Help Is Hard to Find for Addict Mothers : Drug Use ‘Epidemic’ Overwhelms Services

Short on money, short on services, too often short on understanding, San Diego County is making a fitful start at confronting the growing problems posed by pregnant women who abuse alcohol or drugs.

Amid what one physician calls “an epidemic� of cocaine and amphetamine use by young women, San Diego-area hospitals and health agencies say the number of pregnancies complicated by maternal drug use has doubled or tripled in the last year.

The cascade of addict mothers and high-risk newborns has exposed yawning gaps in the systems designed to protect children and salvage families, health experts say.

One example: Prenatal care programs in San Diego turn away four pregnant women for every one they treat. And another: Women addicts must wait up to six months for one of just 26 slots in residential rehabilitation programs where they can live with their children--the programs experts say offer the best chance for success.

Only recently have the professionals who deal with substance-using women--doctors, nurses, hospital and county social workers, treatment experts and prosecutors--begun to talk to one another in earnest about how best to intervene on behalf of mothers and babies.

Too frequently, officials acknowledge, the failure to communicate has meant no one acted until a child was already harmed--either prenatally by maternal substance use or after birth by the mother’s abuse or neglect.

“What San Diego needs to hear is that we have a problem here, and we haven’t even begun to develop the services that are going to make this any better,� said Dr. Suzanne Dixon, an associate professor of pediatrics at UC San Diego Medical Center.

Vivian Vallarta, 24, of El Cajon does not need to be told how hard it can be for an addict mother to get help.

She started using drugs when she was 13. From “huffing� paint with other cholas --tough Chicano girls--she went on to use heroin and cocaine. When she was pregnant seven years ago with her daughter, she briefly quit.

But parenthood was more than Vallarta could handle. Her drug use became constant. She turned to streetwalking and stealing to pay for her habits. “If I wasn’t getting busted for under-the-influence,� she said, “I was getting busted for prostitution.�

In the Las Colinas women’s jail two years ago, doctors told Vallarta that she was pregnant again. It was not until her fifth month that she stopped denying the pregnancy, she said. Vallarta wanted an abortion then, but was told her pregnancy was too far along.

Hoping to protect the fetus from the effects of heroin, she signed up for a government-sponsored methadone program. When she missed a doctor’s appointment, her physician told her to find another doctor. And when she began missing methadone treatments, the clinic asked for notes from the doctor who would no longer see her.

Unable to get methadone, she went back to using heroin and cocaine. Her son, Tomas Sainz Jr., was born in May, 1985--addicted to both.

“As soon as they cut the umbilical cord, he had the shakes,� Vallarta recalled. “They gave him barbiturates for five days and penicillin for two weeks after that.�

A grandmother took custody of the child. Vallarta continued to use drugs, and she ended up back in jail.

It was only then that she stopped falling through cracks. Tomas’ social worker put her in touch with the staff of KIVA, the larger of the two county residential drug treatment centers for women. The day she was released from Las Colinas, “they were there to pick me up,� Vallarta said.

Now, a year later, she is continuing in the rehabilitation programs run by the McAlister Institute for Treatment and Education, KIVA’s parent organization, and she is enrolled at Grossmont College. She is warm, well-spoken and attractive. But Vallarta is bitter about having had to struggle alone for so long and about the consequences for her and her children.

“I was looking for help, but it was like there was no help available,� she said. “Nobody told me about any programs. No doctor would even see me.�

Vallarta’s years without assistance are more typical of the lives of substance-abusing women in San Diego than her finally getting some help, health professionals say.

No one even knows how many local pregnant women have drug or alcohol problems. One guess, by a nurse-consultant from San Francisco, is based on national projections and estimates that there may be as many as 3,700 women of childbearing age in San Diego County with drug- or alcohol-related problems.

But without county statistics--they are not collected for lack of funds--health officials can only draw from their own experiences to gauge the extent of the problem. And the anecdotal evidence says that it is growing:

- At UCSD Medical Center, Dixon says she is seeing as many as three to four times the number of drug-exposed babies at the hospital full-term nursery as a year ago. She treats 12 to 20 such infants each month.

- Referrals of drug-exposed infants to county public health nurses for home health visits also have doubled in the last year, according to Dr. Georgia Reaser, chief of maternal and child health for the San Diego County Health Department.

- In prenatal questionnaires, 15% to 20% of pregnant women seen by physicians at Kaiser Permanente Hospital admit abusing illegal drugs or alcohol, said Dr. Patricia Bromberger, a Kaiser neonatologist.

