Melissa Paige McNamara

House of Hope

Brandy was crawling on the floor near her mother's feet, dressed in her new denim jumper, with tightly braided pigtails framing her dimpled face. Her smile hid any sign that in her nine months, Brandy has already been to jail, to a methadone clinic, and shuttled between three homes.

Brandy was just four months old when her mother, Cheryl, checked into Odyssey House. (Both names are pseudonyms.) Thirty-six years old and
African-American, Cheryl was typical in age and race to the other Odyssey House mothers. And, like most of the mothers in Odyssey House's Mother and Child program, Cheryl resisted treatment until she had little choice.

Cheryl was a mother and a department store saleswoman "making good money and never missing work" before her boyfriend encouraged her to smoke heroin "to escape, for fun." But soon, her escape had her traveling after work in Queens to Starrett City, Brooklyn, just to get a fix. When Cheryl was arrested for selling heroin to an undercover police officer, she was high and pregnant with Brandy. The judge, a mother herself, was so angry that Cheryl had endangered her unborn child with drugs that she had little mercy and sent her directly to jail. After spending 24 hours in a Brooklyn detention center on one meal a day, without her children, Cheryl returned to court pleading for an alternative. The judge sent her to Odyssey House where she would be able to keep her daughter with her after she was born.

Nationwide, there are a half-million children like Brandy out there, born to drug and alcohol-using mothers. Few of them are fortunate enough to find their way to Odyssey House, a residential facility where most of the mothers are recovering from years of heroin, crack, or alcohol abuse. Facilities like Odyssey House seem an effective way to deal with drug-addicted mothers and their children, but instead, increasing numbers of mothers with children are winding up in detention centers. There aren't nearly enough residential centers to treat this growing population of women, and even if there were, it's unclear how many women would voluntarily seek them out.

One thing remains certain: The financial cost to society and the emotional toll children bear is too great not to explore alternative ways to treat this population. It costs upwards of $60,000 per year to jail a person on New York's Rikers Island; foster care for an inmate's child can add another $20,000 to the bill. By comparison, residential treatment centers cost an estimated $26,000 per person, per year. A recently instituted program in Arizona has saved that state an estimated $2.5 million a year by diverting non-violent drug offenders into mandatory drug treatment; the program's success rate one year after treatment is just over 60 percent. There are many more benefits, financial and otherwise, that such programs cultivate: fewer prisons, less addiction-motivated crime, more stable children, and a lighter burden on the health care system. Prisons offer little such hope.

The narrow hallways on the third floor of Odyssey House are lined with rooms neatly stacked with Fisher Price plastic toys, rag dolls, and baby bottles. The arrangement resembles a college dormitory, only cleaner and more organized. A crib and twin bed fit neatly in the bedrooms, which are connected by a common room for mothers in treatment to sleep with their babies. A baby's cries draw attention to a pale green room where small shoes line the windowpane. A mother cradles her baby, singing quietly. The serenity of pastel-colored walls, smells of baby powder, and baby photos provide a sharp contrast to the dangerous situations many of the women and children have recently escaped.

Odyssey House is a 662-bed temporary home for women addicted to drugs or alcohol who want to become sober. Located on East 121st Street, a desolate block in Spanish Harlem, Odyssey House's neatly manicured appearance stands out. Surrounded by vacant buildings that were once crack houses, Odyssey House is one of a handful of drug treatment centers that houses its patients, half of whom are women who arrive pregnant or with small children.

Odyssey House is a therapeutic community that offers a specific type of treatment that conquers addiction through a strict "tough love" philosophy. This philosophy makes residents accountable for their own behavior as well as for the actions of their peers. Advocates of therapeutic treatment claim the structured atmosphere provides residents with the type of environment many never experienced growing up. "Some of these women did things whenever they wanted before they came here, like feeding their children whenever," says a counselor there. These programs can be effective because they don't give the residents a choice of how to schedule their day.

This atmosphere makes it an unpleasant and confrontational place to be at times, residents -- and even some supervisors -- concede. Residents are required to tell a supervisor if they see "inappropriate actions" in the house, an Odyssey House counselor said. Inappropriate actions range from drug use to concealing a romantic relationship. Some psychologists believe having to report fellow residents erodes the trust these women are just learning.

But program advocates believe the strict structure is key to building the most important trusting relationship -- between mother and child. Odyssey House mandates eight weeks of bonding sessions between mothers and their children, in which mothers hold their children and play with them for hours. Many of the children suffer emotional trauma from the neglect they endured while their mothers got high. "The mothers never properly bonded with their children, who they rarely held," Cecila Scott, Director of Family Services says.

"I put so much time into getting high that I didn't see what was happening with my own son," Cheryl says. She blames herself for her son's troubles, which landed him in a juvenile detention center. "I would disappear overnight, sometimes for days," she admits.

To ensure mothers develop strong parenting skills, Odyssey House provides them with nutrition, parenting and child development classes. Their counseling sessions address issues ranging from self-esteem and depression, to pregnancy and postpartum therapy. While the women are in treatment, children attend the Child Development Center from 9 a.m. to 5 p.m., where staff are trained to work with children who may have been exposed to drugs prenatally or who have the emotional deficiencies that children are likely to experience when their mother abuses drugs. Children five and older attend public school nearby.

