Children in Substance Abusing Families

by Child Welfare Information Gateway

As the incidence of alcohol and other drug abuse becomes more visible in our Nation, parental substance abuse is increasingly recognized as a significant factor in cases of child maltreatment. Estimates suggest that 50 to 80 percent of all child abuse and neglect cases substantiated by Child Protective Services (CPS) involve some degree of substance abuse by the child's parents. The profound impact of substance abuse on the lives of children is also documented in research on perinatal addiction. A 1990 General Accounting Office study of medical records at 10 hospitals in 5 cities (Boston, New York, Chicago, Los Angeles, and San Antonio) found the incidence of drug-affected newborns ranges from 1.3 to 18.1 percent of all live births. Other research suggests that over 7,000 children each year are born with Fetal Alcohol Syndrome, a consequence of maternal alcohol use during pregnancy.

Infants and children who reside in households in which alcohol and other drugs are abused may suffer harm in a variety of ways. A parent's overriding involvement with alcohol and other drugs may leave the parent emotionally and physically unavailable to the child. A parent's mental functioning, judgment, inhibitions, and/or protective capacity may be seriously impaired by alcohol or drug use, placing the child at increased risk of all forms of abuse and neglect. A substance-abusing parent may "disappear" for hours or days, leaving the child alone or with someone unable to meet the child's basic needs. A parent may also spend the household budget on alcohol and/or other drugs, depriving the child of adequate food, clothing, housing, and health care. A child's health and safety may be seriously jeopardized by criminal activity associated with the manufacture and distribution of illicit drugs in the home. Consistent exposure to parental abuse of alcohol and other drugs may contribute to the child's own substance abuse.

As is true in most cases of child maltreatment, parents and caregivers who abuse alcohol and/or other drugs do not intend to harm their children. Most do not stop to consider that even a single incident of substance abuse can result in serious injury to their child. Further, the risks associated with parental substance abuse have no socioeconomic or racial boundaries. Upper- and middle-class parents who abuse alcohol and/or other drugs pose just as much risk of harming their children as parents who abuse drugs and live in poverty. The primary difference lies in the tendency of professionals to overlook or forgive the upper- or middle-class substance abuser, or to offer help more expediently to these families.

Because of the harmful repercussions commonly associated with substance abuse, early identification of the problem and early intervention are essential. All professionals who work with parents and children need to understand the indicators and dynamics of substance abuse, routinely probe for the problem in families, and be prepared to intervene when the problem is suspected or confirmed. This requires examining one's own attitudes about substances of abuse and substance abusers, the origins of these attitudes, and how one's attitudes influence intervention with families. Professionals also need to be sensitive to the cultural context in which the families exist.

Additionally, professionals need to be informed about the various substances of abuse and their effects on adult behavior, child development, and parenting. They need to be knowledgeable about the nature of substance abuse and the chronic, often relapsing nature of this disorder. They need to learn to recognize the warning signs of substance abuse in a family and know how to ask the "right" questions, how to conduct a comprehensive family assessment, and ways to protect a child from maltreatment. Lastly, professionals need to be able to provide culturally sensitive support and guidance to families affected by substance abuse, act as advocates for these families in the service system, and work toward improvements in the prevention and treatment of substance abuse. Unless professionals possess these skills and knowledge, services provided for parents and children many prove inadequate or inappropriate.

Identifying Alcohol and/or Other Drug Use

CASE VIGNETTE: Lisa was 19 years old and pregnant with her first child when her mother brought her for her first prenatal visit, which was towards the end of the third trimester. Clinic staff noted that Lisa was tall and quite thin, made poor eye contact, and seemed hostile towards them as well as to her mother. During the clinic appointment, Lisa's mother noted that the baby's father was a substance abuser who was occasionally violent towards Lisa. Just prior to delivery, at a second clinic visit, Lisa revealed to a social worker that she had used phencyclidine (PCP) and cocaine occasionally before her pregnancy. Although Lisa denied that she had a substance abuse problem, staff counseled her about the effects of substance abuse on the unborn child. Two weeks later, Lisa delivered a baby boy who was small for gestational age. Both she and her baby had urine toxicology screens that were positive for PCP and cocaine.

Because of the nature of chemical dependency and the generally illicit use of many drugs, often self-report is not an adequate screening measure to detect drug or alcohol abuse. Professionals commonly encounter denial and withholding of information when interviewing chemically involved clients. Thus, behavioral and physical indications of intoxication, although sometimes ambiguous, can provide important clues. Further, various tests may be recommended to help in the diagnosis and treatment of substance abuse.

Physical and Behavioral Indications of Substance Abuse in Families

The negative impact of alcohol and/or other drug abuse on family functioning and health may become apparent through a variety of physical and behavioral indicators. The following indicators can alert professionals to a possible substance abuse problem among family members:

• personality changes and inconsistent behaviors;
• financial problems despite an adequate income;
• sudden, unexplained wealth;
• frequent automobile or other accidents;
• self-defeating behaviors (e.g., missed appointments, absences from work, repeated lateness);
• repeated changes in friends and associates;
• altered mental status consistent with alcohol or other drug intoxication;
• withdrawal symptoms;
• skin lesions such as abscesses or track marks consistent with injection drug use;
• the presence of drug paraphernalia;
• frequent absences or tardiness of children at school; and
• a family member consistently making excuses for an absent family member.

About the Author

www.childwelfare.gov
Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.