Kaiser patients are more likely than those at UCSD to get prenatal care and to stop using substances when warned of their potential for ill effects. Nonetheless, Bromberger said, there are one or two patients each week who have illegal drugs in their systems when they give birth.

Although the pregnancies of poor women are often complicated by poor prenatal care and unstable life styles, substance abuse during pregnancy is not confined to women of lower socioeconomic standing.

“I’ve had my share of heroin addicts from La Jolla also, where the private physician has denied this woman can have a problem,� said Lydia Roper, a UCSD Medical Center social worker. “Or she’s said she’s on methadone and she’s OK. Or she says she only used cocaine in the first trimester and the doctor never asked her again how she was doing.�

Generally, though, many pregnant substance abusers never see a doctor until they are ready to deliver. With no organized efforts to reach out into high-risk communities and no room in state- and federally funded prenatal care programs, San Diego County is virtually bereft of the preventive services health experts insist are essential to reducing the number of drug-exposed babies.

“Many women are waiting until they’re in an emergency delivery situation and can’t be turned away,� said Ann Bush, director of the Comprehensive Perinatal Program, the county’s state-funded clinical care program. In a recent three-month study period, the program turned away four patients for every one it could accept. “Particularly in the case of alcohol or drug abuse, the baby fetus is compromised by that time.�

Arrival at the hospital does not resolve a problem that has worsened during nine months of a drug-exposed pregnancy. Instead, confusion has reigned in the San Diego medical community about how to handle such a mother at the time of birth.

Hospitals have varying policies on testing newborns for evidence of maternal drug use. Hospital physicians and social work departments differ about whether to report all cases of apparent drug exposure to the county Child Protective Services agency. CPS decisions about when and how to intervene have been inconsistent, too.

Over the last year, the confusion has become worse, health professionals say, as drug-use patterns have shifted. Until this spring, CPS used the indicators of heroin withdrawal as its standard for whether to intervene in a case of maternal drug use. But those symptoms are absent in a mother who has used cocaine or amphetamines during pregnancy, and hospitals have lacked guidance about whether to seek intervention if traces of those drugs show up in an infant’s urine.

As a result, a dangerous hesitancy has gripped the reporting system, officials say.

“The concern is that we have not been involved where we need to be involved,� said Melinda Lasater, chief of the Juvenile Court division of the district attorney’s office, which represents CPS when it seeks to make a child a ward of the court. “You have people who believe the next step in the system won’t act if you don’t have ‘A’ and ‘B,’ so they just don’t take ‘A’ and ‘B’ to the next step of the system.�

A study by two social workers of CPS’ contact with 113 drug-exposed pregnancies between 1981 and 1984 provides indications of the weaknesses of the system.

Nearly half the families were reported back to CPS after taking their infants from the hospital, the study found--one third for continuing maternal drug use, another third for neglect (although fewer than one in 10 were for physical abuse). Ultimately, about 35% of the children became wards of the court, according to JoAnn Pierson Knox, a Grossmont District Hospital social worker who helped conduct the study.

The findings gave ammunition to a campaign by doctors and social workers to begin sorting out the problems in the intervention system.

In April, Lasater convened a task force of doctors, social workers, county and court officials and prosecutors to establish guidelines for intervention and to lessen the distrust among the parties who must work together if the risks to drug-exposed children are to be reduced.

CPS, in the meantime, had already begun moving toward the broader definition of a maternal drug problem urged by health experts.

“They were very narrowly focused. If the baby didn’t have a positive toxicology screen, they wouldn’t take the case,� said UCSD’s Dixon, whose complaints to Dist. Atty. Edwin Miller prompted the establishment of the task force. “Now they’re looking at the whole family context, trying to make some judgment about whether the family has the resources to raise the child and what the child will need over time.�

A subsequent review of 26 drug-exposed births in March and April showed a larger proportion were getting attention from CPS, Knox said. “More kids will become dependents (of the court) that should have been dependent,� she said.

But Dixon, Knox and others who deal daily with perinatal drug problems say that it is not enough simply to make CPS intervention more consistent.

There needs to be earlier contact with women at risk for substance use during pregnancy, experts say, so that their first contact with government is not a threat--delivered at a time of high emotion--that they could lose their babies.

