Need for Treatment

Women with children

According to Miller (2001), the number of substance abuse treatment facilities for mothers with young children is very limited and therefore, implementation of local outpatient programs is very important to meet their specific treatment needs. Substance abuse treatment for single mothers is given a lower importance than the sufficient provision of their children in terms of safety and physical needs (Miller, 2001). Treatment of substance abuse and prevention of lifetime relapse requires various approaches (Miller, 2001). According to the Department of Health and Human Services (DHHS) (as cited in Miller, 2001), more than one-third of females who abused drug have undergone major depressive episodes and shown symptoms of mental health problems. Therefore, women who are abusing substance are more likely to experienced mental health problems as well. On the other hand, there is a high possibility that they will end up becoming the victims of domestic violence or experience partner violence (Miller, 2001). Substance Abuse and Mental Health Services Administration (SAMHSA) (as cited in Miller, 2001) stated that when problems regarding domestic violence failed to be addressed, it will interfere with the effectiveness of treatment and might lead to relapse. Moreover, the high rate of women involving in the legal system is also associated with substance abuse (Miller, 2001). Furthermore, women who are involved in substance abuse lack parenting skills, overreact with harsh discipline or neglecting their children due to their previous experience with same dysfunctional family patterns during their childhood years (Miller, 2001). By looking from the social learning perspective, this means that they are unaware that their children are seeing them as role model and might follow their footsteps in abusing substance.

Need for treatment success

In order to achieve successful participation in substance abuse treatment, the various needs of patients need to be known. Miller (2001) stated that mother with young children will only be able to focus on her addiction after basic needs such as food, shelter, and water of the family were addressed. Therefore, if any of the needs are affected, it may cause the mother to abandon the ongoing treatment. Besides that, in order for the treatment to be successful, clients must believe or have a positive perception towards the treatment that it will help them alleviate their addiction. Catalano, Ashery, Robertson, and Kumfer (as cited in Miller, 2001), found that including parenting program to clients in substance abuse treatment will significantly decrease the chances of relapse after treatment besides improving preservation because these clients believe that having good parenting skills is important.

Miller (2001) pointed out several steps that can ensure a successful treatment program. One of it is to remove attendance barriers by permitting mothers to bring along their children to participate in the treatment program. Besides that, providing child care, training skills for children, and knowledge on substance abuse will make way for the identification of their emotional and behavioural problems. Likewise, providing parenting skills training and support services will help mothers with young children to increase their self-esteem. According to Miller (2001), he stated that funding basis is very important to develop and expand substance abuse treatment program in order to promote and nurture better stability in families by helping mothers to deal with their addiction while at the same time to become a better parent to the children.

Amongst child welfare cases in which parents are having substance abuse is concomitant with increasing rates of child re-victimization, higher possibility of out-of-home placement, longer placement in care, and higher rates of child adoption and parental rights termination (Kaufman & Oliveros, n.d.). Therefore, it is important to focus on several needs and factors besides addressing treatment barriers to ensure the success of treatment completion. One of the ways to ensure treatment completion is with the introduction of Family Treatment Drug Courts (FTDC). According to Kaufman and Oliveros (n.d.), several studies on FTDCs found that they are associated with a better substance abuse treatment initiation, lengthier stay in treatment, lesser days in out-of-home placement for children, higher frequency of family reunification, and higher chances of treatment completion. Kaufman and Oliveros (n.d.) continued to state that parents who attended FTDC and have completed the treatment quicker have almost 90 percent chance of reunification and have their children returned. A study found in the work of Kaufman and Oliveros (n.d.) suggested that it is important to work with extended family and natural supports to enhance permanency outcomes for children.

