America's war on drugs is rife with terrible tactics that succeed in exacerbating the very problems they purport to fix. But even in that rich field of wildly misguided policy, few things are as bad as the treatment of poor people struggling with addiction.

From throwing drug users in jail, to shipping them to court-ordered rehab, to taking kids away from their mothers, standard responses to addiction can trigger trauma and mental health problems that often lead to substance abuse in the first place. And some of the most vulnerable populations—the homeless, or poor and minority women—become ensnared in a system of state control that can wreck any chance they have of pulling their lives back together.

Over the course of five years, sociologists Susan Sered and Maureen Norton-Hawk tracked 47 women in the Boston area after their release from jail. Many had problems with substance abuse, cycled in and out of homelessness, and suffered from trauma rooted in childhood abuse or violence they experienced as adults.

After spending years actually listening to the women and trying to understand their lives (as opposed to the more tried-and-true tactic of condemning them as selfish addicts or bad mothers), the researchers came away with important conclusions about the interplay of poverty, addiction and the criminal justice system, collected in a book titled, Can’t Catch a Break: Gender, Jail, Drugs, and the Limits of Personal Responsibility.

AlterNet's Tana Ganeva spoke with Dr. Sered about why the entire system seems rigged against women struggling with poverty and addiction.

Tana Ganeva: Can you tell me just a little bit about this work?

Susan Sered: I've been working with a group of women whom I met post-incarceration. Massachusetts is quite slow to incarcerate, and women tend not to be incarcerated very long, so I thought it was more interesting and probably more important to meet with women who are wrapped up in the criminal system, but who are not at the moment sitting in prison.

TG: And what did you find?

SS: We could talk for many, many hours about that. A lot of what I found I think is specific to Massachusetts, so just take that with a grain of salt. What I found is, I started to think of these women as institutional captives. Almost all of the women — there were 47 women who entered the study — at the end of the first five years, we were still in touch with 26 women, which is an incredible retention rate considering they're homeless and use aliases and are drug addicts and mentally ill and all this kind of thing. They certainly spend time in jails and prisons, but they really spend more time in various rehab facilities, detox facilities, sober houses, therapeutic communities, battered women's shelters, homeless shelters. They're in this institutional system, and they're really captives of it. There's no way for them to get out of this institutional circuit.

One of the things that struck me is how similar the treatment facilities are to the prisons in sharing a basic ideology of, "You're screwed up, you're messed up, you make bad choices, you need to change," and an absolute aversion to acknowledging the realities of poverty and racism and gendered violence.

TG: So this is very broad, but can you talk about some of the things that precipitate these dire life circumstances? What about their backgrounds has led them to get caught in cycles of poverty and drug abuse?

SS: That's not an easy question to answer, because the women come from a variety of backgrounds. I'm also reluctant to invoke a Freudian mentality of blaming everything on what happens in childhood. I think that people change over their lives. But I would say that most of the women that we came to know came from solid, working class families. There were only one or two women who came from families that were really poor. Most of them came from families, I would say typically one-parent worked in a factory, maybe a mother worked in a clerical job in an insurance agency, some of the fathers were firefighters or policemen. On the whole, their parents were employed. Again, there are a few exceptions, so not everyone comes from the same kind of background, but I would say that was true for most of the women.

TG: What had happened throughout their lives? (I didn't mean to suggest a childhood Freudian thing)

SS: I really hate generalizing. I think that the black women and white women tended to have somewhat different trajectories, but I don't want to turn that into something that's too black and white.

I would say on the whole the white women came from working-class to middle-class families in which there was stable housing, and there was some sort of abuse when they were children. It was generally a friend of the family, a neighbor, a relative, in one case it was a brother, but there was sexual abuse.

In some cases, the parents didn't find out about it or denied it was going on or were complicit in it and, again I'm speaking mostly about the white women, and they then ran away from home. Running away from home is the easiest path to any woman in America ending up in the correctional system, because they get arrested on these status offenses. They're on the streets, and once you're on the streets and you're 16 years old and don't have an education and don't really have a way to get a job, you become vulnerable to predatory men. I would say for many of the white women, that was kind of the story. A few of them, to get out of abusive households, got married very young. And then the person they married ended up being violent. In one case, the person she married ended up actually being a heroin addict, which she didn't even know before she married him. She was young and kind of innocent.

This sort of misery builds up, and they're introduced to drugs. Some of the women are introduced to drugs through their psychiatrists. They're put on psychiatric medication of various sorts, they're put on pain medication of various sorts. Then, when the supply of that is cut off, they get the same stuff on the streets, and then they become involved in the criminal system.

