Health is the part that’s tangible. You stop using, and the shaking goes away, sleep comes back in bits and pieces, and the family says she looks better. That’s good. But the body is the very smallest element of that. Underneath that is a lapsed lease, a suspended license, a child who jumps at the phone, a bank account that’s completely empty. Recovery from SUD doesn’t begin at zero. It begins in debt, and that debt is as real as it is medical.
Women often carry a heavier burden in specific ways. Many are the primary carer, so going into treatment means finding someone to look after the kids or simply not going at all. A lot of them have trauma histories (often histories of violence and abuse) which research has shown to be linked to substance use in women; treatment that doesn’t take that history into account is likely to come to a standstill.
Fear is another factor. Some women will avoid care altogether as a result of the fear that making a disclosure will result in child welfare services being involved and that can happen. Pregnancy intensifies all of these concerns. None of this is a character issue. These are all obstacles, predominantly structural and very much amenable to solution.
Disclosure: Contributed post.
Not One Problem at All: A Pile
A MAT program for women, when it’s built properly, goes after many of those obstacles directly. MAT combines medication, usually methadone or buprenorphine, with counseling. Sounds straightforward. But the evidence behind it is remarkably strong. Large studies have linked both medications to fewer overdose deaths. People also tend to stay in treatment longer. And that matters. A lot.
Some clinicians now prefer the term MOUD (medication for opioid use disorder). Same treatment, different emphasis. The medication isn’t some optional add on. It’s absolutely at the heart of the care.
Child Care
Women’s programs often go beyond the standard clinic. On-site childcare, for example. Prenatal appointments all in the same place. Counselling which is aware of trauma and the fact that many of the women coming into treatment have experienced it.
Support During Pregnancy
Pregnancy makes this even more complicated. You’d be forgiven for thinking that the absolute safest thing to do would be to stop the opioids completely. The ACOG actually recommend methadone or buprenorphine over withdrawal alone. Why? Because the management of withdrawal without ongoing treatment is associated with a very high risk of relapse and relapse in this situation can be dangerous for both mother and baby.
It sounds utterly counterintuitive, yet that’s the medical advice we have.
The med doesn’t do the job all by itself. It deals with the craving and the withdrawal. The rest of life is still up to you.
Access is really thin though. For women childcare is stacked on top.
The Practical Rebuild
Early recovery is almost entirely paperwork. Court dates, fines, back rent. A license is suspended following a conviction, the credit file is a minefield of collections and there’s a gap in your work history that every application will ask about.
The Importance of Save Housing
Housing is the first real hurdle. Without a stable address you miss appointments and it’s very difficult to safely store medication. Work comes slowly. Some women will need training before an employer will even consider them, others will just need a reference.
Daily clinic visits can be the death of a new job which is one of the reasons the recent rule changes are so important. Congress removed the federal waiver requirement for prescribing buprenorphine at the end of 2022 so that any GP can now prescribe it. The federal rules which were finalized in 2024 also maintained the pandemic-era take home flexibilities for methadone. Fewer trips. Fewer lost shifts.
Regaining Physical Health
Physical health doesn’t wait its turn. Untreated hepatitis C, bad teeth, the depression that was there all along etc. all come up in the first few months once you’re stable enough to actually notice. The clinics that treat the physical health issues in conjunction with the medication will of course save a woman the bother of running to five different offices.
The Benefits of a Case Manager
A case manager who knows which office to call can actually save a month. Seriously. All benefits applications, all legal aid referrals, all housing waitlists are governed by deadlines and forms and you simply don’t have the time to be handed a form in the early stages of recovery with no support whatsoever.
The Financial Situation
Money is even slower. Debt incurred in the ‘using’ years isn’t put on hold for treatment. You’re on payment plans with a secured card, boring stuff which slowly gets you back into the mainstream economy.
Rebuilding Trust And A Sense Of Self
Trust breaks quickly and takes a long time to mend. Families who’ve been lied to or frightened don’t go back to normal because she has the ninety days. Some women hear that line from relatives, some from peer groups, a few from staff. It’s a line that wears.
What about Babies Born on Methadone or Buprenorphine?
Babies born to mums on methadone or buprenorphine will go thru neonatal opioid withdrawal syndrome. It’s expected, it can be treated and increasingly it’s being managed with mum and baby together. It’s not evidence of neglect, which is a distinction that child welfare systems have been slow to grasp.
The Social Aspect: Abonndon Friends, Welcome Peers
Then the quieter job of working out who she is without the substance. Her friends from the using days were often her only friends so leaving them is loneliness first and freedom later.
Peer support is of immense value whether it’s a recovery coach or a woman a bit further down the track. Researchers talk about a person’s recovery capital which is the sum of all their resources (social network, stable housing etc). A dry term, but a very useful one as it explains why two people on exactly the same medication can have such vastly different years.
Recovery Time Differs
There is no standard end date for medication. Some women will be on it for months, some for years. A common way back to use is to just stop early without any plan. That decision is the patient and prescriber’s decision. It shouldn’t be dictated by a court date or an insurer’s cap.
Relapse Rates
Relapse gets a straight answer. The NIDA figure on relapse rates for substance use disorders is in the region of 40-60% which is very much in keeping with the rates for other chronic conditions such as asthma and hypertension. That’s not a failure. That’s a signal to tweak the treatment. The programs that see it that way keep people. The programs that discharge people on a positive screen lose them, possibly for good and with the added risk of overdose given the rapid drop in tolerance post lapse.
Never Give Up
Progress rarely looks like a clean line. A woman keeps clinic appointments for six months. Signs a lease in her own name. Sees her son on Saturdays then Saturdays and Sundays. Pays off a small fine. Nobody outside notices any of it, and that’s mostly how it gets done.
Featured photo source: Pexels
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