When Catherine suffered a serious leg injury as a teenager, a doctor prescribed what would become an eight-month regimen of Percocet, a highly addictive prescription pain medication. Within days of her last refill running out, Catherine—who is using a pseudonym—started experiencing extreme withdrawal symptoms and soon turned to heroin and other non-prescription street drugs. Over the next eight years, Catherine’s substance use disorder spiraled, and she spent much of her 20s unable to find permanent housing and stable employment.
During those same years, Catherine moved in with her then-partner and became pregnant. The couple, who both had a history of substance use disorder, decided to turn their lives around and adopt a substance-free lifestyle as they started a family. Catherine stopped using substances on a regular basis and tried a short-term substance use disorder treatment program. Catherine found the process alienating—she said the staff were unprofessional, and her participation in the program ultimately brought her family into contact with New York’s child protective agency, Administration for Children’s Services (ACS). As Catherine sought treatment, she came away believing that both ACS caseworkers and the substance use disorder treatment center’s staff both made erroneous assumptions about her ability to mother her first child.
“Life happened, and ACS removed my child before my baby turned 8 months old,” Catherine said.
Catherine’s story is one shared by many parents and caregivers around the country who have substance use disorders. Like Catherine, many people’s substance use disorder stories started out with legitimate prescription drug use that turned into abuse, especially in the wake of a decades-long crisis of overprescription of highly addictive prescription drugs, including opioids. According to the U.S. Department of Health and Human Services, some 10.1 million individuals are estimated to have “misused” their prescriptions in 2019. The U.S. opioid epidemic started during the 1990s when pharmaceutical companies were not transparent about how addictive new opioid medications really were, and also financially incentivized doctors to prescribe them. In turn, medical professionals over-prescribed opioids and other prescriptions for pain and chronic health issues.
As a result, many patients like Catherine ended up with long-term substance use disorders and started using “street” drugs that are also highly addictive. Many times inequities, lack of health insurance, and other structural barriers play a significant role in comprehensive substance use disorder treatment, especially for BIPOC, who are more likely to be without insurance or the financial resources to seek treatment.
“My addiction was killing me,” said Catherine, who identifies as Puerto Rican and Irish. “I would be dead without treatment,” she said. But rather than providing support to parents with substance use disorders, government intervention often simply means taking away their children.
Barriers to accessing treatment
Social workers can be instrumental in helping caregivers, particularly young mothers who have substance use disorders during pregnancy or during their child’s early years, but can also end up funneling families into the same child welfare system that often separates parents from children. However, some social workers are working to ensure that substance use disorders don’t automatically mean parents lose their children.
“We try to remove the stigma preventing women with substance use disorders from getting the treatment they need,” said Dr. Janeen Cross, a Howard University assistant professor at the School of Social Work. “We can remove those transitional barriers to care.”
According to Dr. Cross, a social worker in private practice providing telehealth therapy, the pandemic has only made things worse regarding accessibility of substance use disorder treatment. In March 2020, in-person treatment stopped at the majority of treatment facilities. In some cases many were unable to get the same level of treatment and appointment slots for months, due to technological and internet accessibility issues. Despite significant improvements since then, anecdotally, many experts state that in-person substance use treatment levels have not returned to what they were pre-pandemic.
Women of color face greater barriers to accessing substance use disorder treatment, and also disproportionately experience intervention by child protective services as compared to white women.
Dr. Cross previously worked at a hospital NICU in Philadelphia, Pennsylvania, and when she encountered mothers with a substance use disorder diagnosis, she took special care to educate them in the days and weeks after birth about how to best show child welfare professionals they were ready to welcome their baby home. Some of the details involved basics like having a car seat—and sometimes helping the moms get a donated free car seat if they needed it—but would also include information on what a child welfare caseworker would say is a suitable environment for a newborn. During home visits, child welfare workers typically look for food in the fridge, making sure there is working electricity or no serious home safety violations, and aim to make sure the baby has a place to sleep and the home is safety-proofed.
When CPS made a placement decision where the agency would take immediate temporary custody of the baby, Dr. Cross said she advised clients to immediately provide information to CPS about a potentially suitable family member who agreed to care for the newborn baby upon their discharge from the NICU. She made this recommendation so that the infant could be with family members instead of being placed in a foster home, she said.
Once mothers completed a hospital or center-based detox, hospital social workers often advised them to enroll in substance use disorder treatment as soon as possible, whether outpatient or inpatient depending on individual circumstances.
The search for supportive, parent-friendly treatment
Two years into the pandemic, organizations like Outreach, a New York treatment center with several locations in New York City and Long Island, are now seeing an incredibly high demand for outpatient and inpatient treatment particularly from female clients, ranging from adolescents to adult women. “After months of telehealth, many want to return to in-person treatment,” said John M. Venza, Outreach’s vice president of adolescent and residential services.