So that tends to be the trajectory for the white women. Here in Massachusetts right now there's been an enormous increase in opiate usage. A lot of that has been driven by prescription pain medication. But that doesn't mean that that's where all of the women started. Some of the women, they were on the streets and that's what was going on in the streets. Some of the women began to do sex work in order to survive, and then once they do sex work the drugs to numb yourself out are really attractive.

Now, the African American women in my project, I think there was a bit of a different trajectory, but the numbers aren't big enough to say that this is a generalizable pattern. [caveat: this study is also specific to Massachusetts, and also I'm white, so I know that I'm missing things.]

But in my observation, the African American women tended to come from much more stable families in terms of there not being abuse in the household. Poorer families, but families that were much more intact. The white women, when they started to get in trouble when they were 14 or 15 or 16, a lot of times their parents kicked them out of the house. Quite a few of the white women, their families still won't talk to them, or some relative got custody of their kids and won't even let them see the kids. That's not the case among the black women. Consistently, I see the black women's mothers and sisters and relatives will say, "If you're stoned out of your mind, you can't come to the house, but if you're sober, you're welcome here all the time."

TG: You found that the black families tend to stay more intact?

SS: Absolutely stay more intact, and there was less abuse. Now, I'm going to explain why that is. I'll get to that in a minute. Generally for the black women, what I saw as the trajectory was that they were living in neighborhoods that were really hit by the economic changes of Reaganomics, and their parents had scraped by in bad low-wage jobs. But with two incomes in a family or three incomes in a household, it was enough to get by.

By the time these young women came of age, there were just no jobs anymore. Housing had become too expensive. It was unrealistic to think they would ever get a kind of job that would allow them to rent a decent apartment. I think that for the black women it was economic changes that … What was there to do?

But this is why I say I want to say all of this with a big grain of salt. The big grain of salt is that, because of the racism in law enforcement and in the so-called criminal justice system, black women are far more likely to be arrested and incarcerated than white women. The way that I look at it is that the path to ending up in prison and in the situation of the women that I know for white women is a really long path, and the only ones who end up where these women end up are really fucked up.

They've had a hundred things go wrong in their life. They weren't raped by one relative, they were raped by two relatives, and then they were raped by the doctor at the hospital. Just so many things went wrong and they're so messed up, whereas for black women, because of the racism, you don't need to be that screwed up to end up in prison. You just need to be black to end up in prison.

That's why when I asked where these women come from, I do think there's the story of race, but I want to be so careful in telling it, because we're not looking at patterns that are 100% true. It's just an overall observation.

I want to say that, for the white women as well, I said that they tended to come from working class families, many of them also came from the kinds of families where the jobs their parents have no longer exist. The only jobs they can get are at Dunkin Donuts or at McDonald's. That's not anything to really help somebody pull a life together.

TG: So all these awful things happen, they end up incarcerated, and then after they're released you found that they were kind of permanently caught up in this system?

SS: Absolutely, on so many levels. First of all, they have criminal records, which makes them unemployable. In Massachusetts they have banned the box, so you don't have to check off on a job application that you have a criminal record, but everyone knows. It's kind of a farce. They have the criminal record that follows them around. Typically, somebody leaves prison with zero money, nowhere to go. No ID, because that got lost somewhere in the shuffle. If you don't have any state ID, any government issued ID, you really can't do anything. That's kind of where they leave prison, and then of course if they're mothers, which most incarcerated women are, they've lost their kids. This is what they're exiting prison into: homelessness, poverty, ongoing health problems and the emotional distress that comes from having lost their kids.

TG: That seems like a really big issue that doesn't get that much attention, the emotional and psychological impact of having this threat of having your kids taken away all the time or having them taken away.

SS: There's no doubt in my mind that that's the case. More than one woman has said similar things, like I have in my mind one woman now who, she had been sort of a light drug user. She was someone who was doing low-level illegal stuff and she ended up in prison. By the way, the most common reason the women are incarcerated is probation violation.

The initial crime wasn't big enough to send them to prison, but they violated the terms of their probation. Sometimes it's a technical violation, just not showing up for an appointment. Sometimes it's a dirty urine. Sometimes it's another arrest, it can be for creating a public disturbance, for anything, and they end up in prison.

What she said to me, this one woman who I'm thinking of said to me (actually, this was one of the African American women, but I don't think that's relevant to this story) She was someone who dibbled and dabbled, is the word that she used. She would use crack sometimes. But once her kids were taken, she said, "I was off and running." She became a full-time user after that.

TG: Talk about unintended consequences. That seems pretty counter-productive. It sounds like she was not an addict but just did drugs recreationally and not really in an unhealthy way, and then she was so traumatized by this that she fell into heavy use?

SS: Yeah, and it's amazing how many of the women keep themselves together in order to take care of their children. Even if they're addicts — which not all are — but some are, and even addicts can keep their addiction under control. Alcoholics Anonymous always talks about people who are functioning alcoholics, I think that's the word they use.

