Posted on 19 June 2013.
By Katie Kerwin McCrimmon
PUEBLO — The 19-year-old and her boyfriend cupped their hands over her swollen belly and made a promise.
“We are not going to hurt you anymore baby,” they told their unborn child.
Addicts who met in detox, Haley and Carlos, awoke the next morning, scraped together another $30 for a single Percocet pill and broke their promise.
They heated the Percocet — an addictive combination of oxycodone and acetaminophen — on a piece of aluminum foil, and smoked it.
“Every time we would do it, we would swear this would be our last one,” said Haley, a devout Christian with big eyes and girl-next-door beauty who once dreamed of joining the Navy or becoming a neonatal nurse.
“I was doing the Percosets before I was pregnant, then I got pregnant unexpectedly. When you’re addicted, it’s hard to just quit.
“I have no intention of hurting my baby or living unhealthy. But, I couldn’t quit, so I decided to get help.”
Now 16 weeks pregnant, Haley is in the middle of a 30-day residential treatment program at Crossroads’ Turning Points in Pueblo. (Solutions agreed not to use full names to protect the patients’ privacy.)
Girls, women need help, but don’t come in
In Colorado, girls and women who are pregnant and need help can jump to the top of waiting lists to get drug or alcohol treatment, and if they qualify, Medicaid will cover costs for their care.
But many of those spaces remain unfilled, and Colorado recently lost some federal funding for a program called Special Connections that offers help to pregnant women struggling with substance abuse.
“Moms are not taking the opportunity to come in for treatment,” said Karen Mooney, manager of women’s substance use disorder treatment programs for Colorado’s Division of Behavioral Health.
Mooney has worked to advertise the program and add providers who can help pregnant women beat their addictions across the state.
“It’s not that women don’t need help. It’s that they don’t come in,” she said.
Colorado used to get about $2 million a year to fund Special Connections, but because some of the money wasn’t being used, the funding shrank to about $1.4 million. At its peak in 2006, the program helped 320 women get drug or alcohol treatment. Now, only about 200 a year are seeking help.
The challenges to getting women help and protecting infants from prenatal drug and alcohol exposure include:
- Stigma. Some women can justify harming themselves through their addictions, but few want to hurt a new life that they are supposed to be nurturing. Many are ashamed to seek treatment.
- Fear of losing older children or challenges in caring for them during treatment. Women who seek drug treatment during pregnancy know they may lose custody of other children.
- Failure of some doctors to ask patients about drug and alcohol abuse during pregnancy. Very few providers routinely screen for prenatal use or abuse. Some say it’s not a problem among their patients. Yet experts say drug and alcohol use stretches across all socioeconomic and racial groups with white women who earn over $75,000 a year reporting the highest rates of binge drinking. There’s also a persistent, dangerous attitude among wealthier women that “Mad Men”-style drinking won’t harm their developing babies.
- No uniform requirements in Colorado for hospital drug screenings at birth.
- No tracking system for newborns who have drugs in their system at birth or whose mothers admitted drug and alcohol use during pregnancy.
Another fear for women is that if they admit to drug or alcohol abuse during pregnancy, they may face criminal prosecution. In the past, police and prosecutors have occasionally tried to jail women for drug use in pregnancy. A new law in Colorado, House Bill 12-1100 now bars prosecutors from using positive drug tests performed during routine prenatal care as evidence in criminal cases.
Law aims to boost screening, treatment
One of the only laws of its kind in the country, the Colorado measure aims to encourage doctors to screen women and get them help. If law enforcement officials encounter a pregnant woman who is using or selling drugs and obtain evidence aside from tests through prenatal care, they can still proceed with prosecution. The law also does not bar health care providers from sharing test results with child welfare agencies in order to protect children.
Dr. Kathryn Wells is a child abuse pediatrician at Denver Health and medical director for the Denver Family Crisis Center. Through funding from The Colorado Trust and in concert with the Colorado Alliance for Drug Endangered Children, she and other providers have been holding seminars for colleagues urging them to be more proactive in getting treatment for pregnant women and thereby protecting current and future children.
With legalization of marijuana and Colorado now second in the nation for abuse of prescription drugs, medical experts expect a surge in use of both legal and illegal drugs. Wells thinks doctors need to work harder to detect drug and alcohol abuse and get pregnant women help as early as possible.
