Effects of Substance Use During Pregnancy

Substances like alcohol, marijuana, and illicit drugs can greatly affect the mother and child during pregnancy and cause complications during and after birth. Sometimes, the mother isn’t aware of her pregnancy and may use substances as if she weren’t carrying. In any case, using substances while pregnant can alter the health of the mother, the fetus, and the baby as it grows in and out of the womb.

Knowing the effects of substance use beforehand can help those who know they’re pregnant or think they may become pregnant carefully assess the risks to plan ahead for a healthier birth and pregnancy.

Understanding Substance Use During Pregnancy

Substance use during pregnancy can look like taking drugs that aren’t approved for pregnant people, like alcohol. These drugs have been identified as dangerous for the mother and fetus or potentially harmful. 

Common substances used during pregnancy, whether done intentionally or not, include alcohol, nicotine, some prescription medications (like prescribed opioids), and illicit drugs like cocaine or heroin. Studies found roughly 5% of pregnant women use substances while pregnant1.

Much of what mothers consume while pregnant reaches their infant because the placenta is easily permeable—including addictive and non-addictive substances.

Effects of Alcohol Use During Pregnancy

Alcohol can have damaging effects on a developing fetus throughout each stage of pregnancy1, even before mothers realize they’re pregnant. Drinking while pregnant can cause Fetal Alcohol Syndrome Disorders (FASD), which includes Fetal Alcohol Syndrome and other birth defects caused by alcohol.

FASDs cause cognitive, physical, and behavioral damage2 that may show right after birth or later on in childhood. Alcohol can disrupt the development of vital organs, like the brain, heart, and how the body functions as a whole. Heavy drinking can cause the most damage, especially when it occurs throughout the entire pregnancy. But no amount of alcohol is safe during pregnancy2. And with many pregnancies not being planned, doctors recommend women not to drink even while they’re trying to get pregnant or think they might be2.

Children born with a FASD may have defining facial features, cognitive impairments, and related behavioral problems. 

Effects of Tobacco Use During Pregnancy

Smoking while pregnant can harm the mother and baby3 in several ways. It can lead to:

  • Premature births
  • Low birth-weight even if the baby is to term
  • Damage to the baby’s lungs and brain
  • Birth defects
  • Higher risk of sudden infant death syndrome (SIDS)
  • A doubled risk for excessive bleeding at birth and during pregnancy

Smoking can also create issues with fertility3 for both the mother and father. Nicotine can affect the fetus throughout the whole pregnancy—some mothers give birth to healthy babies, but that doesn’t guarantee they can smoke through a second pregnancy and get the same results. Smoking while pregnant can even result in a stillbirth (a deceased baby born after 20 weeks). Quitting at any point during the pregnancy can reduce the likelihood of all negative effects.

Second-hand smoke can also cause damage. Pregnant mothers can reduce their risks by quitting smoking and limiting their exposure to second-hand smoke. 

Effects of Illicit Drug Use During Pregnancy

Using illicit drugs when pregnant can double or even triple the chances of a stillbirth1. These types of drugs include heroin, cocaine, methamphetamine, and psychedelics like psilocybin. Since drugs pass easily through the placenta and into the developing fetus, babies can be born reliant, and addicted, to the substance their mother used. This is called neonatal abstinence syndrome (NAS).

Neonatal Abstinence Syndrome: Symptoms and Recovery

NAS correlates to illicit or prescribed opioids used during pregnancy4. Babies born with NAS greet the world in a state of withdrawal, experiencing irritability, stomach issues, seizures, and trembling. Babies with NAS also cry excessively and with a higher pitch than normal.

Medical care can help babies detox4 from substances safely and with greater comfort. Some babies require benzodiazepines, morphine, or methadone to relieve symptoms. They can recover to full health.

Effects of Prescription Medication Use During Pregnancy

Some prescribed medications aren’t fit to use during pregnancy—doctors should make women well-aware of this if they’re trying to conceive or are already pregnant. When pregnant women take prescribed medications against doctor’s advice, or procure them from non-medicinal places, it can harm them and their baby. 

