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Residential Family
Drug Treatment:
One Path to Permanence

from the Winter 2007 Adoptalk

by Diane Riggs

From the 1980s’ cocaine epidemic, to the growing scourge of methamphetamine, to timeless alcohol-related problems, parental substance abuse is one of the most common factors in cases of child endangerment and entry into foster care. When children must enter care due to their parents’ addiction, child welfare agencies face the challenging task of finding more families to raise the youth.
 
But what if a parent, with intensive support, could keep a child safe and herself drug free? What if a parent could live with her child while undergoing drug treatment? For those who want to leave addiction behind, there should be more options like residential family drug treatment—a proven service model that can promote permanence for children who are in or at risk of entering state custody.

Benefits of Residential Family Drug Treatment
 
Treatment programs typically offer intensive residential services (where patients live onsite) for 30 to 90 days—precious little time to make enough changes to stay drug free and maintain or regain custody of a child—and few allow children to live with their parents in treatment. Residential family drug treatment, by contrast, is a longer-term program that enables parents and their children to live in a safe environment that simultaneously treats addictions and promotes healthy parenting.
 
Residential family drug treatment has clear benefits. First, parents who preserve their parental role have a strong incentive  to focus on recovery. In addition, the children’s presence enables parents to practice new parenting techniques in a supportive setting. Conversely, the loss of a child to foster care can make a parent’s recovery and fight to regain custody infinitely harder.
Child development experts also caution that separation from a parent—even a poorly functioning parent—is extremely hard on children. If a child can safely stay with her parent, the child will be spared the trauma of sudden separation. If a parent loses custody, separation trauma and the child’s new attachments can greatly complicate the task of parenting when the child returns home.
 
Residential family treatment makes financial sense too. States can avoid foster care costs for children, and parents facing drug charges will not burden the prison system. If a parent continues to use drugs and harm her children, governmental and social costs will mount. In June 2001, The American Prospect offered these comparisons: while residential centers cost about $26,000 per year, jail runs upwards of $60,000 and foster care for an inmate’s child adds $20,000 more.

Entering Treatment
 
Drug addicts enter treatment after an application and intake process. Too often, however, residential family drug treatment options are not available nearby, or within a timeframe that serves children’s best interests. In Salt Lake County, Utah, for example, the wait for residential beds averages six to eight weeks. Anyone who seeks to enter such a program voluntarily must be persistent and patient.
 
More commonly, parents are referred to treatment after running afoul of the law or drawing the attention of child welfare workers. These days, a parent who is arrested on drug charges may appear in one of more than 1,800 drug courts in the U.S. First implemented in the late 1980s, drug courts were established to curb alcohol and drug abuse along with associated criminal activities.
 
In drug courts, judges offer criminal defendants a chance to receive monitored drug and alcohol treatment instead of jail time. Through heightened supervision and partnerships with treatment and other service providers, the court gives addicts clear rules and goals, and holds them accountable for making progress.
 
Like drug courts, family drug treatment courts collaborate with service providers to offer drug treatment. They also provide addicts with counseling, housing, and other support to help them get clean and keep their families together. A recent Washington Post article reported that about 200 family drug treatment courts operate nationwide, and another 188 are in the planning stages. Just last September, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) offered new funding for family drug treatment courts in California, Arizona, and Florida.
 
A parent who enters a residential program through court may be admitted sooner and, as the National Institute on Drug Abuse (NIDA) notes, to be effective, “treatment needs to be readily available.” A supportive judge can even make the option more palatable for some.

Effective Treatment Program Elements
 
Extended duration. According to NIDA’s Principles of Drug Addiction Treatment, “Remaining in treatment for an adequate period of time is critical for treatment effectiveness.” Treatment time, though, will vary by the person and the addiction. A November 2006 story in the Salt Lake Tribune, for example, reported that research “shows meth addicts…require an average of 410 days in treatment.”
 
Family drug treatment courts usually recognize the need for long-term support. In Maine, where the courts serve families with open child protection cases, parents—depending on their progress—can receive help for 11 to 20 months.
 
Residential treatment centers also accommodate longer stays. In south central Los Angeles, the Exodus Program (run by SHIELDS for Families, Inc.) is an intensive day-treatment program with onsite family housing. Exodus program participants are required to stay at least one year. Located in Chicago’s near west side, The Women’s Treatment Center has designed a two-year continuum of care and treatment for its residents and their families.
 
Holistic, individualized approaches. “Effective treatment,” NIDA declares, “attends to multiple needs of the individual, not just his or her drug use”—including physical and social, as well as mental and emotional health needs. Substance abuse does not occur in a vacuum; it is often preceded and flanked by poor parenting in childhood, victimization and abuse, unemployment, a lack of support, feelings of helplessness and distrust, and an environment that perpetuates drug use.
 