So far, only 7 percent of referrals to the Special Connections program have come from medical providers. Many providers don’t think they have time to screen patients. Or, in the past, if they got a positive test result, they didn’t know where to refer a woman for care. Now, thanks to a program through Families First, Colorado has toll-free help lines for both English and Spanish speakers to get help for patients and providers.
“It should be standard practice to ask questions about drug and alcohol use and to test at least once during pregnancy,” said Wells, who is also president of the American Academy of Pediatrics’ Colorado chapter. “We want to make it super easy. There is no reason not to do this.”
Still, she has known plenty of doctors who don’t ask and don’t want to ask.
“They say they don’t want to know. ‘I don’t want to drive them away. At least they’re here. I’ve got 100 other things I need to deal with.’”
Early in her career, as a pediatrician in a small town in Idaho, Wells thought it was best to come down hard on pregnant women who were using drugs or alcohol.
“I had zero tolerance,” she said.
She thought the babies deserved safe homes far away from addicted mothers. But then she realized that many of the mothers would at least try to kick their addictions if given an opportunity.
“These moms are most amenable to change during pregnancy. It’s the time they’re most motivated. They want to do what’s best for their babies. We need to enhance programs so they aren’t fearful,” she said. “The best solution to this problem is to head it off early on rather than when drugs have been a problem for many, many years. It’s also the best way of preventing abuse and neglect.”
Wells sometimes gets calls from physicians who are angry and frustrated with patients. In Boulder recently, a pregnant woman was using heroin and prosecutors wanted to charge her with a crime.
“We’re trying to avoid that. We don’t want women in jail. The best thing is to get them help,” Wells said.
‘I pray for a healthy baby’
At the Crossroads treatment center in Pueblo, Haley studies a grainy black and white picture from inside her uterus. She doesn’t know for sure, but is convinced she’s having a boy.
“They did an ultrasound to make sure he’s OK. I pray for a healthy baby. It scares me. I’m still early (in my pregnancy) so I probably haven’t affected him too much,” she says.
Haley started drinking at 16 and got a ticket the first time she ever got drunk. She was at the State Fair, slumped on the ground, vomiting.
On the night of her senior prom, she ended up in jail. Dressed in a blue silky gown, her hair in a glamorous up-do, she was drinking straight vodka and doesn’t remember the dance. Police picked her up later at an old boyfriend’s cousin’s house. The mug shot is a far cry from the prom photo she wanted to have.
“When I was drinking, I made so many mistakes. I would sleep with whoever. I lost respect for myself. Kids thought I needed to go to the hospital. My dad would come get me. He’d walk into a party and throw me over his shoulder.
“I have the best parents ever. I just went off on my own messing up. I’m the first in my family to ever smoke weed, to ever do drugs, to ever sneak out.”
Another time, she got drunk and suicidal over a boy. She kept calling and texting him until another girl answered.
“I hope you’re happy that you’re the last one who will ever hear my voice,” she told the girl.
Haley then drove to an overlook in Pueblo called Liberty Point and considered jumping. Police tracked her through her cell phone, found her and promised to get her help.
She ended up in detox, surrounded by scary, older men. One was punching the walls. Another kept hitting on her. Then a handsome young 19-year-old walked in. Carlos wanted help with his cocaine addiction. Haley saw him as her protector, her knight in shining armor.
Once out, they fell into each other’s arms. He helped her avoid alcohol. She helped him kick cocaine. They moved to Alamosa together. Unfortunately, after a couple of months, they found a new drug together: Percocet. She had tried it just before graduation. She said Carlos’ dad used it. It was easy to find all over town. They started blowing every dollar they earned on pills.
“At first you think, ‘the doctor prescribes them so they’re not that bad,’ ” Haley said. “It would kind of calm you down, make you nice and relaxed. Your bones would feel good. It’s a painkiller.
“After a while, we kept getting worse and worse. We’d have one every week, then one every day or two. We’d share it, then have our own: two every two days, three or four every day.”
They escalated, once smoking 16 pills at a cost of nearly $500 in a single day.
The young couple would try to quit, but going through withdrawal together made them testy and angry. It was far too easy to calm down or make up with a pill.
Finally, Haley decided to confide in her mother that she had a new addiction and needed help. She returned to Pueblo where she was able to get into treatment.
The program is intense with chores, multiple group therapy sessions and homework assignments. Weary from her pregnancy and an all-night chat with her boyfriend before she entered treatment, Haley kept nodding off in group therapy at first, earning her the nickname, “Sleeping Beauty.”