These medications include benzodiazepines, opioids, and stimulants like Adderall. Most medications, prescribed or over the counter, haven’t been well-studied in regards to how they affect pregnant women and babies. A study found 9 out of 10 pregnant women took medications1—many of whom don’t know how it might affect their developing fetus, which is why providing a list of all medications taken can help doctors identify any risks.

Some medications can cause NAS, like oxycodone. Other medications may cause no harm, but it’s best to let doctors make the final call.

Combined Substance Use and Its Effects

Using more than one substance, or polysubstance use, can create more pronounced health effects for the mom and baby. For example, a pregnant woman who smokes and drinks alcohol imposes greater health risks to herself and the baby than someone only smoking or only drinking. 

The more substances passing through the placenta to the baby, the more likely they’ll have a negative effect on their development and future health. The National Institute on Drug Abuse says1,

Children born to mothers who both drank and smoked beyond the first trimester of pregnancy have a twelvefold increased risk for sudden infant death syndrome (SIDS) compared to those unexposed or only exposed in the first trimester of pregnancy.

Psychological and Emotional Impact on Pregnant Women

Taking drugs during pregnancy can have a host of emotional and psychological effects on women. They may feel low or depressed as a result of their substance use, especially when that combines with hormone fluctuations. Regular substance use can cause a cyclical effect, where highs are followed by extreme lows and cause someone to continue their use to mitigate the lows.

Impaired mothers may also struggle to bond with their baby once they’re born. Drug use can affect the parts of the brain that help mothers bond with their baby5, making it difficult for them to form a secure parental relationship. This can impact their connection and parenting style throughout the baby’s life.

Preventative Measures and Treatment Options

One of the first steps in preventing substance use during pregnancy is testing regularly (or as needed) for pregnancy if using substances—or don’t use substances at all if you’re hoping to conceive

Educating men and women on the dangers of substance use during pregnancy can help mothers and partners understand and evaluate risks, and then adjust their behaviors accordingly. Knowing these risks before pregnancy can help mothers adequately prepare and create a substance-free environment for their baby to form and grow.

If you’re struggling with an active addiction and become pregnant, you can attend recovery programs and rehabs specifically for pregnant women (there’s a lot!). These programs account for you and your baby, addressing your needs with appropriate medical care, therapies, and prenatal care to support a healthy, full-term pregnancy.

If babies are born with substance-related complications, hospital staff can initiate a detox for the baby with medications to ease their withdrawals. Some birth defects caused by substances can’t be treated or reversed, but medical care can treat some symptoms throughout the person’s life.

Support Systems and Resources

Friends, loved ones, and medical staff can offer key support for pregnant women, helping them navigate addiction treatment if needed, and the journey of pregnancy. Women can join various support groups too, like 12-Step peer meetings or non-12-Step groups like SMART Recovery meetings. Prenatal clinics may also offer support groups to educate women on child-raising, best practices for their health, and to connect women to resources for housing, mental health care, and other personal needs. 
If pregnant women need to detox and/or get addiction treatment, they can go to one of the many rehabs with specialized care for pregnant women. Some rehabs will also offer services and help for other children, helping pregnant mothers attend treatment when childcare needs may otherwise prevent them.

What Is a Gateway Drug?

A gateway drug is a legal or more socially acceptable drug that, once used, could lead to illicit drug use and addiction. Notably, gateway drugs and the gateway drug theory refer to adolescent drug use and how abstaining from all drugs in adolescence can help them avoid illicit drug use and addiction as adults.  

The gateway drug theory1 suggests using “soft” drugs like alcohol, tobacco, or marijuana in adolescence predisposes teens and young adults to use “hard” drugs like cocaine. Order matters in the theory—cocaine use doesn’t lead to alcohol use, but it can be true the other way around.

Researchers haven’t conclusively agreed on the truth of the gateway theory, since not everyone who drinks or smokes becomes addicted or starts using a harder drug. Some people can use gateway drugs and never struggle with illicit drug use. The real connection, some say, is age of onset, preexisting mental health conditions, and genetic predisposition. 

