great. It's good to hear that those outcomes are possible and are happening. You talked before about you know there's not enough crossover, really right, people who are working in substance use disorder may not always have the knowledge of an OBGYN, and then the reverse also applies. What kind of work's being done to sort of to bridge those gaps, so that people are aware that you know there are services available for women in this position and how to connect them with them?

Leah Habersham: 9:42

Yeah, I get invites a lot to do talks at different places, and so I think it's education as tea. We're giving talks within the OB community, within the addiction community, and so it's getting the word out that there is this specialized care. That's one way. There's also the New York City Council, I know, is looking at a bill that will increase education and awareness for providers in general of this maternal population as well as the broader community. And so I think all of that is really needed. I hope it passes. But all of that is really needed in order to address this problem, in order to get people to know that there is help out there and that recovery is possible, even the population, and it's so needed. We need more education really.

Jerry Gretzinger: 10:38

Yeah, that's absolutely true, and I guess that's one of the reasons why we do this podcast right we want to make sure we're helping get the word out. We're very happy to have been able to help share the word about this program that you're involved with and a lot of good work that you've done and hopefully a lot more good work ahead. If people have questions, they have they're looking for more information. You know, obviously you said most times it's another provider who says oh, I know someone who could benefit, but if somebody is out there and hears this and says I'm in that position, what can I do to learn more? Where should they go? What should they do?

Leah Habersham: 11:12

MountSinai. org. You can look up the bridge program on Mount Sinai, and then also we have an email address which is thebridge@mountsinai. org.

Jerry Gretzinger: 11:23

Great, okay, excellent. And you know, if somebody isn't, like you know, local to Mount Sinai, I'm assuming there have to be like referrals to other programs around the state that can be made and, you know, get people the help they're looking for, regardless of you know what corner of New York State they're in.

Leah Habersham: 11:38

Definitely. Yeah, there are all kinds of programs I am happy to connect people.

Jerry Gretzinger: 11:46

Great. Perfect, and I know you gave some email addresses and websites there. We'll put links to those in the notes for the podcast as well. Dr Leah, thank you so much for chatting with us today about this. Like I said, we've done 75 episodes, haven't talked about this, but obviously this is definitely something that's important to focus on and we're glad that you're focusing on it.

Leah Habersham: 12:04

Thank you so much,

Jerry Gretzinger: 12:06

All right. We'll have to have you back at some point when you've got more of those success stories to share with us.

Leah Habersham: 12:11

Happy to do so.

Jerry Gretzinger: 12:12

Great, all right, take care and hey, listen. Thank you so much for joining us for this episode of Addiction: The Next Step, brought to you by the New York State Offices of Addiction Services and Supports. You can always go to our website, oasas. ny. gov, o-a-s-a-s, dot N-Y, dot, G-O-V. And you've also got our Hope Line. It's always a resource 877-8-HOPE-NY. Until we talk to you next time. I'm Jerry Gretzinger, be well.