What it’s like to be a mom with an addiction

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Danielle Almeida had just picked her teenage son and daughter up from school when the letter came in the mail. She had been waiting for it for years.

As the kids scattered to their own corners of the house, she ripped open the envelope in her kitchen. The informal arrangement Almeida had with her ex-husband was finally official — a judge ordered that they would have 50/50 shared custody of the children. She was going to make them dinner that night, and they were going to sleep in her house. 

“That’s what I had worked for,” she said recently. “That’s what I started this journey for.”

Just a few years earlier, her struggle with drug addiction had made it impossible for her to parent. She wasn’t even allowed to take her kids to the zoo without another adult chaperoning.

Today, Almeida shares her story with other mothers as a recovery coach at Southcoast Health’s New Beginnings Moms Do Care program in New Bedford, which provides services for new and expecting mothers who have struggled with addiction. The program’s patients connect with her because she’s been where they are, Almeida said.

“That substance use disorder just takes over,” she said. “I can totally relate with wanting to stop, needing to stop, but not being able to.”

Mothers struggle in Bristol County

Bristol County is a hotspot for mothers with drug addiction. It has the state’s highest rate of women dependent on opioids or anti-anxiety drugs during pregnancy. Experts aren’t sure why this area stands out, but they say mothers need extra resources that are in short supply here.

In 2020, about one in nine new mothers in Bristol County was dependent on opioids or anti-anxiety drugs, such as Xanax, during her pregnancy, according to Department of Public Health data. That number fell to about one in every 14 new mothers in 2023, but the county still leads the rest of the state.

Addiction service providers and state health officials have only theories about the drivers of drug use for Bristol County mothers. The broader drug epidemic has hit this area harder than the rest of the state, the experts said, so they reason that a high overall rate of drug use here would also show up in data on pregnant women.

“I think historically we’ve been on the drug corridor,” said Stephanie Perry, a registered nurse who does outreach work as the leader of the Southcoast Health’s Community Wellness Program. “There’s a supply, and there’s a demand.”

State data about drug dependence and pregnancy doesn’t differentiate between women taking drugs illegally and women taking drugs prescribed by their doctor, such as the addiction-treatment drug methadone. That makes it hard to tell whether Bristol County has a high rate of illegal drug use, or a high rate of women receiving addiction treatment drugs.

Why it’s especially hard to be a mom seeking recovery

Service providers believe many women in the area need treatment but aren’t receiving it. The South Coast doesn’t have enough resources for mothers trying to reach recovery, they said.

“I would love to see more services for pregnant women,” said Danielle Brown, the program director for the local addiction services provider Steppingstone.

Pregnant women and mothers who drop into Steppingstone have fewer options than other clients, Brown said. Addiction treatment usually begins with a stay in detox — but as a client’s pregnancy progresses, it becomes harder and harder to find a detox program willing to take her, Brown said.

Dr. Alfredo Gonzalez, medical director of High Point Treatment Center, which has a large presence in New Bedford, says it’s medically more appropriate for women in their third trimester to go through detox in a hospital. He said women in their third trimester need to get a health evaluation at an emergency room before High Point accepts them into its detox center.

“We don’t want to deliver babies in our detox unit,” he said. 

There are fewer treatment beds for women than for men, providers said, and very few programs are set up to accommodate women caring for young children. Women often forgo treatment because they don’t have another child care option, providers said.

Addiction treatment isn’t the only resource in short supply. Many women turn to drugs to self-medicate for mental illness, providers said, but the region doesn’t have enough mental health treatment.

Brown said pregnant women who are homeless call her all the time. But because the state’s family shelter system is full, there’s often not much she can do to help.

“When you’re out there with no place to go, what do you do?” she said. “You continue to use. To stay warm, to keep your mental health, to feel safe, you use.”

Southcoast Health is trying to close these gaps. This year, the hospital system expanded New Beginnings and moved it to a specially renovated office in New Bedford. The program has enrolled about 250 patients since it started tracking data in 2021.

The new office is designed as a one-stop center where mothers can be connected with any resources they need — whether that’s addiction treatment, obstetric care, or even diapers and formula. The program also provides spaces for mothers to meet with each other and build a circle of support.

Substance use during pregnancy comes with a heavy stigma, but program staff say it’s important to provide judgment-free help so mothers feel welcome, which keeps them coming back. 

Fear of losing custody creates barriers to recovery

Less than two days after Ashley Tavares gave birth to her son at a hospital in Worcester two years ago, a social worker from the Department of Children and Families took him away.

It was exactly what Tavares was afraid would happen. She found out that she and her husband were expecting while she was in a detox program.

“I was freaking out,” she remembered. “I thought, ‘They’re going to take my baby.’”

A detox nurse told her she could stay on methadone during her pregnancy — and she said it saved her life. Still, she worried. None of her four other children were living with her at the time because of her substance use.

After delivery, when her baby was no longer absorbing any of the methadone, Tavares’ usual dose hit her particularly hard. A nurse said she looked high, as if she had relapsed on illicit opioids.

“I know I looked like I was jammed,” Tavares remembers. She says she couldn’t get the health providers to lower her dose or give her a drug test to show she hadn’t taken anything else.

The hospital called the state’s Department of Children and Families, which put her baby in a foster home. For two weeks, Tavares was only able to see him at brief pediatrician visits.

“Losing your kid is the worst feeling in the world,” she said.

With a letter from her recovery specialist and a drug screening taken after she left the hospital, Tavares was able to show a family court judge that she hadn’t relapsed. She got her son back after two weeks of separation. Before he was born, Tavares and her husband had also regained custody of their 4-year-old daughter.

