Feminism and Addiction

Claudia Bepko

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317823063
• Edition: 1
• Topic: Psicologia
• Subtopic: Salute mentale in psicologia

Feminism is a beneficial force in addictions therapy as they have the same goals--mending imbalances of power. A variety of important topics related to addictions treatment are addressed in this timely volume, accompanied by concrete clinical solutions for therapists and counselors to use in their own practice. Feminism and Addiction demonstrates the positive impact feminism can have on addictions treatment. Addictions treatment methods that have been developed primarily based on research with men are examined and questioned to determine what changes need to be made to meet the needs of women. The applicability of twelve-step treatment programs, for example, is investigated as to whether its required adoption of belief in powerlessness is concurrent with feminism's battle with female subjugation. This thought-provoking volume contains the most current theoretical, social, and clinical issues enmeshed in the debates between men's experiences and women's experiences of addiction. Critical issues addressed include advice for how to deal with issues of codependency; how to treat clients faced with physical or sexual abuse in addition to addiction; how to integrate cultural differences into treatment; and how to face the particular difficulties of gay and lesbian clients in addictions treatment. This valuable book will help you apply constructivist approaches to build therapy methods which are collaborative, internal, and organic, thus more appropriate to treating women's experience with addiction. Feminism and Addiction helps family therapists who work with women and their families strike a unique balance between the principles of feminism and family therapy's goal of repairing and healing relationships between men and women.

PART ONE:
THEORY, RESEARCH AND SOCIAL ISSUES: EXPLORING ADDICTION IN CONTEXT

Chapter One

A Descriptive Outline of a Program for Cocaine-Using Mothers and Their Babies

Gillian Walker
Kathleen Eric
Anitra Pivnick
Ernest Drucker

Gillian Walker, MSW, is a family therapist on staff at the Ackerman Institute for Family Therapy in New York. Correspondence may be addressed to her at 149 E. 78th Street, New York, NY 10021. Kathleen Eric, RN, MPH, EdM, Anitra Pivnick, PhD, and Ernest Drucker, PhD, may be reached by contacting Ms. Walker at the same address.

SUMMARY. Crack-using mothers are a population for whom punishment, rather than treatment, has been the norm. The following paper outlines a program for maternal crack users which is based on recent advances in feminist psychology and which defines the moment of childbearing as an opportunity to help women heal those critical relationships which have been fractured by the cycle of drugs and poverty.

The cocaine epidemic has had a particularly devastating effect on women and families. It is estimated that as many as 60% of crack users are women. The majority of these women are mothers of small children and head single parent households. The high percentage of female crack users gives this epidemic a very different profile from earlier drug epidemics where the large majority of users were men, and non-drug-using women held together the families they fathered. For example, New York City reported a 400% increase in maternal drug use in the period 1984–1989 with most of it accounted for by a sharp rise in maternal crack/cocaine use (Kaye, Elkind, Goldberg and Tytun, 1989; Lief, 1985). Between 1982 and 1989, the foster care caseload in New York City went from 10,000 to 50,000 children (New York City Health Department, 1989).

Maternal cocaine use affects whole families. Maternal cocaine use is often associated with inadequate prenatal care, poor nutrition and other adverse prenatal conditions (MacGregor, Keith, Buchina and Chasnoff, 1989; Griffith, Chasnoff and Freier, 1989). Untreated maternal drug use implies substantial risk for fetus and infant (Weston et al., 1989). Mother is placed at high risk for contracting HIV because crack use in women is associated with sexual promiscuity as a means of payment for drugs. If the mother is infected, there is a 30% chance that her baby will contract HIV. Low birth weight and other complications associated with cocaine use during pregnancy (Zuckerman, Frank, Hingson et al., 1989; Chouteau, Namerow and Leppert, 1988; MacGregor, Keith, Buchina and Chasnoff, 1989) appear to place the infant at a developmental disadvantage which is compounded by the emotional instability of the circumstances in which the child is likely to be raised, that is, a revolving door existence between foster care and care by mother and other family members. Neglect and abuse are often the features of this kind of existence. These circumstances may generate a combination of organic developmental handicaps (learning disabilities and the like), psychological traumata, and exposure to drug using behavior which put the child at risk to become a substance user in adolescence.

