If you or someone you know is in crisis right now: call or text 988 (Suicide & Crisis Lifeline). For a possible overdose or any medical emergency, call 911. For help finding treatment, the SAMHSA National Helpline is free and open 24/7 at 1-800-662-4357.
The short answer
If you are pregnant and using alcohol or drugs, getting treatment is safer than not, and it is possible. For opioid use disorder, medication with buprenorphine or methadone is generally recommended instead of stopping suddenly. Tell your prenatal provider as early as you can. Laws about reporting vary by state, so it helps to ask about them early, and legal help exists.
Why treatment matters
Substance use during pregnancy carries risks for you and your baby, and stopping some substances suddenly can also be dangerous. Early prenatal care and treatment improve outcomes. You deserve support, not shame.
What to do first
- Call your prenatal provider or a doctor, and be honest about what you use. They need accurate information to keep you and your baby safe.
- Do not stop alcohol, benzodiazepines or opioids suddenly on your own. Withdrawal can be dangerous, and for opioids, stopping suddenly can increase the risk of relapse. (See [Can You Detox at Home? Dangers of Alcohol and Benzodiazepine Withdrawal].)
- Call the SAMHSA helpline (1-800-662-4357) and say you are pregnant. Many programs prioritize pregnant women.
- For questions about specific substances or medications, MotherToBaby (1-866-626-6847) offers free, confidential information. Verify current contact details at mothertobaby.org.
Safe treatment options, by substance
| Substance | What to know |
|---|---|
| Opioids | Medication treatment, with buprenorphine or methadone, is generally recommended by major medical groups. Medically supervised withdrawal alone is usually discouraged because relapse risk is high. (See [Opioid Addiction Treatment: Buprenorphine, Methadone and Naltrexone Compared].) |
| Alcohol | No amount is known to be safe in pregnancy. Heavy drinkers should stop under medical supervision because withdrawal can be dangerous. |
| Tobacco and vaping | Counseling is first-line. Talk to your provider about other options. |
| Cannabis | Talk to your provider. It is generally advised to avoid during pregnancy. |
| Stimulants | Behavioral treatment is the foundation. Seek care early because stimulants can raise pregnancy risks. (See [Cocaine and Methamphetamine Addiction Treatment: What Works].) |
| Benzodiazepines | Do not stop suddenly. Your provider can plan a supervised taper if needed. (See [Benzodiazepine Dependence: Why Tapering Should Be Medically Supervised].) |
Medication for opioid use disorder in pregnancy
Buprenorphine and methadone help stabilize the pregnancy, reduce cravings and withdrawal and lower the risk of relapse and overdose. A baby born to a mother taking these medications may have temporary withdrawal symptoms, called neonatal opioid withdrawal syndrome, which hospital teams know how to treat. It is not a sign that treatment was the wrong choice. (See [Medication-Assisted Treatment (MAT): How It Works and Who It’s For].)
Levels of care and programs for pregnant women
Programs may include prenatal care alongside treatment, women-only groups and parenting support. (See [Women’s Rehab: Why Gender-Specific Programs Matter].) Many publicly funded programs prioritize pregnant women, so mention it when you call. (See [How to Get Into Rehab Fast: Same-Day and Next-Day Admission Options].)
Legal protections and risks: what to know
Rules differ by state, so ask before you disclose.
- Reporting rules vary. States differ in their policies on mandatory reporting by health care professionals of substance use during pregnancy and in the consequences for women. Depending on the state, mandatory reporting can either support or block access to treatment.
- Federal law requires “plans of safe care.” The federal Child Abuse Prevention and Treatment Act, as amended in 2016, requires a plan of safe care for infants affected by prenatal substance exposure and for their caregivers.
- Experts urge a treatment-first approach. ACOG and the federal law recommend a plan of safe care approach focused on treatment and family support, rather than punishment. Fear of a child-protective-services referral is a barrier that stops some women from getting prenatal care.
- Some states treat prenatal substance use as child abuse or neglect, or have used criminal laws, while others focus on treatment. This varies, and it changes.
What you can do:
- Ask your provider what their reporting duties are and what happens after a report, before you share details if you are worried. Also ask whether the program has a plan of safe care process.
- Look for legal information. Pregnancy Justice (pregnancyjusticeus.org) provides legal help and information on state laws.
- Contact a legal aid organization or an attorney in your state.
- Remember that getting treatment, especially medication under a doctor’s care, is generally a positive step. Ask about how prescribed treatment is treated under your state’s rules.
Coverage and costs
Medicaid covers pregnancy-related care, including treatment, for eligible women, and many states now extend coverage after delivery. (See [Does Medicaid Cover Addiction Treatment? How It Works by State].) Ask programs about financial help. (See [Free and Low-Cost Rehab Options Without Insurance].)
After the baby arrives
- Keep your treatment going. The postpartum period is a high-risk time for relapse.
- Ask about breastfeeding. Many people on medication for opioid use disorder can breastfeed. Talk to your doctors.
- Line up support: family, peer groups and postpartum care. (See [What Is Aftercare? How to Build a Relapse-Prevention Plan].)
If you are a family member
Offer support without judgment, help with appointments and childcare and encourage honest conversations with providers. (See [How to Talk to a Loved One About Addiction Without Pushing Them Away].)
Frequently asked questions
Is it safe to get treatment while pregnant?
Yes. Treatment is generally safer for you and your baby than untreated use, and some medications are recommended.
Can I take buprenorphine or methadone while pregnant?
Major medical groups generally recommend them for opioid use disorder in pregnancy, under medical supervision.
Will I be reported for seeking help?
It depends on your state and provider. Ask about reporting rules and seek legal information if you are concerned.
Should I stop using suddenly?
Not without medical advice. For some substances, stopping suddenly can be dangerous.
Where can I get help right now?
Call your doctor, the SAMHSA helpline (1-800-662-4357) or, in an emergency, 911.
Sources
- American College of Obstetricians and Gynecologists. Opioid Use and Opioid Use Disorder in Pregnancy (Committee Opinion).
- Child Abuse Prevention and Treatment Act (CAPTA) and the Comprehensive Addiction and Recovery Act (2016).
- U.S. Department of Justice, Bureau of Justice Assistance. Substance Use and Pregnancy: Current State Policies on Mandatory Reporting. bja.ojp.gov
- SAMHSA. National Helpline. samhsa.gov
This article is for general information only and is not medical or legal advice. State laws change, so talk to a qualified attorney about your situation.