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The Coke Generation

Just one use of cocaine by a woman in early pregnancy can have serious long-term effects on the child. Doctors are beginning to fear a wave of hyperactice, learning-disabled children.

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"When I was 29, I guess it was, I had gotten pregnant. I didn't know until I was like three-and-a-half-months pregnant. I didn't know because it's not unusual when you're doing a lot of drugs not to get your period. And when you're high all the time, you don't really notice bloating and side effects and all that. I took a test at a local clinic--I found out on a Saturday. On Monday I went to the doctor, and all they did was verify that I was pregnant and make another appointment for me to see a doctor. And I told them I thought I should see a doctor right then--I really wasn't feeling well, something didn't feel right. Well, when I got home I started to miscarry."

Anne (not her real name) was rushed to a north-side hospital. "I'll always remember this--when I got into the emergency room and they tried to set up an IV on me, they realized that I was an IV drug user. I was doing not much heroin but lots of cocaine. I was lying there, and they couldn't get the IV in. And they had a couple of interns, a nurse, and this and that--and everybody had an arm and a leg and was stabbing me all at once. They never told me anything. I just wanted to get out of there as soon as possible, because they treated me like a side of beef."

Anne assumes she lost that first baby to cocaine. Although she had only just found out that she was carrying a child, she was surprised at how upset she was to lose it. "I had tried many years prior to that to get pregnant, and then gave up on it because I thought I was too old. Everybody that I knew had families by the time they were 23." There had also been times when she hadn't even been sure she wanted children.

Shaken by her miscarriage, she cut down on her drug use, but she didn't stop. Five months later she found out she was eight weeks pregnant. "At that moment I stopped," she says. "I just didn't want to go through losing a child again. It wasn't easy--it was probably one of the hardest things I've ever done. But for me there was just no question. What I usually tell everybody is, it's a matter of priorities--the baby was more important than my getting high. And I had decided when I miscarried that if I was to get pregnant, that was it. I just don't understand how--I mean, do what you want to yourself, because God knows I've abused myself badly. But when it comes to someone else's life, your own child's especially, I don't see how there's any question."

Though she never used drugs again, Anne went into a program for pregnant addicts, the Perinatal Center for Chemical Dependence at Northwestern University Medical School, where she delivered a seemingly healthy girl. Yet a fetus exposed only once to cocaine, especially in the early weeks, can have permanent damage that may not be apparent for several years. Anne's daughter, who is now five years old, is one of the oldest children being followed by doctors at the center in a long-term study of cocaine babies.

Anne, who is white, grew up in a comfortably middle-class home. Last August, the same Northwestern doctors who are watching her daughter's progress reported that their study of 36 hospitals around the country showed that at least one out of ten newborns has been exposed to illegal drugs--the most common by far, cocaine. They also found that the exposure rate in hospitals with low numbers of public-aid and low-income patients was similar to the rate in large urban hospitals with many poor patients. One of the conclusions to be drawn is that huge numbers of middle-class, probably white women in their childbearing years are using drugs. These women are probably some of the least likely to be suspected of drug abuse by their doctors or the public.

Anne, who is now 36, spent most of her childhood in Skokie. When she left home, she moved around the suburbs and then into the city. "That's where you had to go to get dope anyway," she says. She speaks quickly in a low, gravelly voice, and has a dry, sarcastic wit that is often directed at herself. "I mean, they had it in the suburbs, but everybody got it from the city and brought it out to the suburbs and cut it down. So in the city I was closer to everything."

She says she started doing drugs when she was 19 or 20. Like many women who use drugs, she was introduced to them by the man she was involved with. Her first husband, to whom she was married for only two years, encouraged her to try heroin. "I used to be afraid to get shots. I thought, 'My God, you do that?' And then I thought, 'Well, if you do it, I guess it can't be that bad.' So I tried it--and 'Hey, can we get some more of this?' And that was it. But see, if we didn't have money, he was happy to go get his beer or his bottle of Ripple or whatever. But not me. I wanted the dope. I always liked that type of high--being laid-back and relaxed--because I was always more hyper. When I found heroin, that was it. No more pills, no more nothing." During their divorce proceedings, her husband claimed she was a known drug addict. "Well for heaven's sake," she says, "who started me?"

