IN the inner city, where drug abuse strikes its most devastating blows, the sensational nature of the drug crisis overshadows the extent of despair. At root are complex social issues such as poverty and broken homes, which contribute to and stem from drug abuse. But public funding favors a law-and-order approach - apprehending and imprisoning drug dealers and addicts. Treatment and prevention receive a fraction of national and local antidrug budgets. And the larger social issues are often overlooked in the short-terms solutions.
In this city, for example, the Alcohol and Drug Abuse Services Administration (ADASA), which provides treatment and prevention programs, has a $40 million budget compared with, say, more than $30 million the police department spent on a single antidrug program, its Operation Clean Sweep, an 18-month assault on open-air drug markets. The police department budget for 1991 is $257 million, all of it driven by drugs and related violence, say police officials.
After incarceration or traditional treatment, drug users and dealers return to the same streets that pulled them into drugs. Antidrug experts increasingly assert that drug programs must address the world the addict lives in and not just the addict himself.
For instance, pregnant drug abusers are propagating the drug crisis and its associated problems by giving birth to one in 10 babies in Washington, D.C., according to public hospital officials.
``Two years ago the district's infant mortality figures, which had been on a downward trend, turned radically upward,'' says John Jackson, director of ADASA.
``There is a set of circumstances around pregnant substance abusers that frustrates the public health system,'' he says, listing among them maternal and child health, prenatal care, food and nutrition, foster care, sexually transmitted disease, and child protective services. ``The complex part of it is coordinating all these services - it's often the overlooked part.''
Enter the new D.C. Institute for Mental Health's Center for Family Health, an agency designed to be a model of how to link public and private antidrug efforts.
It will provide a network of services at one location for cocaine-exposed infants, their siblings, parents, surrogate parents, and extended families, says program director Mary Ann Walker. Start-up funding from the US Office for Substance Abuse Prevention and D.C. Medicaid will help the program in its first three years to serve 200 people. But the D.C. Institute for Mental Health plans to make the demonstration project a permanent service.
The goal of the Family Health Center is to show that creating an umbrella of services and intervening with a drug-exposed infant and its family early can cost significantly less than future hospitalizations, says Dr. Johanna Ferman, the medical director of the D.C. Institute for Mental Health.
``But the concern we have is that this is not a foregone conclusion [among policymakers].... The political system feels compelled to respond to perceived community pressure to keep the community safe. But that safety has to come from within, building strong people,'' Dr. Ferman says.
``Drug treatment sits at the interface of social polity - health care, religion, culture, labor, ... family, the school system, child welfare, courts, churches. All the pieces impact and we're trying to coordinate them under a single umbrella,'' she says.
The drug culture threatens family life with extinction in some communities, says Ferman. The evidence of crack cocaine's strong appeal to young women is particularly alarming. Elementary schools here are being ``flooded'' with new students who have some form of psychiatric and learning disability due to drug exposure before birth, observes Ferman.
An addicted mother, financially and emotionally into the drug culture, may neglect her children in many ways, from the giving of affection to the giving of food. She may totally abandon them. Siblings may be raising siblings. Other family members may be too overwhelmed with the dangers of living amidst the drug culture or their own poverty to help.
The staff of the Family Health Center, located in the troubled Anacostia sector of the city, is now seeking clients. Up to 30 babies of crack addicts will be treated.
``You think about cuddly babies, well these aren't,'' says Ferman. So it will take specially trained surrogate families to handle the difficult physical and emotional needs of crack-exposed infants. Hospitals have been enlisted as partners in the project to provide medical and psychiatric care for the children.
Meanwhile, the biological mothers will receive a range of services to help them get off drugs, get housing, possibly reunite with their children, and develop job and parenting skills.
``Not all women or all parents involved with drugs don't care about their kids,'' says Ferman. ``Our program acknowledges that there are human strengths in the black community to draw on and it provides supports that offer some hope [toward] reuniting the family.''
Traditional treatment programs can be a waste of money, suggests Ferman, because women have nowhere to leave their children while they are recovering.
To a large extent, because of the months-long waiting lists for treatment in Washington, detoxification (a few days in the hospital) becomes the basic form of treatment, says Ferman. ``But successful treatment takes two or even more years.''
Recognition of this holistic approach is increasing throughout Washington treatment and prevention programs, from the simple concept of teaching children how to play and make friends to offering ways to build the self esteem of addicted prison inmates hoping to break the cycle of despair they entered as ghetto children.