What Are Common Gateway Drugs?

Gateway drugs are almost always legal (in some states), broadly accessible, socially accepted, and easy to ingest. Three primary gateway drugs include:

  1. Alcohol

Alcohol is a prevalent, easily accessed, and socially promoted substance across all age groups. Teens and adolescents may feel pressure to drink with other peers or want to experiment. Some teens can drink occasionally without issue, but one study also found children ages 12-17 who drank alcohol were 50% more likely to later use cocaine2

  1. Nicotine

Cigarettes and vapes contain nicotine, a psychoactive component of tobacco. Daily smoking or vaping was found to lead to marijuana use1 and other hard drugs. Those who smoke were found to be 19x more likely to use cocaine2, compared to teens who didn’t smoke.

  1. Marijuana

Marijuana (also called weed) is a psychoactive chemical that comes from the cannabis plant. It’s legal in some states but commonly used whether it’s legal or not. Weed can be smoked, eaten, or applied topically. It has a pungent mossy odor.

Some teens who used cannabis were 85x more likely to use cocaine2. Another study found teens who use marijuana usually don’t use harder drugs later on. The connection depends not solely on marijuana use1; age of use, timing, and the teen’s mental state primarily provide the ‘gateway’ effect.

Which Drug Is Often a Gateway to Other Drugs?

One particular drug doesn’t always lead to illicit drug use. Taking any psychoactive substance can increase the likelihood of adult substance use1, particularly stronger drugs like cocaine. 

Alcohol and nicotine could be considered more common gateway drugs because both are legal and easy to access, whereas weed isn’t always legal and can be harder to get. 

Are Gateway Drugs Addictive?

Gateway drugs can be addictive. Alcohol, nicotine, and marijuana can all affect and change the brain3, leading to dependence and eventual addiction. Just because they’re legal and common doesn’t mean they’re safe. 

For example, about 29.5 million Americans have been diagnosed with alcohol use disorder4. In 2020, alcohol killed more people than COVID-19. Similarly, nicotine is highly addictive5, and the action of smoking/vaping is reinforcing. 

Are Gateway Drugs Not as Serious as Other Drugs?

No, gateway drugs are serious. Any psychoactive substance can harm your mind and body, unless taken under clinical advice and supervision. 

The World Health Organization (WHO) recently released a statement that “no level of alcohol consumption is safe.”6 Any amount of alcohol, they say, is toxic and has the potential to cause harm and dependence. 

Nicotine is one of the most addictive substances7, found to be as addictive as “hard” drugs like heroin and cocaine. Nicotine also takes effect right away (or as soon as you smoke or vape), which can worsen the rewarding effect and prompt frequent redoses. Starting small can quickly turn into an addiction.

Marijuana can affect your brain, heart, lungs, and learning capacity. Issues with memory, concentration, and learning can be permanent. Marijuana and tobacco smoke both contain carcinogens10 too, which can cause cancer.

Gateway Drug Statistics

A survey by the National Household Survey on Drug Abuse2 found some staggering statistics about gateway drugs and stronger drugs (cocaine was the stronger drug in their example, but it could also be opioids, hallucinogens, and various synthetic drugs.)

Other factors can influence the following statistics, like personality, environment, age of onset, and more. Simply taking a “gateway drug” doesn’t mean your teen will start using stronger drugs or develop an addiction.

  • 99.9% of people who take cocaine first used alcohol, nicotine, or marijuana
  • 90% of teens and adults who take weed first smoked or drank
  • An adult who used marijuana as a child is 17x more likely to regularly take cocaine
  • An adult who smoked as a child is 3x more likely to take cocaine
  • An adult who drank as a child is 6x more likely to use cocaine
  • An adult who used all 3 gateway drugs (alcohol, nicotine, and weed) is 323x more likely to take cocaine
  • A child who uses all 3 gateway drugs is 266x more likely to take cocaine

Implementing Early Prevention Strategies for Gateway Drugs

Several drug use prevention programs specifically focus on adolescents, including Youth.gov, the STOP Act, and D.A.R.E. The well-known D.A.R.E. movement focused on complete abstinence; more recent preventative strategies focus on community education, mental health treatment, and specifically discouraging marijuana use. 

