Alcohol Consumption During Pregnancy

In order to bring awareness to the dangers of alcohol consumption during pregnancy, hosts Amber-Rose and Alyssa discuss this topic with special guests Delton Francis and Wahaila Begaye from Navajo Nation Department of Behavioral Health and Mental Health Services. In this episode, we discuss the risks of consuming alcohol during pregnancy and how it can lead to fetal alcohol spectrum disorder. Delton and Wahaila also discuss the resources and prevention methods that pregnant people can use in order to ensure a safe pregnancy for themselves and their child.

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This podcast was sponsored by the Arizona Department of Health Services through federal funding from the Health Resources & Services Administration, with support from the Navajo Native American Research Centers for Health (NARCH) Partnership between Diné College and Northern Arizona University through federal funding from the National Institute of Health’s National Institute of General Medical Sciences, award number S06GM142121. The views expressed are the sole responsibility of the program staff and do not necessarily reflect the views of the Arizona Department of Health Services or the United States Government.

Transcript

Amber-Rose 
Ya'at'eeh. Welcome to the MCH podcast where we discuss maternal and child health topics and provide strategies for improving the health of Navajo families. Amá dóó áłchíní ats’íís baa áháyá baa yadelti (Translation, we will be talking about the health of mothers and children).

Amber-Rose
I’m your host, Amber-Rose Begay Hashk’ąąhadzohi nishli, Táchii’nii bashichiin and Tábąąhá dashichei and Naakai Dine’é dashinali. Nataani Nez denashaa. So I’m originally from Shiprock, NM where I live and work at Diné College as a project coordinator of the Diné College MCH Project. I am a Navajo woman and mother of 2. Thank you for joining us today to learn more about maternal and child health on the Navajo Nation. Today, I, along with my co-host Alyssa, will be discussing the topic of alcohol consumption during pregnancy and its short-term and long-term effects it has on children.  

Alyssa
 Hi, I'm Alyssa. I'm a senior at Northern Arizona University majoring in public health. I'm working on this podcast as a co-host for my internship and I'm excited to be raising awareness on all the maternal and child health topics we discuss on these podcasts.  

Amber-Rose
Thank you, Alyssa. Today we are going to talk about maternal alcohol consumption and fetal alcohol spectrum disorder order. The reason we are discussing these topics when it coincides with national health awareness months and days into, we'd like to discuss the period, the prenatal stage, and how mothers include all individuals who can become pregnant and have a birth, including individuals in the transgender community, to be and stay healthy.  

Alyssa
We invite special guests Delton Francis and Wahaila Begaye. Thank you for joining us today. Can you please introduce yourself and your work at the Navajo Nation Department of Behavioral Health and Mental Health Services?  

Delton
Hello. Good afternoon. My name is Delton Francis, and I would just like to say thank you for inviting us to you the podcast. It's totally awesome to work with other resources and collaborate. So I am a prevention specialist. I'm located out here in Kaibito Outpatient treatment center, and I work for the Navajo Nation Division of Behavioral and Mental Health Services. And my clans are Dziłaa' Táchii'nii.  Tsinaajinii ei bashchiin. My cheiis are Tábaahí and my nails are Tséníjíkiní. So at that point in time, you know, I do live in Page, but I do work in Kaibito, you know, been doing prevention work for quite some time. But I do have an extensive experience working in behavioral health for a good amount of time, years and years. So I will pass it on to my colleague.  

Wahaila
Thank you, Dalton. And it's so good to be here joining you all today. My name is Wahaila Begay. I am a prevention specialist with the division of Behavioral Mental Health Services. I provide services all across the Navajo Nation, but I am stationed in Window Rock, Arizona currently and shi ei Tséníjíkiní. Tsinaajinii ei bashchiin. Adóó Tó Tsohnii ei dashicheii.  Tł'ógí ei dashinali.  I'm originally from White Cohen, Arizona, and currently reside in Fort Defiance. So again, I'm so happy to be here with you all today.  

Amber-Rose
Awesome. Yeah, it's nice to have you both join us and have you part of our series on maternal and child health. So we'll get into the interview. When researching the topic of maternal alcohol consumption, we noticed there are differences between pregnant women who have alcohol use disorders and women who drink during pregnancy. Can you shed light on the differences?   

Delton
Yes, I will. We will, myself and my colleague do our best to answer that question. So the differences, to be honest, of all the times I've been working with DHS, is we really do not see a difference. We treat everybody equally that comes through our doors or gives us a phone call. And when we look and talk about substance abuse disorders, DSM five defines, you know, substance use disorder is a mental disorder that affects a person's brain and behavior, leading to a person's inability to control their use of substances such as legal or illegal drugs, alcohol or medications. Symptoms can range from mild, moderate, severe to addiction. So, yeah, we go by a lot of, you know, evidence-based materials. And of course, we've been using that. The clinical team does use the DSM five. I'm slightly familiar with the whole process of client intakes, all the way to treatment planning and to providing services. So in my previous position, I used to assist in that process. But as far as differences, I believe there's women who are pregnant and who may not be pregnant. So it all depends on the person's choice of wanting to use substances. And it's just an unfortunate fact that sometimes young women will be knowingly using substances while they're pregnant, while in other cases, young women will be using substances not knowing they're pregnant. So it can take up to 4 to 6 weeks to actually know or start feeling changes in, you know, in a person's body to know that they're with child. So at that point in time, some people will stop using alcohol. But in other cases, if the person is struggling with addiction, they will possibly continue to use.  

