Another contextual issue that must be considered in any discussion of addressing problems related to substance abuse is that substance abuse treatment, particularly treatment tailored to the needs of women and parents, is in chronically short supply. As illustrated in Figure 6-1, approximately 37 percent of problem drug users who are mothers with children under 18 years of age reported receiving some form of substance abuse treatment in 1994-95, significantly fewer than the 48 percent of male parents with substance abuse problems in treatment (HHS/SAMHSA, 1997d).
Table 6-A shows trends in the demographics of substance abuse treatment clients 1980-1992. Women make up less than a third of substance abuse treatment clients, up only slightly between 1980 and 1992. The population of persons in treatment closely resembles the age and racial/ethnic distribution of the population of parents in need of treatment (presented in chapter 4, Table 4-B), but differs significantly from the population of parents with substance abuse problems who are clients of child welfare agencies in gender (child welfare clients are predominantly women), and race (minority and especially African American women are over represented in the child welfare system).
Table 6-B shows the prevalence of substance abuse treatment by type of treatment and demographic group. As shown, an estimated 3.3 million Americans, 1.5 percent of the population age 12 and older, reported receiving some form of drug and/or alcohol treatment in 1995. The number reporting any form of substance abuse treatment was only slightly higher than the number reporting treatment for alcohol abuse (3.3 million versus 3.0 million), which suggests that the great majority of substance abuse treatment clients (upwards of 90 percent) sought treatment partly or wholly for problems with alcohol.
Additional information on substance abuse treatment supply and demand are available from State and local sources. The National Association of State Alcohol and Drug Abuse Directors (NASADAD) reports that in on a given day in 1997 there were nearly 52,000 persons on substance abuse treatment waiting lists maintained by State agencies (NASADAD, 1997). Further, only 10 percent of child welfare agencies report that they can find substance abuse treatment programs for most of the clients who need it within 30 days (Child Welfare League of America, 1998). Although not everyone who receives treatment will recover, and not all those who need it will enter a treatment program even if one is available, without treatment few of those who are as severely impaired by substance abuse as are many child welfare clients will be able to address their addictions successfully and become better functioning parents.
While women's specific treatment needs are slowly being recognized, recent drug treatment data demonstrate that over the past decade there have been significant declines in the delivery of a variety of services provided in conjunction with substance abuse treatment. For instance, only 8.3 percent of patients in outpatient, drug free treatment programs (through which most persons are treated for substance abuse) had received any family services (such as parenting classes or family therapy) during the first three months of treatment according to a 1990 survey. A similar study a decade earlier had found much more comprehensive service delivery. In the earlier study, nearly 43 percent of outpatient clients reported receiving family services. Clients of long term residential programs and short term inpatient programs were somewhat more likely to receive family services, but even in the most service intensive modalities fewer than 40 percent of clients received these services (Figure 6-2).
Similar declines were reported in the provision of medical, psychological, legal, educational, vocational and financial services. Declines were marked in all modalities but were especially severe in outpatient programs, where fewer than 10 percent received any ancillary services other than medical treatment, and over 60 percent received no services beyond basic substance abuse counseling (Etheridge et al, 1995). Pressures from managed care may be responsible for some of the decline in comprehensive services. The shortages of substance abuse treatment, particularly treatment with services designed specifically for women with children, mean that treatment programs do not feel the need to develop new referral sources such as child welfare agencies - their programs are full without seeking new clients. Despite increased Federal substance abuse treatment funding over the last decade, funds to develop additional treatment capacity have not caught up with the need.