In San Francisco County Jail Number 8, the 21 orange-suited women in the SISTER program are getting a lesson in self-esteem from Jackie Gordon, a onetime heroin and crack addict who did 18 months in California State Prison and has been clean and sober for six years.
"What limits you?" she asks. "You go so far and then you go back to what is familiar."
A light-skinned Hispanic woman named Carolyn raises her hand. "I don't know if you guys know it, but I'm on my way out of here. It's my fourth time going into a program and I always relapse."
She takes a deep breath. "There's always an excuse: Someone tells me I can't smoke and I say, this program is not for me. People irritate me. I irritate myself. I'm scared because I can't keep doing this.
"I'm lucky," she adds. "I'm going into a good program, and I don't know what's going to pop up."
A few minutes later, a guard gives Carolyn a nod. Clutching a crumpled brown paper bag, she strides up the aisle, throws her arms around Gordon and rushes out to freedom, and the unknown.
SISTER (Sisters in Sober Treatment Empowered in Recovery) is one of only a dozen or so comprehensive treatment programs nationwide for incarcerated women dependent on drugs and alcohol. Though there are hundreds of programs for male offenders, including an entire prison - the Sheridan Correctional Center in Illinois - dedicated entirely to drug treatment for men, resources for women are scarce.
America's 25-year war on drugs has taken an exorbitant toll, both human and economic. Drug arrests have tripled since 1980; as a result, the number of jailed drug offenders in 2000 equaled the total number of inmates in U.S. prisons and jails 25 years ago, according to The Sentencing Project, a research and advocacy group.
By most estimates, women have paid the highest price. Between 1977 and 2001, figures from the Women's Prison Association show a 592 percent increase in the number of women jailed, from 12,279 to 85,031. According to the WPA, the growth "corresponds directly to the mandatory minimum sentencing laws in effect since the early 1970s. Since more women are convicted for nonviolent, drug-related crimes than for any other, these sentencing policies have had a particularly profound effect on women."
Though men still far outnumber women in arrests for drug-related crimes, women now represent the fastest-growing prison population nationwide for drug offenses. In 1996, the number of female state and federal inmates in jail for drug crimes grew at nearly double the rate of males. In New York State, whose Rockefeller Drug Laws are among the harshest sentencing laws in the country, nearly half of all women in prisons are serving time for drug-related offenses.
"It's increased dramatically. All the studies show it," says Elyse Graham, program manager of SISTER, a collaborative project of the San Francisco Sheriff's Department and Walden House, the largest therapeutic drug community on the West Coast. "We're seeing cycles and generations of women who are addicted and in our jails. We see mothers and their daughters, sisters, cousins, and maybe now their children who are in foster care. The cycle is continuing and that's pretty disheartening."
"Women have become the silent casualty of the war on drugs," says Malika Saada Saar, executive director of The Rebecca Project for Human Rights, a national advocacy organization that works with low-income families on issues of substance abuse, criminal justice and the child welfare system.
In fact, 70 percent of women in jails and 65 percent of women in state prisons are mothers of minor children, according to the National Institute of Corrections. Not surprisingly, 80 percent of children in the foster care system are the offspring of incarcerated parents.
When the National Center on Addiction and Substance Abuse at Columbia University analyzed the costs of alcohol and drug abuse in a 2001 report, it concluded that the 50 states spent an incredible $81.3 billion in 1998 alone. Of every dollar spent on substance abuse, it found that 96 cents went to "shovel up the wreckage" brought on by addiction and substance abuse, while only four cents went to prevention and treatment.
Today, with addiction now widely accepted as a public health problem - - among the nation's top 10 - experts question the value of imprisoning a chronically ill woman at a cost of $30,000 a year and placing her children in foster care for another $30,000.
"We are approaching a chronic illness as an acute model," says Michael Flaherty, executive director of the Institute for Research, Education and Training in Addictions at the University of Pittsburgh. "As if it were a cold."
Approaching addiction as a chronic illness like diabetes or hypertension upends the whole dialogue in the professional community about the relapse of drug abusers. Instead of seeing addiction as a moral failure, it becomes a disorder that requires continuing care.
"What we're trying to do is change the approach entirely," Flaherty says. "All the science says that if you don't give someone at least a 90-day continuum of care, it's an economic and clinical waste. That's why the relapse rates are so high."