Wahaila
One thing that I wanted to add to is that with our clients and people that we work with may perhaps be in recovery before they get pregnant. So just knowing that, you know, recovery is a process and this is a major life event and offering that extra support so they don't relapse when their pregnancy starts or finding out they're pregnant. So I just wanted to make a note of that is that, you know, the recovery process when we are clinicians and our counselors are providing services along the whole line of the timeline of recovery and whether they're still trying to decide to seek treatment or not, you know, we try to offer as much support, especially during pregnancy, that, you know, there are those times when people do fall out of recovery just knowing that they are pregnant. So offering that extra support is especially important.

Alyssa
Thank you for clarifying the differences. How can how does alcohol consumption during pregnancy affects the baby?  

Delton
Again, everything's a process. Everything has different stages of pregnancy. When the young lady is using alcohol, really, we probably in the early stages, I believe, Wahaila clarify this a little bit more. But I'll do my best and give it a shot here. So I understand that when the fetus is forming, it has not fully connected to the mother's, has not connected to the mother yet, and it's still growing. So there's a little, I guess you could say, leeway, it's almost like a built-in protective process to where the human body, the female human body, is kind of protecting itself. At the same time, this is when I stated that when some young women are still drinking, and they don't know they're pregnant yet, you know, that's almost like a failsafe, kind of like a backup thing. But we should not, you know, think it's like that all the time. But just to clarify that any amount of alcohol is never safe for a young lady while she's pregnant. And it comes with many complications when a young lady does use alcohol, and it starts affecting the baby, a lot of the time, I believe there's not enough testers out there available to understand or to see if alcohol has an effect on the baby while still in utero. It is only when the baby is born and when the baby starts to maybe try to hit their early childhood milestones that there might be a cause for concern there, possibly with speech, possibly, you know, the different symptoms of fetal alcohol spectrum disorder. And there's different levels depending on how much the mother used while she was pregnant. And a lot of it can range from a different spectrum of the FASD.  

Alyssa
Right. And most of the time, when people think about the complications that arise from pregnancy itself, you know, we like Delton had stated, there are no proven specific identifying tests that go and say, you know, your child does have fetal alcohol spectrum disorders or has been affected, you know, for different other syndromes such as Down syndrome, any type of chromosome abnormalities, they can do amniocentesis. But again, we can't really see how alcohol consumption during pregnancy and how severe the consequences of consuming alcohol is until after the baby's born. So maybe things like within Apgar score reflexes, you know, our are different types of newborn screening that we currently have, even things such as breathing reactions, facial features, and as the child will grow and develop, you know, we are able to see these different characteristics of FASD. So in pregnancy, just like Delton has stated, you know, there's a certain point in time when you know this embryo is not connected to the mother and it's just kind of living on its own for a while all of this cell division is happening. And I was explaining to my colleague how very, very intricate the cell division is, you know, from embryo to fetus. And everything that is developing. It's just so delicate. And anything that enters the mother's bloodstream, I mean, there is the way the human body is made. It's so very, very protective, especially when it comes to reproduction. And there's many, many lines of filters, metabolisms, chemical reactions, breakdowns that happen in the digestive process, even going into the filtering of our blood before it hits the baby and the bloodstream and the umbilical cord. So, you know, nonetheless, as my colleague had stated, no amount is ever safe. We're all built differently. But no doubt in my mind that, you know, as early as that blood flow, that blood supply starts crossing the placenta, its effects are detrimental at that point because there's huge brain development happening in those very, very early stages. And when the pregnancy is very, very early on, that's when we have our brain and spinal cord developing. So that's where we get a lot of our neurological impairments, our learning disabilities that come later on in life with these young children.  

Amber-Rose
Thank you, Dalton and Wahaila. And thank you for also talking about the process. You know, when a baby is forming, how alcohol might affect that process. And I like that you stated any amount of alcohol is never safe for anyone who is pregnant. So speaking of fetal alcohol spectrum disorder, are there any taboos around talking about FASD?  