“A family that has a chemical dependency problem cannot be expected to solve that problem without extraordinary input from the outset,� Dixon said. “To sit around and wait until there’s a family failure is not the way to go about this.�

Mothers see CPS as a punitive agency and are wary of doctors and social workers. “Our name is already mud out on the street,� said Roper of UCSD, “because they think they come to UCSD and we’re going to take their baby away because we screen very closely.�

Some social workers say the antagonism has increased with the prosecution by San Diego County authorities of Pamela Rae Stewart, the El Cajon woman accused of contributing to her infant son’s death by ignoring a doctor’s advice and using illicit drugs during her pregnancy.

“I have women calling me up and asking me, ‘Am I going to be put in jail because I have told you honestly about my drug abuse problem?’ � Roper said. Prosecutors now say drugs play only a minor role in the Stewart case but acknowledge that they hope that the extensive publicity given the charges results in better care for fetuses and infants.

Meanwhile, a glaring shortage of services for mothers who abuse alcohol or drugs hampers intervention in drug-exposed pregnancies.

San Diego County sued the state in July, challenging the aid allocation formulas that rank the county last in California in per capita funding for mental health, alcohol and drug programs.

Pregnant women and new mothers, in turn, rank low when it comes to dispensing the $7.3 million the county has to spend on combatting drug and alcohol abuse.

The county drug program office has about $250,000 in its budget this year to serve pregnant drug users and addict mothers--nearly all for a part-time counselor at a Chula Vista clinic and for treatment at KIVA.

The office has a $2-million wish list for additional programs, but aid for drug-using pregnant women, whose numbers are small in contrast to other groups of users, does not make the first cut.

“We see it as a gap in our services,� said Melinda Newman, administrator of the county office, which has virtually the same budget this year that it had in 1973.

Spending cuts imposed by Gov. George Deukmejian scuttled county alcohol program office plans to start a fetal alcohol syndrome prevention campaign, according to Bob Reynolds, program chief. Reynolds is preparing a report on initiatives the county could take to combat drinking by pregnant women. But for now, he said, the county spends nothing to counter maternal alcohol abuse, the third most common known cause of birth defects.

“The services available to women with children are just practically non-existent,� said Jeanne McAlister, executive director of the McAlister Institute. “And for pregnant women, they are non-existent.�

Women alcoholics and drug addicts can wait up to six months for a bed in a residential treatment center, and even longer if they want their children with them in a program that both combats addiction and teaches mothers to cope with the responsibilities of parenthood. The county’s two residential programs--KIVA, with room for 22 women but only eight children; and the Salvation Army Family Recovery Program, with space for four families--are oversubscribed.

Daphne Halkias, clinical director of the Salvation Army substance abuse programs, cannot maintain a reliable waiting list for the family program. Many women who do not get in when they first call never call again, she says.

“It’s really hard to wait,� Halkias explained. “When you need treatment, you need it now.�

Lacking cash to help solve the problem of maternal substance abuse, county officials and drug experts are left to devising rhetorical attacks, dreaming up model programs and hatching schemes to raise the money to pay for improved services.

County supervisors in October passed an ordinance requiring retailers of alcoholic beverages to post signs warning pregnant and nursing mothers of the dangers drinking can pose to fetuses and infants.

In April, the drug program office established the San Diego Council on Pregnancy and Chemical Dependency, which is composed of professionals in alcohol and drug treatment and prenatal care. The council hopes to gather statistics on mothers who abuse alcohol or drugs, train doctors and other professionals to recognize chemical dependency and to act as an advocate for additional services, according to drug counselor Cathy Hauer, its co-chairwoman.

Hauer and Newman say they know what kinds of programs need to be developed. Newman would add women’s specialists in the county’s regional drug programs and hire peer counselors--ex-addicts who would look for drug users in their neighborhoods and make sure they got prenatal care and drug treatment.

That, of course, would require more treatment programs. Hauer envisions new residential programs where a pregnant woman could get drug treatment, then remain after delivery to learn to be a parent in a drug-free setting. Short of that, she pictures a women’s center offering outpatient drug treatment as well as programs to improve self-esteem, job training and referral to other services.

In the end, however, the best program is of little value unless drug users want to get better.

Ask Vivian Vallarta. She walked into Jeanne McAlister’s office Tuesday to confess that she had slipped back into drug use. “I started in the same pattern--lying, stealing and cheating--and then I ended up using,� she said Wednesday.

It’s a major setback in her rehabilitation. But Vallarta is not starting over from scratch at KIVA.

“This program messed up my using. There’s no way I can go out and use and enjoy it,� she said. “I can’t even live with my lies.