In Eugene, Oregon, Willamette Family’s residential treatment program addresses some of these issues through a variety of training. Residents receive assertiveness and life skills training, relapse prevention classes, health and nutrition instruction, and help building new support networks.
 
The Exodus Program works with an addict’s entire family. After school, resident children receive individualized developmental support, and once a week mothers and fathers can attend parenting classes. Staff will even transport children to and from school so parents can focus on treatment. As needed, the program is also authorized to treat other disorders and prescribe medication.
 
Structured and supportive treatment. To keep residents safe, and help them learn a new life routine, treatment programs must be tightly regulated by respectful, supportive staff. A recent study of mothers in four New York City residential family treatment centers  found that those surveyed were especially appreciative of staff and peer support, and even saw the value of strict rules, such as regular drug testing.
 
As one mother said, “This environment is protective. It’s not like I was living with my mother. Here, I can’t get away with things…. In here, I can’t run from treatment while I am in treatment.” [1]
 
Sound parenting guidance. In a recent study of birth mothers whose infants had prenatal substance exposure, researchers noted that addicted mothers are much  more “stressed, …dysfunctional in interactions with their children, and…distressed in their parental roles,” than demographically similar parents without addictions. If such parents are to keep their children safe after treatment, the researchers conclude, they must have “intensive parenting training and support.” [2]
 
The Tulsa Women and Children’s Center promotes positive parenting by holding therapeutic mother and child activities, teaching non-violent discipline methods, and giving mothers supervised time outside the center to practice “clean and sober living” with their children. Facilities run by Straight & Narrow in Utah and The Village in Miami, Florida, also offer special parent/child therapy and train staff to model and encourage positive parenting every day.

Practical, applicable training. Because parents must return to the real world after they graduate from a residential program, they should receive training on as many life skills as possible. The more skills they acquire, the more likely it is they will be able to parent effectively, achieve success in other areas of their life, and stay off of drugs.
 
The Tulsa Women and Children’s Center provides 35 hours per week of group work addressing issues ranging from past trauma to patterns of addiction to healthy eating. Mandatory chores and the possibility of earning temporary leave passes also establish positive patterns of behavior that residents can carry with them.
 
Formed in 1996, Nashville’s Renewal House operates on the theory that “training is treatment, and treatment is training.” In addition to individual and group therapy, Renewal House’s five-phase residential program emphasizes basic life skills and vocational training. Designed for pregnant and parenting teens in Vermont, the Lund Family Center’s residential drug treatment program includes GED and adult diploma instruction.
 
Comprehensive aftercare services and support. To heighten chances of success, NIDA suggests that recovering addicts participate “in self-help support programs during and following treatment.”
 
The Tulsa Women and Children’s Center holds weekly aftercare groups for parents who graduate from the center. For parents who leave the area, the center provides referrals to support services in other communities. In New York City, Odyssey House provides transitional off-site housing for families who are re-entering society after treatment.
 
California’s Exodus Program provides lifetime aftercare; support groups meet twice a week. The program also helps families qualify for and obtain Section 8 vouchers, which allow low-income tenants to pay 30 percent of their income instead of the full rental rate.

Program Outcomes
 
The Journal of Drug Issues has featured several research articles about residential family drug treatment. A mid-1990s study of a program in Florida [Vol. 27, No. 3] found that mothers who lived with their children during treatment spend an average of 252.7 days in treatment (versus 91.7 days for those apart from their children). They also tested much higher for self-esteem and much lower for depression. A Texas study  [Vol. 33, No. 2] found that women whose children lived with them during treatment were five times more likely to still be living with their children 6 and 12 months after discharge.
 
Melissa Smith, who spent 15 months at Renewal House with her son a few years back, credits the experience for teaching her things she never learned growing up, and bringing her and her son out of the abyss of “just existing.” Now gainfully employed and helping others to live well, Melissa asserts, “Renewal House gave me life and kept my son out of state care.”
 
For Melissa’s son, and for other children whose drug- or alcohol-addicted parents have a chance to get treatment without losing their children, residential family drug treatment can lead to permanency with healthier and better-prepared parents. Better still, this permanence can be achieved without the trauma of placing or leaving a child in foster care.

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[1] “Social Support: A Key to Positive Parenting Outcomes for Mothers in Residential Drug Treatment with Their Children” in Impact of Substance Abuse on Children and Families: Research and Practice Implications. 2006.

[2] “Facilitating Visitation for Infants with Prenatal Substance Exposure” in Child Welfare 85(6); 2006.

 


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