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“Compassionate Coercion”: Factors Associated With Court-Mandated Drug and Alcohol Treatment in Pregnancy 1994–2005

Terplan, Mishka MD, MPH; Smith, Erica J. MPH; Kozloski, Michael J. MA, MS; Pollack, Harold A. PhD

doi: 10.1097/ADM.0b013e3181b562dc
Original Article

Objectives: To describe trends in court-mandated treatment in pregnancy. In particular, to determine whether pregnant women who enter treatment via the criminal justice system differ from women who enter voluntarily.

Methods: Data were obtained from the Treatment Episode Data Set, an administrative data set that captures admissions to federally funded treatment centers in the United States. Demographic and treatment-related measures were examined among pregnant women comparing referral source and stratified by year of admission to assess trends over time.

Results: Throughout the study period, the proportion of pregnant women entering substance abuse treatment via the criminal justice system increased more rapidly than the increase observed among men or nonpregnant women reaching 30.9% by 2005. Compared with voluntary admissions, admissions originating in the criminal justice system were more likely to be white, young, and employed. The primary substances compelling court-mandated treatment for pregnant women were alcohol and cocaine in 1994, and by 2005 it had shifted to amphetamine and marijuana.

Conclusion: The increase in criminal justice referrals parallels the growth of drug courts. The demographic characteristics of the pregnant referrals, however, suggest the presence of gaps in both screening and treatment in pregnancy.

Dr. Terplan was awarded the 2009 Young Investigator of the Year Award by American Society of Addiction Medicine.

From the Department of Obstetrics and Gynecology (MT), University of Maryland, Baltimore, MD; Departments of Obstetrics and Gynecology (EJS, MJK) and Sociology (MJK), School of Social Service Administration (HAP), The University of Chicago, Chicago, IL.

Received for publication March 18, 2009; accepted June 30, 2009.

Send correspondence and reprint requests to Mishka Terplan, MD, MPH, Department of Obstetrics and Gynecology, University of Maryland, 11 S. Paca St., 4th Flr., Room 14, Baltimore, MD 21201. e-mail:

Supported by the Center for Health Administration Studies at the University of Chicago.

Some of the results from this manuscript were previously presented at the 39th Annual Medical-Scientific Conference of the American Society for Addiction Medicine for which it received the Young Investigators Award.

© 2010 American Society of Addiction Medicine