Drug & Alcohol Use Online Course(s) & Continuing Education
Access the latest clinical skills and research for Drug & Alcohol Use for Lactation & Breastfeeding professional training. These Drug & Alcohol Use online courses provide practice-changing skills and valuable perspectives from leading global experts. This Drug & Alcohol Use education has been accredited for a variety of CEUs / CERPs and can be accessed on-demand, at your own pace.


Ted Greiner received a PhD in nutrition for developing countries from Cornell University. For 19 years he worked as nutrition advisor for the Swedish International Development Cooperation Agency, based at Uppsala University where he was Associate Professor of International Child Health, helping to ensure their long-term support for IBFAN and WABA. Dr. Greiner was Professor of Nutrition at Hanyang University in South Korea for seven years. He has consulted for UNICEF, World Bank, FAO and others. He is now retired and edits the journal World Nutrition. He has lived in 8 countries and worked in 10 more. His areas of research expertise include infant feeding and programs to combat vitamin A, iron and iodine deficiency. In the 1970s, he did the first scientific work on the impact of baby food advertising on breastfeeding patterns. His PhD dissertation was on the planning and evaluation of a 1978-81 project to protect, support and promote breastfeeding in Yemen (terminology quickly adopted by UN agencies). Over the next decades, the duration of breastfeeding there doubled. During the planning the Innocenti meeting, he represented Sida, one of the 4 agencies involved. He was active in changing how WHO viewed HIV and infant feeding. He has over 100 breastfeeding-related publications.
Moderate alcohol use by breastfeeding women appears to be relatively common. Alcohol concentrates in breast milk at levels similar to maternal blood, peaking at 30-60. Most studies find no link with the duration of breastfeeding. However, seven studies have found a link with a shorter duration of exclusive breastfeeding. Alcohol affects oxytocin release, leading to reductions in breast milk consumption in the following hours and reduces infant sleep, both temporary if the mother does not continue to drink. These effects on the infant and the breastfeeding process could be interpreted by mothers as signs of infant dissatisfaction with their breast milk, “insufficient milk,” or other causes for premature supplementation. Chronic alcohol consumption may have a number of more serious effects, including on infant development, but research is limited. Younger infants tolerate alcohol worse, so abstention or avoidance of infant exposure for the first months of breastfeeding may be wise. Messages to mothers on this issue are conflicting, confusing and often outdated. Too little is done to teach mothers how to reduce infant exposure. Research is needed in different cultures into whether various forms of cautionary messages are likely to discourage breastfeeding.

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Balancing Beneficence, and Prevention of Harm When Caring for Pregnant Women with Substance Use Disorder

Liz Stokes JD, MA, RN, is the Director of the American Nurses Association Center for Ethics and Human Rights. She completed her BSN at the University of Virginia and worked several years as a critical care nurse. Liz received her Juris Doctor from the University of Richmond and worked as a Consultant for the D.C. Board of Nursing interpreting and conferring professional ethics provisions in nursing. She recently completed her Masters in Bioethics from Loyola University Chicago. Her leadership is also demonstrated through various charitable roles in the health and legal communities. She is a member of The American Association of Nurse Attorneys and serves on the board of the American Society for Bioethics and Humanities Affinity Group for Nursing. Liz also serves as an Associate Editor for the Journal of Bioethical Inquiry and is an active volunteer with the District of Columbia Bar Association. Liz is currently an American Academy of Nursing Jonas Health Policy Scholar.
It is well established that the care of pregnant or postpartum women with substance use disorder(SUD) can be a source of work-related stress for clinicians (Maguire, Webb, Passmore, & Cline, 2012). Providers must balance the ethical principle of beneficence, or preventing harm, with fidelity, which requires fairness, truthfulness, and advocacy (ANA, 2015). This can be a challenge for clinician who are in positions where there is a mandatory requirement to report a pregnant woman’s substance use. In these situations, clinicians must be compassionate, truthful, forthcoming and transparent when communicating obligations with patients to maintain trust in the patient-provider relationship. This discussion will provide recommendations for compassionate care for women with SUD including education on mental health, SUD, interpersonal violence, and treatment options (Hill, 2013). As patient advocates, clinicians can be a strong voice for pregnant women with substance use disorder and their unborn babies (Ferszt, Hickey, & Seleyman, 2013).