Later another male friend introduced her to cocaine, which people were then saying was not physically addictive. "I said no, no, and finally I said OK--for months I said no. And I did it, and it was instant gratification. I didn't like the high--if I had had to snort it I would never have done it. But it's like the rush--it gets you right away, and it was just like somebody'd thrown a sheet over my head. That to me felt so great. It was like 'Hey, forget everything. This is where I'm at.' And then after that wears off, you've got that speedy high, which made me real paranoid. I was crazy. I used to crawl around on the floor with the lights out. I used to think people were looking in the windows, the police were going to get me. And the only way I could get over that was to do another hit and get that rush again. That's why people free-base--to keep going and going.

"The thing with coke is, when you're out of money and out of coke, it's just like the end of the world. You feel so horrible, and you regret all the money you've spent. But then you want to get some more. I mean you really feel bad, but 'Hey, if I get some more, I won't feel bad anymore.' And it's just a vicious circle."

She worked as a secretary, but didn't make enough at that to buy drugs. So she fenced stolen goods for a time and even tried streetwalking once, though she fled before she'd taken any of her clothes off. "I did things--when I think about them now, it's horrible," she says. She took money from her mother, who knew that Anne did drugs because she'd watched her shoot up. "That wasn't because I wanted to hurt her, or because I didn't care," Anne says. "It was just because we've always been close, and I had never hidden anything from her.

"I used to come up with unbelievable stories to get money out of her. Like 'I rolled into somebody at a red light, and I have a suspended driver's license. I don't want him to call the police. He's going to call the police if I don't bring $500 to him in a half hour.' So she'd go, 'Oh, my God,' and I'd get her out of bed. 'Go run to the bank. Run to the Jewel. Get your check card. You've got to do it now.' I think she knew what I was doing, but if she didn't give it to me, she figured she'd be bailing me out of jail or I'd be doing something dangerous. Gosh, my mother even used to take me to cop if my car broke down. She thought her hands were tied." She pauses and then says quietly, "And now I look back on how I must have hurt her."

Then Anne started dealing, and she didn't need her parents' money anymore. She dealt to her friends, who, she rationalized, were buying anyway and might as well buy from her. But she says she never sold to the women who wanted to buy when they were pregnant. "I knew that they would go somewhere else, but I didn't want to sell them anything. Even before I had kids I felt like that. I thought it was just so horrible."

Her life became routine. "Get up. Get my customers taken care of. Get me taken care of. No matter what time it was, the cycle just kept going. And I did it for so many years, I didn't know any other way of life. I didn't even know what month it was, much less what day of the week. There would be mornings when I could hardly get out of bed--I was just sweating, cold shakes, nose running, and achy bones. I used constantly." She stretches out her arms with her wrists up. Only the thinnest blue lines lace under her pale skin. "Try to find a vein on me. If I needed a transfusion, I'd probably die. They told me they'd come back, but nothing really has."

Her life twisted in a new direction when a friend was killed after a deal went wrong. "We didn't trust the guy, but it was such a good deal, my friend just couldn't pass it up. He went over to this girl's house to do the deal--they killed her, too. The only one they didn't kill was the dog. The thing was, they killed him and they didn't even get the money."

Anne was called in to identify her friend's body. "The whole thing just freaked me out, so I thought the thing to do was to get as far away from the drug scene as possible." She started by cutting way down on her drug use. "I was doing it maybe twice a week instead of like 15 times a day." Then a woman she knew took her to a bar and introduced her to a friend. "He was an alcoholic and hung out in this bar. I thought, well, that's far away from the drug scene. I married him six weeks later. That was all like a chain reaction." She was 29 years old. It was five months after she was married that she miscarried.

