I. A Cultural Norm
A woman named Ashley lives in an encampment under the Market-Frankford Line, where she keeps her clothes, makeup and toiletries scattered inside and around her tent. She moved to Kensington from Camden, New Jersey three weeks ago.
Surrounding her resting space, people openly use drugs while Ashley prepares for “dates” with men in the area.
The men Ashley goes out with will bring her food and clothing, but not without a price. She said she’s been beaten up, raped and regularly deals with men refusing to pay her after sex.
“I used to think that was the price I had to pay, being raped,” Ashley said. “But then I went to rehab and realized no matter what I’m doing, it’s not OK in any case.”
She added that a lot of women with addiction have experienced similar types of trauma, sometimes from sex work.
“All of them,” Ashley said. “Every last one of them, unless they’re just starting out.”
Drug counselor Adrienne Miller estimates that 80 percent of the women she has worked with over the past three years have experienced either verbal, physical or sexual trauma.
Women are more likely to experience trauma as a result of their addiction, due to unhealthy relationships, dating violence and sexual assault. This can be a barrier for women trying to enter recovery, Miller said.
“There’s often untreated trauma they’re trying to self-medicate,” said Miller, who works as the outreach team coordinator for Women for Sobriety, a women-only recovery program. “It’s often trauma happens in addiction.”
A woman who goes by the name of “Pony” said she spends every day from 5:30 a.m. to 10:30 p.m. on the streets asking for pennies and dimes to pay for drugs.
Recently a man Pony didn’t know assaulted her in an alleyway. He held a gun to her head, punched her and knocked two of her teeth out with a brick before he stole her money.
“I don’t want to live like this,” Pony said. “He beat me for $16 and the way I was raised, I’m not giving it to you. When he put the gun to my head I said, ‘Do me the favor and shoot me because I’d rather die.’”
Row home in South Philadelphia’s Point Breeze neighborhood. PHOTO BY SYDNEY SCHAEFER
II. A Lack of Resources
Women with substance use disorder who experience homelessness may not actively seek help, but turn to other options, like sex work or abusive relationships, for living essentials like housing.
“Some guys will come and let me stay at their house,” Ashley said. “Usually that’s great because you appreciate [a place to stay], but you don’t want to move in. You’re not interested.”
“Men help women in different ways than the gentlemen out on the streets get helped,” said Carol Rostucher, the president of the Kensington outreach organization Angels in Motion. “It makes it a little bit harder for them to want to go in for help, because they’re not sleeping on the streets a lot at all.”
Once women decide to seek help, Rostucher said there is a lack of women-specific recovery resources in Philadelphia. According to data from the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), 23 percent of Philadelphia residents who entered treatment for substance use disorder in 2015 were women.
Housing is one example of the discrepancy in women-specific recovery options. According to the Pennsylvania Alliance of Recovery Residences resource manual, privately owned recovery residences for men outnumber those for women nearly two to one in Philadelphia. Of the 51 total PARR-identified residences that list what genders they house, 15 exclusively serve women, and two allow men and women.
Rostucher said the perception that women don’t struggle with addiction as often as men contributes to this discrepancy. This disconnect is a result of the perception that women take better care of themselves on the streets, she added.
“The majority of women keep up with themselves and try to find a place to stay every night, where the majority of the men are homeless and not showering, not bathing and not taking care of themselves,” Rostucher said.
Jessica Bright is the clinical director at Interim House, a 25-bed, women-only recovery house in West Mount Airy. PHOTO BY SYDNEY SCHAEFER
III. Trauma-Informed Therapy
Women-specific recovery programs have begun to integrate therapy methods that acknowledge trauma — despite the lingering idea that addiction should be treated separately first.
“Somehow that could be put off to the side and it had to wait, because you just have to focus on one aspect,” said Jessica Bright, the clinical director at Interim House, a 25-bed, women-only recovery house in West Mount Airy. “Now, I think most programs are starting to understand it’s got to be combined treatments.”
Interim House Director Kathy Wellbank said the core of the recovery house’s therapy program is dialectical behavior therapy.
Kathy Wellbank is the director of Interim House a 25-bed, women-only recovery house in West Mount Airy. PHOTO BY SYDNEY SCHAEFER
DBT is a type of cognitive behavioral treatment that helps teach patients how to handle life’s stressors. It has four pillars: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
In the mindfulness unit, women reduce anxiety by focusing on being present and taking responsibility for their future. Distress tolerance helps women deal with pain and circumstances that are out of their control. DBT’s third unit — emotion regulation — teaches women how to identify and manage their emotions. Finally, women use interpersonal effectiveness, the fourth DBT pillar, to better communicate with others and handle situations.