Creating cross-system collaborations and placing a substance abuse specialist in child welfare institutions seems to be an effective strategy for increasing intake rates (Kaufman & Oliveros, n.d.). Motivational Interviewing (MI), a person-centered and collaborative form of counselling that stimulates and reinforces motivation for change is an extremely effective approach to improve treatment initiation and completion as well increase treatment entry among substance abuser (Kaufman & Oliveros, n.d.). Furthermore, substance abuse treatment initiation can be enhanced by outreach and engagement strategies (Kaufman & Oliveros, n.d.). Outreach and engagement strategies are also effective at increasing substance abuse treatment completion rates when used with FTDC (Kaufman & Oliveros, n.d.). On the other hand, today, FTDC and the newly developed home-based treatment intervention for substance abuse seem to be the most promising treatment program to improve treatment outcomes (Kaufman & Oliveros, n.d.). Home-based substance abuse treatment program has an advantage of dealing with poverty related treatment barriers by bringing the program to those who cannot afford to access other substance abuse treatment programs.

Treatment approaches that are delivered must not only emphasize on reducing the symptom but must also increase environmental stability and improve social functioning (Belcher, Briggs, Suarez, & Titus, 2012). In order to achieve treatment success, structural resources that assist bonds among providers must be developed or enhanced to nurture more integrated service sectors (Belcher et al., 2012). Treatment services can only be fully integrated after changes are implemented across the whole system rather than within individual treatment programs (Belcher et al., 2012). Berlin (2002) stated four main common concerns that every treatment should have. The first concern is that treatment must be multi-dimensional and comprehensive by identifying numerous domains. Treatment must also include resources or access to services. Next, family therapy must be included to enhance communication among family members besides improving parental and guidance skills. The last concern is that after-care must be included in order to prevent relapse from occurring.

Pressing Problems

Parents who abuse substance are associated with the significant increase risk of child maltreatment and it is frequently under reported by child protective services (Bellettiere, Chuang, Cross, & Wells, 2013). Family functioning and the well-being of children are also at risk when parents abuse drugs and alcohol (Bellettiere et al., 2013). Besides that, there is a high possibility that caregivers who abuse substance will engage health risk behaviours and mistreat the children in their care (Bellettiere et al., 2013). On the other hand, the children of parents who abuse alcohol and drugs will probably experience problems in terms of their emotion and behaviour as well as cultivate their own substance abuse in their later stage of adolescence and early adulthood (Bellettiere et al., 2013).

A number of costly and alarming social problems can be associated directly to drug dependence. Recent studies estimated that the United States government has to spend around 67 billion dollars annually in crime, low productivity of work, foster care, and other social problems caused by drug dependence (Kleber, Lewis, McLellan, & O’Brien, 2000). Volkow and colleagues (as cited in Kleber et al., 2000) found that the dopamine system of individuals who abstain from using cocaine was impaired three months after their last use. Other studies (as cited in Kleber et al., 2000) found that there was sustained variations in the stress response system after former substance users abstain from using opiate or cocaine. The response of encountering an individual or something that is earlier associated with drug use that might create conditioned physiological reactions and craving for the drug can combine to produce the feeling of loss of control (Kleber et al., 2000). The relapse frequencies which were reported to be very high are a clear sign of the negative reinforcement that alcohol and drugs have on people (Berlin, 2002).

Alcohol causes more than 150,000 deaths each year and alcohol kills more Americans compared to other drugs other than tobacco which caused 440,000 deaths annually (Wu, 2005). Alcohol consumption has a negative effect on the central nervous system and brain that will cause those who consume alcohol to be aggressive and engage in risk taking behaviours (Wu, 2005). National Institute on Drug Abuse (as cited in Wu, 2005) stated that marijuana might induce impairment of short term memory, attention span, judgment skills, coordination and balance, learning skills, and other cognitive functions. The withdrawal symptoms of marijuana include irritability, restlessness, decreased appetite, insomnia, tremor, chills, and increased body temperature (Fisher & Harrison, 2013). Besides that, cocaine will cause someone to have decreased appetite and sleep, increased heart rate, muscle spasms, and convulsions (Wu, 2005). The withdrawal symptoms of cocaine include intense drug craving, irritability, depression, anxiety, and lethargy (Fisher & Harrison, 2013).