Speaker 3
 I can only speak from my opinion, and the people I worked with and experienced culturally standing from my point of view is that it is not necessarily taboo. It's more or less, I see it as like guidelines of how to take care of oneself and how not to be exposed to different negative or traumatic events, especially when a young lady is pregnant and expecting a child. When families teach and talk about Hozhoojí, you know, living the beauty way of life. Everything gravitates and surrounds the upbringing of positivity around, you know, the child. So when a young lady is pregnant, you know, they do everything they can to provide that Hozhó and beauty within the cultural aspect of, you know, come into this world unharmed. And that kind of to me, a kind of my perspective is that it kind of relates to ACES. I know you guys did a study. You guys talk about it a lot. And for me, that's just like Western society catching up to some indigenous and native cultures' teachings already in place. Just like I stated, when a young lady is pregnant, culturally speaking, and the Navajo Diné way, they're supposed to have a Hózhóójí and then like a protection ceremony for the mother and child so that, you know, the whole birthing process and the whole pregnancy will be a good one, a good experience. So and in that perspective, it's just basically protecting the womb, the child, and the mother because the mother is still living, you know, in an exterior life and is exposed to everyday traumas, different things that might be happening around her that possibly she might not have control of, that she might be exposed to different things that are happening around her, that that trauma can easily be transferred to the child that's still in utero. So that was in our culture, long before ACEs was put together. So that's just like for me, not necessarily taboo, but more or less like guidelines on how to be healthy, how to take care of oneself when they're expecting and just trying to put culture in there to where they can, you know, feel confident and feel good about their future with the child and motherhood and parenthood.  

Wahaila
One difference is, you know, we are brought up with these do's and don'ts, right? Our ethics, our disciplines, our values, and our beliefs as Diné, as Navajo people and, you know, even more so when a woman is pregnant, we have like 1001 other rules to follow. And sometimes that could be very difficult in our day and age here today because you see like Delton said, things that you're exposed to even more so, you know, things that we ingest and how we treat our mind and how we take care of our mind. And it's as far as taboos; it's like you can't do this because there is always a reason behind it. So a lot of these do's and don'ts that we're told by, you know, our grandparents, great grandparents, there's a reason for, and it makes it when we're talking about pregnancy, it just fascinates me how intelligent and genius our ancestors were to put these in place. Don't do this. Don't do that. Even things that you see here. And, you know, I'm thinking, like, way back when I hear stories about how women used to, how they used to get along in their day when they were pregnant. They basically sat there and prayed. That's how I was told and had no outside temptations, no outside exposure to things that were not healthy or things that could bring them harm. And so when I say this today, you know, it's it's like, oh, gosh, you know, how did they used to do that in the past? Even with the food we eat, things we ingest and taking care of ourselves. And even as far as like you, you know, I hear a lot from our elders say you don't eat fish, you don't eat anything that comes from the sea, especially when you're pregnant. And, you know, this is hundreds of years ago. And like, they must've been very, very smart because, you know, coming up today, science is finally catching up with some of our culture and traditions. Right. And, you know, there's now evidence based on research going on about mercury and some of the food and even going back to how our clanship was established. It just wasn't established. I mean, you know, even now, coming up today, like how our ship is and how it was a protection of chromosome abnormalities and, you know, just different things like that. So when it comes to taboos and especially regarding fetal alcohol spectrum disorder, it's like a lot of those were in place, a lot of the teachings were already in place, and all for the benefit of a child, for the benefit and the well-being and wellness for future generations to come. Again, they weren't just said just because, you know, there's always a reason behind it. So I really admire, and it's very remarkable to me how a lot of these old teachings are finally, you know, science is finally coming up with it. They were you know, our ancestors were so genius and very, very disciplined in their ways of living  to have that carried on. So I just wanted to add that.

Alyssa
Thank you for providing us with those insights. So how can we inform people who are trying to conceive the importance of stopping consuming alcohol before getting pregnant?  

