Treatment Together: Drug Rehabilitation Models Without Separation
A model that works with familial responsibilities to address drug and alcohol addiction proves to be successful, but struggles amidst defunding and austerity for treatment services.
Parents with a substance use disorder face multiple challenges when seeking help; facilities that offer childcare services are few and far between, and parents are plagued by the fear of having a child removed from their care whilst often burdened by time and financial constraints. Rehabilitation centres like Trevi and Portage show us one way of tackling this problem by providing treatment without separation.
Trevi is a charity based in Devon and is the only British residential rehabilitation centre exclusively for mothers and their children. Trevi takes referrals from across the country for its Jasmine Mother’s Recovery Service and can house up to 12 women and their children at a time, who remain at the centre for an average period of 24 weeks. During this time, each woman undergoes a rigorous rehabilitation programme which includes daily counselling, relationship analysis, group therapy, medical examinations, and check-ups from social services. Following treatment, Trevi’s Sunflower Women’s Centre is available for those in the Plymouth area who are seeking support and as a result: many women, who have gone through Trevi’s Jasmine Mother’s Recovery Service, have chosen to relocate to Plymouth to be near the centre.
Portage, a large Canadian based charity, also offers a mother and child residential programme to respond to fears of losing custody, offering on-site childcare services. The centre has capacity for 25 women and their children, provided that they are between the ages of 0 and 6, who will usually remain at the centre for a period of 24 – 32 weeks. Admission is voluntary and free for all citizens of Quebec.
It is not uncommon for women entering these centres to have suffered from difficult pasts; over 85% of those entering Jasmine Mother’s Recovery Centre reported experiencing childhood trauma. This is against a wider backdrop of trauma and mental health disorders amongst those suffering with substance use disorders. According to the UK Government’s 2019 survey, 59% of those entering treatment for “substance misuse” need mental health treatment. Trevi also emphasised to TalkingDrugs that over 50% of the women they treat have already had at least one child removed from their care. This constitutes an extremely traumatic experience for many women. In an interview with TalkingDrugs, a representative of Trevi stressed that:
“When a woman’s child has been removed permanently from her care it can be difficult for her to engage with services. At the end of a court case, there will no longer be involvement from a legal team or social worker, and women report a further sense of abandonment.”
The complex needs of these women means that many who enter treatment will have a ‘dual diagnosis’, a term used to describe someone with a diagnosis of both mental illness and substance abuse. This phenomenon has meant that women with multiple needs have at times been prevented from accessing mental health support because they have developed a problematic relationship with drugs or alcohol; similarly, drug and alcohol services can refuse to support those with untreated mental health problems, as noted by the 2018 Women’s Mental Health Taskforce report. Therefore, holistic treatments that integrate childcare with trauma informed treatment and drug replacement therapy where necessary are of vital importance, especially now as rehabilitation centres are under significant strain due to austerity-related funding cuts.
Particularly in the UK, many grassroots organisations have closed their doors, with some Local Authorities having reduced treatment expenditure by 40% according to Dame Carol Black’s 2020 review of drug policy in the UK. The Black Review has made it clear that “the treatment workforce is declining in number and quality.” The closure of local charities has particularly affected women and those from minority backgrounds as they find their needs are not met by more general forms of treatment.
Although residential rehabilitation centres like Trevi and Portage incur high costs and local councils in the UK face difficult choices as to where to allocate funds in the wake of the pandemic, they are more necessary than ever before. About £4 billion was spent on ‘looked after’ children in 2016-2017. The total number of ‘looked after’ children (defined as children in the care of their local authority for more than 24 hours) in the UK stands at around 102,000 and has been steadily growing every year since 2010, increasing by 10% in just the last five years. Problematic substance use is a common factor in decisions behind placing children in care, with drug use listed as a factor in 19.3% of children’s services’ assessments, and alcohol in 18.4% of them. Although it should be noted that in many cases problematic relationships with drugs and alcohol could be concurrent with other issues that impact a child’s wellbeing, it is clear that treatment without separation offers a gentler opportunity to keep families together while reducing wider costs to the state in raising children in foster homes, and other potential long-term costs.
A 2017 study on the effectiveness of residential rehabilitation treatments, which examined cases from several countries, concluded that a “recovery-orientated treatment system must include ready access to residential treatment for alcohol and drug users.” Trevi’s Jasmine Mother’s Recovery centre demonstrates how successful such a system can be, as 98% of women who enter the facility successfully detox and 80% of children remain with their mothers. Additionally, there is a growing body of literature that suggests that addiction treatment combined with parental counselling, where both mother and child remain together, can produce positive outcomes. Amongst reviews of centres that have opted for this approach, there is a recurring theme, where mothers in treatment feel the presence of their children has been a huge motivator to overcome their addiction. However, it should be noted that much of the quantitative research available is limited by small sample sizes; more research is needed to consolidate these initial results.
Treatment without separation offers a way out for many trapped in untenable situations. However, there are still many challenges to be faced: single fathers have even fewer opportunities to seek treatment without relinquishing their role as a parent, and ideally there would be more obvious support systems in place to catch people before they are referred to places like Jasmine Mother’s Recovery through social services or the courts. In an interview with TalkingDrugs, Trevi stated that given the volume of women who may need services like the ones the charity provides, “it really is just a drop in the ocean.”
The government’s ADDER programme has promised to expand treatment services that acknowledge and accommodate the multiple and exigent demands of being a parent, but there are no guarantees at this point that these needs will be met. However, at a time when 58% of females and 49% of males entering treatment are either parents or live with a child, the need could not be more pressing.