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dependent women than they do with men in the drug sub-
Drug treatment was originally designed to address the problems of male prisoners. Since the early 1930s conventional treatment, developed with male alcoholics and heroin users in mind, has focused on the drugs of addiction and not the process, the influences that drive and sustain addiction, or the efficacy of attempts to address addiction. Consequently there are few options for women, who increasingly face prosecution, within the current treatment system.
Research on addicted women, treatment needs, and efficacy of treatment, is extremely limited and poorly funded. The needs of drug dependent women have been clearly defined, since it is the fastest growing population seeking treatment. As Worth put it:
What we have to ask is why there are only twenty-one comprehensive treatment programs (as of April 1990] for women throughout the country. Why most of them are privately funded, can only take small numbers of women and children and are chronically short of adequate funding. What we have to ask is why we are not funding what
seems to work. 1 There are even fewer treatment programs for women addicts who are pregnant, primarily because treatment facilities and hospitals deny access due to the lack of liability insurance, and increased physical and emotional complications related to their addiction, requiring greater medical care that many facilities are able to provide.
There are a number of factors differentiating women's problems, needs and options from those of men that underlie the reason for distinct treatment programs for women.
Most drug dependent women are overly self-critical and have poor ego boundaries, often as a result of being sexually abused as children. Women who have been sexually abused as children (between 40-80 percent of all intravenous drug-using women] cope through mechanisms of learned helplessness with males. Such women need to be separated from men while going through treatment so they can unlearn dependent coping patterns and interact with and learn to trust other women, who will play a crucial role in the social networks needed to support changes
in their lifestyles. 167 Many drug dependent women also have resorted to prostitution in order to fund their habits or that of their drug addicted spouses or boyfriends. Another factor differentiating the needs of women is that as many as thirty percent of women in treatment identify themselves as lesbians. 168 Most women addicts are faced with divorce, single parenthood, poor job skills, and stigmatization which make it difficult to enter and stay in conventional drug treatment
166 Dooley Worth, op. cit., April 17, 1990, p. 1. 166 Ibid., p. 7. 167 Ibid., p. 6. 168 Ibid., p. 10.
facilities. Others experience sexual harassment in coed treatment facilities which further damages already poor self-esteem and increases the chance they will leave treatment before completing the program. These factors make it clear that successful treatment outcomes for women mean that treatment programs must be specifically tailored to their needs, and separate from those facilities treating men.
An addict in recovery in a drug treatment facility in Maryland recently recounted her experience with a coed facility. She was forced to describe how getting high helped chase away the shame from a childhood full of sexual abuse and her later involvement in prostitution on the streets of Washington. "It was humiliating to have to say that in front of men, and they treated me differently afterwards. It was like they ripped my guts out, threw them on the floor and said, 'You're healed.'
There are a number of obstacles to women seeking treatment. Perhaps the greatest barrier to participation, and most common reason for women to leave treatment, is the lack of childcare. The decision to seek treatment in many cases depends on the mother's ability to find appropriate child-care situations. Women-only facilities such as Women's Inc., a live-in treatment program, and the Eleanore Hutzel Recovery Center have provisions for women, pregnant women who need child-care, tutorials and after-school activities for their children. 170 Interestingly enough, most women decide to seek treatment because of the effect of drug use on their ability to care for and nurture their children. 171 Men, however, enter treatment mostly because of the effect of drug use on their jobs.
The lack of transportation often deters chemically dependent women from entering treatment. This is a problem in both rural and urban settings. This is particularly crucial if women enter outpatient facilities and have daily or weekly transportation needs and are unable to afford a car or live far from public transportation. The inability to enter appropriate facilities within close proximity to home is a deterrent to receiving treatment, and causes treatment to end prematurely.