At one Odyssey House parenting skills session, the counselor asked clients to describe their childhood, pretending they are guests on Oprah. Mecca, a resident finishing her treatment says, "My alcoholic mother gave more attention to the dog than to me." Several women shake their heads in empathy. "My earliest memory is picking my mother up off the streets and bringing her home to get sober," Jacqueline echoes.

A National Concern

Federal studies consistently show this type of residential program is successful, but there are few of them. There are even fewer programs like Odyssey House, which is one of the few that accept parents with two children under five. Most facilities, if they offer residential care at all, have room for only one child. Margo Matzdoff, Director of Women's Services at New York State's Office of Alcohol and Substance Abuse Services' (OASAS) estimates there are fewer than a dozen centers that treat mothers and children in New York State.

The federal government's year 2000 National Drug Control Strategy reports that women are "woefully underserved." According to the Child Welfare League of America, in 1997, only 10 percent of child welfare agencies were able to locate treatment within a month for clients who needed it. Just 37 percent of substance-abusing mothers of minors received treatment in 1997. "We're proud of our progress, but we need to do more," Matzdoff says.

Despite the large number of women in need of treatment, places like Odyssey House have openings. That's because just 5 percent of people enter Odyssey House completely voluntarily. The rest have to be forced in by the legal system -- and that system is geared more towards jail sentences than treatment.

The Winding Road Toward Treatment

Many addicted mothers end up in the prison system when they are first arrested, either for using or selling drugs. It's a costly process to keep an addicted woman in jail and there is little evidence to suggest it's a path to sobriety.

Nevertheless, U.S. spending on the incarceration of drug offenders has soared in the past two decades. More than 450,000 people are now imprisoned in the United States on drug charges, compared with about 45,000 in 1980, according to The Sentencing Project. More than 90,000 of them are women. And in New York, due in large part to mandatory sentencing laws, 91 percent of the increase in women's sentences from 1986 to 1995 was in connection with drug offenses.

In light of these staggering numbers, key members of the criminal justice system may be on the brink of exploring alternative ways to treat this population. The Brooklyn District Attorney's office recently proposed an initiative to let up to 25 female convicts guilty of nonviolent crimes, and all of their children, live together in a residential setting. This center, located in Brooklyn's East New York, would be the first in the country to allow a woman convicted of a felony to live with all her offspring -- and the first built and run by a District Attorney's office. The Bank Street College of Education has already agreed to offer educational advice for children at the center, and the law firm Cravath, Swaine, and Moore has said it will provide free legal work.

Within the legal system, drug courts may offer a promising alternative to reach mothers in trouble. These courts mandate and arrange for drug addiction treatment, actively monitor progress in treatment, and arrange for other services for drug-involved offenders. The U.S. Department of Justice Drug Courts Program Office provides the federal support for planning and implementing the courts. The treatment usually occurs in community-based settings, and proponents of drug courts emphasize that even if children are placed in foster care while their mothers are treated, reunion rates are higher.

The Challenges of Recruitment

All these approaches require waiting until a mother is arrested. The most daunting challenge, and the one most in need of attention, is how to encourage women to seek treatment before they confront the criminal system. Most experts agree it is critical to catch substance abusers early. But it is difficult to find these women and once found, few agree to submit to treatment voluntarily.

The reason is simple: "Why would you choose treatment when you want to get high, have sex, and sit in a bubble bath -- nothing treatment allows?" asks Angel Lopez, longtime House Manager of Odyssey House. Lopez knows first hand about drugs' temptations. Sober now for more than 15 years, he spent a year at El Regreso, a residential drug treatment center in Brooklyn. In and out of prison for several years for dealing and using drugs, he entered El Regreso only after he broke parole, sold drugs to an undercover officer a final time, and eventually gave in to a judge who provided him with few alternatives other than treatment.

And, if men like Lopez hesitate to seek drug treatment, it is a "thousand times" less likely that addicted mothers with children will voluntarily enter treatment centers, he says. Mothers fear losing their children to foster care or adoption if they admit an addiction, Lopez explains. Some of the women have been in foster care themselves. Or they have family members with children in foster care, and they can't get them back, says Cecilia Scott, Odyssey House's family center director.

Some organizations have come up with creative methods of recruitment. For example, OASAS has embarked on an innovative marketing campaign launched on Mother's Day. The campaign features decorative posters with uplifting messages about the benefits of treatment for women and how it has changed their lives. Featuring personal testimonies from women who have successfully recovered from addiction, OASAS plans to distribute brochures listing treatment options and facilities to places where these women are more likely to be: health clinics, public assistance offices, doctors' offices, and hospitals.

Another way to encourage women to get treatment is through the welfare system. Statistics suggest that about 20 percent of women receiving public assistance need substance abuse treatment, but only 3 or 4 percent ever receive it. Through an education campaign, OASAS hopes to train Temporary Assistance for Needy Families (TANF) employees to reach out to these women. One way to make women aware that treatment with their children is possible is to require all women watch a video discussing treatment options as they come in for assessments. OASAS will also educate TANF employees about the range of services available to clients. The challenge is to make the campaign forceful enough to push women to get treatment, without making them feel guilty or fearful that they may lose their children, Matzdoff explains. "It's a struggle, but we have to dream big."

Melissa McNamara is associate director of development for Demos, a public policy organization in New York.

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