She and her second husband argued a lot. "He used to get on me about being a drug addict, and I would get on him about being an alcoholic. In every fight I was a scumbag junkie or something. And that's something, too--when you're labeled, you figure why bother?" She started using more cocaine again, though not every day. "Even when I was pregnant and didn't get high on anything, he still said I was a junkie. But see, when drugs were around, he was right there with me. He, like my first husband, was happy with anything. He would drink cologne that was ten years old if he had to to get off. But he was all right because, socially, drinking is accepted. You don't go to jail for buying a six-pack."

The two of them left the city after one week in which a group of 11-year-olds mugged her husband, a sniper shot her friend and a dog in her backyard, and someone broke into the apartment downstairs and would have attacked the young girl there if the girl's younger brother hadn't hit him over the head with a frying pan. "Now this is all in one week," she says. "And the garbage truck hit my Cadillac. So I said, that's it. We've got to get out of here." They moved out to a far suburb--"where God left his socks." It was while she was living there that she gave birth to her first daughter and, a year later, to her son.

Early on her marriage had turned ugly. "He used to beat me even when I was pregnant. The police were over all the time--they wanted to take me out of the house. They took him out once and dropped him off at the bar, and he came back and whaled on me again. The cops were afraid of him--I think these little towns are so Mickey Mouse. He was crazy, I'll tell you, when he would get wild and drunk. He picked up the washing machine and threw it at the police--and they left. I'm going 'Please!'

"He used to tell me every day he was going to kill me. If he'd go out of the house, I didn't know if he was going to come home in five minutes or five days or five weeks--though I knew that when he did, he was going to go off on me. So that one day when he told me he was going to kill me, I just could not take it." That day she had gone with her son and daughter to a Halloween party at the local drug-treatment center. "One of the drug counselors took it from there. She said, 'You can't go back there.' So there I was, with a 7-month-old and an 18-month-old in Halloween costumes, all on my own."

For the more than ten years that she took drugs, Anne hid her use from everyone she could, except her drug-using friends and her mother. "I didn't want her to be shocked," she says, and pauses. "Or maybe I wanted her to try and help me." She had been in a drug-counseling group more than once, but she's vague about why they didn't help. Maybe because she wasn't ready, she says. Maybe because she hadn't found a counselor she could really respect. For some people, she says, the groups served simply as a way to make new contacts. It wasn't until she went to Northwestern's perinatal center, she says, that she met counselors who understood and were genuinely concerned about her.

She says she knows why she started using cocaine: "I started because I wanted to do what my friend did." But she isn't sure why she stayed with it. "I guess to escape. I don't know. Because it felt good. I really can't tell you, to this day." She can tick off partial explanations, which came out in counseling. Though she wasn't abused as a child--as many women addicts have been--she was afraid of her biological father, an alcoholic who died when she was 11. She may have used drugs to escape her husbands, both of whom beat her. But she seems to prefer to take most of the responsibility herself. "Hey, I'd like to say that I had a big problem to blame my drug abuse on. But it was no big deal. My father drank and used me as a scapegoat, but I don't think I suffered from it really. I mean maybe it had something to do with it, but I sure am not going to put the whole blame on it. It was because I did it. I continued it because I liked it. I guess because it was an escape from reality--not that my life was so bad or anything. But the outlook just seemed a lot better when I was high for some reason."

She says that she always did everything to excess, that she has an addictive personality. Now, she says laughing, she's addicted to ice cream. She still smokes a lot but seems self-conscious about it, blowing the smoke she exhales high above her head and waving away the line that drifts up from the end of her cigarette.

She couldn't stop using drugs to spare herself, but she could stop to spare her child. "I know what's right and wrong. When it was just me, who cares? I was only hurting myself. I stopped basically because of the baby. And then you get to thinking about yourself, your family, your parents, and who you're hurting, and the things you'd have to do to get the money." Having found a reason to stay clean for the seven months until she delivered, she found she had the same reason to go on being straight. "Even after getting the baby here, you've got to follow up. You can't just go back and get high and go, 'Well, here's the baby. I did my part.'"