Another barrier to participation for inner city drug dependent women is that many are usually dependent upon Medicaid to pay for treatment and many facilities do not accept Medicaid. Other inner city women do not even have the option of Medicaid. 172 In Detroit, if a person does not have insurance, there are virtually no treatment options. 173
As stated there are very few programs that will admit pregnant addicts because of the lack of liability insurance and the lack of resources to handle the complications that can arise. A survey conducted in New York City of 95 percent of the treatment facilities revealed that 54 percent refused to treat pregnant women, 67 per
169 Lisa Leff, "Treating Drug Addiction With the Woman in Mind: Arundel Halfway House Focuses on Female Users," the Washington Post, March 5, 1990, p. El.
170 Testimony from Kattie Portis and Beverly Chisholm at a hearing before the Subcommittee on Legislation and National Security, April 17, 1990.
171 Eldred, Grier, and Berliner, "Comprehensive Treatment for Heroin-Addicted Mothers," Social Casework, Vol. 55, 1974.
172 Dooley Worth, op. cit., p. 8.
173 Hearing before the Subcommittee on Legislation and National Security and the Subcommittee on Government Information, Justice, and Agriculture, December 14, 1989.
cent refused to treat pregnant women on Medicaid, and 87 percent had no services available to pregnant women on Medicaid addicted to crack. 174
There are several problems connected to the treatment of chemically dependent pregnant woman. First, witnesses before the committee stated that it would be unwise to establish facilities only for pregnant women in the way that considerable funding is now being directed. Rather, women should have special treatment programs at all stages of their lives, to build their confidence as individuals, not because they are pregnant.175 Second, the fact that many "federal, state and local officials have responded to the problem of increased drug use among pregnant women by seeking punitive sanctions against these women,” is having a very adverse impact on women and children in the inner cities.
These sanctions range from criminalizing drug use during pregnancy to placing newborns who test positive for drugs at birth, along with existing siblings, in the custody of the State. These punitive measures are ill-considered and short-sighted and will deter pregnant addicted women from seeking prenatal care for fear of negative con
sequences. The children who are farmed out to the state, or to friends of the family are at a higher risk of engaging in drug use in the future.
Punitive measures have been employed in a number of states. A case in Muskegon County, Michigan in September of 1988 illustrates the general problem encountered by pregnant women across the United States. Alan S. Rapoport, the attorney for a mother who used crack during pregnancy and delivered a crack-addicted infant, stated: “The war on drugs has degenerated into a war on women. And why is it that all these straight white men are telling pregnant women how they should act and feel?” 177 Dr. Ira J. Chasnoff, founder and president of the National Association of Perinatal Addiction Research and Education in Chicago, entered an affidavit in support of the crack dependent mother:
Pregnant black users are nearly ten times more likely to be reported for substance abuse than pregnant white users. Treatment programs for pregnant addicts are scarce enough; prosecutions only scare addicts away from seeking
even basic prenatal care, for fear they'll be turned in. 178 Poor women are more likely to be prosecuted because public hospitals, where poor women go for care, are more vigilant in their drug testing and more likely than private hospitals to report women whose tests show drug use. Drug testing indicates that poor minority women are more likely to use cocaine which may present more serious consequences for the mother and child, whereas white, middle class women are more likely to use marijuana, the effects of which are not immediately noticeable.179 A study conducted in New York City on the damage to children of mothers who use crack indicates that there is more impairment from tobacco and alcohol use to the fetus than from crack. 180
