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A Crack in the System

Reports the conclusion reached by researchers' interviews of 50 crack-using mothers that drug-treatment programs will not work unless they address the context of women's lives. The need to consider sexual violence and family addiction; Aftercare; Researcher Wendy Chavkin.

Crack is rapidly becoming an equal opportunity destroyer. Thirty to 40 percent of crack addicts in this country are now women--a fourfold increase in just 10 years.

As the ranks of crack-abusing women grow, so too do the numbers of pregnant women who are using. Trouble is, most drug-treatment programs are built with men in mind.

And that's a double whammy: They not only fail women, but their children, too.

Hundreds of crack-abusing women have been slapped with criminal charges for using drugs while pregnant. Though none have been convicted, countless others have, in fear, refused treatment altogether.

A team of researchers from Beth Israel Medical Center in New York learned about the lives of addicts by interviewing 50 addiction experts and 150 indigent, crack-using mothers. All came to the same conclusion: treatments will not work unless they address the context of women's lives.

About half the mothers had a history of sexual assault, jail, and psychiatric treatment and had grown up in households that were affected by drugs and alcohol. "The history of trauma was very clearly associated with a drug problem that included starting drug use at an earlier age, doing more drugs, and being involved with a man who was coercing her into using drugs," reports Wendy Chavkin, M.D., M.P.H. So, for starters, "A successful program would have to address sexual violence and family addiction."

Both mothers and experts cited aftercare--support after the initial phase of treatment--as the number one missing element in existing programs. Next was child care, the thorniest issue. Some women avoided treatment altogether because they were afraid of losing custody of their kids. Chavkin explains that the lack of child care in most all-day or residential programs "puts a mother between a rock and a hard place: She has to give up her kids to be in treatment and she can't be in treatment if she wants to keep her kids."

Many addicts feel shame and guilt for using drugs during pregnancy. For some that's a primary motivation to enlist in treatment. It makes others run. "Treatment approaches that emphasize shame and anger seem counterproductive," comments Chavkin, an associate professor of public health and obstetrics/gynecology at Columbia University. "They don't work for people feeling crummy about themselves to begin with."

Hostility toward drug addicts, along with the prohibitive costs of treating them, are holding back counseling, aftercare, and child care advancements. But money spent in the criminal justice system, foster care, jail, and homelessness make such problems a downright bargain--to say nothing of preventing another generation of disenfranchised, angry children raising itself.

PHOTO: Traditional crack treatments doubly fail women with children.