During the years Anne used drugs, she hadn't always been able to hide it from the doctors and nurses she occasionally had to see. She says that rather than offer her help, they often treated her with contempt or hostility. She says many of her friends who used drugs were treated the same way. She says that once she went to a gynecologist for a minor problem, and that when the doctor saw that she was a user, he started screaming at her and called her a "junkie broad" in front of everyone in the waiting room. "That was it," she says. "I didn't care if I was dying. I wasn't going to a doctor for anything for a couple of years after." Then she was abused when she miscarried and the hospital personnel couldn't get an IV into her.

But the scorn didn't end when she stopped using drugs. When she went to the hospital for minor scalp surgery while she was pregnant with her son, she was treated kindly at first. "They told me everything was going to be fine. The nurse was so nice, told me exactly what was going to happen.

"Well, when I got in there, they couldn't get an IV into me. They wanted to know why, and I told them I was an ex-drug abuser. And then they too were all stabbing me, going 'My God. My God.' I said, 'Well, gee. Had I known ten years ago that this was going to hurt you as much as it is right now, I never would have done it.' They treated me just horribly. They gassed me and then they gave me an IV while I was out. And I had holes all over me. I had dried blood dripped everywhere--legs, arms. I had blood all down my face. It was like they did it on purpose. I just felt so humiliated. Here I was done with it, hadn't gotten high for about a year, and they're still treating me like a jerk. So what do you do? I've repented, I think. I made a mistake, but that doesn't mean you're better than me or that you can treat me like shit on your shoe."

Occasionally, Anne has run into doctors who are not contemptuous but simply ignorant about drugs and drug addiction. When she was pregnant with her son, she thought she might be better off going to a local doctor--her friends told her Northwestern was too far to drive if she went into labor. "I went to the guy, and I was talking about having taken different drugs. And he takes out his PDR [Physicians' Desk Reference] and starts looking through it. And I said, 'Well, I think I hear my mother calling me. I'll be right back.'" She laughs. "I was out the door. He was looking it up? He doesn't even know what I'm talking about?"

The fact that she was once a drug user, even though the last time she used was more than five years ago, seems to repel a lot of people. So most of her friends now are former drug users. "I never really had very many real close friends--I was getting high too much. Most of my friends are ex-abusers like myself, but they've been clean as long as I have. I guess maybe I'm still afraid of being rejected, because some people consider that like--well, it's a lifelong illness. I'll always be an addict. But some people that don't understand treat you like they're going to catch it from you, or they put you down for it. So it seems like it's safer to be with people that I know aren't going to put me down because I know they've been there. And also they know how hard it is to be clean--what they have to go through to do it, how they have to change their lives. Maybe it's because we give each other moral support and praise each other."

Now and then she runs into an old acquaintance who is still using. "It's amazing. You can see these people in ten years and they'll still be doing the exact same thing they were doing the last time you saw them--ripping and running, getting high, doing this, doing that, talking the same line of bullshit."

A cocaine-using mother who quits can probably recover all or most of the mental capability she once had. But many of the babies who are exposed to cocaine in utero may have damage that is irreversible. It is also impossible to tell how many cocaine babies, even if they seem perfectly normal, have lost a potential that nothing can retrieve.

Shortly after a mother takes cocaine, the drug passes easily through the placenta from her bloodstream into her baby's. But while the drug usually cannot be detected in the mother after 24 to 48 hours, it may stay in the fetus's system for five to six days. The fetus, with its immature liver, has difficulty breaking down cocaine, but will convert much of it to the even more toxic norcocaine, which it excretes into the amniotic fluid. But norcocaine is only slowly reabsorbed into the mother's bloodstream and eliminated, so the fetus swallows the drug, exposing itself again.