Delton
That would be a tough question to answer, I think, all around. So, yeah, I mean, I understand, you know, a lot of us when we were young, you know, we like to go out and do things and experience the world, and certain things that, you know, some of us may experiment with, you know, using substances, alcohol, drugs. And, you know, we get to be with somebody and, you know, possibly might have a child with. And we're not necessarily thinking about having a child with this person. You know, we're spending a lot of time with. So a lot of the times, I think it just goes back into doing our best with the different platforms that we have, you know because in our line of work, a good percentage, maybe 80 to 90% percentage of people are coming through our doors are court referral in a smaller percentage of people wanting to get sober, wanting to get help. But the majority are coming through our doors with our court referrals and that's going to be only until after the fact, you know, until after they have done, you know, that they've experienced something that it's not good for them or having, you know, experiencing risky behaviors. So in our line of work in prevention, work prevention, would be looking at the onset of use, meaning before they start using or the before they start wanting to experience these risky behaviors. We looked at a lot of different factors at play to where a person will want to use substances. And, you know, we talk about prevention as far as, you know, there's sex education out there, there's alcohol and drug education to let the youth know that these factors can come into play that could happen if they're not careful, if they decide or make decisions that will affect them in the long term. And it's very hard, you know, it's very hard to inform and educate people, you know if they don't think it's important or if it's not something that's, you know, gravitating towards them. So, us, as prevention specialists, we do our best to get the message out there and say, hey, we would like for our youth and for the people and the people to make the best possible decision, if they can, around their circumstances. Again, we have tons of health disparities out there that we have no control of that might set us up to want to participate in risk behaviors. So in that notion, we advise the youth like, you know, you guys are young, you guys have a lot of stuff ahead of you. You know, please don't decide to start experimenting with these different substances. Please be careful with your relationships with aiding, you know, even down to dating. You know, there's education behind that as well, as far as like experiencing domestic violence, experiencing the power of control of a relationship. And there shouldn't be power of control. There should be equality. So there's a lot of different things to look at as far as trying to prevent or try to discuss and educate the public and the youth about mixing alcohol and drugs with, you know, sex and relationships. And sadly, we do have a large amount of that, you know, in media. You know, there's a lot of it portrayed in the media and how it's fine and how it's, you know, portrayed to where there's no consequences. But in reality, we do have consequences. You know, if you want a relationship and we have an unplanned pregnancy, if we're experimenting with drugs, we might do or say something that might affect us in the long term. As far as the law and as far as taking care of ourselves, our bodies. So a lot of us are not, you know, thinking that way. Our job is to our best ability to educate and make awareness that this is a possibility. But we just want you guys to learn and educate themselves to make possibly the right choices. 

Wahaila
Right. I think it's a lot of exposure to education and awareness. I know a good handful of people who actually plan their pregnancies and then even a bigger number of people who became pregnant without planning for it at all. And it's just those lifestyle choices that we have. In the meantime, again, before we even get a positive test result. So in knowing that, you know our behaviors and how we are living our lives, the decisions that we're making pre-pregnancy, and whether or not that you are trying to plan a pregnancy or if you're sexually active, just knowing that the behaviors that we have pre-pregnancy are probably going to follow into the pregnancy itself. So it's just like Delton was saying, you know, it's a lot of prevention. But then also knowing, you know, as prevention specialist, especially, you know, during pregnancy. But it was it would be across the board, you know, we would say, you know, try to abstain from any substance use at all. And that goes for very, very young children all the way to our elders. That would be our number one message is, you know, try to abstain, You know, if there's any support that's needed. We're here to help even more so during pregnancy. But as you know, with our group, with our team, that would be, you know, wellness, well-being and trying to go through major life events, even day-to-day events, alcohol and drug-free. So for people who are trying to conceive, you know, we're talking about pregnancy here. And I think what a lot of people seem to forget is that that time in pregnancy and, you know, in the newborn stage, it happens very, very quick. So when we look at the long-term effects, you know, one of these days, these children who are very, very new, brand spanking new newborn kids, they're going to be adults some days and they're going to have to live with these different detriments that occurred while consuming during pregnancy. So we failed to look at that long-term effect and not knowing that it's not just when they're babies, it's not when they're first born or, you know, they get this diagnosis. And then, you know, when you meet a person who has fetal alcohol spectrum disorder, and they're a very, very old adult, I think that's what we need a lot of exposure to. It's not just temporary; it's lifelong. And so that's one thing that I really encourage. You know, if we know anyone or anyone who's planning to conceive that has a substance use problem or has an addiction is to support them and trying to inform them as much as we can. You know, we can inform, inform and educate. It's, you know, it comes down to it. It's going to be their decision. And, you know, when they have all of this information, it's going to make hopefully pushing toward that better decision to say no and not just during pregnancy, but lifelong, you know, trying to abstain from substance use. So that would be my message. And that's, you know, in any point in life and in any phase in life, as for myself as a prevention specialist, would be  lifelong effort not just during pregnancy, but not say that it's not important during pregnancy, but, you know, just educating and just getting that awareness out. We don't really seem to have that conversation. And, you know, just personally, I'm a mother of five and I was never told anything like this from my health care providers. So it's it started in a conversation. And, you know, having this knowledge that we do from what you guys do and the research that you do. And then also, you know, with us in our groups, it's just spreading that awareness. A lot of people don't know, and a lot of people don't know what could happen to children if they choose to drink during pregnancy. So and, you know, we would think that you know, people would be informed about this, but some aren't. And, you know, they were never included in the conversation. It's something that we don't teach in school. So not until you actually either see it for yourself, experience it firsthand, or know someone, a relative or friend, that is going through this.  

 Amber-Rose
Thank you for that. I know what you mean by you know; we don't really know until we experience it firsthand. And I think with anything health-wise, it's kind of a hard way to learn a lesson. So and I like that you both, I guess, advocate for education, you know, across all ages. You know, we're never too old to learn. So I think you sort of answered this question before, but maybe there are some things that you forgot to mention. What Navajo cultural foundational teachings do you use to inform your work with pregnant mothers who consume alcohol during pregnancy?  