This multigenerational transmission of substance use has been extensively documented (Harbin and Mazier, 1975; Klagsbrun and Davis, 1977; Madanes, Dukes and Harbins, 1980; Kaufman and Kaufman, 1979; Stanton, 1980). The recursiveness of the drug abuse cycle within such families means that, over time, drug abuse becomes the principle regulator of family behaviors and defines the nature of family relationships, just as family behaviors and relationship patterns maintain drug-abusing behavior (Harbin, 1975; Alexander and Dibbs, 1975; Kaufman and Kaufman, 1979; Stanton, 1980).

Paradoxically, for drug-using women, their children may be their strongest and most loving attachment (Bauman and Dougherty, 1983; Reed, 1985; Deren, 1986), an attachment which is filled with hope for a better future. But few drug treatment programs utilize this powerful and positive motivating factor and, as a result, there are few appropriate drug treatment options available to women who are pregnant and/or who have young children. The majority of New York City programs exclude both pregnant women and crack using women on Medicaid (Chavkin and Kandall, 1990). In-patient detoxification programs and residential drug treatment programs which accept crack using women do not provide for residence with children, or for interim foster care.

The absence of appropriate treatment slots for the crack-using mother creates a Scilla and Charybdis situation where the mother faces losing her children if she seeks treatment but may neglect the children or have them removed from her care if she does not. If she seeks treatment, her children will have to be placed. The majority of siblings will be separated from each other in placement, a terrifying experience for children who, in all likelihood, have already experienced too much trauma. Even brief residential treatment may cost the mother the housing which would permit her to reassemble her family upon release and her children may remain in placement long after she is psychologically able to manage their care. But if she does not seek treatment, and her children remain with her, compulsive drug-taking behavior will impede effective parenting. If she is lucky enough to have family who are willing to take responsibility for her children while she is in treatment, she may find that the additional burden on family members, coupled with the relapsing and chronic aspects of drug use, strains her relationships with her family network.

Relatives feel burdened by additional care demands, and by the emotional problems of children traumatized both by maternal loss and by previous experiences of growing up with a mother who used drugs. Family members are also frustrated that the mother cannot get her act together despite their help. If the drug-using woman is lucky enough to find a treatment slot, the family will frequently find itself viewed by treatment providers as a noxious influence promoting drug use. Since most drug treatment programs do little to reach out to families to provide them with necessary information and support, conflictual interactions between the drug-using woman and her family of origin may become so increasingly frustrating that they may culminate in separation of the drug user and her children from the one system that can give her support.

Furthermore, most drug-treatment programs operate under the philosophy that the client’s rehabilitation depends on developing a new set of behaviors independent of the previous context of her life. In order to do this the client must be separated from context in order to be free to work on the self. As a result, treatment programs do not place an emphasis on retaining and working with bonds to family or spouse/partner, at least during the initial phases of treatment. Most inpatient programs do little, if any, family work, even during the critical re-entry phase. If a woman seeks treatment, she may not only be separated from her children but, if her partner uses drugs, she may lose her primary adult relationship. This loss not only costs economic or social support when she returns home, but it may have deep meaning for her. Viewing the partnership only from the perspective of its relationship to drug-taking behavior would lead us to encourage separation as a step away from temptation. But if we believe that drugs are a part, but not all, of a person’s life, then we may understand that there can be aspects of the relationship which are positive and supportive, the loss of which may be deeply painful to both partners and to the children they may have between them.

THE ORIGINS OF A COLLABORATION

The Program for Maternal Drug Users and their infants was developed by the Division of Community Health and the Women’s Center of the Department of Social Medicine, Montefiore Hospital, in collaboration with North Central Bronx Hospital’s Ob/Gyn Midwifery Program and Early Family Outreach Project, and the Ackerman Institutes’ AIDS and Families Project. The goal was to demonstrate that if the mother’s ties to her child could be preserved and social and familial networks strengthened, there would be a reduction in maternal drug use, an improvement in maternal and child health, and a reduction of the number of children placed in foster care.

The groundwork for this project was laid by the Department of Social Medicine’s Women’s Center, established in 1987, directed by Kathleen Eric, aided by medical anthropologists Anitra Pivnick and Dooley Worth under the supervision of Ernest Drucker (Eric, Drucker, Worth, Chabon, Pivnick and Cochrane, 1989). The goal of the Women’s Center and its research is the reduction of destructive patterns of drug use leading to HIV infection, and, for those women already infected, the reduction of transmission to their sexual partners and their children. Peer support in groups, co-counseling and telephone buddy systems have been the main treatment modalities. Family therapy becomes a part of the program after women who join the peer support groups seek help for their partners and children. The program is largely run by volunteers, who include ex-drug using women and their families and friends, and its philosophy is one of consistent peer support and outreach. The group model has evolved from the center’s establishment as a place where community women shared their knowledge of their community and its needs with medical anthropologists, to its development as a place where women who are or have been drug users come together to support each other through the ongoing difficulties of their lives in an urban ghetto. These lives inevitably harbor the threat of relapse and the shadow of HIV.

