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The Impact of Prenatal Alcohol Exposure on Addiction Treatment

Grant, Therese M. PhD; Brown, Natalie Novick PhD; Dubovsky, Dan MSW; Sparrow, Joanne MA; Ries, Richard MD

doi: 10.1097/ADM.0b013e31828b47a8

Fetal alcohol spectrum disorders (FASDs) are conditions caused by prenatal alcohol exposure in amounts sufficient to cause permanent deficits in brain functioning. Extent of damage largely depends on timing, dose, frequency, and pattern of exposure. Timing is especially important because prenatal alcohol exposure during critical periods of gestation can affect brain development in ways that produce varying patterns of neurocognitive deficits and associated adaptive impairments. This article describes some of the more serious neurophysiological and neuropsychological sequelae of prenatal alcohol exposure that contribute to increased risk for substance abuse problems among people with an FASD. We discuss the unique interface between pharmacological treatment and FASD, noting that failure to consider the possibility of FASD in treatment planning may result in treatment failure and/or relapse. Finally, we present a clinical case example and recommend service accommodations to address some of the impairments in FASD that limit substance abuse treatment success.

From the Department of Psychiatry and Behavioral Sciences (TMG, NNB, JS, and RR), University of Washington School of Medicine, Seattle; and Substance Abuse and Mental Health Services Administration Fetal Alcohol Spectrum Disorders Center for Excellence (DD), Rockville, MD.

Send correspondence and reprint requests to Therese M. Grant, PhD, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 180 Nickerson St, Ste 309, Seattle, WA 98109. E-mail:

The authors declare no conflicts of interest.

Received December 09, 2012

Accepted February 02, 2013

© 2013 American Society of Addiction Medicine