Why are crack babies so screwed up?

Dear Stanton:

I am a student attending —– and I have chosen a topic in a Sociology class. The topic I am researching is “Crack/Cocaine Babies” and the consequences that this has on society. I am hopeful that the ‘Ask Stanton!’ page could help me locate specific topic criteria with references to back it up. Addictive women having babies and the social ramifications of the problems crack/cocaine children are causing our society.

Tom

Dear Tom:

I hope this won’t get you in trouble with your sociology class, but the “crack baby” phenomenon was overhype. Basically, women with a wide range of problems, some of whom took cocaine, gave birth to children with a number of problems. Immediately (and predictably) this was blamed on cocaine, and the “crack baby” phenomenon was born.

Let me summarize what we know:

1. Women with “crack babies” rarely take only cocaine; indeed, drugs are rarely their sole problem. Among the problems they face are malnutrition and sexually transmitted diseases, and the babies are relatively often premature. (Please see the article in the “Demystification” site of my library entitled, “The new thalidomide,” concerning fetal alcohol syndrome — FAS.)
2. No direct link was ever drawn between mother’s use of cocaine and fetal damage. This was just hypothesized — crack is so bad, it must permanently damage fetuses.
3. The original alarmist projections that crack babies were permanently damaged proved unfounded. In a follow-up just two years after the identification of crack babies, Dr. Ira Chasnoff found that their “average developmental functioning level is normal.” Chasnoff was an original discoverer of fetal cocaine (and other drug) damage.
4. Another founding investigator of the “crack baby” phenomenon, Dr. Claire Coles (also very active in establishing and making claims about the permanent damage caused by FAS, likewise re-evaluated her initial assessments of these children, and decided the worst damage these infants experienced seemed to occur in their worlds after birth.
5. The phenomenon that most needs to be examined for a sociology class is (a) why we are so irrational about drugs, (b) how the wildest, most unfounded claims about new drug scares are so readily accepted, widely propagated, and so hard to extinguish (see your views), (c) how we can create a rational atmosphere in which to conduct science and public policy both.

Here are some references:

Ira J. Chasnoff et al., Cocaine/polydrug use in pregnancy: Two-year follow-up, Pediatrics, 89:284-289, 1992.

Claire Coles et al., Effects of cocaine and alcohol use in pregnancy on neonatal growth and nuerobehavioral status, Neurotoxicology and Teratology, 14:23-27, 1992.

Gideon Koren et al., Bias against the null hypothesis: The reproductive hazards of cocaine, Lancet, December 16, 1440-1442, 1989.

Linda C. Mayes et al., The problem of prenatal cocaine exposure: A rush to judgment, JAMA, 267:406-408, 1992.

Barry Zuckerman and Deborah Frank, “Crack kids”: Not broken, Pediatrics, 89:337-339, 1992.

Update, December 20, 1999

Researchers led by the chairman of the division of neonatology at the Albert Einstein medical Center in Philadelphia, Dr. Hallam Hurt, found when investigating “crack babies” that, “The findings are overwhelming and persistent — there may be a drug effect, but it’s totally overshadowed by poverty.”  The researchers found that poor children tracked to 4.5 years of age performed poorly on cognitive tests compared with other children, whether or not the poor children had been exposed to cocaine prenatally.  Of course, even if the cocaine babies did slightly worse on the tests, the most harmful effects to children from cocaine-using mothers could be due to the variety of other disadvantages the children experienced.  Children of such mothers were more likely to live in poverty, to be victims of abuse and neglect, and to be inadequately nourished and to suffer other health problems.

Betancourt, L. et al., Problem-solving ability of inner-city children with and without in utero cocaine exposure, Journal of Developmental and Behavioral Pediatrics, 20:418-424, 1999.

Update, March 28, 2001

Yet again, the same underlying discoveries are made — crack babies are not the result of crack use, but rather of multiple health and environmental problems, and their development and behavior — if abnormal — are quite remediable. The latest research in which this was found analyzed 36 studies in which pregnant women or newborns were drug tested and the babies tracked over the years. “There is no need to assume that [cocaine-exposed babies] are a doomed generation or a biologic underclass, which is what was said about them initially,” said Deborah A. Frank, a pediatrician at the Boston University School of Public Health. “The idea that these children are uniquely ‘unteachable’ or somehow out of control is simply not supported by the data.” The authors noted that developmental problems “can be explained in whole or in part by other factors, including prenatal exposure to tobacco, marijuana, or alcohol, and the quality of the child’s environment.”

Frank, D.A. et al., Growth, development, and behavior in early childhood following prenatal cocaine exposure: A systematic review. JAMA, 285:1613-1625, 2001.

Dr. Stanton Peele, recognized as one of the world's leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions. Dr. Peele is the author of 14 books. His work has been published in leading professional journals and popular publications around the globe.