Substance abuse is a family issue, even if what makes the news is celebrities going it alone.

Actress Lindsay Lohan might not have to worry about keeping a family together while dealing with her addiction, but that isn't the case for many people who need help, such as the 928,000 Pennsylvanians who abused controlled substances in 2005, according to estimates by the Substance Abuse and Mental Health Services Administration.

And in Lancaster, there is a treatment program that helps women to deal with family and recovery at the same time, by keeping mothers and their children together.

Vantage, at 208 E. King St., allows women to bring their children, up to age 12, with them when they enter rehab, so they don't risk having them placed in foster care while they are away. Children up to age 2 stay with their mothers in rooms with up to four women, while older ones live in dormitories and continue attending school.

Vantage is administered by Gaudenzia, which also runs four other rehab facilities as well as outpatient counseling.

As a "therapeutic community," Vantage attempts to teach women to lead a normal life while recovering from addiction and dealing with other problems, such as abuse. It began in 1979.

"Most of the women we're dealing with are dealing with more than just drug and alcohol abuse," said Paula Kiernan, the facility's program director.

As part of their treatment, the women work to keep the facility running, through helping with tasks such as child-care and laundry, as well as caring for their own children when they aren't attending educational sessions or group therapy.

"We try to provide the most home-like environment we can," said Kiernan.

Those without high school educations are also required to enroll in a GED program after their first month of treatment. Some addicts arrive at Vantage directly, and others are referred from other programs when they need longer treatment.

Time for structure
Tanedia Thomas recalled coming to Vantage with her two sons in 1994, "scared and looking a hot mess." She was transferring from another facility to treat her crack cocaine addiction.

"It was a hard experience in the beginning, and it became easier and easier," said Thomas.

She recalled challenges, known as "learning experiences," such as waking up earlier than usual to write papers about her feelings and actions.

"Writing that paper really helped me," she said. "I don't even think about crack."

Despite the difficulties of adjusting to a structured life with required cleaning and group sharing, Thomas said that she knew she couldn't return to her old life.

She had hit rock bottom when she found herself weighing only 93 pounds and trying to sell her food stamps to buy drugs.

"I had to do something with myself," she said. "[I said] 'You weren't born this way, girl; get up and do something.' "

And she did. Though she was discharged in 1995, she only recently celebrated her graduation with other former residents who felt ready to present themselves to the community in their new lives. She is now the house manager at Vantage.

"It's not a job; it's a home," she said.

Her work as house manager requires her to comfort, listen and occasionally be "the scapegoat when [the residents] get angry" while learning to express themselves positively.

To that end, the residents meet for educational sessions on how to manage stress and for group therapy.

"One thing that people who have an addiction have trouble with is talking about how they're feeling," said Kiernan.

Support is key
Vantage hopes that by teaching communication and life skills, the women can stay off drugs after their six months of treatment are over.

Following treatment, addicts are encouraged to attend Alcoholics Anonymous or Narcotics Anonymous meetings and to build strong support systems.

The Council on Drug and Alcohol Abuse, which helps people seeking help with substance abuse to find programs, often recommends that addicts attend 60 meetings in as many days.

Amy Sechrist, an information and referral specialist for the council, described such meetings as often providing "brutal honesty."

"A lot of drug and alcohol counseling is zeroing in on people's patterns of thinking," she said. "Once you start to break down your own denial, you can recognize your own problems in other people."

Meetings might be only one part of "aftercare," a gradual stepping down of treatment intensity. Some people also need counseling or enter a halfway house, which conducts drug tests on its residents. Many people don't complete their aftercare, though, Sechrist said.

"It's very difficult to make real changes in your life."

Those changes can include getting over a physical dependence and changing behaviors that lead to addiction.

Many people also feel that they don't need aftercare.

"Once people are off drugs ... they start to feel really good," said Sechrist.

Some people's addictions, however, are not so severe that they need to enter rehab.

A standard drug and alcohol assessment scores an addict on the basis of the type of substance, how much of it is used at one time, how often it is used, and any consequences that resulted, such as arrests, losing a job, or blackouts.

The assessment then determines what level of treatment a person needs.

The least intensive is outpatient counseling, in which the person attends meetings and counseling sessions, which gradually taper off.

The next step up is intensive outpatient counseling. The person would attend counseling and group therapy every day in off-hours and could still hold a job. The sessions become less frequent over time.

Beyond that is partial hospitalization. The person checks in for 40 hours per week, but is allowed to go home for nights and weekends. Checking into a residential facility, or rehab, is the most extreme treatment.

A person who has a strong support system of friends and family is more likely to be recommended for a lower level of treatment. Ultimately, however, cost might dictate what treatment a person receives, though the county Drug and Alcohol Commission does have contracts with some facilities for free care.

"The insurance company makes the final decision," said Sechrist, adding that sometimes insurers like to try a lower level of treatment before paying for a higher one.

Most companies pay for 28 days of rehab, and might stipulate how many times a person can reenter it. Even outpatient care can be limited in the number of counseling sessions a person can go to in a year or over his or her lifetime.

Court-ordered treatment is generally free, and paid for by home counties. Most of the women at Vantage fall into that category because they receive welfare, said Carol J. Schonour, its community affairs manager.

To enter rehab, addicts call a center, which will sometimes do a brief assessment over the phone to determine if they need to be admitted. After insurance verification, the addict is admitted immediately; sometimes the facility even picks him or her up.

For outpatient counseling, they can call a provider such as the council and make an appointment. The average waiting time is about a week, with the exception of pregnant women, who are given priority. The council recommends attending support group meetings while waiting.

Thomas hopes that more people will seek help for their addictions because she believes it can work.

"[If] more women could knock on our door if they need treatment, I would be happy."

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Megan Hart is a staff writer for the Sunday News. Her e-mail address is mhart@lnpnews.com.