Starting the conversation about alcohol and drugs can help your teen know the consequences of drug use and that they have other coping strategies available (like therapy, hobbies, and connecting to you as a parent). 

Treatment for Gateway Drugs

Many teens, young adults, and adults use drugs and alcohol as a coping tool for mental health disorders and emotional distress. Treating the symptoms of mental health conditions can prevent teens from using substances in the first place.

Behavioral therapies like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) can correct thought distortions and help patients find new coping skills for emotional distress.

Sometimes, teens and adults may need detox and residential treatment for addiction. Detoxing from gateway drugs in a clinical setting safely removes toxins from the body. In residential rehab, patients receive daily monitoring and support, group therapies, and individual therapy to address the root causes of their addiction.  

Outpatient levels of care include day treatment, intensive outpatient, and general outpatient treatment. In outpatient, you live at home and go to treatment so you’ll have more time for school and work. 

Find The Best Drug And Alcohol Treatment Centers

To find a drug and alcohol treatment center and compare your options, you can browse RehabPath’s collection of rehabs to see photos, reviews, and insurance information.

The Signs of Drug Use in Teens

Drug use in teens is an increasing problem in the U.S. It’s important to recognize the signs of drug use in order to intervene and help teens struggling with addiction. Common signs of drug use in teens include changes in behavior, including mood swings, attitudes, and school performance. Additionally, physical signs can include red eyes, changes in sleep patterns, and changes in physical appearance. Finally, teens with drug addiction may show signs of financial or legal trouble, including stealing money or getting into trouble with the law.

If your child is using drugs, this recovery journey you’re about to embark on can not only help your teen, but it can also make your whole family grow closer. Getting teen treatment can set your child on the path to success. 

Signs, Symptoms, and Behaviors of Drug Use in Teens

If you know what to look for, you can discover if your teen is using drugs or drinking alcohol. Be on the lookout for these signs:

Changes in mood:

  • Irritable
  • Withdrawn
  • Unable to focus
  • Depressed or hyperactive

Changes in appearance:

  • Unkempt appearance
  • Bloodshot eyes
  • Flushed cheeks

Changes in behavior:

  • Sneaking out
  • Secretive about their phone or their whereabouts
  • Missing school or work
  • Hanging out with a new crowd of friends

How to Spot Drug Use in Teens

If you have a hunch your kid is using drugs, but you want to be sure, there are some things you can do to get a better idea of the situation:

  • Have eye contact conversations, and see if their eyes are bloodshot.
  • Smell for smoke.
  • Pay attention to their emotional state, this may be out of the norm.
  • Go through their belongings: This can be a sensitive topic. Giving your children the privacy they deserve is important, but if you are concerned about your teen’s safety and well being due to possible drug use, you may want to consider this option.

Teen Drug Use Statistics

 According to the National Institute on Drug Use, since the start of COVID-19, reported drug use has decreased1. This is likely due to school closure and social distancing (i.e. less peer pressure). Luckily, the downward trend has continued through the last couple of years; however, substance use still poses a threat.

The Most Commonly Used Drugs Amongst Teens

The most commonly used drugs reported in 2022 were nicotine/vaping, cannabis/marijuana, and alcohol. (Keep in mind that these are only the reported statistics. More teens likely use these substances and just don’t report it.)

  • 20.5% of 10th graders vaped
  • 19.5% of 10th graders ingested cannabis
  • 15.2% – 31.3% of 10th graders drank alcohol

While this downward trend provides some hope, research findings show dramatic and rising death rates in youth between the ages of 14-18. 

Also, it’s important to know that fentanyl, amongst other dangerous players, has contaminated the U.S. and worldwide drug supply2. This substance is extremely potent, meaning even the tiniest drop can make the user overdose. Fentanyl could be found in drugs like cocaine, MDMA (ecstasy), and heroin because it’s cheaper to cut these drugs with fentanyl than sell the pure substance.

