Given the multi-problem nature of these clients and their families, it is no wonder that programs serving them find it difficult to meet their needs. Indeed, most evaluations of programs serving parenting substance abusers report that it is difficult to identify these women, it is difficult to engage them in services, and it is difficult to retain them in treatment. Women who are in need of treatment often do not seek it due to the social stigma of using alcohol and other drugs. Denial of her problem on the part of the woman and her family, as well as the fear of losing her partner, is another significant barrier to treatment for a substance abusing women. However, many of the grantees operating programs developed under SAMSHA's women's and children's programs have developed substance abuse treatment programs that are sensitive to the needs of women and children and have been successful in recruiting and retaining them in treatment. Programs have shown particular success if they have
- Removed barriers to attendance by allowing the women to come into treatment with their children;
- Provided therapeutic child care, children's skills training and substance abuse education for the children to simultaneously address their emotional and behavioral problems; and
- Provide parent training and parent support services to improve the women's feelings about being a more effective mother and her actions to accomplish these goals.
The physical and mental health consequences of alcohol and other drug use for women are often different in nature and degree from those of men, as is the etiology of alcohol and other drug use. Often women arrive at substance abuse treatment later in the progression of the disease than do men. These factors require both different approaches to treatment of the drug use itself and to treatment of the consequences of use.
SAMHSA's Center for Substance Abuse Treatment has developed a model for women's substance abuse treatment services (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration, Center for Substance Abuse Treatment [HHS/SAMHSA], 1994) which recommends a series of 17 components that are critical for substance abuse treatment for women. The model recommends that all services planned and developed must be age appropriate, culturally relevant and gender-specific for the different populations of women and their children. The components range from substance abuse counseling to obstetrical and gynecological services, and parenting counseling through housing and legal services. These components are implemented through:
- Carefully monitored proactive case management approaches which are an integral part of the treatment process, beginning with intake procedures and following through with continuing care;
- Materials that address the multiple needs of the women;
- Counseling and educational processes that address therapeutic needs and life skills services;
- Involvement of the family and other care givers in the recovery process; and
- A focus on effective discharge planning methods, including creative arrangements for shared housing and relapse prevention services.
A detailed description of this model appears as Appendix B.
Working with parents and children together is generally more effective than working with children only, particularly if the children have conduct problems (Dishion & Andrews, 1995). However, a number of children of alcohol and drug abusers programs have been developed to work directly with these children primarily through educational and support groups offered through schools, community agencies, or faith-based organizations. Research suggests that these children need to be informed about their potential genetic, biological, cognitive and emotional risk factors. School-based programs such as the CASPAR program and the New York-based Student Assistance Services program (HHS/SAMHSA, 1993, HHS/SAMHSA, in press) have demonstrated significant reductions in risk factors and improved social competencies and effective problem solving skills. Services like these could be used effectively in substance abuse treatment programs to produce educational and behavioral change and ultimately reduce the risks these children face for later drug use.
Addressing families' multiple needs is a critical factor in the successful engagement and retention of clients in substance abuse treatment and related services. Often a family's basic needs (such as those for food, shelter, and safety) are so pressing that they must be addressed before a parent has the ability to focus on his or her addiction. Further, a crisis in any single area of their lives may cause a client to relapse and/or drop out of treatment. If a treatment program does not or cannot help the client to address what he or she defines as the family's most significant problem(s), the client is likely to view the program as irrelevant. Efforts to coordinate treatment with other systems are also vital to treatment engagement and retention. These program design issues will be discussed further in Chapter 7.