Delton
When you look at the Institute of Medicine model, we look at there's a whole like a fan, a whole spectrum. And we look at the first part of that is prevention, which is what we're a part of. And then right in the middle of that spectrum is treatment. And then we look at the ending part of the fan procedure is aftercare. So in that order, if a person comes through our doors, you know, even if they're pregnant, we do an assessment. They do an evaluation. The clinical team will do an individual assessment, and they will ask questions to see if the person is well enough to be able to receive outreach services or outpatient care there in the office or if the situation or their home living is a little bit more severe to where they need to be in an inpatient program, to where they know that they need to be safe and sheltered and being able to attend treatment and that way. So when clinicians enroll a person or a young lady that's, you know, possibly pregnant, they will look at their current situation, you know, what's your home life like? Are you expecting a child? And that's all part of an assessment and intake process. So we look at the person's situation and then from there, the clinical team will decide to see if they can receive treatment at an outpatient center or if the person is in dire need of inpatient, meaning if the person does not have much control to maybe or they're using substances. In that case, the clinical team will recommend inpatient treatment, meaning like rehab services. So we do have treatment available in New Mexico call a place called Marbut in Shiprock. They do take adults there. And if the person is very severe to where they're not in so much control of their use and they're just using while they're still pregnant, then in that case, clinicians would recommend and advise that they would receive a higher level of care because  it will be completely unethical for us to take a person to say we know what we're doing if we don't know what we're doing and what's this person needs actual psychiatrist, and actual doctors on site to receive services. So it's in the clinical team's best interest to make that assessment. And if the person needs a higher level of care to where they need maybe around-the-clock supervision, where they need medication, they will be referred out in that order. You know, that's one of the things about the reservation is we don't have those specialty services. And that's what my colleague Wahaila was talking about earlier. We had a truly long discussion when you guys asked us about this podcast, and that was one of the things that she came across; it reminded me of was that we on the reservation have, you know, there's certain specialty services that we don't have access to, so we have to advise and recommend and refer some of our, you know, Diné people off the reservation to receive this higher level, better quality of care services.  

Wahaila
So I just wanted to add just a little bit more to what Delton was saying for this question. You know, all our, our counselors, our clinicians here with our group, with the DMHS are very, very sensitive to our Navajo tradition and cultural teachings, even to a point where we have a group of traditional practitioners that come and are able to help with the wellness journey, whether it's recovery, you know, things that our clients are going through. There's always that available to, our clients. But you know, coming from our team we believe, and I was taught that we believe in holistic wellness and that holistic wellness is not just mental health. That's all over eight realms of wellness. And when we talk about, you know, if you're going into recovery or maybe someone has substance use disorders or different types of addictions, we come to the perspective of wanting to treat and wanting to heal, you know, and all realms of those aspects of wellness. And for women who are pregnant, again, not just , we don't categorize people who are either self-referred or referred. You know, we just see them as a person. But everybody comes in on their different walks of life, and their treatment plan goes accordingly to what they're seeking. Now, specifically for women who are consuming during pregnancy, that's the cultural and the traditional sensitivity will be there for them. And but at the same time, we need to remember, you know, not all of our Diné brothers and sisters were brought up traditionally or culturally. We also respect that as well when we're talking to them and trying to inform them about different things of being on a road to having a healthy pregnancy. So I think that, you know, with our team, we also offer pastoral services, you know, and that type of support from our group. So when we're looking at cultural and traditional teachings, that's something that we with our team, I know that we really try to emphasize, we really try to emphasize the importance of it and how it's used as a protective factor, especially for our expectanting mothers. Sometimes we forget to think about that. And, you know, if we are having someone seeking services who is pregnant, who is perhaps using, we want to include that as a protective factor for them; it might be a life-changing decision for them. A lot of times we go day by day not remembering a lot of our teachings and, you know, not on purpose, but sometimes, you know, we get so busy with our life or sometimes we forget. And a lot of times, we need to be reminded. So our traditional practitioners are there for that help. And as far as ceremonial purposes are concerned, that's something that can be included in the treatment plan for them.  

Delton
And that just goes back into. I want to add something real quick that, we do utilize the Navajo wellness model in our prevention program in which, where we talk about respecting yourself, taking care of yourself, and trying to finding a way to be one with yourself using the Navajo wellness model. And again, just like what Wahaila was stating, the treatment plan is tailored to the individual person, and each individual person has a different treatment plan. So the person might come in, might have a belief of faith-based into which, will have faith-based counselors assist in the treatment planning, or if the individual is traditionally, culturally inclined. And then we will have sessions put in place for them to maybe speak to a traditional practitioner or possibly, you know, having other services provided there as well.  

Alyssa
Thank you for saying that. It goes by case-for-case basis. Are there any tools and resources that are currently available specifically for pregnant women on Navajo Nation who are trying to reduce alcohol consumption?  

