Drug addiction and pregnancy

A New Jersey court determined that a mother had not abused her child when she sought help for her painkiller addiction. She was placed on methadone. Her baby showed signs of withdrawal after birth causing child protection to intervene.  The fact that she sought treatment was seen favourably. Thus she was determined to have not been grossly negligent.

The case is worrying.  By implication had she not sought treatment then she would be negilgent placing her in the position of abusing her baby. This not only shames mothers with addiction but drives them away from help for fear of the implications.

Many women who are addicts do not get pregnant by choice. They are not seeking pregnancy. Most addicted women are victims of abuse. Many pregnancies occur within patterns of inter personal violence. I wonder what happens when we see the mother and the baby as victims together both in need of support. This case did not seem to seek to criminalize the mother as cases elsewhere have done. This is good  

Now we need to bring a harm reduction and support lens to these cases

The war on drugs is a war on children

There have been two publications in the past week or so that have struck me as profound evidence that the war on drugs is an utter failure. Let me say up front, I see addiction as a health issue.

The first report is from The National Academies and is a report titled, The growth of incarceration in the United States: Exploring causes and consequences.  It points out that the USA incarcerates more people than any other country in the world and that drug issues are the prime reason.  The report concludes:

The change in penal policy over the past four decades nay have had a wide range of unwanted social costs, and the magnitude of crime reduction benefits is highly uncertain (p.7)

The report also brings into question mandatory minimum sentences and long sentences. They note that incarceration is used when there are less intrusive and more beneficial options.  If imprisonment is not reducing crime, then why use it as the prime response pattern. Insanity is defined as doing the same thing over and over expecting different results.

The second report comes from the London School of Economics titled Ending the drug wars. It concludes:

The pursuit of a militarised and enforcement-led global ‘war on drugs’ strategy has produced enormous negative outcomes and collateral damage. These include mass incarceration in the US, highly repressive policies in Asia, vast corruption and political destabilisation in Afghanistan and West Africa, immense violence in Latin America, an HIV epidemic in Russia, an acute global shortage of pain medication and the propagation of systematic human rights abuses around the world. 

These reports tells us that, despite over 40 years of prohibition and interaction as the prime social policy approach for which literally billions of dollars have been spent, we have not been successful in even reducing the problem. The LSE report notes that prices have been falling while purity has been increasing.

What neither of these reports talk about directly is the impact that the prohibition approach has on children:

1. When a parent is incarcerated, the child essentially loses the parent. When incarceration is for long periods, then the child must go through a grieving process that leaves the child with an emotional hole. As the Adverse Childhood Experiences research shows, incarceration of a parent has long term impacts;
2. The child is more likely to exposed to violence when a parent has an active addiction as the parent must go through illegal channels;
3. The family system lives in fear when the addiction is present but health resources are seriously underfunded;
4. Incarcerating a parent is more likely to impact the child's economic survival;
5. More chance of being brought into care

We also know that untreated addiction has long lasting impacts on a child. Thus, if we shift our focus to one where health resources are enhanced, then the impact on children will be more intact families and more present parents. As well, rehabilitation is likely to be much less expensive.

What if the war on drugs was failing?

What if we were to come to the conclusion that the war on drugs has been a failure? What if we were to link that war to increased violence in communities? What if, despite the war on drugs, they have become more potent and less expensive? These are the conclusions of research done by the International Centre for Science in Drug Policy (Disclosure: I am a recent member).

The answer to these questions raises significant concern for the child protection systems. If indeed, the war on drugs has failed, then we must conclude that the billions of dollars being spent in interdiction are not being spent wisely. These monies may indeed not be reducing the demand for drugs and are not assisting those that have become drug dependent.  It may also mean that too many families have been disrupted as interdiction leads to high levels of incarceration (particularly in the United States) for individuals who have been in possession of small amounts of drugs or have been at the lower end of the drug dealing enterprise.  For children, this has meant reduced family cohesion, a parent in jail, increased financial strain in the family and possibly placement in care outside the family.

What perhaps may be missing is a focus on rehabilitation via seeing the person who is abusing or dependent on drugs as having a medical disease. A large volume of research supports that addiction is just that – a disease. Indeed, the Canadian and American societies on Addiction Medicine have taken a stand that addiction is a primary disease. What other medical condition do we treat as a crime in the way that we treat addiction?

What the body of research leads us to is that the financial resources should be redirected to health interventions. The research also leads us to a discussion about the role that gover

nment should play in the marketplace. We need a better discussion about whether government should retail marijuana, for example, in the way that it retails alcohol.  

Where I live, in Calgary Canada, not a single day goes by that I do not walk down a main street smelling someone using marijuana. It is now prevalent. Access is easy.

The ICSDP research notes:

 The study authors conclude that there is a need to re-examine metrics of drug strategy effectiveness, which currently place a disproportionate emphasis on seizures as a marker of reducing drug supply rather than reducing problematic drug use. For example, rather than using indicators of the quantity of drugs seized, which appear to be unrelated to actual supply, governments could assess the effectiveness of their drug policies by employing indicators of drug-related harm such as the number of overdoses, the rate of blood-borne disease transmission (e.g., HIV and hepatitis C) among people who use drugs, or emergency room mentions of drugs.  

Children in the child protection system will benefit from greater family cohesion if a health approach is taken. We can reduce the costs of child protection by focusing community efforts on treating. This is not an easy discussion but when the evidence keeps mounting that the present approach is not working, it is needed discussion.

Drug Courts can be quite effective fir child protection

Some lovely new research by Bruns et al. has shown that drug courts can be quite effective in working with substance abusing parents in the child protection system. This matters. As they point out, substance abuse is one of the most significant issues in child protection. They note prior research showing that it is related to higher involvement in foster care; longer duration in care and poorer reunification rates. In addition, they highlight that it can often take many months before parents are connected to needed treatment resources

Drug Treatment Courts have a solid history of working within the criminal court system in various jurisdictions.

The aim of most drug courts is to use the court process to facilitate a coordinated, team-based, and inter- disciplinary approach to treat individuals who have been charged with an offense related to their addiction or substance involvement (p.2).

Family Drug Treatment Courts aim to increase reunification, family safety as well as parental abstinence. To my knowledge, they are not yet common within the child protection system, so this review may well assist in raising such an approach as an important tool for child protection systems.

A study of four FTDCs in sites across the United States found that participants enrolled in treatment more quickly, received treat- ment services for a longer mean duration, and were more likely to complete treatment successfully than parents in regular dependency courts. (p.3).

However, the published research data base remains small and is not been subject to the kind of disciplined review that might give long term confidence. The present study helps to fill the gap and shows positive results including entering treatment faster, completing and having better child protection outcomes. The children were more frequently returned to parental care.

This promising research adds to the idea that structured, comprehensive substance abuse interventions that include the courts can substantially improve outcomes. This might be an approach that is worth considering in more jurisdictions.

Reference:

Bruns, E.J.,, Pullmann, M.D., Weathers, E.S., Wirschem, M.L. &. Murphy, J.K. (2012). Effects of a multidisciplinary family treatment drug court on child and family outcomes: Results of a quasi-experimental study. Child Maltreatment, In Press. doi: 10.1177/1077559512454216