Some of the women at the center have court-ordered treatment. Haley says those women have little motivation to change. Some have already offered to hook her up with drugs as soon as they’re all out.
‘So much death’
Dawn Goodrich, a substance abuse counselor at Crossroads, said the center is unique because women can bring small children with them for residential treatment.
Unfortunately many who enter treatment remain resistant and 30 days won’t change that.
Many are dealing with outside stresses including poverty, domestic violence and a lack of family support. Counselors try to focus on what’s positive in their lives. For pregnant women, the arrival of a baby signals hope.
“We’ve had quite a few girls who will be with us and will come back once they’ve had their babies,” Goodrich said.
At the same time, she sometimes sees obituaries for women who have passed through their program, but failed to win the fight.
“I don’t think I’ve ever seen so much death in my life,” said Goodrich.
Opiates seem to be the most persistent problem now and communities throughout southern Colorado struggle with very high rates of substance abuse.
Altogether, over the last five years, Goodrich says she has learned that about 10 former patients have died.
“One woman was here with us for 30 days with her newborn. A year later she OD’d.”
Despite some depressing outcomes, Goodrich thinks treatment is vital for pregnant women struggling with addiction.
“It’s needed. It’s up to them to fight. We don’t have magic wands that we can wave and say they’re cured, but we’ve reunited families. We’ve given moms back to their children and children back to their moms.”
A happy life, a white picket fence
Martha, 34, says she wants more than anything to be there for her children again. She just completed the Crossroads program for a second time. She is also pregnant, just a week ahead of Haley. She’s expecting her fifth child. She already has lost custody of her older children, all of whom are boys and range in age from 5 to 14. The newest father is the fourth.
Martha grew up in Monte Vista. She recalls getting drunk for the first time at age 12 on a church trip, then at 16 she started smoking pot every day.
Half Native Mexican and half Anglo, she said she used to get called “nigger girl” and had no friends. Partying made her feel like she belonged. But her father, who is an Indian from Mexico, had terrible problems with alcoholism and Martha believes she inherited them.
“I would get really drunk and black out,” she said.
During previous pregnancies, Martha said she would always try to give up drugs and alcohol, but rarely pot. She said she’s smoke it her whole life, just like her mother, to decrease stress.
There have been times when Martha has been homeless. During one of those stints, she was staying with her mom and children in a Pueblo motel. Martha said she and her mom fell asleep while the two oldest were at school. Restless, the two youngest decided to go on their own to buy a toy at a Walgreen’s. They crossed a busy six-lane road to get there. Martha woke up and realized they were gone. She raced to the store. But, it was too late. A social services worker already had picked up the two young boys.
“After I lost the kids, I got really depressed,” Martha said.
Everything came to a head one night when she got so drunk a neighbor called the cops.
“I was completely out of control. I remember bits and pieces. I cut my head open. I was talking to one of the cops. I spit blood in her face and they charged me with two felonies.”
That was in March. Martha then spent 37 days in jail, where she learned she was pregnant again and qualified for treatment.
She acknowledges that her life has been a rollercoaster ride and that her older children are entitled to believe that she has abandoned them.
“It was a wakeup call, losing my kids. Going to jail and realizing I was going to spend six years away from my kids. It scared me. Life needed to kick me in the ass. It’s good being in treatment because it helps me to realize that I’m not just a screw-up. I have a problem. It’s a sickness and alcoholism is one of the worst ones.”
On the walls of the center are motivational sayings, like a poster that says: “Wish it. Dream it. Do it.”
Martha dreams of a life she’s never had.
“For once, I want to have a normal family with a husband who works and doesn’t do drugs. I don’t have to drink. I want a normal kid and a white picket fence and a nice house,” she said. “I want a happy life, maybe not quite Beaver Cleaver, but a normal happy life.”
Haley wants her child to have parents like hers.
“They’re so in love with each other, married for 25 years. They make it through everything with love and faith,” she said. “I wanted to come get help so that I’m not hurting my baby during my whole pregnancy. Once I have the baby, I don’t want social services involved.”
She has told Carlos that if they have any hope of being together, he’ll have to get clean and they’ll both have to stay in treatment.
“It’s really hard for us. Two addicts together just isn’t good. But I have a lot of hope in him.
“Maybe God is making this happen right now because he can see I’m trying to get my life together. I quit cigarettes. I quit soda. This is my baby. This is it. I’ve got to be really strong.”