Delton
On the reservation, I just know that we do have the Navajo Nation Division of Behavioral Health Services available. We have several outpatient treatment centers located across the reservation. Again, we look at the individual as needing assistance and help, and everything is, you know, judgmental-free. We don't have judgments on a person. We just look at the person as needing help. So, again, it goes back into, like you stated, it's a case-by-case situation where a clinician will look at the person's current situation and try to fit the best treatment possible if they can, if they're able to receive services from DBHS or if they need a higher level of care, then they will be referred and a team is put together to help with their case management and advocate for them to receive a higher level of care and will continue to follow the person until they complete treatment.  

Amber-Rose
So I was wondering, are your services free?  

Speaker 3
Yes. As long as you have a CIB, it's free to all Navajo residents and even extended to non-natives who are married to families.  

Amber-Rose
So treatment plans can range from maybe like a month to like two years, or is there a standard treatment plan?  

Delton
There is no standard treatment plan. It depends on the recovery process of the individual. And again, it can range down to where when they do an assessment where just hypothetically, let's say a person comes through our doors today, our clinical team will ask them a number of questions. The clinical team does use the ACE assessment tool as well, and we'll look into see if they need more psychiatric services available as well. In that case, we will collaborate with the outside resource and work with them while our offices concentrate on the addiction side of treatment. And this can range from cognitive behavioral health therapies, dialectical behavioral therapies, assertive community treatment, and therapeutic communities. And the last two I name is like making sure the person goes into like rehab, living in a clean and sober community, and try to relearn new types of behaviors because each individual possibly might be going through different things in their life, different traumatic events. So a pregnant woman, young lady might have gone through some traumatic event that we have no clue about, and their only coping mechanism would be using substances. So, in that case, if she were to enter an outpatient or inpatient program, we would then provide the best possible prevention education we can to the individual, and we would call them as like groups. And in these groups we talk about domestic violence, we talk about fatherhood, motherhood is sacred, we talk about the Navajo wellness model. We do alcohol and substance use education, talking about the scientific side effects of abusing different substances and how it's harmful to the body, how can you change our behaviors. So, the big word in addiction and treatment and a person seeking help and services is, you know, the scary word is change. And any change to anybody's everyday life is going to be traumatic. Change is something scary for everybody. And it is our job to hopefully provide the best coping mechanism, a healthy way of making those positive decision-making skills. Saying like, if I was angry, and upset about something one day, and the only way I know how to cope and feel better is if I drank or if I smoked or if I did something to have ingestion of substances to feel better. But in our case, we do our best to try and educate this person that you can feel better. It's going to take time and it's going to take behavior changes. It's going to take time to learn coping skills its going to educate the person about emotional awareness, emotional intelligence. What makes me mad, what makes me sad? What makes me cry? We have to learn who we are as a person. And I believe that in our treatment process, we begin that first step and hopefully, you know, it snowballs into a self-discovery of empowerment to show that, you know, they have the ability to adapt and change and say, hey, I can get through this situation and this thing in my life to where I can control my behavior to where I don't need substances anymore. And it's a very tough change, is very difficult even for sober individuals. Change is very scary. It frightens us. Anything that's different in our daily routine. Well, you know, some of us will totally throw it off. But I believe and have faith in our people that we have the ability to adapt and, you know, and be able to learn these new coping mechanisms. And one of the foundations in our treatment process is that, you know, having that traditional native indigenous background of your foundation of belief, we support that. If you believe in faith-based and we have pastoral counseling services, and we support that. Anything to keep the individual sober and try to, you know, change over to a healthy lifestyle, whether the person is expecting or not. And in that terms, you know, we're not going to jump in and say, hey, we're going to prescribe to medication or prenatal vitamins. That's not up to us. We would refer the individual to a doctor, and we would just follow up with follow through and say, what did you learn today? What did you learn about, you know, pregnancy? What did you learn about the process of being pregnant? You know, what's the next step of what you want to do or what do you see for yourself and your child? You know, those are the type of things that encompasses a whole person and their well-being. You know, just like Wahaila was saying, it's a whole holistic view. We don't look at just the physical side of treatment. We look at the spiritual and holistic mental wellness side of treatment as well.  

Wahaila
People will come in and say initially, they come in individually, and then it happens to turn into a family treatment plan where the family will come in. And even there, you know, you have your say, older adults going to our younger family members. So it ranges when we're talking about timeline because it's not just one individual, and then you go off on your own. We want to make sure that they have a support group, and a lot of times it's friends or family. And when the friends and family get involved, you know, sometimes their treatment timeline or their course could be longer, and sometimes it could be shorter. And once they get that support and, you know, when people get informed and really have a good understanding of what's happening to their loved one, then they support even more. So it goes both ways sometimes.  

