AUSTIN (KXAN) — After a year and a half of drug addiction without treatment, Anisa Madero spent her 17th birthday in a rehabilitation facility.
A birthday without cake, presents and miles from her high school friends, may not be the ideal celebration for most. However, Madero was grateful to spend any time in residential treatment — even her birthday.
“I wasn’t worried about whether I was going to pass my math test, or are my clothes going to be ironed for school tomorrow?” Madero said. “No, my situation was: Where am I going to lay my head at night?”
Today, Madero is 20 years old, sober and a community guest specialist at an adult drug treatment program. Her time in treatment as a teen played a crucial role in her current sobriety.
“Being in a facility with a lot of the women who are in the same boat in different water, it was kind of heartwarming, because an addict helps an addict; an alcoholic helps an alcoholic,” she said.
“If I was just learning about [sobriety] now, it’d be 10 times harder, at least 10 times harder,” Madero said.
Despite residential treatment centers’ positive effects for Madero and others, only a small number of women in the state receive residential drug treatment as teenagers.
Over 70% of beds available to adolescents for residential drug treatment in Texas are designated for males. Male juveniles in the state have more than double the options for treatment facilities a female the same age can access.
Although addiction rates are historically higher in men, the estimated 260-bed difference does not reflect the current need for female juvenile drug treatment in the state.
“It isolates the females that want recovery. They don’t have as many people to call. Their network is automatically smaller than the males’ network,” said Libbey Sanford, program director of University High School, a sober school in Austin.
KXAN obtained the RTC facility data through the Texas Public Information Act from the Texas Health and Human Services Commission. However, several corrections to the data have been made after speaking with staff at various RTCs during the reporting process.
There are only two all-female adolescent RTCs verses about 13 dedicated to the treatment of adolescent males. One major difference in the treatment of males and females with substance abuse problems is the length of stay and severity of addiction once women reach residential treatment, said Dr. Hani Talebi, a licensed psychologist working with the Meadows Policy Institute.
“We know that, oftentimes, females will stay longer in RTCs than males do, and we know that they will come in with greater symptomatology and more acute presenting issues relative to SUD (substance abuse disorder),” Talebi said.
Madero’s initial stay at an RTC lasted six months.
The difficulty girls have finding treatment has clear effects once they begin their addiction recovery. However, it is challenging to quantify the issues faced by young females with drug addiction in the state — beyond the length of stays at RTCs — due to lack of research, Talebi said.
“I think that that limits our ability to draw some meaningful conclusions about what we’re seeing out there,” he said.
The Long Road to Recovery
Unlike boys who can get inpatient treatment in Austin, girls struggling with addiction have to drive nearly three hours to Houston, for any kind of inpatient treatment.
“Community is so crucial to recovery … I just think it’s a lot harder to build that when you have to go out of the city,” Sanford said.
University High School in Austin takes referrals from residential treatment centers and refers relapsing students to various RTCs.
“A lot of times, females have to travel for residential care,” Sanford said. “It’s harder for the parents to be involved, we see success when the whole family gets treatment and does their own work, and I do think that’s harder with the lack of female treatment centers.”
Phoenix House, which has an all-male RTC in Austin and a co-ed RTC in Dallas, accepted juveniles from 70 to 80 different Texas counties in the last year alone.
“The reason why we see that from so many counties is because there are so few residential beds that have been made available to adolescents with substance use disorder that don’t have a funding source, or their funding source is state funds,” said Bart Loewen, CEO of Phoenix House.
The Referral Road Block
Unlike adult RTCs, adolescent programs see very few self-referrals. This means someone must identify a juvenile as having a problem and force them to attend treatment. Typically, juvenile substance use disorder referrals come from schools, juvenile justice programs or parents, according to Stacey Burns the Chief Clinical Officer at Nexus Recovery in Dallas.
The problem with this referral system stems from how people are accustomed to thinking about addiction, Talebi said.
When schools transitioned online and courts temporarily shut down due to COVID-19, two of the three all-female juvenile RTC programs serving indigent clients closed. The Selena House, where Madero attended as a teen, closed in August 2020.
“The systems that are in place for intake, screening, identification of diagnostic criteria for inclusion are typically catering toward the male presentation,” Talebi said. “Men who have more acute overt presentations, versus females, who tend to be more covert, internalized have an approach to managing their distress.”
Loewen sees referrals for both adolescent males and females. He said most boys in Phoenix House facilities are coming from the Texas Juvenile Justice Department. It is not as clear where girls are being referred from because it is “just so different,” he added.
“When the boys are doing something, there is a quicker consequence for it,” Loewen said. “I think by the time that our parents and our community address the female behavior, they’re probably a little further along into their use behavior.”
Sanford noted many of her female students are coming to the alternative high school after leaving a behavioral or mental health program, not addiction-focused treatment. Her observation may reflect a larger trend of treating female drug use as a cause of an underlying mental health condition.
“We miss a lot by just saying, ‘Oh, she’s got depression,’ … ‘She’s dealing with this issue or dealing with that issue,’” Talebi said. “Some of that is wrapped up in societal norms and expectations.”
Madero completed three inpatient mental-health programs separate from any counseling during her addiction treatment.
Dual diagnosis of a mental illness and addiction is common, and treatment of both is important. However, viewing female addiction as simply a cause of another issue can prolong a young female’s addiction recovery, according to Talebi.
“Essentially, what’s happening is, [females] are taking longer to get into treatment because they’re being poorly evaluated and screened,” Talebi said. “By the time they finally get up to some kind of warranting inclusion, they’re already far more acutely psychiatrically ill.”
‘Little Second Chance’
“I think sometimes you have to be plucked out of the environment that you’re in to get healthy and well,” Sanford said.
A common alternative to adolescent residential treatment is outpatient programs where teens attend treatment during the day but sleep at home.
But those outpatient programs have drawbacks. If a teen used drugs in their bedroom, being sent back to that bedroom immediately following outpatient counseling could potentially lead to a swift relapse, Sanford said.
“There are so many triggers that we’re not aware of, and I do think that if a kid can’t get healthy in an (intensive outpatient program), I think they do need residential to get away from the current environment they’re in,” Sanford said.
For Madero, the ability to get treatment 24 hours a day and away from her home was critical to her sobriety. However, adolescent female RTCs continue to struggle with referrals, making it less likely women like Madero will find treatment earlier.
“Some girls, like me for example, we just need that little second chance, that little push. We didn’t grow up the right way,” Madero said.
Madero had access to treatment at the now-closed Selena House in San Antonio. She credited the center for keeping her off the streets and even staying alive. Today, girls in Central Texas have no local options for treatment.
“The Selena center showed me a positive outcome in life,” Madero said. “They showed me how to live life instead of just trying to survive life every day.”