The cycle of substance-abuse related family discord illustrated in Love and Diane must be broken. One starting point is the provision of services to pregnant and postpartum women. The Substance Abuse and Mental Health Services Administration (SAMHSA) has funded an array of services for women with substance abuse problems. Some of these services provide residential treatment that allows infants and minor children to reside with their mother in the treatment facility. Family centered residential substance abuse treatment for women with children avoids pitting the needs of women seeking substance abuse treatment against the needs of children. In-home assistance can also help with parenting.
More than 60% of women reported remaining completely clean and sober 6 months after discharge from a residential treatment program, and employment rose from 7% pre-treatment to 37% after treatment. Only 12% of the women continued to live with an alcohol involved or drug involved partner after treatment, down from 45% prior to treatment.
Unfortunately, residential treatment programs for mothers with histories of substance abuse were not prevalent during the explosion of crack addiction that ensnared Diane during the late 80s and early 90s. Until the SAMHSA funded programs were first established between 1993 and 1995, there were few treatment facilities with the knowledge, resources, and training sufficient to address the range of issues and severity of substance abuse affecting women. While significant gains have been made over the past 12 years in expanding treatment capacity for women, SAMHSA has recognized the need to continue to expand treatment capacity in order to adequately address the needs of this population.
Participation in a residential treatment program for women or women and their children is not always a requirement for the mothers to retain custody of the children. However, if the mothers enter the program through the court system or child welfare system, participation in a residential program could be a requirement for them to retain custody of their children.
One of the main barriers to residential treatment is cost and the availability of state funding, however there are other obstacles. Some residential treatment programs for women do not accommodate children and the mothers may not even be allowed visitation or contact with their children during the early phase of their treatment. Even if a woman could bring one or two children into treatment with her, often they have to leave one or more of their children, making it more difficult to be away from home. This can set up a conflict if the woman is also expected to visit the child, or receive visits, as part of her reunification plan with the court. A very difficult situation for the woman. The ambivalence of partners, who usually use drugs, may also stand in the way of the woman's efforts to stop using. Transportation and housing in the post-residential treatment period are also major barriers.
H. Westley Clark, M.D., J.D., M.P.H., is Director of the Center for Substance Abuse Treatment in the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. In this position he leads SAMHSA's efforts to provide effective and accessible treatment to all Americans suffering from alcohol or drug addictions.