There are absolutely functioning heroin addicts. Heroin doesn't mean that you're lying in the gutter hallucinating. I would say that many of the women that I know were functioning drug users. I've known them when they're functioning drug users. Their apartments are clean and neat and they have food in the refrigerator and they're getting their kids to school. Is that the ideal way to live? No. But are they adequate parents? Absolutely. But once they go to jail, then everything falls apart.

TG: Right. I'm sure you're familiar with the work of Dr. Gabor MatÃ©. He makes the point that the way we deal with drug use, you couldn't invent a better way to make addiction worse.

SS: I totally agree.

TG: So in addition to having their kids taken away and given to strangers, what are some other ways encounters with the criminal justice system can be traumatic for women?

SS: There are so many levels. First of all, throwing people in prison is never going to be useful. Do I think that all drugs should be decriminalized? I don't know. I'm honestly confused about that. I certainly think that putting women in situations in which to get drugs that they feel that they need they need to do sex work is a bad thing.

To have a different way of structuring social responses to the fact that there are so many people who are really miserable, and who are miserable enough to use mood altering substances that they know are going to kill them. Every single woman I know says that, that she knows it's eventually going to kill her, but she's so unhappy that that's really the risk that she's … She doesn't really see another way to do it. I think that not taking kids away from women is really important and not forcing women into situations where they have to turn tricks. I think not locking people up in prison is really important.

I'm ambivalent about methadone. My son is a family doctor and is interested in it and has done some work around addiction, and I know he's pro-methadone and Suboxone, so I definitely hear both sides of it. But I think that my discomfort with methadone is I think its use rests on an assumption that was propagated by Alcoholics Anonymous, which is "once an addict, always an addict." I don't see that that's true. I don't see the scientific evidence for that. I don't see that that's been true at other times in history. I see among the women in my project that, for the most part, they kind of age out of drug use. In their mid-to-late 40s, very few are using drugs any more.

And it's not because there was some new miracle cure for addiction, because they've all been in the same programs a zillion times. There was no new treatment, it's just that they kind of aged out of it. The concern with methadone is it re-inscribes and reinforces this idea of "once an addict, always an addict." A woman named Francesca, I was with her yesterday, her drug of choice is Percocet. She had just gotten out of detox, which she goes to voluntarily periodically. They had wanted to put her on methadone, and she absolutely refused to go on methadone. She said that she knows she has an abuse problem with Percocet, but she is not at a level of addiction where she has to take it every single day or she gets dope sick.

TG: So what is your theory about aging out idea of addiction? Is it the circumstances of their lives that change?

SS: I know some people are writing now about addiction being a developmental disorder. I don't know if that's the case. I can tell you my take on it. There's no simple answer. I would not give any one answer to it. I think that part of it is that, from the beginning with drug use there's the ups and the downs of it. There's the fun parts and the not fun parts. The fun part of being high, and the not fun part of turning tricks. I think that after a certain age, the not fun part starts to outweigh the fun part. That's what I hear from the older women, that they really don't enjoy it anymore, that being high isn't enjoyable. Whether that's a change in the brain, I just don't know.

I think that most of us get wiser as we get older. I'm now 59, and when I look back at the things that I did raising my kids 30 years ago, oh, my God, I can't believe that I did those things. I've been a teacher for almost 40 years, and I think I'm a much better teacher now than I was 40 years ago. We do develop wisdom as we get older. I think that's probably part of it. I think that the urge to use seems to start to decline. At first, I thought that maybe some of the awful life circumstances changed, so that's why there's less of a need to use, but I don't think that that's the case, at least for the women that I know. The awful life circumstances are still there.

In terms of it being a developmental thing, I don't know that this is an answer, but I wonder whether the absolutely horrible things that they experienced, that they've carried this pain around with them for so many years, I wonder if at some point we become emotionally able to let some of that shit go. I know that psychologists consistently find that older people are happier than younger people.

TG: This also seems to raise the discomfiting question of whether rehab works, which, some people seem to say that it doesn't.

SS: I think that rehab works in the short term. I see that especially with people who are in like a nine-month program or a one-year program can be doing well while they're in the program, and by doing well I don't just mean not using drugs, by doing well I mean feeling all-over happy and optimistic about their lives. That seems to maintain for a couple of months, and then it's over, which leads me to believe that, what was, quote, "working" in rehab was having a secure place to live, having social interactions, decent food, and having structure in their lives.

TG: I talked to some women who were in treatment and they really gushed about their treatment program, like, "Oh, we love all the other women, all the people treat us with respect, they treat us really well. We have fun craft days or whatever and activities and we're learning good child-rearing techniques."

But you're saying that doesn't last too long outside of the facility?