A baby exposed to cocaine in utero most likely has been exposed to other drugs as well. Most of the cocaine-using women who come into the perinatal center at Northwestern, for instance, also use alcohol, marijuana, cigarettes, barbiturates, or some other drug--each of which adds its own risk. The synergistic effects of these drugs are for the most part unknown, though Ira Chasnoff, a pediatrician and the director of the center, says that the effect of two drugs may be worse than the sum of their separate effects. He points out that studies show that a woman who uses alcohol and marijuana is five times more likely to have a child with fetal alcohol syndrome than if she had used alcohol alone.

A single use of cocaine by a pregnant woman can cause her child's death or serious, irreversible physical damage, especially if she uses during the first trimester. Because cocaine is a vasoconstrictor, it causes a sharp rise in the mother's blood pressure, which can lead to uterine contractions and a miscarriage. The mother's use also decreases the blood flow to the fetus, limiting its oxygen supply and causing its blood pressure to rise. That can cause the fetus to have a stroke or heart attack; it can also cause genital or urinary-tract deformities. A cocaine-exposed baby is far more likely to be born prematurely than a normal baby, usually weighs less and has a smaller head, and has ten times the normal risk of crib death.

But the most worrisome effects of cocaine may be the long-term neurological and consequent behavioral problems. No one yet knows the exact correlation between the extent of these problems and when, how often, or in what doses the cocaine was taken. No one even knows yet exactly how cocaine causes the damage. It does seem clear that the earlier a mother stops using, the better off her child is likely to be. But even children who are exposed only in the first trimester often have neuro-behavioral problems.

Many cocaine-exposed newborns are extremely irritable--one of the first signs of problems to come. "The way I try to explain it to the moms," says Dan Griffith, a developmental psychologist at the perinatal center who is one of the doctors following Anne's daughter, "is that it's very similar to what goes on in anybody's life when the things they're dealing with are at a level so that the next least little thing is going to set them off. That's probably the way these babies feel most of the time." The damage to their nervous systems makes them incapable of tolerating much stimulation. They are easily overwhelmed, at which point they generally respond either by screaming or by going into a deep sleep. "They spend very little time in that nice, quiet alert state, which is where most learning takes place in the first few months," says Griffith.

Griffith and the other staff at the center teach the mothers in the program how to engage their babies without overexciting them. They also teach them how to calm the babies by doing such things as swaddling them. Yet the frustration of dealing with such difficult babies may be one of the reasons that many of their mothers go back to using cocaine. About half of the mothers who are treated at the center relapse, despite all the support they're given--full medical and psychological care before and after their babies are born. But very few pregnant users get such care. Last year a panel of state alcohol- and drug-abuse-center directors told a congressional committee that 90 percent of all drug users who voluntarily ask for help are turned away. Moreover, many of the public treatment programs with space available prefer not to take pregnant women.

It is extremely difficult to test infants and small children to see what kind of subtle, long-term problems they may have; but there are standard tests that can be used to compare the responses of normal babies and those of cocaine babies. The Northwestern study of cocaine babies has been going on longer than any other study in the country, but the oldest babies to have gone through a complete series of standard tests are now only three years old. Yet some of the early tests indicate the kind of problems these children may have later on.

One standard test for a 12-month-old baby is to put a cup and nine red cubes in front of it and ask it to put the cubes in the cup. A normal baby will put three or four in before it gets bored with the task. "Most of the cocaine- exposed kids, however, can't do even three," says Griffith. "In fact, they usually don't put any in. Because as soon as you put that many things in front of them at once, they start throwing them around, mixing them up. But if you hand them one block at a time--if you add that structure for them--they can go ahead and finish the task." He adds that mothers who carefully follow the training given them at the center have babies who do better on these tests than the babies of mothers who don't follow the training.

According to Griffith, other tests indicate that, as the children grow older, their overall development and IQs seem to be within the normal range. But by the time they reach school age, he says, "Most people strongly suspect that there're going to be a number of cocaine-exposed children who have learning disabilities, and especially attention deficits and hyperactivity." There is plenty of anecdotal evidence to back up that fear. Griffith says, for instance, that preschool teachers have contacted him and told him that in the last couple of years they've seen large increases in the number of children who are hyperactive and who have trouble paying attention. Some of the teachers told him they found out that the mothers had taken cocaine while they were pregnant.

