Mother's battle to be free of cocaine Recovery: At a shelter in Philadelphia, women fight a personal war on drugs. Consumed by cravings for cocaine, they struggle toward well-being.


PHILADELPHIA - Carla usually looked forward to the group therapy sessions in the drug-treatment program. They were a place to vent, to cry, to debate, a haven where she could get and give support. But not on this particular Friday.

Carla wanted crack cocaine. Her cravings had been growing for days. Now another woman in the group was confiding that she had gotten high earlier that day, arousing Carla's desire even more.

Carla said nothing to the five women at the table. It would pass. She could handle it.

Proud and resourceful, Carla was in the final months of a year-long outpatient treatment program at the University of Pennsylvania's Treatment Research Center in Philadelphia.

The treatment seemed to be helping her. Except for one brief relapse in April, she had been clean for 10 months. But now the cravings were overwhelming her again.

Her 5-month-old twins, sleeping in the child-care room, were the only things keeping her from heading to the Bottom, the nearby West Philadelphia neighborhood where dealers and crackheads knew her by name, where she had squandered too many of her 35 years.

She pictured the babies' faces, and tried to shake the memory of crack's seductive pleasure.

The horror of crack cocaine has been epitomized by the "crack mom" - a woman so obsessed that she addicts her fetus, abandons her children, steals from relatives, sells her body and winds up sucking her last breath from a filthy pipe.

But there is another, more hopeful image that has been largely overlooked in the decade since crack hit this country, setting off a cataclysm of addiction in poor African-American neighborhoods.

It's the recovering crack mom - a bereft woman, consumed by cravings, yet so determined to turn her life around that she moves into a shelter, avoids fun and friends who spell temptation, and drags her children on a grinding rehabilitative odyssey.

Odds not encouraging

It's a woman like Carla, so ashamed of her crack history that she didn't want her real name or her children's in this story.

The odds facing her are not encouraging. Experts say fewer than one in five cocaine addicts recover.

Since the late 1980s, medical science has sought to make it easier.

The National Institute on Drug Abuse (NIDA), a leading drug-abuse research organization, recognized that most treatment programs - developed by men for men - didn't work for women.

Crack moms were avoiding treatment for fear of losing their children or quitting treatment because it ignored their roles as mothers. Addiction was only a symptom of a larger pathology that often involved physical or sexual abuse and the social ills of poverty.

The NIDA-funded study at the Treatment Research Center is building on research aimed at finding the most cost-effective ways to successfully treat cocaine-dependent new mothers.

The need for economies and successful approaches is more urgent than ever.

This year, Congress slashed a major source of drug-treatment money by more than half - from $215 million to $89 million.

Yet federal statistics over the past decade show that, even as occasional cocaine use has dropped by 75 percent, cocaine abuse, indicated by hospital emergency room treatments, jumped by 45 percent to 130,400 last year. For reasons that are complex and hotly debated, African-Americans account for most of this growth, the statistics show.

Hidden in the dry data of addiction are women such as Carla, each fighting a personal war on drugs, and each wanting, as she would want this day, to surrender.

After group therapy, Carla went into the bustling child-care room.

Her trademark bracelets jingled as she deftly changed Margaret's diaper, then Annie's, and packed up. Thoughts of getting high kept distracting her. She had to stay focused. She was determined to be a good mother this time, as she should have been to her other girls.

Seven other daughters

Seven other daughters, fathered by six men, beginning when she was 13. All taken from her. Only the oldest, Virginia, 21, was still part of her life. The rest were in foster or adoptive homes.

She often spoke of them. "If only I could tell them I miss them and still love them," she said one day.

Carla strapped the babies into the used, gray double stroller, Margaret in the front seat, Annie in back. As she bent to kiss each one, she had a rare moment of pride. Because she had shunned crack for most of her pregnancy, she had brought them into the world drug-free. If only she could make these latest cravings stop. She glanced at her watch. It was 2:30 p.m. She would avoid temptation by going straight back to the shelter.

The challenge confronting the University of Pennsylvania's Treatment Research Center (TRC) and other programs is huge.

Cheap, potent and smokable, crack has been called the most deadly, most addictive form of cocaine. No medication exists to wean addicts or kill their cravings.

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