Delton
And I just wanted to add that the treatment process is actually a lifelong process because the individual, whether they're pregnant or not, is learning to live a new way of life. So it's a total lifestyle change. And a lot of things that I've said to past individuals was that I know it hurts. I know things, you know, make you upset, things make you cry, things make you confused. And I tell them, we're going to have to go through that as human beings, but we're just going to have to do it sober. And that's the key, is you're going to have to do it sober. And once you find those skills, you know, you have that sense of empowerment. And that's one of the key things that I tell a lot of individuals that come through our doors. And that's one of the things I keep reminding everyone that comes to our groups. You know, exactly like Wahaila was saying, they got to have that family support because, let's hypothetically, Amber, I'm not trying to wish anything bad on you, but let's say hypothetically, if you were receiving treatment, you would be in light of your emotional awareness, of your emotional intelligence, of, well, what makes you who you are and you're figuring that out. But when you go home, guess what? You're the only one that knows how to process your emotions and your feelings. But whoever you're living with has not been exposed to or learning those things, those coping skills. So even in that when a person is going back into to their home area, that's why we have aftercare and we have the individual come in at less different times by treatment process. And again, this is a lifelong decision change to where they need to be somebody different, be somebody new to where they can be able to learn the coping mechanisms to make good decisions in their life. So it's a lifelong change. Treatment can range from a few months to possibly even years, and it takes that long for a person to understand change. And it doesn't happen overnight.  

Amber-Rose
Thank you. I think, you know, just this information, I think it's important to get that out there. Because for maybe those people that want to take that step but are a little afraid of what's going to happen, you know, if they do go to a treatment center and are like, you know what's going to happen when I first go in? So, you know, you would need to do an assessment. And then from there, you know, your treatment plan is tailored to your needs and, I guess, maybe your goals according to a few articles, most alcohol abuse, services and resources, and native communities are tailored to men. Do you think that the Navajo Nation has enough services tailored to women and, more specifically, pregnant women?  

Wahaila
We were discussing this earlier, and I was saying, you know, just based on some of our statistics, we tried to retrieve the most recent statistics from our Navajo Nation police department. It seems like a lot of services are tailored to men who have been either arrested or in the criminal system for some reason. And they a lot of times are ordered to receive some type of treatment, whether it be anger management, DV groups, AA, or even seeking counseling services individually. And for a lot of times it's just how our men get introduced to the behavioral health component of a treatment plan. And not saying that this doesn't happen to women, but a lot of times, it's more likely that a man will come in court-ordered. So there is that premise that they will receive treatment. But it just goes to, you know, inquiry that, you know, how many of our native women are not seeking services. And, you know, there's a lot that benefits from the whole process of being either arrested, you know, there are some really, really significant lifestyle changes that occur. And then, on the other hand, that's there is not. Now, when we go to pregnant women and we get into that situation of domestic violence, of course, the safety and welfare of our women and having those domestic violence support groups and come to find out there's just a lot of harmful behaviors that are happening in the home. And, you know, a lot of times there's co-occurring instances that take plave like there might be domestic violence and included. That is, you know, they do have alcohol in their household and then included in that, you know, there might be other criminal activity. So there's a lot of different types of abuses that are happening and it's just not an addiction. And we all know that there's all kinds of other household factors that that take place for people to, you know, make these decisions to either use or even continue in an addiction. So with the differences between men and women, I was talking to Dalton earlier and saying, you know, a lot of these women will be self-referrals, but we see a lot of our men come in just because they're forced to, or maybe they're on some kind of diversion program. So it seems to you know, it seems like, you know, we're having all of these either teenage or adult men coming in, and they might be a big majority of our of our clientele, of the people that we provide services to. But, you know, with our women to there there might be things that are involved like, you know, as far as threats from threats from their family, threats from their partners, threats from, you know, just different people. And on Navajo Nation, we are fighting the stigma of seeking mental health services, especially for addiction and especially for substance use. And just like you're saying, you know, there's that we do as a people care what people think in some cases, and in some cases, our communities are just so tight-knit that people won't go and seek services for themselves even when it's in the course of their pregnancy. Maybe because of shame, maybe because of dishonor, maybe, you know, having that thought in mind that if nobody knows and there's you can't tell when the baby's born, then we're not going to. Say anything, you know, and we hear that a lot from a lot of people that we provide services to. I don't want anyone to talk bad about me or even perhaps disown me. I don't want to have that mental health stigma or that label on me because I'm going to refuse to seek treatment because I don't want anyone to know. So a lot of times, that is the case for women, which is it is very disheartening, you know. But that was a campaign that we had just these past couple of months is trying to reduce that and encouraging. You know, we were just talking about families seeking services. Sometimes families don't, and they don't want to have that label. And so it's a really good triumph and success for us when families want to get involved for the betterment of their loved ones. But sometimes people will be like, that's not my family member. You know, that's just them. And they label them, quote unquote, crazy or unstable or, you know, just that stigma associated with it. So when we're looking at services, you know, we're really trying to encourage anyone, men, female, expecting, not expecting. Just for those who really want to make a change for the better in their lives that it's okay to seek out for help. But you know, just knowing that our services are available for women and we see that a lot of guys coming through due to court order or due to maybe some type of probation they might perhaps be on. And, you know, just going towards the statistics that we receive from our local police department.

