Multiple Disorders Leave Addicted Women MIA

(WOMENSENEWS)–Alexandria Harding wonders how different things might have been.

She and her siblings might have had a mother who took care of them.

Her grandmother’s home might have been a place to go for special visits. "She would’ve been like the fun grandma."

But that’s not how it was for the 21-year-old community college student who works part-time in a telecommunications customer-service center and asked that her name be changed to protect her family’s privacy.

Today, Harding’s mother is attending community college full time and talking about a nursing career. A program in Pennsylvania called Keystone Education Yields Success, or KEYS, assists her with tuition and costs.

Her mother has spent time in jail and prison for crimes related to drug addiction and come through in-patient treatment programs. Lately she’s been around more, but Harding says she can’t remember much about her mother from her childhood.

One of her mother’s 10 children is now living with her but the rest are in a variety of places; with a grandmother, a father and foster parents.

That scattered family might be much more clustered around her mother, Harding can’t help thinking, if she’d received the right treatment sooner.

National studies show that a very small percentage of women who need addiction treatment get it. A smaller number receive all the help they need. Nearly 3.6 million full-time working women were in need of substance use treatment, with only around 6 percent of those actually receiving treatment at a specialty facility, according to the July 22, 2010 National Survey on Drug Use and Health Report, published by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration.

Lack of Access

Thirty-six percent of those who needed or perceived they needed treatment and tried to get it did not receive it, because of a lack of health insurance or being unable to afford the costs, reported the Center for Health and Justice, of Chicago’s Treatment Alternatives for Safer Communities, Inc., in 2006.

To benefit from treatment, women must often find a program that screens for and treats mental illnesses and trauma. But Hortensia Amaro, founder of two substance-abuse treatment programs for women in Boston, says success all depends on the kind of treatment a woman gets. Recovery success, she thinks, is most likely in programs that address the multiple, co-occurring disorders–clustered around mental health and trauma–from which many drug-dependent women suffer.

Her programs, for instance, provide work force training for women financially dependent on abusive partners; leadership and communication skills for women silenced by trauma; practical life skills such as budgeting, shopping wisely, writing a resume and looking for a job; and workshops in family reunification and communication.

Often, Amaro says, women with drug addictions have a history of trauma that started in childhood and continues into adulthood and is frequently related to physical and sexual abuse. A high rate of mental illness correlates to such traumas.

Women with drug addictions don’t tend to be able to develop in a healthy manner, says Amaro, a professor and associate dean at Bouve College of Health Sciences and director of the Institute on Urban Health Research at Northeastern University in Boston.

"These issues impact who they choose as partners, the kinds of relationships they get in, their ability to care well for their children, even though they care a lot about their children," she said.

Another holistic treatment model is provided by the Dependency Drug Court of Ventura County, Calif., which offers a multi-agency, multi-discipline collaboration that includes public health nurses and mental-health services.

Milestone Charms

Female participants receive a wrist watch when they enter the program. Little charms are added when the women reach milestones, such as 90 days without any drugs or the day they secure a job.

The graduation rate for the program, which began in 2000, is 60 percent for the last two years. Nineteen of those 32 graduates were women with children, some with multiple kids.

In an e-mail Meynardo Mendoza, a coordinator for the Drug Court, said participants who did not graduate at least went through an "episode of treatment" that would improve their chance of becoming clean and sober in the future.

Barbara Bonsignori, a registered nurse, works with mothers over 18 and their children through Rx for Kids, a program of Ventura County Public Health. The treatment goal is six months in-patient followed by six months out-patient and in some cases additional out-patient treatment. Bonsignori says she provides everything from health assessments to guidance to accessing care to providing infant massage.

In addition to the court and Ventura County Public Health, other agencies involved in the program include CalWORKS, California’s welfare to work program, and providers of transitional housing.

Mental Health Component

The inclusion of mental health professionals is significant.

"Addiction treatment has historically not dealt well with mental health problems or traumas," Amaro said, "and people who deal with issues like domestic violence don’t deal with or are not trained with substance abuse. Everybody’s dealing with their part of the problem but not comprehensively. As a result, issues aren’t addressed in a comprehensive manner."

Large, coordinated programs like the one in Ventura, however, are hard to maintain and duplicate, added Amaro, hindered in great part by a shortage of clinicians trained to treat drug addiction’s common co-occurring disorders.

Amaro says her own Boston programs are held back by low payments from Medicaid, the public health program for low-income people.

People who might need intensive services can be limited by Medicaid rules to one or two out-patient services, or number of days in a program.

"The level of payment is usually very inadequate," she said. "Reimbursement for the services is quite low. You never end up having enough money to have a program if you rely on reimbursement."

Budget cuts are another limitation, she says.

"There are more cuts coming," Amaro said. "That means more programs will have fewer spots or will have to close."

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Angeli R. Rasbury is an educator, artist, lawyer and writer specializing in women, girls and culture. Her 2006 article for Women’s eNews, "Out of Jail, Mothers Struggle to Reclaim Children," won an award from the National Council on Crime and Delinquency.