Educating yourself on these dangers, and knowing how to help your child, is crucial for prevention, awareness, and recovery if/when needed.

Reasons Why Teens Use Drugs

Each teen has their reasons for using drugs. Here are some common factors that can push them to experiment.

  1. Peer Pressure: Being a teenager is hard, and they just want to fit in with their peers. If their best friend, or someone they admire, offers them drugs or alcohol, they’ll likely take it to feel accepted. 
  2. Media: TV shows, movies, and especially social media nowadays can show drug use as glamorous, normal, or fun. This can appeal to impressionable teens.
  3. Self-Medication: Mental health issues start to pop up around adolescence, and some teens may see the escape of drugs as a way to avoid these complex feelings.
  4. Experimentation: Teens are curious and ready to try new things, especially as they start to gain some freedom.
  5. To Feel Grown Up: Wanting to be a grownup and assert their independence can lead them to drinking or doing drugs.

Find Help for Teen Drug Use

So you’ve had the conversation with your teen about their drug or alcohol use. Now is the time to start gathering resources on how to help them.

  1. Gather Information: Begin by browsing programs for teens. Think through what you want to get out of this experience—for your child and your family. You may want to look for gender-specific care. These programs address hardships that boys and girls uniquely experience by giving them tools to face uncomfortable emotions and experiences. Gender-specific care also helps them focus on treatment without distractions. 
  1. Engage in Family Therapy: Family therapy will likely be an important part of the recovery process, for your teen and your whole family. Addiction education for loved ones is usually offered with this, as well. This gives clarity on your teen’s journey with substances and recovery. So when your child comes home after treatment, everyone will have the skills they need to maintain a healthy recovery environment.
  1. Be Supportive: Most importantly, be a rock for your child. They’re likely going through a confusing time, so having your support will make this process easier and improve their chances of success.
  1. Make Sure You Have Support: Give yourself grace through this journey. Helping your child through addiction recovery can be emotionally draining. You will have support from medical professionals, but other family members or friends can also provide support in this process. 

4A. Remember to prioritize your own self-care. Engage in activities that bring you joy and practice stress-reducing techniques.
As your kids grow older and start making their own decisions, you can act as a compassionate guide and lead by example. What you do from here on out is what matters most. A bright future awaits for your child with the right teen treatment.

find help for teen drug use

Rehabs That Allow Smoking: Tobacco and Vaping Policies in Rehab

Are you getting ready to enter treatment, but not sure if you can pack cigarettes? Or are you anxious about the possibility you may not be able to smoke for the next few weeks? Many rehabs allow patients to smoke outside at their facility. But rehab also presents a great opportunity for you to quit smoking with the full support of a clinical team. And rehabs that have smoking cessation programs provide specialized treatment for people wanting to quit for good. 

Can You Smoke Cigarettes in Rehab?

Almost every single rehab in the U.S. has an indoor ban on smoking,1 but most rehabs allow smoking outdoors. That’s because most state laws require rehabs to ban indoor smoking. However, a few states also ban smoking anywhere on a rehab’s campus:2

Other countries have different smoking policies. Many countries ban indoor smoking,3 especially in healthcare facilities. However, if you’re interested in traveling abroad for addiction treatment, you can contact your rehab to ask about their tobacco policies.  

Most of these laws are specifically about cigarettes and cigars, because of how new e-cigarettes are. However, some states already have bans on indoor e-cigarette smoking,4 which includes treatment centers. And many rehabs’ smoking policies extend to e-cigarettes. 

Your rehab’s treatment philosophy can also influence their views on smoking. Some providers believe that restricting patients’ use of tobacco adds stress to treatment.5 In fact, smoking used to be encouraged during addiction treatment6 because providers saw it as a less harmful addiction. 

However, studies actually show that smoking cessation promotes abstinence7 from other substances and can even reduce risk of relapse. And the research shows that treatment is most effective when you address both tobacco and other addictions8 at the same time. 

