An Assessment of Long-Term Outcomes Among Drug-Dependent Women by Dr. Louis Hampers

Many of the most marginalized women of our society suffer from a severe substance abuse addiction. Substance addiction does not happen in a silo; it frequently comes from trauma, abusive family environment, and co-occurring mental illness. It can lead to criminal behavior and lack of resources or ability to seek help. The Haven is one of the few pro-grams in the country that takes a holistic approach to addressing substance addiction and co-occurring mental illness.

Introduction

The Haven is about much more than simply substance abuse treatment. The Haven seeks to provide women with life-skills that equip them for the many challenges of sobriety: societal, financial, familial, educational and more. In 2013 the Friends of the Haven conducted a survey of the women who have graduated from the program. Our goal was to learn how the lives of these individuals have been changed after their time at the Haven. The data confirmed our expectation that in addition to staying sober, most of our graduates were now employed, with bank accounts, stable household incomes, supported by friends and family, and in positive mothering relationships with their children. These favorable outcomes were also reflected in the profound gratitude expressed in response to narrative questions about what these women had learned while at the Haven. “The Haven saved my life,” was an often repeated refrain.

Background

Founded in 1992, The Haven is a 65 bed Modified Therapeutic Community for women and infants. The program offers long-term, intensive treatment for substance abuse and co-occurring disorders. Referrals are from the criminal justice system, a direct judicial sentence or from a variety of non-criminal agencies.

Methods

In January 2013 letters were sent to the last known address of 200 program graduates. This initial letter explained the project goals and offered a $20 gift card for participation in the survey. For those women who agreed, a consent and confidentiality form was sent along with the questionnaire and the $20 gift card. For addresses with no response, a second invitation to participate was sent. If there was still no response, or the letter had been returned “address unknown,” we attempted to find a current address using the Intelius ™ service.
The surveys were stored and analyzed in accordance with The Haven’s usual practices regarding the protection of personal health information. Data from the questionnaire were entered into an Excel™ Spreadsheet. These data were then abstracted, analyzed and reported by an independent 3rd party reviewer.

Quantitative Results

A total of 80 women completed written surveys about their lives since graduating from the Haven. These successful graduates had spent an average of 17 months (range: 9 – 50) in treatment. Their average age upon leaving the program was 36 years (range: 21 – 56). Respondents had been out of the program an average of 4.1 years (range 0 – 18) when they answered our questions.
These women had received treatment for some of the most difficult-to-treat and highly relapsing addictions. Methamphetamines had been the first or second drug of choice for 76%. Cocaine was the first or second choice for 28%.

Despite the challenges often associated with criminal records, when asked about employment status, 90% reported that they were currently employed. In fact, 81% noted that they had been continuously employed since graduation. Seventy-six percent had checking accounts and 71% had saving accounts (only 16% had neither). Median household income was reported to be between $25,000 and $35,000.

Almost 59% of respondents were currently enrolled in some form of school or training. The highest educational level achieved since graduation is depicted below:

“I envisioned a life of sobriety and independence.”

Haven Client

A criminal record (often including felonies) was also recognized as an obstacle to home ownership. However, nearly all respondents reported some sort of stable housing arrangement: 70% were renting, and 23% owned their home.
Our respondents identified many sources of support for their recovery. These included family (84%), spouses (56%), places of worship (43%), 12-step fellowships (35%) and peers and friends (34%). Significantly, only 21% reported relying on any form of public assistance. It was also encouraging to note that 61% reported that they currently serve in a mentoring role for others.
Regarding the difficulty staying away from the influences to return to drug use (i.e. people and places), on
a scale of 0 – 5, where 0 indicated “not difficult at all” and 5 indicated “very difficult,” respondents averaged 0.97. This occurred despite a report that 35% of women still had a family member active in an
addiction. Nearly all (96%) the women still remained in touch with fellow Haven graduates.
The self-reported relapse rate was 23%, most commonly onto alcohol. However, 89% currently report sobriety and abstinence from all drugs, including alcohol. Only 5% had been arrested since leaving treatment.

Eighty percent of the respondents are mothers. Of these, 27% had at least one child accompany them while in treatment. A total of 43% of all children had custody taken from their mothers by Social Services due to drug use and/or criminal behavior at some point. However, at the time they responded to our survey, custody had been returned to the mother (or the children had reached an age of maturity) in 63% of those cases. Thus, 84% of all children were currently in the custody of their recovered mothers or had reached an age of maturity.

