The availability of illegal drugs has long undermined the quality of life in inner-city communities in the United States. The introduction of crack cocaine in the mid-1980s had devastating consequences because of the drug's appeal to women, many of whom were mothers or were of childbearing age. During these years, crack cocaine use among women quickly escalated to epidemic dimensions, and the link between maternal drug abuse and child well-being was reflected in a significantly increased number of child protective services (CPS) reports related to substance abuse. The dramatic increase in the nation's foster care caseload indirectly measures the over-use of out-of-home placement and the slowness of public policy development premised in principles of prevention and family preservation.
New York City, like other urban areas, was hit hard by the problem. Between 1982 and 1989 the number of substance abuse-related CPS reports doubled (Child Welfare Administration, 1993). In 1988 alone, nearly 5,000 newborns were reported to CPS because they tested positive for exposure to drugs. These reports were clustered in the city's poorest neighborhoods and overwhelmingly involved families headed by single women of color. The city's initial response was to develop new specialized foster care beds and automatically place children in care. This approach was not only extremely costly, but also left mothers with little incentive to overcome their addictions.
In an effort to contain costs and develop policies that promote a more humane response to families, the city developed the Family Rehabilitation Program in 1989, which offers comprehensive services to families involved in substance abuse-related CPS reports as an alternative to foster care placement. Concurrent with the development of a new prevention program is the need for systematic data evaluating the program's effectiveness. This article discusses the results of an exploratory study conducted with 20 women who had successfully completed the Family Rehabilitation Program.
Overview of the issues
Substance Abuse and Women
Policies and service development on behalf of substance-abusing women are influenced by societal norms that define the role and status of women. Poor women of color suffer constraints imposed by gender and endure additional burdens imposed by class and race or ethnicity. Before the 1970s, when the women's liberation movement increased awareness of the fact that illicit drug use among women differed significantly from that of men, substance-abusing women received scant attention in the professional literature. This awareness prompted the National Institute for Drug Abuse (NIDA) to research the treatment of female addicts; however, the NIDA tended to focus on the link between drug abuse and criminal behavior, targeting studies to female addicts on the streets (Rosenbaum & Murphy, 1990).
During the crack cocaine epidemic, concern shifted to the implications of maternal addiction for family and child well-being, leading to a proliferation of literature focused on negative obstetrical, neonatal, and child development outcomes (Chasnoff, Burns, & Burns, 1987; MacGregor, Keith, Chasnoff, Rosner, Shaw, & Minogue, 1987). These studies did not examine treatment options for helping women overcome their addictions and did not address the needs of poor women of color, who were frequently coming to the attention of the courts and public child welfare agencies.
Role of the Courts in Policy Development
Whereas early research did not support the advancement of policies to preserve families and rehabilitate addicted mothers, subsequent court litigations prompted new policies that encouraged program development to help mothers overcome addictions while continuing to function in the role of primary caretaker. The Bronx New York City Family Court (Matter of Fletcher, 1988) held that a mother's prenatal drug use did not establish her inability to parent. …