Alyssa
I like that you mentioned the stigma because that's kind of a hard thing that people like don't like to talk about. So how can we kind of like break the stigma and like help pregnant mothers transition from consuming alcohol to no longer drinking during their pregnancy?

Wahaila
I think that any progress, it's a success and that the most brqavest and courageous thing you can do for yourself is to reach out for help. I mean, talk about all-time sky-high courage. It takes a lot to go in and admit, and then even more so talk to a complete stranger about how you want to better yourself, someone you may have perhaps never met in your life. And that is definitely a huge step of courage. But, you know, just getting to that point, even thinking about getting help, is a success in itself. So, you know, we always go and compare our mental health to our physical health. If something were wrong with you physically, of course, you would go to seek a physician or go to the hospital. Same way for mental health, we want to make it as commonplace that you can go and seek a counselor or seek a clinician, not only when you're doing bad, but when you're doing good, too. Because we have wellness visits, we have annual exams, you know, just to check in and make it that commonplace for you to go say, hey, I want to be mentally healthy as well. And it's I see that a lot in our communities. And it's going to take some time. But as long as we can keep that open mind and support, you know, trying to lay off the gossip, trying to lay off the labeling. And it would be such a great thing for us to have, you know, mental health annual visits. But we failed to do that. So if you are one that have in the past reached out for help yourself, a huge, huge thank you from me to you. Or if in the past you have supported a family member or loved one, friend who needed help and, as a support person encouraged them to do so. A huge, huge thank you from me. We need more people like that. We want our family to be well. We have love, care, concern for different ones in our lives, who we choose to be our family, and we only want the ones you know; we want only the best for them. So, you know, if you have a family member that is on that road or maybe has even talked to you about seeking services or if you seem concerned even to suggest, hey, you know, I want to encourage you to maybe some support. Keep doing that. Keep doing that. We need more of that on our nation.  

Speaker 3 [01:00:36] 
I agree with her totally 100% that, you know, we need to get rid of that stigma. It does take a lot of heart to ask for help. You know, we all experience, one thing I tell everybody is we're all human beings. So whether you're in treatment, whether you're in addiction or not, we all experience a lot of negativity. We all experience good and bad. It's just a way of us learning how to address those situations. And some of us are possibly better equipped. And that's just the way I see people needing services. And if a person needs services, by all means, reach out and please, please, you know, if you're going through something tough in your life and you need someone to talk to, reach out to the counseling services 100%.  

Wahaila
And then even more so during pregnancy, I mean, it's not like you can lengthen the time of the pregnancy for you to, you know, decide to seek out services where on a specific timeline, there's all of these developments that happen in utero on a specific timeline and, you know, maybe a day or two difference for most women. But we it's a very, very critical time. And, you know, like I was saying, don't hesitate to let your health care provider know. Don't hesitate to, you know, like I said, a lot of times these visits are routine, and it takes a lot of courage to say, you know, I am using a substance and I am expecting, but I guarantee that if you tell your health care provider, say it a routine appointment, they'll get you some help. They'll refer you to, you know, someone from our team or even within the hospital setting, but they won't let it go. And a lot of times, you know, their questions are so very, very brief that you can answer with this simple yes or no. So if you are finding yourself in that situation, you know, it's so very, very difficult, and it can be very shameful, embarrassing. You feel a lot of guilt. But please, you know, if you know someone or you yourself are in the situation we're on a really, really short timeline here, you know, nine months is not a lot of time, but it is a lot of time to find some sort of support. And you know, for us and our group and the different collaborative groups that we work with, you know, we jump right on it. So I'm just encouraging our listeners like that.  

Amber-Rose
Thank you to you both. I think that's very good to address some of these things because I think that even if I were to encourage maybe a family member or friend, they would be worried about going in, especially if they were pregnant, about getting services, about trying to overcome the addiction. So thank you for that. It's very encouraging. And I'm really glad that we're able to have you both on today to talk about this because I feel like maybe we don't thank you guys enough for the work that you do because this is such a big area of mental health, overcoming abuse and addiction that's very, you know, an area that I feel like is being talked about more and more, but on the Navajo Nation, you know, this was always an area that, you know, was taken care of through our teachings, our cultural teachings. And even today, you know, with through your services, that is being, you know, addressed, you guys help anyone and everyone. So thank you for joining us today. We really appreciate your time and all the valuable information you provided.  

Delton
Awesome. I'm glad to be part of it.  

Wahaila
Thank you for having us on today. We appreciate all you do and all of the information and research that you guys do. It's great really, really do applaud you for that, and continue the great work.  

Amber-Rose
Thank you so much.  

Alyssa
Thank you.  

Amber-Rose
Ahe’hee. Thanks for listening to the MCH Podcast. For more information about the Diné College MCH project, please visit Navajo MCH Project at Diné College on Facebook.