In addition to the four pillars, DBT encourages “mindfulness,” which means an individual is in a “wise mind,” said Lynne Berry, a consultant at Interim House who supervises the therapists.
A “wise mind” is a healthy balance between the emotional mind, which responds based on feelings, and the rational mind, which responds based on logic, Berry added. It allows women with addiction to handle situations appropriately, she said.
“They come to us having lived their whole lives letting their feelings run the show,” Berry added. “‘If it feels good it is good,’ but that’s not necessarily the case.”
Interim House will also refer residents who need specialized care to the Joseph J. Peters Institute in Center City, which treats women in recovery who have also experienced extensive trauma. JJPI and Interim House are both affiliates of the Public Health Management Corporation, a nonprofit institute that runs more than 350 programs.
JJPI therapists commonly use cognitive behavioral therapies, like DBT or prolonged exposure. Prolonged exposure has patients repeatedly revisit a traumatic memory to improve stress tolerance and teaches them how to control their emotional reactions.
Juanita Brown sits on her bed at Interim House in West Mount Airy. PHOTO BY SYDNEY SCHAEFER
Juanita Brown, a 46-year-old mother of six, is at Interim House for a 90-day stay. She has had substance use disorder for more than 20 years, and she entered treatment at Interim House for the first time in 2000. Brown said the DBT sessions challenged her to get in touch with her emotions.
“I appreciate this program allowing me the opportunity to deal with those things, because they’re valuable,” she said. “It’s okay to embrace them. They’re mine.”
Tara Reiff, 37, who has been at Interim House since March, said the skills she’s learned from DBT made her a better person.
Tara Reiff poses for a portrait at Interim House in West Mount Airy. PHOTO BY SYDNEY SCHAEFER
It helped her deal with the trauma of being put up for adoption at 3 years old, which likely contributed to her addiction. After being born dependent on cocaine and heroin, she started using drugs at 14.
She stopped using when she got pregnant at 17, but relapsed in 2015, on the night of her sister’s funeral. Her sister died from a heroin overdose.
“I always say when she died, I just snapped,” Reiff said. But, she added, “Instead of breaking down and going out to get high, I can sit down and think about using my five senses, I can use my wise mind.”
Joseph J. Peters Institute in Center City treats women in recovery who have also experienced extensive trauma. PHOTO BY SYDNEY SCHAEFER
IV. Women-Only Treatment
Gabrielle Bilotta, a senior clinician at JJPI, said the women she treats have had similar experiences — including trauma, substance use disorder and mental health issues. In this facility, it is a cultural norm.
It is those shared experiences that can help women build relationships with each other while in therapy. Many of the women she works with for Project Dawn Court, a Philadelphia drug court for women who have substance use disorder and engage in sex work, had clients in Kensington.
“They’re healing together,” Bilotta said. “They’ve all known each other from the streets or from jail, so they’re getting to see one another grow.”
Having a women-only program also creates a nourishing and supportive environment at Interim House, Brown said.
She added that women-only groups can make participants feel more comfortable revealing the root of their trauma and addiction, whether it be rape, molestation, abandonment, anger, resentment or struggling to admit an addiction.
Gabrielle Bilotta is a senior clinician at JJPI, which treats women in recovery who have also experienced extensive trauma. PHOTO BY SYDNEY SCHAEFER
Bilotta and Bright agreed that most of the women they work with started using because they’re trying to avoid dealing with emotions and trauma.
“It’s just like peeling the layers of an onion,” Bilotta said. “You’ve got to get to the core of that in order to find out why it keeps happening.”
Elizabeth Perez, another resident who is in recovery at Interim House, was physically abused by her father and sexually abused by her older brother and uncle while growing up.
“A lot of the girls do witness trauma, and it kind of leads you up to addiction,” Perez said. “And even in addiction, you go through a lot of traumatic experiences.”
Perez said Interim House’s women-exclusive treatment program improves the recovery process because women can open up about the traumatic events they’ve experienced in a way they couldn’t in a mixed-gender program.
“It feels safe being able to talk about certain things with the women in the house, because nine times out of 10, we’ve all been through the same thing,” she said.
Brown added that the beauty in dealing with only women is feeling comfortable revealing the roots of trauma and addiction, whether it be from rape, molestation, abandonment, anger, resentment, or struggling to admit an addiction.
“To see one, two, three or four other women that are actually going through it, it helps me get more comfortable with the fact that there is a problem being aligned inside of me,” Brown said. “And it’s okay for me making the decision to expose it.”