SS: Yeah. I think if you're unemployable and living in a room in a rooming house, you really have nothing to do. If you're in these programs, I think a lot of what they have them do is busy work, and in some of the programs that's so obvious and women really resent it.

I think that also in the better programs there's a real sense of having goals, and they work towards the goals. I think most of us like having goals that are realistic that we can work towards, and the good programs have realistic goals. The problem is that once you're out … I've been to so many graduations, I can't tell you. I've been to a graduation, it was one of the first graduations I ever went to. This wasn't a residential facility, this was kind of a job preparation training program, and at the graduation the mayor of Boston was there. It was women and men.

And they were all given business suits and attachÃ© cases, as if they were really going to be able to get jobs in the business world. Of course, nobody got a job. They'd all had internships while they were in the program because the interns were free labor for various companies. Nobody was hired by the company they interned for. It's very depressing.

TG: So some of these programs may create unrealistically good environments within their walls, and then have to send people into a world that just structurally can't support sustainable lives?

SS: That's absolutely true. People often ask me, what do I think works? I don't have an answer for that. I think getting older, if you manage to stay alive, works. But one of the things that I believe is under-recognized is how diverse this population is. I'm sure the same thing is true for men, but I don't have first hand experience of it. Of the women in our project, a third of them were formally diagnosed with learning disabilities when they were in elementary school, and considering that many of them went to lousy elementary schools where no one ever diagnosed anything, the numbers are probably higher.

I would say about half of the women that I know, even in the best of circumstances, are not fully literate. There's one woman who, she is so good at keeping a schedule, she always calls me up the same time, the same day every week, she's so organized, but she just couldn't learn how to use the computer she needed to punch in at work working at a supermarket.

I would say maybe a third of the women that I know, really the help that they need has to include a recognition that they are either non-literate or close to non-literate, that there are seriously impaired cognitive skills. Then, at the other end, I think there's a bunch of women who are really, really, really smart, who with the right breaks and the right opportunities could hold down good jobs in which, in a better economy, they would have a chance to be promoted and progress and have good professional lives. But they're all shoved into the same programs.

TG: So more individualized treatment and preparation.

SS: I think it's more of an understanding that being incarcerated or being a formerly incarcerated person isn't a single identity, that that doesn't tell you very much about the person other than that they happened to get caught doing something that in the year, whatever, 2012 or '13 or '14 or '15, was deemed illegal.

TG: In terms of public policy we're still stuck in moralistic thinking about addiction, especially when it comes to women. Treatment is on the more progressive, humane side of things, but that doesn't appear to be a perfect solution either. It seems like forced drug treatment especially, which by some is considered the progressive way to deal with addiction, can be similarly oppressive?

SS: I think that it is. I really think that it is. In terms of motherhood, I'm often asked, what works? What do I think would actually be helpful? I've thought about a few of the women who I know who do have their kids or have their kids on and off, and who really struggle.

They struggle because of poverty, they struggle because of their own poor executive functioning, they struggle because they're on methadone so they're spaced out a lot of the time — for whatever constellations of reasons, they struggle. One of them, actually she's another woman whom I saw today, she has two little girls, and she really wants to be a good mother. She struggles getting her little girls to school on time in the morning. Her house is kind of chaotic, and they forget their homework, they forget this and that. The woman herself has a lot of physical health problems, like rheumatoid arthritis.

Her daughter got into a school for gifted kids, and the mother's terrified they're going to kick her out of the school because she comes late so often. I realized the cheapest thing that the state of Massachusetts could do is send over an AmeriCorps volunteer to their house for four hours in the late afternoon, early evening, and then for an hour in the morning every day, every single solitary day. It would be dirt cheap. It's so much cheaper than any other kind of intervention that anyone would ever think of.

TG: Right, something to help allay her stressors.

SS: I have four kids, and there were periods when I thought I was going to lose it. And I was in a stable relationship with a nice man and we had enough money, and I couldn't stay on top of things. Just the list of things that you have to do when you're a parent, there's so many things that you have to remember and do simultaneously. I was lucky, because I was always able to pay for babysitters and I had a cleaning woman. I had au pairs for years. What this woman who I met with today, in the book I call her Katia, she's needs an au pair, she needs a nanny. Rich women get them. Yeah, life is easier when there's another adult, another pair of hands around.

TG: So, obviously what you're describing right now would make conservative and even some not-conservative Americans' heads explode: giving poor addicts nannies? But really, what you're describing might be cheaper and more helpful for everyone.

SS: Yeah. I'd love an economist to figure out the finances of it and make a strong case for this being less taxpayer money.

TG: Because where does the taxpayer money go otherwise? Into jailing, coerced treatment, probation?

SS: All that stuff is more expensive. A nanny is sort of an extreme example, but in terms of parenting, I believe the right policy direction is to give women and families the support they need to be able to stay in their homes and take care of their children.