Qualitative Themes

Narrative input was requested in four areas:

• Our subjects were asked what “skill, strategy or tool” they learned while at the Haven was most useful to their recovery. By far, the most common responses referenced “cognitive therapy.” Specifically, they acquired an understanding of how to carefully assess decision-making as actions and ultimate consequences rather than impulse and emotion. “After the Haven, I stop and play things out or play the tape through and have forethought.”

Other important themes were accountability, selfdiscipline and selfreliance. “Being able to be responsible, like make a doctor appointment for myself, refill prescriptions, pay my bills on time.” And, “I didn’t leave the program looking for free handouts or government aid. I envisioned a life of sobriety and independence.”
Not surprisingly, many women commented on how the program had improved their selfesteem. “What helped me the most was isolation from the outside world to learn how to love myself and gain self-esteem and the ability to believe in myself. Being there I also FINALLY grew up and became a real adult.”

• Graduates were also asked about the greatest challenges they had faced since leaving the program. Many mentioned the struggle to repair relationships damaged by their addictions. “To get my children back with me and to face and make amends with those that I hurt. I overcame this challenge by realizing I am an amazing person, mother, daughter and I have a disease. I learned how to be assertive, take responsibility and communicate with others! I know how to live in recovery and knew if I could do treatment at The Haven I could do anything.”
• As noted above, a criminal background was a significant and frequently mentioned obstacle. “With a criminal background it’s hard to get anyone to rent to you or give you a job, but that gets better over time.”
• We found it helpful to ask our graduates for suggestions to improve their treatment and outcomes. Some indicated that it would have been useful to have programs to keep them linked to others in recovery after graduation. “The Haven provided plenty of services that I utilized at first. I wish I would have just stayed connected and continued to ask for help and keep my bonds with my peers.”

Many women also mentioned that they would have liked more family counseling. “I would have liked to have a family group available to us- they have circles of support now and it is an incredible class showing how the client and family need to communicate and understand the others’ feelings, struggles and desires.”

• Finally, our graduates were invited to provide us with any additional feedback. These responses were overwhelmingly positive. “I think the Haven saved my life and I’m very grateful for this remarkable program. I have my family and kids back now.” And, “The Haven is my ‘home away from home.’ It saved my life and helped me to become a strong, independent woman and showed me how I need to live as an addict in recovery. I cannot say enough good things about this place. It truly is a Haven.”

Limitations

The 80 surveys returned represented 40% of our 200 initial mailings. Regarding housing, the period just after graduation is rather fluid for many women, regardless of how successful they are. It has not been practical for The Haven to maintain an updated registry with current addresses for all our graduates. Thus it is not surprising that we simply could not locate many potential respondents. The true response rate, had everyone on our list actually been contacted, would certainly have been higher.
Our results are necessarily limited by the fact that our outcomes rely on self-report. For some variables, such as housing or education, this was unlikely to have made a difference. But for some subjective outcomes, or those associated with shame, such as relapse rate, the effect may have been significant.

Summary

Despite having difficult-to-treat addictions to methamphetamines and cocaine, 89% of graduates reported that they are currently sober from drugs and alcohol. Ninety percent are employed and median incomes are $25,000 – $35,000. Nearly all have bank accounts. Almost 91% have a GED or higher. Only 21% reported receiving any form of public assistance. Despite a large number of cases in which child custody had been lost, 84% reported that they currently have custody or that their children are grown. Graduates reported learning life skills through cognitive restructuring as well as improved self-discipline and self-esteem. The greatest challenges of sobriety included mending family relationships as well as obstacles due to having a criminal record. A desire for more programs to link recovering addicts together was frequently mentioned.

Conclusion

Graduates of The Haven who responded to our survey demonstrated a low rate of return to the drug-using lifestyle. They now exhibit high levels of social responsibility in the forms of education, employment and family cohesion.
Based on the findings, ARTS will consider identifying more effective ways to bring recovering addicts together on a regular basis through peer recovery programs, enhancements to our continuing care services, and program modifications, if required.

Acknowledgement

The LAARK Foundation provided a grant for this project through The Friends of The Haven. We are grateful for their support.

“I know how to live in recovery and knew if I could do treatment at The Haven I could do anything.”

Haven Client