But last year, she was diagnosed with stage four lymphoma. Within a few weeks, she lost her husband to a drug overdose.

“Being a single parent, it’s hard,” she said recently, cleaning milk off the floor of her apartment from a spilled sippy cup as Bluey blared on their TV. “I never get time to myself.”

Tavares said she has stayed sober through the chemotherapy and grief so she can keep her children. One recent afternoon, she sat on the couch next to her daughter, with her son asleep in her arms. 

“I love my kids to death, and it took me years to get where I am,” she said with tears in her eyes. “Everyone told me I was going to fail and relapse, and where I am today — I’m crying happy tears because I never thought I could do this.”

Tavares said she wants to show other moms that it’s possible to get your kids back and stay in recovery, even in the most challenging of circumstances. A few years ago, she was living in a tent behind a Taco Bell. Today, she’s proud to live independently while caring for her kids.

Her story also highlights how Department of Children and Families investigations can affect mothers with substance-use disorder.

The fear of losing their children is a key reason many mothers avoid treatment, providers said. Brown, the Steppingstone program director, said she has firsthand experience — years before she became a treatment provider, she used illicit drugs while pregnant and didn’t tell her doctors.

“​​If I tell my doctor, they’re going to notify DCF and they’re going to take my child,” Brown remembers thinking.

Brown said she wasn’t able to break out of her addiction until much later, when she had lost her children and they were about to go up for adoption. 

New state law sparks hope

Providers say a recent change in reporting requirements is a step in the right direction.

Until recently, Massachusetts health care providers were required to file a report with DCF whenever a baby was born with a dependency on “an addictive drug.” Critics of the rule say it led to unnecessary, traumatizing investigations for women who were in stable recovery and taking prescribed opioids like methadone to treat their addiction.

But late last year, state lawmakers updated the rule. Under the new law, mothers taking prescribed addiction treatment medicines won’t be subject to automatic reports when other warning signs aren’t present. Instead, doctors and nurses can decide whether to file a report based on a more comprehensive assessment of the child’s safety. 

Local providers said the new rule may steer more women into treatment and prenatal care. They also hope it will de-stigmatize the use of lifesaving treatment medications like methadone.

“We don’t want the message to be, ‘Don’t go in there or you might lose your kid,’” said Sherry Ellis, CEO of SSTAR, a Fall-River based treatment network.

A spokesperson for DCF said the agency is currently rewriting its guidelines to comply with the new law.

The change recognizes that addiction is treatable, said Kim Shapiro, the agency’s substance use director. DCF supports medication-assisted treatment as a pathway to recovery, she said.

“We want parents to have healthy, happy infants and work with their providers to make the right choices for them during their pregnancy,” she said.

Providers said DCF involvement can still be necessary, and often helpful, when a mother is still in active addiction. In addition to placing the child in a safer setting when it’s appropriate, a case worker can connect parents with resources and help them make a plan for recovery.

How addiction is treated in pregnant women, and how it affects the baby

Medications like methadone and Suboxone are a go-to treatment for substance use, including for pregnant women, doctors say. 

These medications are opioids, but when they’re used properly, they don’t cause the same “high” as other opioids and they have a far lower risk of overdose. They reduce withdrawal symptoms and drug cravings, keeping patients away from illicit drugs.

“When you take these medications, you’re more likely to be alive,” said Dr. Genie Bailey, the chief of research and former chief behavioral medicine officer at SSTAR.

Medication-assisted treatment during pregnancy can sometimes cause the baby to be born with opioid dependence. Providers say they have to weigh that risk against the risks of asking the mother to completely abstain from all opioid use.

“Detoxing a pregnant person is certainly dangerous,” Bailey said.

Going into full opioid withdrawal puts stress on both the mother and baby, doctors said — it can even lead to miscarriage.

It also comes with a very high risk of relapsing. The vast majority of patients who try to detox without medication-assisted treatment will end up relapsing on street drugs, doctors said. Relapse is more dangerous to a pregnant woman’s baby than medication-assisted treatment.

“Those babies are being exposed to an unpredictable amount of substances that we don’t know anything about,” Bailey said. She described medication-assisted treatment for pregnant women as “the lesser of two evils.”

Opioid withdrawal symptoms in newborns include trembling, frequent crying, sleep problems, and seizures. But health care providers say these symptoms are treatable, and they note that not every woman on medication-assisted treatment will give birth to a baby dependent on opioids.

“What you see in the media is the extreme,” said Lauren Sousa, a registered nurse and New Beginnings’ team lead. “That’s usually the exception, not the rule.”

Treatment protocols have improved in recent years, providers said. At Southcoast Health, doctors and nurses use the “eat, sleep, console” model, which focuses on allowing mothers to soothe their babies through withdrawal symptoms in a calming environment. Staff say they’re seeing significantly better results compared to the old model, where babies were moved to a separate special nursery.

Recovery coach celebrates her own recovery

Almeida, the New Beginnings recovery coach, says her children were ages 4 and 6 when her ex-husband took full custody. They were ages 9 and 11 by the time she was allowed to see them on a limited basis, and it took a few more years before she received that shared-custody letter from the judge.

Now, Almeida is teaching her daughter to drive. She says it makes her think about the years she missed.

“I allow myself those days, those tears, but then I have to move on,” she said. “Because you can’t change the past.”

Almeida said she’s grateful to have her kids again, and to have rebuilt her relationships with the rest of her family.

On this day, she was celebrating a special milestone in her recovery.

“Happy six years,” Almeida’s mom texted her that morning. “I’m so proud of you.”

Email Grace Ferguson at gferguson@newbedfordlight.org

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