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Breastfeeding and Neonatal Abstinence Syndrome

Amber Valentine Forston is a Speech-Language Pathologist who graduated from the University of Kentucky with her MS in Communication Disorders. She is a Board Certified Specialist in Swallowing and Swallowing Disorders and an International Board Certified Lactation Consultant, as well as a Certified Neonatal Therapist (CNT). She worked for Baptist Health Systems, Inc for 8 years before moving to Florida where she worked for Wolfsons Children’s Hospital and Mayo Florida. She is now back in Kentucky working for Baptist Health Lexington. She has experience in adults and pediatrics with feeding and swallowing difficulties including: bedside swallow evaluations, Modified Barium Swallow studies, FEES, and pediatric feeding evaluations including NICU. She has experience with head and neck cancer patient including evaluation and treatment of swallowing difficulties, PMV use, and voice after total laryngectomy including TEP. She has provided guest lectures for the University of Kentucky, Eastern Kentucky University, and the University of Louisville on feeding and swallowing topics. She has presented at the hospital, local, state, national, and international levels on pediatric feeding/swallowing and breastfeeding.
Topic: Breastfeeding Medically Complex Infants in the Neonatal ICU - [View Abstract]
This presentation is designed to discuss the role of feeding therapy, breastfeeding, and family dynamics with infants with neonatal abstinence syndrome. These baby/family dynamics can be complex situations and feeding difficulties are extremely common. Breastfeeding education/information can be implemented prior to birth along with other education for families to promote more infant/family bonding and reduce stress of being born in substance exposure. Breastfeeding dramatically reduces stress signs in infants exposed to substances neonatally. Working together as an interdisciplinary team, we can set these families up for more successful feeding opportunities and decreased stress in developmental care.

Empowering Breastfeeding in Women Receiving Medication-Assisted Treatment for Opioid Use Disorder: A Call for Policy Change

Dr. Kelly McGlothen-Bell is an Assistant Professor at UT Health San Antonio, School of Nursing. As a nurse scientist, Dr. McGlothen-Bell is dedicated to understanding and resolving perinatal-infant health disparities in underrepresented groups, particularly among mother-infant dyads impacted by substance use disorders and preterm births. Dr. McGlothen-Bell uses interdisciplinary research, bio-behavioral methodologies, and community-engaged strategies to define and explore health priorities that can be remedied through culturally appropriate and sustainable health solutions. Her program of science focuses on understanding the relationship between infant feeding behaviors and readiness in high-risk infants and attunement between the primary caregiver and child during infancy and toddlerhood. The culmination of these findings contributes to the development of evidence-based interventions geared toward improving parental engagement and pediatric feeding success in marginalized populations. Dr. McGlothen-Bell has published numerous peer-reviewed articles related to developmental strategies for high-risk infants. She has also presented her work at conferences nationally and internationally. Dr. McGlothen-Bell has received numerous awards to include the 2019 National Association of Neonatal Nurses (NANN) Mentee/Mentor Grant Award. She was also selected as a 2019-2020 Academy Jonas Nurse Policy Scholar.
Topic: Feeding Behaviors in the Opioid Exposed Infant - [View Abstract]
Inequitable access to mother's milk often disempowers those who may benefit the most from it's' benefits. Moreover, suboptimal breastfeeding has the potential to negatively impact the health and well-being of future generations to come. Mother's own milk is internationally accepted as the most optimal source of nutrition for infants, yet breastfeeding initiation and duration rates among minority populations (i.e., women with opioid use disorders [OUDs]) continue to lag significantly behind that of the general population. The implications of the current U.S. opioid crisis and its increasing influence on women of reproductive age presents important considerations for the ways women and infants may receive inequitable access to breastfeeding and the benefits of mother's milk. In this presentation, learn the keys needed to empower lactation support providers to advocate for the use of scientific evidence that informs breastfeeding practices for women receiving MAT for OUD.

