A day after her son Asher was born, state social workers paid a visit to Amber Johnson in the hospital. She had tested positive for meth, marijuana and painkillers during her pregnancy and, fearful she would lose her son, told them about her addiction.
“I’d never talked to anybody about it before, but I just opened up about what was going on,” Johnson says. “I was honest with them that I did have an issue and that there was also domestic violence issues going on at home, and that I was just stuck in a really bad situation.”
Three weeks later, Asher was taken into protective custody along with his sister, Indica. Johnson was devastated.
“It was the most excruciating thing I’ve ever been through in my life,” Johnson says. “I felt like my life had ended. I didn’t even feel like a person anymore. I was just like a shell.”
Since 2011, the number of Missouri infants born dependent on opioids has more than quadrupled. At the same time, the number of children entering the foster care system has increased, and experts think that’s connected to parents’ drug use.
Turning old ideas upside down
Kansas City health and social service groups are now trying to reverse these trends with a strategy that turns upside down old ideas about children and parents who’ve used drugs.
In short, they’re working to keep those families together.
After Johnson’s children were taken from her, she moved into a domestic violence shelter and entered an intensive recovery program with one goal in mind: getting her kids back.
“I basically just dedicated my life to changing my life,” Johnson says. “I had nothing else. My kids were everything to me.”
Children’s Mercy Hospital neonatologist Jodi Jackson says the birth of a child can be an opportunity for transformation, even for women who’ve used drugs for years.
“The maternal-infant bond is strong enough that that gives us our chance to get in and now we can actually do something,” Jackson says. “Don’t do it for you. Do it for your baby.”
That opportunity for transformation can be squandered, however, when the children of mothers in recovery end up in foster care.
Removal is hard on the children, too. Foster kids are at high lifetime risk for depression, anxiety and behavioral and learning problems.
Keeping families intact
Sarah Knopf-Amelung, a senior research associate at the University of Missouri–Kansas City School of Nursing and Health Studies, is an organizer of KC Perinatal Recovery Collaborative, which provides drug recovery, housing, counseling, job support and education services to mothers in recovery.
“The substance use disorder we’re now seeing is a disorder,” Knopf-Amelung says. “It’s a disease. And we wouldn’t remove a child because a parent has diabetes or heart disease. So similarly, we’re advocating for trying to provide the proper treatment and recovery supports to the mother so that we can try to keep the family intact.”
It’s costly care, funded by a patchwork of federal, state and private agencies, that may be required for years.
But Dr. Jackson says the payoff can be immense. Mothers in recovery who can stay with their children are far more likely to stay sober, which can put an end to generational cycles of substance abuse.
“That’s the vision we need to have,” Jackson says. “It’s like break the cycle and we reduce the costs of foster care and state intervention and the cost of supporting a woman who’s nonfunctional. So, in the long run, it’s incredibly beneficial to do this.”
Potential for abuse
But the approach is not without risks. After all, some of the most common drugs to treat opioid addiction, like methadone, are narcotics themselves.
“There is the potential for abuse,” says Stacee Read, director of development for the National Alliance for Drug Endangered Children, which aims to protect children from potential abuse and neglect that can occur when a parent uses drugs.
Treatment with methadone and other recovery drugs is usually closely monitored, but it can go off the rails.
“If mom goes to the doctor, and they don’t see her take the medication, if mom leaves there and then sells it on the street for money for something else, that becomes an issue and we do see that quite a bit,” Read says.
Read thinks programs like the one in Kansas City can work very well given the presence of treatment clinics, recovery homes and sympathetic employers.
But in many small towns and rural areas hit hard by opioids, the same kind of program can be much harder to implement.
“The parts of the country that do not have accessibility that some of the larger cities would have become a problem for families. Not only with addiction but with a lot of other things as well,” Read says.
It took three months of hard recovery work, but Amber Johnson was finally able to get her kids back.
Red-headed Asher is now 3 years old and the family lives at Amethyst Place, a recovery home in Kansas City.
Johnson is studying interior design and her family is healthy, although Johnson worries at times about whether her past drug use may have long-term effects on her son or if her recovery might falter someday.
“Do I think I’ll relapse? No,” Johnson says. “But I’d be lying if I said that that doesn’t cross my mind. I think that since I’m an addict, it’s going to be something that I’m going to live with for the rest of my life.”
But right now, all the signs point to the children and their mother being better off. They are, after all, together.
Alex Smith is a health reporter for KCUR. You can reach him on Twitter @AlexSmithKCUR