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Issue
The Problem
In 1996, an estimated 13 million Americans had used an illicit drug in the past month. There are many children affected by this substance abuse. There are estimates that more than 8 million children live in households where at least one parent is an alcoholic or needs substance abuse treatment. The vast majority of these children do not come to the attention of any group or agency that can help them. There are about 3 million reports to child welfare agencies and about 500,000 children in the child welfare system. In addition, there are children in the womb affected by the substance abuse of their mothers.
There is some limited data about the extent of the problem among women [Center for Substance Abuse Research]. Emergency room visits by women because of drug-related problems rose 35% between 1990 and 1996. During that period, the number of visits related to heroin and marijuana rose more rapidly for women than for men. Women substance abusers account for almost one-third of the total number of people in treatment in 1996, an increase since 1980 when one-quarter of all treatment clients were women.
Current Government Programs
Each year the federal government provides about $3 billion to fund drug abuse prevention and treatment activities. More than $1 billion in block grant funds are distributed to states for planning, implementing, and evaluating activities to prevent and treat substance abuse. However, determining the need for treatment services - for the general population as well as for specific subpopulations, such as women and women with children - may be problematic due to limitations in national and state data on treatment need. Assessments of need for mothers, either pregnant or with children, are especially hard to determine. Current means of estimating treatment need have significant limitations especially for some groups, like pregnant women. About 25% [14] states did not report information on women needing treatment. However, women-specific programs comprise only a small fraction of the programs available. Only 6% of the Substance Abuse and Mental Health services Administration [SAMHSA] budget, 15% of the National Institute on Drug Abuse [NIDA] budget, and 19% of the National Institute on Alcohol Abuse and Alcoholism [NIAAA] budget is specifically designated for women's programs.
Treatment is available to only about one-third [37%] of all those who need treatment. There is evidence that treatment saves money and improves people's lives. In Washington state, a five year follow-up study of clients receiving publicly funded substance abuse treatment found that treated clients incurred lower Medicaid medical expenses than did a group of people who were eligible but did not receive treatment. The majority of this cost savings is from a reduction in inpatient hospital costs. According to a Washington state treatment evaluation, indigent clients who completed the full continuum of treatment had higher levels of employment than did a group of clients who did not receive treatment. The conclusion of the evaluation was that by helping clients overcome their dependence on alcohol and other drugs, treatment provides a critical function that moves clients on a trajectory toward increased economic independence.
Impact on Children
All these issues are especially important when they impact the lives of children. Every year, approximately 4 million women give birth. Although data are sketchy, one study found that 12% had used at least one drug in the week prior to delivery. There is no reliable national data on how many pregnant women get substance abuse treatment, the data that is available indicate that only a small fraction are getting treatment. Pregnancy can be an ideal time to intervene in the life of a woman who is addicted to alcohol or other drugs. Concern for her own health and the desire to have a healthy baby are powerful motivators for recovery. Unfortunately, data show that very few women suffering from addiction are identified and referred to substance abuse treatment by physicians or nurses who cared for them during their pregnancies.
Unfortunately, because of the limited treatment resources specifically designed for mothers, either pregnant or with children, states are increasingly responding to these concerns by punishing mothers and limiting opportunities for rehabilitation. Criminalization is a largely punitive response that rests on the assumption that a mother's behavior is morally reprehensible, punishable, and therefore within the jurisdiction of the criminal justice system rather than the health care system.
USCCB Policy
In New Slavery, New Freedom [1990], the bishops recognized that substance abuse creates many casualties, the most tragic are the children. Some are placed in foster care as substance abusing parents are no longer capable of providing home or family. Others are born addicted themselves, heirs of the drug slavery destroying their mothers. Abuse of alcohol and other drugs victimizes hundreds of thousands of other children in their own homes when it fuels the gratuitous violence and anger of their parents.
In Putting Children and Families First [1991], the bishops recognized that unborn and other children are at risk from substance abuse. They called for expanded national efforts at education and prevention, the provision of prenatal and other health care, and treatment and rehabilitation of abusers of alcohol and other drugs. System-wide reform was called for, including special attention to families where there is substance abuse.
The bishops also noted that our nation's continuing failure to guarantee access to quality health care for all people exacts its most painful toll in the preventable sickness, disability, and deaths of our infants and children. They called for extension of access to quality health care to all, beginning with our children and their mothers and stressed that there can be no excuse for the failure to ensure adequate health c are and nutrition for pregnant women since nothing would make a greater contribution to reducing infant mortality than progress in this area.
Action
The Administration has called for a $70 million increase in mental health services funding in the Community Mental Health Services Block Grant. The money will be targeted at adults with severe mental illness; those who are dually diagnosed with mental illness and substance abuse; those who have had interaction with the criminal justice system; the homeless; and children with serious emotional disturbances.
Congress will be reauthorizing the Substance Abuse and Mental Health Service Administration. Senator Frist [R-TN] will be sponsoring the bill. Senator Dodd [D-CT] may reintroduce the Services for Children of Substance Abusers Reauthorization Act which targets families and children at risk because of their parents substance abuse.
We have been working with the Child Welfare League and the March of Dimes to educate Hill staffers about the needs of children and families for treatment of substance abuse, specifically targeting mothers with children, and to survey state mental health directors regarding their interest in receiving targeted funds.
It is important to bring this issue to the attention of your members of Congress and ask that they consider the clear need for more comprehensive services that are not only more readily accessible but also configured to aid the pregnant as well as the parenting women.
Resource
For more information, contact:
Patricia A. King , USCCB at 202-541-3188/pking@usccb.org