When, in 2001, the federal Center for Substance Abuse Treatment evaluated 50 residential treatment programs designed specifically for substance-abusing women who were pregnant or the mothers of infants or young children, the results were better than anyone had anticipated. The study showed an 84 percent reduction in the risk of low birth-weight babies and a 67 percent reduction for infant mortality.
Even more telling, 60 percent of participants reported being alcohol- and drug-free during the six months following discharge, and only 7 percent of participants arrested for alcohol-or drug-related offenses.
The longer a woman stayed in treatment, the better her chances of recovery. There, the statistics also spoke volumes: 68 percent of those in treatment longer than three months remained clean and sober, compared to 48 percent of those who left within the first three months. And only 9 percent of those with longer stays were arrested, compared to 20 percent of those who left earlier.
Long-term care is cheaper, too. A California study found it costs seven times more to imprison and take children away from a drug-abusing mother than it does to break her of her addiction with long-term residential treatment.
Yet those programs are a rarity. In Washington, D.C., where thousands of women -- and men -- are addicted to crack cocaine, only one such program exists, the Community Action Group's Family Treatment Program, with 14 beds.
"Many women say it's easier to wind up in prison than to get treatment," Saar says. "Treatment programs are turning women away because they have children. Or they're pregnant. And if they do go into a single adult program, they're often unsuccessful because their children aren't with them. So they spiral down further and eventually wind up behind bars."
That's what happened to Lorna Hogan of Silver Spring, Md., two weeks after giving birth to her fourth child in 2001. By then, she'd had a 13-year run with crack cocaine, had been in and out of jail, and made several attempts to quit. Her latest effort had been met with outright rejection from a six-month program that wasn't equipped to deal with children.
Drug treatment programs were designed with men in mind. For years, many refused to even admit women and those that did typically used a confrontational approach that drove many women away.
As the study of female addiction has come of age, one of its main tenets is that women have a different relationship with alcohol and drugs than men. For women, substance abuse all too often is bound up in a history of domestic violence, childhood sexual abuse or physical and emotional trauma. Symptoms of post-traumatic stress disorder are widespread. And that understanding plays a key role in the kinds of treatment that work -- and don't work -- with women.
"You take a female who has been traumatized and raped, and shame them for some infraction of the rules, they'll split," says Randy Muck, lead public health advisor for adolescent drug treatment at the federal Substance Abuse & Mental Health Services Administration.
Men are another big reason why women leave treatment.
"Relationships are the No. 1 issue that takes women out of treatment," Jackie Gordon tells the women of the SISTER project. "Right?"
A murmur of assent runs through the room.
"You get into a program, you feel good about who you are, you have a routine every day. And then the first time someone shows an interest in you, you get defocused."
In fact, many women not only choose relationships over treatment; they choose them over freedom. According to the National Advocates for Pregnant Women, women often incur long sentences because they are unwilling or unable to give prosecutors evidence about a husband's or boyfriend's crimes and connections.
The loyalty they show isn't necessarily returned in kind. Incarceration puts a special stigma on a woman.
"You see it when you go to the D.C. Jail," Saar says. "There are always far more family members visiting the men than the women. There's an attitude that because they are mothers, they have done something terribly wrong. They're stigmatized."
The last time Hogan was released from jail, she discovered that her children had been dispersed to different group homes throughout the District of Columbia. She begged a social worker for help, admitting to almost everything she had ever done. Hogan was fortunate. The social worker referred her to a family treatment program for women at the Center for Mental Health in southeast Washington.
"She told me what I needed to do," Hogan says, "and that's exactly what I did."
For the next 18 months, she underwent routine drug testing; took parenting classes; and received individual therapy, domestic violence counseling, and training in jobs skills and life skills.
"But I think the thing that helped me most was hearing the accomplishments that the other women described in group meetings," Hogan recalls. "A lot of them had lost their kids and were getting them back. They were getting their own housing - not transitional housing, but real places to live. There were women going back to college, or maybe they had never finished high school and were getting their GED. It gave me encouragement."
Her story had a happy ending: she got her children back; she found a house, she got a job.
Today, as associate director of the Rebecca Project's parent advocacy group, Sacred Authority, she regularly goes to Capitol Hill to tell her story and advocate for comprehensive family therapy.
"I wanted to get my life together so bad, but when you don't have the right type of treatment, you feel hopeless," Hogan says. "That door was open for me. And I am so grateful."
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