Child Care Needs Keep Poor Addicts From Treatment

The problem is especially tough among the homeless, study finds

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By Amanda Gardner
HealthDay Reporter

FRIDAY, Feb. 24, 2006 (HealthDay News) -- The problem of how to care for children while undergoing addiction therapy may keep many poor or homeless addicted parents from getting the help they need, a new study shows.

"For many of these people, I would guess that it was simply a problem of where to put the kids when they went to AA. For others, entering into treatment might stand in the way of pursuing employment and other responsibilities they would have towards their children," explained lead researcher Dr. Stefan G. Kertesz, an assistant professor of preventive and general internal medicine at the University of Alabama at Birmingham.

His team published its findings in the March issue of Medical Care.

Experts estimate that more than 22 million Americans suffer some sort of addiction. While research on middle-class populations has shown that people are strongly influenced by family members, and by their own perception of the consequences of substance abuse, there's been little research on poorer populations. This includes the homeless, where the consequences of addiction can be especially harsh.

"Our basic premise is that there's good evidence that addiction treatment can play a helpful role in the resolution of addictive problems, but a lot of people who need treatment don't seem to get it," Kertesz said.

"The study makes the assumption that drug abuse is a relapsing disease, and that if people don't get treatment, they are constantly relapsing," added Jerry Flanzer, health science administrator at the U.S. National Institute on Drug Abuse, which helped fund the study. "This is costing our society a great deal of money."

Any number of reasons may explain why people don't get the treatment they need, including lack of availability of programs.

But this study aimed to identify key personal factors blocking addicted individuals from joining mutual self-help groups such as Alcoholics Anonymous and Narcotics Anonymous.

The prospective study followed 274 people addicted to cocaine, alcohol or heroin.

The participants were identified in a short-term detox program in Massachusetts, and were followed closely for the next two years. Individuals were about equally divided between cocaine, heroin and alcohol addiction, and most used more than one substance. Some 60 percent experienced homelessness during the follow-up period, and 22 percent were chronically homeless.

Not surprisingly, people who spent time with other addicts were less likely to get treatment, the researchers found. And -- in keeping with data on middle class substance abusers -- poorer addicts were more likely to get treatment once they perceived major negative consequences stemming from their addiction.

"It's not how much you use," Kertesz added. "It's how severe you perceive the consequences of drugs and alcohol to be."

The finding seemed to jive with what addicts themselves said. Sara, a recovering substance abuser currently serving time in a New Mexico jail, said her tendency is to seek treatment when she hits an "emotional rock bottom."

Hitting this psychological low may have nothing to do with having your kids taken away or losing your home, added another woman in recovery, Lulu.

However, caring for children did seem to be an important factor in whether or not addicts sought treatment. Study participants who lived with their children were half as likely to obtain treatment or attend meetings.

The problem is a simple one: "You have to balance immediate responsibilities with long-term health, and that balance can be extremely difficult if you have a strong duty towards your children," Kertesz said.

"There's a clear message that men are also affected greatly by involvement in the family and particularly by whether they have children," Flanzer added. "This has real policy implications."

The findings do seem to point to some practical ways to increase access to treatment, Kertesz said.

"I take care of patients in an inner city hospital, and doctors and nurses can feel a real sense of futility and despair in engaging patients with medical complications of alcohol or drugs," he said. "We need to realize that people who are poor who need addiction treatment are trying to balance that need against other issues in their lives that could be very important, and this can include children. We need to find out about these problems."

More information

For more on recognizing and fighting addiction, head to the U.S. National Institute on Drug Abuse.

SOURCES: Stefan G. Kertesz, M.D., assistant professor, preventive and general internal medicine, University of Alabama at Birmingham; Jerry Flanzer, Ph.D., health science administrator, National Institute on Drug Abuse; March 2006 Medical Care

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