MIST: Mothers and Infants Sober Together
- Need: To address the needs of pregnant women who are using substances and infants born into drug-positive families.
- Intervention: The Mothers and Infants Sober Together (MIST) program assisted mothers who used substances get treatment and provide a safe, drug-free home for themselves and their newborn.
- Results: MIST has helped mothers find treatment and education and has helped children grow up in safe and healthy homes.
Babies born whose mothers used opioids during pregnancy,
or were receiving buprenorphine due to medication
assisted treatment, are born exposed to the drugs and
experience withdrawals once born. Children born drug
positive have special needs. With East Tennessee's
high number of neonatal abstinence syndrome (NAS), it
is important to secure these women in treatment early on
in their pregnancy.
In order to help mothers access
substance abuse treatment and properly care for their
Mothers and Infants Sober Together (MIST) program was
formed in 2006 through the Ridgeview Behavioral Health
Center. The program's mission was to improve the
quality of life and daily functioning of drug-exposed
infants and families.
The program, which started small, eventually expanded to
include Anderson, Roane, and Campbell counties in
Tennessee. The program provides case management, group,
and individual therapy to pregnant women and mothers with
Many clients come from referral sources such as:
- Department of Children Services
- Obstetrics and gynaecology (OB/GYN) doctors
- Anderson, Roane, and Campbell County Juvenile Court
- Health departments
- Community probation services
- Treatment providers
- Self-referral from clients
This program received support from a 2006-2009 Federal
Office of Rural Health Policy
Rural Health Care Services Outreach grant.
The program team consists of case managers, a therapist,
and a program coordinator. Together, the team works with
mothers to create a stable, drug-free environment for
their infants and the families. To be eligible for
services, mothers must test positive for substances
during pregnancy or at time of birth and/or admitted to
using drugs during the pregnancy. The majority of the
women that MIST serves use opiates, Suboxone,
tetrahydrocannabinol (THC), and methamphetamine.
Same-Day Access for initial appointments.
Next Day Medication Management is initiated following
the assessment where a psychiatrist evaluates the patient
and can prescribe medication-assisted treatment (oral or
injections) or referrals to additional MAT treatment
using Suboxone or Subutex. Providers use a methodology
called Just-in-Time to prescribe dosages to help mothers
with medication management.
Additional services include:
- Home visits
- Mental health counseling
- Substance abuse treatment
- Relapse prevention
- Parenting education
- Supervised visits for mothers without custody of
- Case management
- Weekly support groups
- Individualized treatment plans
- Individual therapy
From August 2009 to June 2016:
- 942 referrals were received by the MIST Program from
- The average age of a MIST client was 24, with the
youngest client being 13 years old and the oldest client
- The program has had an increase of pregnant women
- Many women successfully detox before giving birth,
with the assistance of their OB and Subutex doctors.
- Drug-free, healthy babies have
been born to women who were previously addicted to drugs
MIST has caught the attention of local and national media
MIST has continuously faced barriers to reaching pregnant
women for substance treatment and detox. The enactment of
Tennessee Fetal Assault Law of 2014 led to a greater
number of women who avoided discussing their substance
use for fear that they would be arrested. This law
expired on July 1, 2016.
The program continues to work towards substance use
prevention in communities, providing medical resources to
spread the word about available treatment. A preeminent
goal is to establish the reputation of being a welcoming
place of assistance, making women feel comfortable and
Organizations wishing to bring something like this to
their area should find a clear plan for sustainability.
They should also work closely with area law enforcement,
judges, healthcare workers, and mental health centers in
order to be the most effective.
Children and youth
Maternal health and prenatal care
Substance use and misuse
January 24, 2007
Date updated or reviewed
May 2, 2023
Suggested citation: Rural Health Information Hub,
MIST: Mothers and Infants Sober Together [online]. Rural Health Information Hub. Available at:
[Accessed 21 September 2023]
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.