“It’s essential that clients get long-term support and treatment near the communities they live in,” he said. Substance use disorder treatment often works in conjunction with individual counseling, family counseling, parenting classes, and more, Venza said. “When it comes to parents with substance use disorder who do not have their children living with them, the ultimate goal is treatment and family reunification whenever possible,” he said.
Odyssey House, a New York City-based program with multiple locations, is one of the few mother/child substance use disorder residential treatment programs in the country. Family caregivers can access inpatient treatment while living with any of their children from newborn up to the age of 6, said Odyssey House’s Asha Cameron.
When Catherine became pregnant again, she was desperate to get inpatient substance use disorder treatment at another facility and also needed mental health treatment for an earlier diagnosis of bipolar disorder. Early in her second pregnancy, she found the treatment she needed at Odyssey House.
Being pregnant can disqualify a woman for admission to an intensive long-term inpatient treatment program since many facilities cannot accommodate newborns or young children. Additionally, since many substance use treatment facilities are so specialized, having mental health issues and substance use disorder (known as being a dual diagnosis patient) can also disqualify a family caregiver for an available bed for a treatment program. While Odyssey House operates their intake process on a case-by-case basis, their mother/child program will not disqualify any patient who is pregnant or who has children.
Families’ needs don’t stop at treatment
Even after a family caregiver gets the treatment help they need, systemic racism and inequality continue to impact individuals with substance use disorder on a societal level. Solely as a result of drug use, parents with substance use disorder can be labeled by child protective services as neglectful. When CPS intervenes and removes a child from the home, there can be long-lasting consequences for a caregiver’s mental health, stability, housing options, employment and more, along with impacts on children’s mental health.
“Obviously, I am not promoting drug use for parents and caregivers, but we have to fix the root of the problem, not cut down one branch,” said Washcarina Martinez Alonzo, an attorney working in the economic justice unit of Legal Services NYC. “People who do drugs are in dire need of resources. They are using those drugs as a coping mechanism. That is the root of the problem. Removing kids doesn’t solve the root issue.”
In fact, Martinez Alonzo explained, CPS intervention and labeling can keep families economically vulnerable and unable to find or keep employment for years even after parents have successfully completed treatment for a substance use disorder. Martinez Alonzo recalls one client who was up for a promotion at work and who needed to undergo an intensive background check. The client was immediately terminated from her long-time job when they found a substance use “neglect” charge from ACS from five years prior. The case is ongoing. After years of advocacy from organizations like JMacForFamilies, New York State’s laws have changed. Now, if parents have neglect charges, these records are sealed from an employers’ background check after eight years, instead of 28 years.
Given such challenges, according to Cameron, housing is one of the most pressing needs treatment facilities like Odyssey House should help clients with during discharge planning.
Unique, who is using a pseudonym, is an African-American mother of four who has two adult children and two younger children who are under 18. Two years into the pandemic, New York City’s real estate market has become incredibly overpriced. Unique says she has been at Odyssey House for 15 months and struggles to find housing elsewhere.
“I have been putting in the foot work since I got here. I have not had any luck. I am going to keep trying. If it were up to me, I would give the less fortunate housing first,” she said.
According to Unique, landlords often choose to deny a rental application to individuals who have subsidized housing vouchers. Unique also believes the fact that she has a prison record or substance use disorder diagnosis may sometimes lead to landlords making assumptions and deciding not to rent the apartment to her.
Unique’s alcoholism and other substance use started in her teen years, following the death of her grandmother, who helped raise her. “I started using alcohol continuously every day,” she said. Her first stay at Odyssey House was back in 2009. Back then, Unique successfully completed treatment when her now adult children were younger.
According to Unique, things in her life took a downturn. “I had gone to prison—first time ever getting locked up,” she said. Following Unique’s release after a two-year prison sentence, her son was taken away by ACS. Then the 2020 pandemic happened. “I started drinking continuously again,” Unique said.
“I was having a hard time with Zoom visits. I really wanted to be with him,” said Unique, speaking about CPS supervised video visits with her young son instead of in-person supervised visits that routinely happened pre-pandemic. Finally, after 10 months apart and being in substance use disorder treatment, Unique was finally reunited with her youngest child. Unique’s youngest son joined her at Odyssey House’s mother/child residential program, where the two will remain for the foreseeable future.
Isobelle Surface, Odyssey House’s senior vice president and director of communications, said, “Our goal is a healthy child and a healthy family. We want to be a bridge to our clients achieving their goals.”