When Drug Policy Separates Families

We know how important the family is to society, and we acknowledge the primacy of the bonds of attachment between biological mother, father, and child. We experience the fray when these bonds are cut—the cycles of intergenerational poverty, addiction, and violence. But what happens when drug policy, rightly or wrongly, institutionalizes family separation and unwittingly perpetuates such cycles? 

Recently, I had a distressing conversation with Emily, a neighbor who lost custody of her four children due to her drug use (I've shared more about Emily's story in a previous post). “Once heroin gets a hold of you, it never lets go,” she said, comparing it soberly to the clutches of hell itself. 

I first met Emily in 2012 when my husband and I moved in across the street from her Mamaw and Papaw’s house, where she lived, at that time, along with two aunts, two cousins, her boyfriend, and their one-year-old son, and sometimes her aunt’s on again-off again boyfriend. She had just turned 21 and was a doting mother of a toddler with another child on the way. She told me that she'd wanted to be a mom for as long as she could remember. 

Like many women after labor and delivery, after giving birth to her oldest son, she was given an opioid prescription by her doctor. She filled it and continued to use pain pills long after her body had recovered from childbirth. (A recent study led Dr. Alex Peahl, an OB-GYN from the University of Michigan, found that about 2% of women prescribed opioids after childbirth go on to have “persistent” opioid use. For women covered by Medicaid—which covers 40% of all births in the U.S.—the percentage is higher at 4.6%.)Emily’s Mamaw often complained about missing pills—presumably stolen by her granddaughter—and resorted to keeping her prescriptions in her purse and carrying it with her from room to room or in her lap as she rocked on her front porch. 

For Emily, the pills provided respite. “I found if I took enough not only did I not feel physical pain, but [I didn't feel] emotional pain, as well,” she told me. “I didn’t hurt anywhere. And not feeling anything was nice after 18 years of hurting.”

One of the deepest hurts she shared with me was being violently raped at the age of three. When she was older, her parents split, and her mom turned to drugs, alcohol, and men, leaving Emily to do a lot of the child care for her younger siblings. At various points in her life, Emily was diagnosed with bipolar disorder, PTSD, and major depression. She frequently woke in the night, screaming in terror. The pills seemed to help her cope. And the habit didn’t seem so bad that she couldn’t stop it if she wanted. In fact, she quit for a time during her pregnancy with her daughter and worked with United Way to get her own housing. 

It was during that time that she invited me and my son to her son’s birthday party. Her home was tidy, and a cheese and meat tray, veggie tray, and an Elmo birthday cake sat on the kitchen table, along with a special dairy-free cake for my son who had food sensitivities. Emily took pride in her place, her children (born and unborn), and especially the new path she seemed to be on.  

But after her daughter was born, Emily eventually went back to pills until one day they stopped working, and she turned to heroin. “The heroin changed me even more,” Emily shared. “I lied to everyone I loved, and I stole from everyone I loved. I lost everything: my family, my home, my kids, and myself.”

In 2015, her third child was born premature and addicted to heroin. During his stay in the NICU, Emily only visited him once. “Heaven knows, I was not a good mom,” she admitted. When she went to jail, detoxed, and got sent to rehab, she realized what she had done. She says her shame was like no pain she has ever experienced.    

Emily completed her GED while in rehab, and she was clean for a year, hopeful that she could get her kids back. But when a caseworker told her that there was basically no way this would happen, the despair was so great that she intentionally overdosed, hoping to die. Her boyfriend and EMTs with Narcan saved her, and they took her to a psych ward. 

Today, she is in a better but tenuous place. She was given new information and now believes that the caseworker was incorrect about her chances of being reunited with her children. She is working full-time at a Burger King with the goal of getting the stability needed to prove that she can be a capable mom. She would like to go back to rehab. “But I would have to catch another charge, just to get free rehab, and that’s pathetic,” she said. She worries about her children—especially that their lives will play out like a variation of her life on repeat. 

If the opposite of addiction is not sobriety but connection (as journalist Johann Hari contends), and if addiction is more akin to mental illness than crime, then we need new ways of approaching addiction treatment for mothers of young children. 

“Do you have any thoughts about what could be done to help end the heroin epidemic?” I asked Emily recently.  

“Well, I think a lot of people like me, they stay on [drugs] because they lose their kids," she answered. "And I think if Children’s Services and the government could be a little bit more lenient and not just keep sending people to prison, keep sending people to jails…Rehabs do help but I don’t think they’re enough. I mean, you get to see your kids one time a week for an hour. That’s not enough. You’re gonna relapse as soon as you get out.”

“Because you feel like your kids were…” I suggested.

Emily answered, “That’s what kept me going. [With them gone] it’s like, ‘Why bother?’ Even in rehab, you’re only allowed phone calls every other day, and you only get two phone calls that day. And if they don’t answer, sucks to be you, you know, and it’s sad.” 

Emily mentioned that some states, including Ohio, had prison nurseries, which she saw as a limited start, given the fact that they only were available to mothers who give birth in prison. She knew of the controversy surrounding such nurseries, but asked,

How do you know that kid doesn’t want to be with their mom? Even if right after the mom has the baby and gets to hold it, you rip that baby away, it’s still gonna remember its mom’s touch and its scent. Even if they don’t remember it, they know that there’s something missing...

Research on prison nurseries suggests that recidivism rates are lower for women who leave these programs, suggesting that there is indeed something uniquely powerful about the mother-child bond.

Are there existing models for how to apply this approach to addiction treatment, while prioritizing both child and maternal well-being?  

It turns out, there are—just not enough of them to serve the skyrocketing population of mothers with substance abuse disorder. In Cincinnati, First Step Home is the only addiction treatment facility that allows children (up to the age of 12) to live with their mothers while they undergo residential addiction treatment. It was founded in 1993 by a group of women, many of them mothers with firsthand experience of addiction who understood the complexity of the choice between seeking help for an addiction and losing custody of children. First Step Home gives women access to an extensive list of services, including residential and outpatient treatment, counseling and trauma-informed services, housing support, job placement, on-site childcare, prenatal and primary healthcare, parenting and nutrition classes, in-home support for newborns, peer mentors, and family support groups, among other supports. The goal is to help women "rebuild their families as they break the cycle of drug and alcohol addiction."

Could the money currently spent on the criminalization of addiction instead be better spent to provide this type of support for addicted mothers who exhibit a real desire to change?

If the opposite of addiction is not sobriety but connection (as journalist Johann Hari contends), and if addiction is more akin to mental illness than a crime, then we need new ways of approaching addiction treatment for mothers of young children. We need a system that is by default integrative, acknowledging and nurturing the mother-child relationship and recognizing that, for many mothers, keeping the connection strong with their children may be the most powerful motivation to get better. And for many children, maintaining and improving the attachment with their mothers may be the least traumatic path in the long run. 

Amber Lapp is a Research Fellow at the Institute for Family Studies and, along with her husband David, co-investigator of the Love and Marriage in Middle America Project, a qualitative research inquiry into how white, working-class young adults form families and think about marriage.