Whether or not you can smoke in rehab depends on your specific treatment center’s policies. You can always call ahead to ask if they’re not in a state that mandates tobacco-free grounds. 

Why Do Rehabs Allow Smoking?

For some people, the prospect of treatment without the ability to smoke may prevent them from going to rehab. If that’s how you feel, then a rehab that allows you to smoke could ease your anxiety and transition into treatment. 

While almost all rehabs prohibit smoking indoors, about 65% of U.S. rehabs allow smoking9 in designated outdoor areas. For example, Landmark Recovery in Kentucky allows patients to smoke outside. But they also encourage patients to quit smoking and provide therapeutic support for those who wish to do so.  

landmark recovery sign
Landmark Recovery in Kentucky allows patients to smoke outside, but provides therapeutic support for those who want to quit.

Smoking Bans in Rehab Facilities

If you don’t smoke, or if you’re looking to quit smoking, then a smoke-free rehab is a good choice to avoid both secondhand smoke and social pressure to smoke. About 35% of U.S. rehabs have tobacco-free grounds.10 

One example is Paradise Valley Healing Center in British Columbia, Canada. Their Founder & Director, Nirmala Raniga, explains why tobacco is important to quit:

Smoking is more than an addiction to nicotine. It is a physical and emotional release from stress and tension. It meets an inherent need that smokers might not have been able to address any other way.”

She also acknowledges the link between tobacco and other addictions to explain why they ban smoking: 

“Very often, those who stop drinking will turn for example, to smoking or even caffeine as a substitute for alcohol. Instead of substituting one substance for another as a way to address the pain arising, the recovering person must get to the root of the traumatic issues that led to the addiction in the first place. Only then, will this cycle be broken.”

If you decide to take the opportunity to stop smoking during rehab, many centers offer smoking cessation programs to help you quit.  

paradise valley facility
Paradise Valley Healing Center in British Columbia bans smoking to help their clients avoid substituting one addiction for another.

Smoking Cessation Programs in Addiction Rehab

Studies show that up to 87% of patients in addiction treatment smoke tobacco.11 And patients in treatment for substance abuse are more likely to die from their tobacco addiction12 than from their primary addiction, which is why many states have started to mandate smoking cessation programs.

About 25% of states require rehabs to provide smoking cessation programs.13 And studies show that these mandates have been successful. For example, when New Jersey began to require smoking cessation programs in all licensed rehabs, tobacco abstinence increased significantly,14 while dropout rates stayed constant. These programs help many quit smoking and don’t lead people to leave treatment early because they can’t smoke. 

Benefits to Quitting Smoking in Rehab

Quitting smoking builds your resilience15 and confidence in your ability to manage your addiction, which is helpful for preventing relapse

Plus, quitting smoking improves your mental health16 almost immediately. After withdrawal symptoms, most people experience a more positive mood and reduced depression, anxiety, and stress. This uptick in your mental state may make treatment both easier and more successful. 

Quitting tobacco is great for your physical health.17 Most people who quit find it easier to exercise and tend to develop more nourishing eating habits. Rehab is an opportunity to start a new life. Quitting smoking allows you to kick-start your new lifestyle in an even stronger way. 

Smoking Cessation Treatment Methods 

Smoking cessation programs in rehabs can be incorporated into the rest of your treatment program. And just like other addictions, there are several different therapy options for quitting smoking:18

Studies show that the most effective smoking cessation programs19 are a combination of counseling and medications. Your rehab will have its own program to help you quit smoking while you work on other addiction or mental health issues.

Quit Smoking in Rehab for Long-Term Success

If you’re worried about not being able to smoke in rehab and it’s holding you back from seeking treatment, plenty of rehabs allow smoking outdoors. However, research shows that this is actually an ideal time for you to quit smoking. You’ll be surrounded by professionals who can help you find new coping strategies in a healing and supportive setting. 


Explore rehabs with smoking cessation programs to learn more about pricing, insurance, treatment options, and more.