174 Chavkin, op. cit., p. 3.
177 Jan Hoffman, "Pregnant, Addicted-And Guilty?", the New York Times Magazine, August 19, 1990.
At least eight states now include drug exposure in utero in their definition of child abuse and neglect, and many more have legislation pending. Civil libertarians argue that prosecuting women for what is in essence their conduct during pregnancy abrogates constitutional rights to privacy and turns pregnant users into secondclass citizens, deprived of equal protection. It is also argued that if the line isn't drawn at drug abuse, prosecutors may go after pregnant women for drinking, smoking or even taking aspirin.181
The first nationwide meeting of top prosecutors and health care specialists on the problem of drug-affected babies was held in Chicago in July 1990. Some prosecutors recommended that while prosecution may sometimes be necessary, criminal justice officials need to encourage drug-addicted pregnant women to seek counseling and prenatal care; others indicated that prosecution serves as a necessary deterrent to drug-addicted women passing health problems on to their newborns. 182 Recently, a Missouri health-care panel of 100 professionals who care for pregnant women and babies, met at a conference on perinatal substance abuse. Because of the growing number of babies born with addictions, and the increasing number of women prosecuted (over 60 thus far), the panel concluded that better treatment programs for women, training for physicians to learn how to identify and refer these women, and more housing for chemically dependent women in treatment programs are needed. “We've got to convince lawmakers that the bottom line is: it costs less to provide prenatal care and drug treatment than it does to pay for the consequences of the criminalization,” stated Dr. Janie Vestal, a Missouri Department of Health medical specialist.183
Congress has enacted legislation to support programs for women with addictions in the form of a women's set-aside, such as the ADAMHA block grant which required states to spend five percent of their block grant on new and expanded prevention and treatment efforts for alcoholic and drug dependent women. This setaside was increased in 1988 to ten percent. The amount of funds allotted for services for the problems of addicted women since 1985 totals $364 million. Yet, according to Susan Galbraith:
Despite the presence of a federal requirement since 1984 to devote a portion of federal funds to women, the states' commitment to creating and expanding programs for women has been minimal. The proof of this minimal commitment has become markedly clear in light of numerous reports documenting the virtual absence of treatment programs which serve women and their children, generally,
179 Gina Kolata, “Racial Bias Seen on Pregnant Addicts,” The New York Times, July 20, 1990, p. 30.
180 Dooley Worth, op. cit., April 17, 1990, p. 138. 181 Hoffman, op. cit.
182 Colleen Diskin, “Prosecutors Say Prison Isn't Answer for Pregnant Women Who Use Drugs,” Associated Press, July 30, 1990.
183 Associated Press, "Treatment, Not Penalties Needed For Pregnant Drug Users, Panel Says," September 7, 1990.
and pregnant women, specifically. Presumably, if states
Crack babies Alarming numbers of infants born with addictions because of their mothers' drug habits are being reported by hospitals nationwide. The ONDCP strategy report estimated that 100,000 babies are born exposed to crack every year. The Health and Human Services Inspector General surveyed 12 metropolitan areas which represented 17 percent of the population of U.S. cities of more than 100,000 people, and found that 8,974 babies were born with crack addiction. These babies will incur health costs of over $500 million for their first five years of life. 185 At a metropolitan hospital in Detroit 38 percent of the 1,000 newborns have been exposed or are born addicted to drugs. 186
According to the Inspector General, 70 percent of the cocaine babies look healthy and most are not identified at birth; exposure may appear at the age of 2 or 3 years old. Prenatal exposure can lead, however, to premature birth, low birthweight, birth defects, and respiratory and neurological problems. Crack babies have a significantly higher rate of Sudden Infant Death Syndrome than babies not exposed prenatally. While the full range of long-term effects of prenatal cocaine exposure are not known, experts believe that many crack babies will suffer developmental disabilities. 187 The Inspector General reports that of the crack babies identified, 50-75 percent go home with their mother or another relative and 30-50 percent go into foster care. Other affected babies must go into emergency or congregate care, usually for 30-90 days.
In New York City, the first generation of children born to crackaddicted mothers joined other children this September for the first
184 Statement of Susan Galbraith, Director, Coalition on Alcohol and Drug Dependent Women and Their Children, before the Select Committee on Children, Youth and Families, May 17, 1990, pp. 7-8.
186 Office of Inspector General. “Crack Babies," U.S. Department of Health and Human Services, Office of Evaluations and Inspections, February 1990.
188 Statement of Donald L. Reisig before the Subcommittee on Legislation and National Security and the Subcommittee on Government Information, Justice, and Agriculture, December 14, 1990, p. 4.
181 Statement of Michael F. Mangano, Deputy Inspector General, DHHS, before the Subcommittee on Health and the Environment, April 30, 1990, pp. 1 and 4.