The Women’s Center volunteers are expert in obtaining concrete services. The program encourages women to find work or to attend various educational programs. The atmosphere is not one of confrontation but of mutuality, love, trust and respect. Members of the original women’s group have become program leaders who provide role models of women who have gotten off drugs, are finding education, have been helped to regain custody of their children, and are working. Two family therapists, a Latina and an African-American, from Ackerman’s AIDS and Families Project, who had previous experience working with substance users, joined the Women’s Center to work with couples and families. They were flooded with requests for therapy. Women realized that their healing from the experience of substance use required a mending of the tears which drugs had created within the fabric of their families, as well as a the strengthening of bonds to family, partners and children.

The idea for a collaborative grant between Ackerman and the Montefiore Department of Social Medicine to work with cocaine-using mothers and their addicted babies came out of the work of the Women’s Center, an Early Family Outreach Program at North Central Bronx Hospital, and two projects of the Ackerman Institute, the AIDS Project and The Women and Violence project. The Early Family Outreach Program has successfully used outreach workers to aggressively pursue families in order to improve pediatric follow-up on children born at North Central Bronx Hospital. The Ackerman AIDS and Families Project began to treat increasing numbers of inner-city women who had been, or were, active drug users and who were HIV infected. This work included other family members who had become substitute caretakers for their children. Work with HIV-infected women who were currently using drugs or who had recently become drug-free created a dual awareness: there is a lack of adequate drug treatment services designed to meet the needs of women and their families, and most drug treatment programs operate on theoretical models designed for men.

The work of Ackerman’s Women and Violence Project, in which four clinicians – Virginia Goldner, Marcia Sheinberg, Peggy Penn and Gillian Walker – explored spouse abuse through the lens of new developments in feminist thought, provided a conceptual framework for understanding women’s psychosocial development, relative to their families, that could be applied to the particular needs of drug-using women (Goldner, Penn, Sheinberg, and Walker, 1990). For example, Gilligan’s work on care versus justice perspectives in moral development (Gilligan et al., 1988) provides the framework for explaining why many women have felt alienated by the confrontational and punitive nature of the therapeutic community. Therapeutic communities operate primarily from a justice perspective. Programs use levels of achievement as indicators of cure. Fears that substance users will use “care” as “manipulation” – that is, as a way of “getting over” or avoiding responsibility – are countered by the emphasis on the importance of adhering to rules, rules which are often immutable – even when ordinary compassion might dictate otherwise.

By contrast, women find that the Women’s Center programs, based on a therapeutic approach which emphasizes a care perspective, provide a more positive and sympathetic environment. These programs promote bonding to positive female role models, attend to the repair of connections to family and children damaged by the cycle of drug use, encourage positive empathic exploration of the feelings leading to the decision to use drugs, and provide concrete family-building services.

The Montefiore/Ackerman grant for maternal drug users has been funded by the National Institute of Drug Abuse, and will test the efficacy of a feminist-oriented family case management approach. The grant considers the moment when a woman gives birth to a cocaine-addicted baby as a crisis for the mother. This crisis often results in further alienation from the non-drug-using culture along with the creation of a cycle of foster care placement for the baby, which all too often leads to the replication of the mother’s drug-use patterns in the next generation. Alternatively, it can be an opportunity to reach the mother, and to offer her and her family the kinds of services that Ackerman and the Women’s Center have been able to provide for other populations.

In this program, family case management is provided for women bearing an infant who is identified as cocaine toxicology positive, and every effort is made to engage the family in a constructive relationship with the drug-using woman. The family is encouraged to take responsibility for the child, or children, while we work with the mother in peer groups, or she enters detoxification or other drug treatment. During our work with the mother we address parenting issues to strengthen her bond with her child or children. We hope to enable her to see herself as a potentially effective mother. Our belief is th...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• ABOUT THE EDITOR
• Introduction
• PART ONE: THEORY, RESEARCH AND SOCIAL ISSUES: EXPLORING ADDICTION IN CONTEXT
• PART TWO: FEMINIST APPROACHES TO TRAINING AND TREATMENT OF THE ADDICTIONS
• PART THREE: SPECIAL ISSUES IN TREATMENT AND RECOVERY: REFLECTION AND INTERVENTION