Barriers to Treatment
According to Green (NIAAA, 2006), women face many more barriers than men to treatment entry, such as economic barriers, lack of time because of family responsibilities, lack of transportation, lower education rates, susceptibility to feeling stigmatized or shame, a high prevalence of anxiety or depressive disorders, and more physical disorders. Brady & Ashley (2006) point out that, among clients who present for treatment, women have more children living in their homes, are often younger, have lower incomes, face heightened scrutiny of substance use during pregnancy, and lack affordable child care. Mothers involved with child welfare were found to be even younger and had more children and more economic problems than other women in treatment (Grella, Hser, Huang, 2006). While earlier research suggests that because of these problems women were less likely to seek help than men with similar problems, more current research indicates the rate of treatment entry has improved. In 2002, about 30% of admissions to substance abuse treatment facilities were females, up from 28% in 1992 (Brady & Ashley, 2006).
National studies indicate that the availability of family services or a focus on issues more typical of child welfare clients has declined. According to Semidei, Radwel, & Nolan (2001), “[i]f child welfare clients enter treatment in large part because of family concerns, but their treatment programs fail to address family issues, it should not come as a surprise when clients drop out” (p. 126).
Placement and Substance Abuse Outcomes
There is very little empirical evidence using multivariate methods to support the link between parental drug use, low reunification rates, and treatment noncompliance (Smith, 2003). In her study on reunification, Smith found that of 498 children who were in an out-of-home placement, only 14% returned home by the end of 21 to 30 months. Drug treatment compliance increased the rate of reunification; however, there was no difference found in the likelihood of ongoing drug use by treatment completion. Of the parents who completed treatment, 29% reported ongoing drug use; of the parents who had not completed treatment, 30% reported ongoing drug use. This raises the question as to whether overburdened workers are simply focusing on client behaviors that meet easy-to-measure criteria and that are valued by the community, or whether the reunification decision actually reflects safe parenting.
The likelihood of achieving family reunification for parents with substance abuse problems is very low. Budde and Harden (2003) found that 86% of substance-exposed infants entering care in l994 were not reunited with their parents by January 2002. Gregoire & Schultz (2001) found that nearly one-third (31.1%) of clients did not complete the substance abuse assessment required by the child welfare plan, only 23.4% completed treatment, and 61% continued substance abuse, resulting in 52.7% of parents not having custody of their children, and 21% losing all parental rights. Even for those who enroll in treatment, dropouts and relapses are common; in another study of custodial mothers with substance abuse problems, only 20% either completed or were enrolled in substance abuse treatment (Hser, Anglin, Grella, Longshore, & Predergast, 1997, cited in Ryan, 2006).
Idaho Pre-Treatment Program