Philippa Morris and Andrew Bevan outline the work of the women-only drug and alcohol rehabilitation charity, the Hebron Trust

The hebron trust is a charity which offers mainly residential services to women and sometimes their children to address serious drug and alcohol problems. We run two houses: Hebron House and Bethany Lodge. Although Hebron Trust is a Christian charity we offer our services to women without discrimination on the grounds of race, religion, philosophical belief, sexual orientation or social class. Both houses comprise a small therapeutic community providing abstinence based treatment and care. We believe our particular strength is an ability to respond to the specific needs of a limited client group flexibly and comprehensively. Our catchment area covers most of England and Scotland but we don't seem to get many referrals from Wales and the South West of England.

Hebron House opened in 1987 to meet a perceived need for women-only drug/alcohol treatment and rehabilitation units. Research showed that women were less likely to access treatment due to various factors and our experience was that a number of particularly vulnerable women fared badly in mixed rehabilitation settings. This latter circumstance has improved but the literature recognises a clear need for women-only facilities.

Initially confrontational group work was contra-indicated so the original regime was largely based on one-to-one teaching and counselling. The two main strands were 12 Step facilitation therapy augmented by cognitive work on the nature of addiction. Subsequently the team introduced group work based on relapse prevention, the 12 Steps and nutrition. We found the latter group to be particularly helpful for eating disorders - rather than pathologising this behaviour eating and nutrition were normalised and taken out of the emotional arena.

The local University of East Anglia is noted for Person Centred Counselling and we have replaced confrontation with a client centred therapeutic approach including some solution focused therapy and motivational interviewing. We have found the emphasis on personal choice and responsibility to be useful for empowering what often seems to be a highly disempowered group of people.

However, there were still a number of women with childcare responsibilities who were not able to undergo rehabilitation without their children and there were very few mother and child units nationally. Either there was no one else to look after their children or they feared that if they put them into care they would not get them back after treatment. If children were looked after by family members or put into temporary foster care this was harmful to their relationship and it was felt that to keep families together was a priority.

Consequently Hebron Trust opened Bethany Lodge in December 1998 to meet this gap in service provision.

At Bethany Lodge families receive an integrated structure of care where women are not only helped to get over their serious substance misuse problems but are also encouraged in their parenting. This gives them more confidence in their abilities and facilitates a better transition into the community after treatment. It is important to note that Bethany Lodge is neither a "rehab with a crèche" nor a children's home - mothers remain responsible for their own children.

Obtaining funding for children accompanying their mothers into treatment was also problematic. Priority is given to children who are perceived to be "at risk" so a drug using mother who has no prior contact with Children and Families Services would not be able to get funding for their children. If the mother's drug/alcohol problem progresses this often leads to far more expenditure in the future and harm to children that could have been avoided.

Funding for mothers comes from Adult Services and there is a lack of coordination between them and the Children and Families Division. Recent changes in the adoption process have also led to problems. The emphasis now is on fast tracking adoption so children can be settled in adoptive families at an early age. This has led to Courts imposing unrealistic demands on women such as reducing the timescale involved in women sorting out their substance misuse problems when in reality waiting time and funding procedures make it impossible to meet these requirements.

Since the government's consultation document, Tackling Drugs Together, was published in 1994 there has been broad consensus about the importance of treatment for tackling illegal drug use and drug related offending. This consensus does not appear as strong as it was and there is much less agreement about the role and priority of alcohol treatment - alcohol misuse actually has far greater social and economic costs.

The drug and alcohol treatment field is currently facing increased regulation. In our view this is broadly a positive development which will lead to improved standards, better qualified staff and better treatment. But it would be tragic if this results - as (so far, anecdotal) evidence suggests - in the closure of treatment centres and the loss of beds.