Q and A with Addiction Experts

Overdoses have claimed more than one million American lives in the past two decades. The situation is dire—but there is hope. Dedicated professionals in communities across the country are leading the charge to save lives, providing science-based, compassionate support directly to people in need. This interview series spotlights these inspiring individuals, sharing their work and insights.

Toni Mayes, LCSW-C, is a Maryland-based social worker who helps new moms with substance use disorders manage their illness so that they can be the best parents they can be. She supervises master level social workers to deliver services, treatment referrals, and resources in the hopes of keeping families together and babies safely at home.

It's vital to have women just like Toni working in the addiction space. Thanks to women like her, they're enhancing the quality of care and supporting clients and their children through a difficult time. We're proud to honor Toni's work during International Women's Day. 

Toni spoke with us about meeting her clients where they are, the long-term journey of recovery, and the success stories that make all the hard work worth it. 

What’s a day in the life look like for you and your staff?

I am a social worker in child welfare where the mission is to protect children from abuse and/or neglect. Currently, I supervise social workers who work with families where women with substance use disorders (SUD) have just delivered a newborn baby. In this role, we assess and support mothers and newborns who test positive for drugs at the time of delivery. Instead of this being a punitive process, our social workers provide referrals and support to the mothers (and fathers) in hopes of connecting them to treatment options, to assist in their sobriety, so they can be the best parent possible.

Our ultimate goal is for children to remain with their parents whenever possible. Here in Maryland, our clients have access to mother/baby programs where the mother and child can reside together while the mother receives inpatient treatment for substance misuse. There are also options for outpatient programs and intensive outpatient programs.

We try to meet the client where they are while also ensuring the safety of the child. The social workers I supervise go to the hospital upon delivery and will then complete home visits with the family to ensure that the child can safely go home. If they cannot go home safely, the social worker will assist the family in identifying alternative placement options. Alternative placement options can include using what we refer to as “safety plans,” which outline certain expectations of the parents. These expectations can include items such as the parents being supervised by family members or fictive kin while caring for their newborn, participating in random urinalyses, and engaging in substance use or mental health treatment. If the child is unable to safely remain in the home, the social worker will begin to consider kinship care or foster care as a temporary means until the SUD can be addressed. 

The social workers’ days vary from hospital visits, home visits, transporting clients to treatment, and working collaboratively with the treatment providers.  

How did you first get involved with work centered on substance use disorders (SUD)? 

I spent most of my social work career in Child Protective Services which opened my eyes to the impact that SUD has on families and children. In my current position, I have been able to see firsthand how the cycle of addiction can impact families.  

What are some of the biggest issues you see impacting the populations you work with? 

First and foremost: lack of resources! Secondly, I believe: the stigma that so many people (professionals as well) associate with child welfare. Although our goal is to keep children with their families whenever possible, most people see us as the enemy and instead of wanting to work with us, they try to work against us. This impacts the working relationship between the child welfare staff and the family.  

What are some of the most effective tactics that you use to help people?

I think one of the most effective tactics is to meet people where they are at that moment. Some people may only be ready for harm reduction programs, some others may be ready for outpatient programs, while others are ready for an intensive inpatient program. If you force people to do something they are not ready for, then the likelihood of them completing the program successfully and maintaining their sobriety lessens. 

What’s something you think most people misunderstand about SUD?

I think one of the biggest misunderstandings about SUD is the thought that people who "want" to stop using substances can just wake up one day and stop. In this role of working with families impacted by substance use, I have seen firsthand how this is just not true. Most mothers do not want to be addicted to substances and they don’t want their child, or children, to go through neonatal abstinence syndrome and have to be in the hospital for months.

Instead, most mothers want to be good parents and raise their children. If it was as easy as them just "wanting" it, I probably would not have a job. I want people to understand that just like depression or anxiety or any other medical illness, SUD is a disease, and it is not as easy as stopping when you "want" to. 

What’s something you wish more people knew about SUD?

I wish more people knew that recovery is a marathon and not a sprint. There will be times of relapse, times of disengagement, but also times of success. Recovery is a lifelong process and the more support and understanding we can provide as a society, the better the outcomes. 

Within your work, what sort of changes could be made to save more lives and help more families?

I think there needs to be more outreach during the prenatal phase for mothers (and fathers) so they can understand the effects of exposing their children to substances and the possible consequence of having social services involved. I would love to see child welfare staff and OBGYNs have a close relationship with each other so there can be a warm handoff when the mom delivers, and social services is called. In my state this conversation has started, but I think other states should start having these conversations as well. 

I would also love to see more inpatient programs for families. In my state we only have programs specifically for mothers to go with their children, but this leaves the father at home having to seek out his own treatment without his family. Although it is crucial to have the newborns be with their mothers during that bonding time, it is also important for the fathers to be a part of that as well. 

You've got such an important—and tough—job. How do you stay strong? 

The social workers I supervise help me find the strength to continue in this challenging field. Seeing them out in the field every day working on getting their clients into treatment, and making safe plans for the children, while also managing the lack of resources and the rollercoaster of addiction with their clients, is admirable. 

I have seen mothers who overdosed during their pregnancy survive, get into treatment, have their children come along with them, and then be successfully discharged. That is what keeps us all going. Each person we work with who is able to get it and turn their life around for themselves and their children makes it all worth it.