I ndi Islam spent her late 20s in the hazy abyss of addiction. It began with painkillers,prescribed after a car accident when she was 25. Then she turned to black-market oxycodone.
At 26, she gave birth to a son, whom she'd leave with her mother for weeks at a time, high on the heroin that eventually replaced the first two meds.
One day last spring, she found herself without money or a phone, or anyone willing to house her. She spent her first night on the streets, on a park bench.
"That was God's way of telling me that it was over," said Islam, 29, slim and soft-spoken. The next morning, she said, "I called my mom and said: 'I'm done.' "
It's estimated more than 20 million Americans suffer from severe drug addiction. In Philadelphia, there are at least 55,000 opioid addicts alone.
One of the reasons it's so difficult to stem the tide of addiction is that the decision to stop is only a first step. Recovery is a complicated long game that hinges on many factors, including the quality and fit of available rehabilitation programs.
Islam thinks she's found the right one for her. "This place saved me life," she said toward the end of last year, looking around the sparsely furnished meeting room of Family House NOW (New Options for Women), a residential treatment center in a large brick building in West Philadelphia. "It sounds cliché," she said, "but it really did."
Key for Islam is that Family House NOW, founded in 1995, is one of approximately 10 substance abuse treatment programs in the Philadelphia area where women can live with their children. The model was born out of the crack-cocaine era, when the women's health advocacy community, along with a few obstetricians, started realizing that the punitive and isolationist models of rehab - separating addicts from any possible triggers, including familiar people and places - wasn't working for pregnant women or mothers. The fix seemed intuitive: keep mother and children together so the family can recover as a unit.
Today, nine women can live for an average of six to nine months with up to two children each at Family House NOW, which is operated by the nonprofit services provider Resources for Human Development. The days are long, beginning at 5 a.m. Moms must ready their kids, prepare breakfast, and drop their little ones at the in-house day-care or at the bus for school, all before 7, when they leave for their drug treatment at city hospitals or clinics. (Eight out of nine current residents are coming off an opioid addiction and receive daily methadone doses.)
The women return by 9:30 a.m. for a full day of classes (nutrition, healthy relationships, and more), trauma-informed psychological support sessions, and group therapy. There is a consistent focus on parenting skills, too. The idea, said Raymond Harrod, Family House NOW's director, is to "teach responsibility and budgeting and more, all while they are taking care of their kids so that it's not a shock to the system when they leave and have to learn it all over again."
At 3:30 p.m., moms pick up their children and enjoy downtime or do homework before a group dinner cooked by one of the residents.
The rigorous schedule is worth it, said Shannon Mantz, a 25-year-old first-time mom to 8-month old Damien. "I always spend five to 10 minutes playing and laughing with him in bed in the morning," she said. "Those are the little things that I like, the things that keep you going." Mantz has not been high since Damien was born - her longest clean stretch since she started using the summer before ninth grade. "Every single time I've been in rehab, I've always had plans to go and relapse as soon as I left the doors," she said. "But I think it's because I really didn't have anything to necessarily live for. It's different when you have a kid."
That sentiment resonates with Olivia Silber Ashley, director of risk behavior and family research at RTI, a research institute in North Carolina, who has studied mother and child addiction treatment. Though the data are limited, Ashley said the existing studies "are pretty compelling in terms of markers of success." Overall, she said, graduates of these programs are generally more likely to be abstaining, employed, in custody of their children, and in support groups than women in traditional rehabilitative settings.
It's also likely that the existence of these programs has increased the number of those who enroll in treatment. Hallam Hurt, medical director of the Special Babies Clinic at Children's Hospital of Philadelphia, remembers when choosing treatment meant leaving children behind. "That's a huge emotional decision and sometimes a very practical one, in terms of who would you leave them with?" Hurt said. She said she recalled countless women effectively refusing treatment with one sentence: "But how can I leave my kids?"
Experts are at pains to emphasize that children aren't just a tool for mom's recovery; they benefit, as well. "In the best programs, kids are clients in their own right," said Nicole Edge, an associate professor at the University of Arkansas for Medical Sciences who's been monitoring the experience of mothers and children in residential programs for almost two decades. "This is really an opportunity to assess the child's needs. Most of these kids have experienced a variety of traumatic events," she said, and good mother-and-child facilities draw up treatment plans for the children, too, if needed.
There is, of course, no magic bullet for addiction. On average, only half of Family House NOW residents successfully complete the program. According to the National Center on Addiction and Substance, a 70 percent to 80 percent dropout rate is typical. Mother-child centers also are costly, mainly because they are staff-intensive: between child-development specialists, therapists, and daily staff, Family House NOW has more workers than adult residents.
Ashley Brunson was 23 with a newborn daughter when she spent more than six months at Family House in 2008. And although she relapsed about a year after graduation, she credits the "relapse prevention plan" she created as a Family House participant with getting her back on track.
"At Family House, I learned how to ask for help when I need help," she said, "And that it's OK not to be OK." To expect that every participant will be sober for the rest of her life would be unrealistic, said Harrod. "We're talking about addiction here," he said. "We're talking about a disease, an illness."
Every resident develops a posttreatment personalized housing and employment plan. On a December afternoon, Islam, with son Masood nearby trying his hand at a gingerbread house kit, spoke of her goals: college, to become a nursing assistant, and maybe eventually work with other women suffering from addiction.
Islam turned her attention to the gingerbread house but couldn't get the cookie walls to stay upright. Another resident, noticing she was having trouble, leaned across the table to help. "Thanks," Islam said as the house began to take shape. "This is harder than I thought it would be."