Camille Friant does not enter the shadows of Ghent’s social housing blocks alone. Beside her is Billie, a dog who serves as more than a companion; he is a social bridge. In the precarious environment of the Blaarmeersen and the Watersportbaan, where ten social housing blocks cast long shadows over the lives of vulnerable youth, Billie is often the only thing that makes a guarded teenager or a frightened young woman feel safe enough to speak.
For four years, the 35-year-old has worked as a youth street worker, a role that differs fundamentally from traditional social work. While most aid systems are built on rules, intake forms and strict conditions, Friant operates on the currency of trust. She meets her clients in laundromats, squares, and community centers, offering everything from a birthday cake for someone with no family to accompanying a homeless girl through a surgical procedure and staying until she wakes from anesthesia.
But recently, Friant has found herself at the center of a polarizing debate that pits the rights of the mother against the health of the unborn child. In Ghent, policy makers are weighing proposals that would allow for the forced detoxification of pregnant women struggling with addiction—a move intended to prevent babies from being born with withdrawal symptoms, but one that Friant warns could drive the most vulnerable women further into the shadows.
As a physician, I have seen how the clinical reality of addiction often clashes with the rigid structures of public policy. Addiction is rarely a simple choice; We see a complex intersection of neurobiology and trauma. For the women Friant supports, substance use is often a survival mechanism for untreated trauma, homelessness, and a profound sense of uselessness. When a system responds to that trauma with coercion, the medical outcome is often secondary to the psychological rupture.
The Fragile Bridge of Trust
The core of street work is the removal of thresholds. Many of the women Friant assists have a history of negative experiences with psychiatric wards or youth services, where they felt patronized or controlled. To them, the “door” of an institution is not a gateway to help, but a trap.
Friant, who is herself a young mother, notes that her shared experience of pregnancy often makes her the first point of contact for women who are terrified of the system. These women may visit a doctor to confirm a pregnancy but hide their addiction for fear of immediate judgment or the forced removal of their child. The goal of the street worker is to act as a “go-between,” mobilizing a network of midwives, physiotherapists, and social workers without the threat of legal reprisal.
The tension arises when the “right to self-determination” clashes with the “right to protection.” While some advocates argue that the state must intervene to save a child from the effects of prenatal drug exposure, Friant argues that a radical choice for the child can lead to the total loss of the mother.
Comparing Approaches to Prenatal Addiction Care
| Feature | Forced Detoxification Model | Trust-Based Outreach Model |
|---|---|---|
| Primary Goal | Immediate cessation of substance use to protect the fetus. | Long-term stabilization and maintenance of the mother-child bond. |
| Mechanism | Legal mandate, compulsory admission, and supervision. | Voluntary engagement, low-threshold support, and networking. |
| Primary Risk | Patient “disappears” from the radar; loss of trust in healthcare. | Possibility of the baby being born with withdrawal symptoms. |
| Success Metric | Clean toxicology reports during pregnancy. | Retention in care and successful transition to postpartum support. |
The Clinical Complexity of Forced Detox
From a medical perspective, the idea of a “forced detox” simplifies a process that is inherently volatile. Addiction does not have an on/off switch. Forced admission without addressing the underlying causes—such as homelessness or severe PTSD—often results in a revolving door of relapse. When a woman is forced into a facility, she is stripped of her agency, which can exacerbate the very trauma that fuels her addiction.
Friant shares the story of a client who, after her first child was born with withdrawal symptoms, entered addiction care with her baby. She left after a single day, not because she didn’t want help, but because she “wasn’t ready.” Today, that same woman is clean, though her children remain in foster care while she painstakingly rebuilds her life. Had she been forced to stay, Friant suggests, the result might have been a total psychological collapse rather than the gradual recovery she eventually achieved.
There is also the issue of medical ignorance. Friant recalls a case where a pregnant client was addicted to lighter fluid—a substance that is less discussed in policy circles than heroin or cocaine but equally damaging. If policy only targets “hard drugs,” it leaves a gap in care for those using volatile solvents or alcohol, creating an arbitrary and ineffective standard of protection.
Navigating the “Mother’s Heart”
The emotional toll of this work is significant. Friant admits that as a mother, it is agonizing to witness a newborn suffer through Neonatal Abstinence Syndrome (NAS). However, she maintains that professional intervention must be guided by sustainable outcomes rather than individual emotions.
“The future of mother and child may not be determined by individual emotions,” Friant explains. “By making a radical choice for the protection of the unborn child, you can lose the mother. You deprive her of her freedom and signal that her baby will be taken immediately. She may simply vanish from the radar.”
To prevent this, Friant employs a strategy of “concerned confrontation.” She does not ignore drug use—she maintains a strict rule that no substances are used in her presence—but she avoids the “scolding finger.” Instead, she mirrors the client’s behavior back to them, allowing the woman to feel the weight of her choices without feeling the weight of social condemnation.
Systemic Failures and the Path Forward
The debate over forced detox often ignores the systemic failures of the Belgian healthcare system. Waitlists for addiction care are extensive, and access criteria are often too rigid for those living on the street. Forcing a woman into a system that is already overburdened and under-resourced is a recipe for failure.
the reliance on social professionals to act as informants for the justice system threatens the very foundation of street work: professional secrecy. If a street worker becomes an agent of the state, the trust required to guide a woman toward a midwife or a doctor evaporates.
Disclaimer: This article is for informational purposes only and does not constitute medical or legal advice. For guidance on addiction or prenatal care, please consult a licensed healthcare provider or a certified addiction specialist.
The next critical phase for this debate will be the legislative review of the proposed policy changes in the Flemish region, where officials must decide whether to prioritize immediate fetal protection or the long-term stability of the family unit. The outcome will likely determine whether thousands of vulnerable women continue to seek help or retreat further into the shadows of the city.
We want to hear from you. Should the state have the power to mandate medical treatment for the sake of an unborn child, or does that risk destroying the possibility of long-term recovery? Share your thoughts in the comments below.