"Our suspicion," says Griffith, "is that, based on what we've seen clinically and from talking to other experts around the country about what they've seen, once these children get into preschool settings or especially school settings, where it's very unstructured--at least in terms of their needs--and they've got possibly 20 children with one teacher, they're going to be overwhelmed and become real behavior problems. And they're going to have difficulty learning under those conditions." He says he can't guess what percent of the one out of ten babies now being exposed will be affected. But he adds that the problems may be compounded if, as the children grow up, they remain in environments where the accepted way of coping with frustration is to use drugs.

Anne says she never particularly liked other people's children. "You know. 'Kids. Fine. Get 'em away from me.' It was 'Hi! Oh, brought the kid? Good. Take it home. Nice seein' ya.' But my mother told me, 'You'll get shit under your fingernails and you won't care a bit.'" Anne hadn't been sure she wanted children, in part because she thought the world was a not very nice place headed for a nuclear end. "I thought if it was just me, who cares? I can handle myself. I've done it for years. But then when you have someone to worry about--it's like I just didn't want to get attached, I didn't want to have to care. But now I have three children--five, four, and 21 months. And I care."

Anne now lives in a small house in the suburbs. Plants hang from the eaves and sit on every step of the porch. Inside, children's paintings and construction-paper projects hang not just on the refrigerator but on the living-room walls. She has a dog, a puppy, five cats, and two kittens--all rescued from one misery or another. "Kids and animals," she says. "I guess it's things that can't do for themselves, things that don't know better. Adults know better--they're the ones that beat the kids and kick the dogs and slam the tails of cats in the door." That was how one of her cats lost half its tail.

She patiently picks up her 21-month-old daughter when she asks to be picked up, puts her down when she wants down, repeatedly gets up and trails her into the kitchen to give her what she points at, and makes her say please and thank you. "She doesn't talk a lot. The doctor says it's because I just give her what she wants. The first one--" She stops and laughs. "Here I am at one week old going, 'This is a telephone. This is a dish. Dish.'" She waves toward her youngest daughter. "This one's spoiled."

She's the drug story with the happy ending, she says. She lives with the father of her youngest child, an ex-user who became her friend when they were in a drug-counseling group together and who helped her after she left her husband. He left his wife when she refused to give up cocaine. "He's so great. And to my kids, he's their father, because he raised them and everything. He spent more time with them the first week that he was around than their father did the whole time. They just love him to pieces. And I'm not afraid of him or anything."

She also says her mother long ago forgave her. "She's so glad it's over, and the grandchildren I gave her were enough to forget about it. But it did take a while to win her trust back. If I needed money to pay a past-due bill, she wanted to make sure it was for a bill. I often wonder what I'm going to do if ever she--I mean, I'll just miss her so much. She's just done so much for me, and I know I put her through a lot."

It could be years before Anne knows whether her cocaine use has affected her daughter, who is now in preschool and, according to tests, bright and normal. Anne's well aware of the potential problems. "I know a woman who has a child who's like nine or ten. The kid's so uppity. Well, here she finally admits she was doing cocaine during the pregnancy. But they weren't looking for that back then, you know? Did her daughter cry a lot as a baby? No. But look at her now--she's right up the walls. She's just real hyper, won't sit down. Think cocaine has anything to do with it? Yeah, I think so."

She says she thinks she quit so early that it couldn't have affected her daughter. "Even during those first two months I wasn't doing it every day. I probably could have counted the times on one hand--well, no, maybe on my fingers and toes." But when asked whether she worries that her daughter may have problems that simply haven't shown up yet, she says, "I say no firmly. But maybe it's because I'm hoping no."

Art accompanying story in printed newspaper (not available in this archive): illustration/Robert Goldstrom.

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