Marijuana and Breastfeeding: A Second Look, A Better Approach

Sekeita Lewis-Johnson is a Registered Nurse and International Board-Certified Lactation Consultant (IBCLC). She earned her Bachelor of Science degree in Nursing from Michigan State University in 1997. Most of her career has been as a labor and delivery nurse, with almost 10 years of experience as a Lactation Consultant. She consults with clients in the hospital setting, as well, as outpatient settings. She is currently a Doctor of Nursing Practice candidate at Wayne State University. Passionate about breastfeeding and its health outcomes, Sekeita provides lactation services with an emphasis on exclusivity.
Sekeita recently received “The People’s Choice Award” from the Michigan Council of Nurse Practitioners for her Poster Presentation titled: Implicit Bias of Health Care Providers and Breastfeeding Disparities Amongst African American Women. Additionally, she was awarded “IBCLC of the Decade” by Black Mothers’ Breastfeeding Association. She participated in a Community Innovations Project for the Massachusetts Institute of Technology (MIT). She is currently the President of Black Mothers’ Breastfeeding Association.
Legalization of marijuana for medicinal and recreational purposes presents challenges for health care providers in maternal-child health. Inconsistent messaging regarding marijuana use and lactation management is creating alarm for patients and health care organizations alike. Oftentimes, policies and policing of marijuana use are filtered by biases. This webinar will explore current literature regarding marijuana use and breastfeeding, as well as, confusing and inconsistent messaging and policies regarding marijuana use while breastfeeding. Discussion will include recommendations for equitable care practices regarding this topic.

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Pharmacokinetics and Clinical Implications of Drugs in Human Milk: The Substance-Exposed Infant

Wendy was one of the founder members of a UK charity the Breastfeeding Network. In her employed life she was a community pharmacist and also worked in doctor surgeries. She qualified as a pharmacist prescriber on primary prevention of coronary heart disease.
Wendy left paid work to concentrate on writing her books Breastfeeding and Medication (Routledge 2013, 2nd edition 2018), Breastfeeding for Dads and Grandmas (Praeclarus Press) and Why Mothers Medication Matters (Pinter and Martin). She co edited with Prof Amy Brown A guide to supporting breastfeeding for medical professionals (Routledge December 2019) and self published Breastfeeding and Chronic Medical Conditions in 2020.
Wendy is known for her work on providing a service on the compatibility of drugs in breastmilk and has been a breastfeeding supporter for 34 years. She is passionate that breastfeeding should be valued by all and that medication should not be a barrier. She has 3 daughters and 6 grandchildren all breastfed.
She was awarded a Points of Light award by the Prime Minister in 2018 and an MBE in the New Year’s Honours List 2018 for services to mothers and babies. She received her award at Windsor Castle in May 2019 from Her Majesty the Queen.
Topic: Pharmacokinetics and Clinical Implications of Drugs in Human Milk: The Substance-Exposed Infant - [View Abstract]
We are aware that an increasing number of babies are exposed to opiates, to methadone, to cannabis and cocaine through maternal breastmilk. In this presentation, I will discuss the pharmacokinetics of the medications and how this impacts the clinical care of the babies both immediately after delivery and later on. We need mothers to be open and honest about any drugs which they have taken in order that we may care for the baby appropriately if it is exhibiting clinical symptoms. This impacts on safeguarding issues but our aim should be to help the mother consider the impact on her baby using evidence-based information and to maintain breastfeeding appropriately. What are the long- and short-term implications of exposure for mother and baby? Is there sufficient research? As always, more questions than answers.


Dr. Frank J. Nice has practiced as a consultant, lecturer, and author on medications and breastfeeding for over 40 years. He holds a Bachelor’s Degree in Pharmacy, a Masters Degree in Pharmacy Administration, Master’s and Doctorate Degrees in Public Administration, and Certification in Public Health Pharmacy. He retired after 43 years of government service, including 30 years of distinguished service with the US Public Health Service. He currently is self-employed as a consultant and President, Nice Breastfeeding LLC.
Dr. Nice has published Nonprescription Drugs for the Breastfeeding Mother, The Galactogogue Recipe Book, and Recreational Drugs and Drugs Used To Treat Addicted Mothers: Impact on Pregnancy and Breastfeeding. Dr. Nice has also authored over four dozen peer-reviewed articles on the use of prescription medications, recreational drugs, Over-the-Counter (OTC) products, and herbals during breastfeeding. He has organized and participated in over 50 medical missions to the country of Haiti.
Topic: The Recreational Drug-Marijuana Dilemma - [View Abstract]
It is quite apparent that in our current society, pregnant and breastfeeding women do use and ingest recreational substances (in both a wisely manner and unwisely manner) and drugs of abuse, natural and/or synthetic. Marijuana use is of special concern currently, especially considering the ethical and legal concerns of its use. The objectives of this presentation are to effectively evaluate recreational drug use during breastfeeding and pregnancy; to counsel mothers who are pregnant or breastfeeding and using recreational drugs, including marijuana; and to discuss and address ethical concerns regarding marijuana use.

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