Parental Substance Abuse : Substance Abuse and Mental History

by Child Welfare Information Gateway

(Page 5 of 10)

Substance Abuse History

Exploring a parent's history of alcohol or other drug use provides the professional with an understanding of the chronicity of the problem, and also helps in determining which treatment resources are most appropriate for individual parents. Although the information obtained during an initial interview may not be complete, talking with parents over time frequently reveals accurate information regarding substance abuse. Communication with members of the extended family, significant others, and professionals from other agencies can be particularly helpful in gathering a parent's substance abuse history. For many reasons, parents frequently deny the length and severity of their drug or alcohol use.

In assessing a suspected alcohol and/or other drug abuse problem, it is important to keep questions open-ended and assume use in order to elicit more realistic responses. The following are possible questions a professional might ask to gather information about patterns of use and the parent's perceptions about use:

• How often do you drink beer, wine, liquor?
• How many drinks do you generally have when you are drinking?
• How old were you when you had your first drink?
• When do you tend to want a drink? When alone or with others? If you drink with others, with whom? When bored or when you want to "party"? When you are angry, frustrated, or stressed?
• What drugs have you tried?
• How often do you use?
• How do/did you use/take it?
• How long have you been using? How long did you use?
• How much do you smoke?
• When do you usually want a cigarette?
• When you were pregnant, what was your drinking/use like?
• How does your behavior change when you drink/use?
• How do you feel when you drink/use?
• What impact has alcohol and/or other drug use had on your own health?
• What legal problems have you encountered as a result of your alcohol and/or drug use?
• How has the use of alcohol and/or other drugs affected your employment?
• How has your use of alcohol and/or other drugs affected your social relationships?
• Has the use of alcohol and/or other drugs resulted in violence or abuse in the home?
• What concerns do you have about your use of alcohol and/or other drugs?

It is also helpful to assess the impact of use on the family, since this information can be used in developing an effective intervention plan. The following are areas a professional can explore with other family members to gather information about a parent's alcohol and/or other drug abuse problem:

• How do family members view alcohol and/or other drug use?
• Do family members deny use and/or its impact?
• Do family members express worry about the user?
• Do family members feel tense, anxious, or overly responsible?
• Are family members angry with the user?
• Do children in the family exhibit adult behaviors or assume adult parenting roles?

Drug and Alcohol Treatment History

Professionals also need to explore parents' attempts at substance abuse treatment in order to understand how parents have dealt previously with their abuse of alcohol or other drugs. Obtaining the parents' treatment history helps ensure that current treatment referrals will be appropriate. For example, parents who have been repeatedly unsuccessful in outpatient treatment may benefit more from a referral to a residential setting than from a referral to yet another outpatient program. Professionals should determine the following:

Have the parents ever been in a drug or alcohol treatment program? If so, where and for how long? What was the motivation for seeking treatment, and what were the circumstances under which the parents left treatment? Any indication of motivation should be pursued as a possible strength.

For parents currently participating in a treatment program, what is the frequency and extent of their participation? Some parents, for example, may attend a treatment program only sporadically, whereas others may attend regularly but still continue to abuse drugs or alcohol. Other parents may be appropriately engaged in treatment. In evaluating compliance, it is important to remember that, although the parents' participation may provide a clue to their level of commitment, it also may indicate the need for different or supplemental treatment approaches.

Health and Health Care

Often, substance-abusing parents have health problems related to their alcohol and other drug use. Such problems can adversely affect the parents' ability to care for both themselves and their children. Thus, professionals should assess the following:

What is the parents' general state of health? Are there any untreated medical problems or chronic illnesses? Chemically involved parents are at high-risk for communicable diseases such as tuberculosis and sexually transmitted diseases, including acquired immunodeficiency syndrome (AIDS), and may need to be referred for medical evaluations.

If medical care is needed, does the parent have financial and logistical access to services?

In situations of perinatal substance abuse, the professional should determine whether prenatal care or drug treatment services were available to the mother during pregnancy. It then is important to learn whether the mother obtained regular and consistent care; this information can reflect a parent's ability to use health care systems and also may be an indicator of the mother's ability to plan and obtain appropriate medical care for her infant. In this respect, it is important to communicate with health clinic personnel or private physicians who may have treated a mother during pregnancy. Although it would be of concern if a mother had obtained no prenatal care, this information could be viewed quite differently if the woman had sought services and none existed, or if services were difficult to access.

Mental Health and History of Psychiatric Treatment

Parental mental health problems require careful evaluation but may be difficult to assess due to current intoxication or chronic substance abuse. However, identification and assessment for coexisting psychiatric problems is essential for appropriate case management. In evaluating mental status, it is imperative for professionals to determine the following:

Have the parents ever obtained assistance from a mental health counselor? Have they ever been hospitalized for psychiatric reasons? If so, the history of hospitalization, length of stay, and reasons for admission should be explored.

Have psychotropic medications been prescribed for the parents? If so, why were they prescribed, and are the parents currently taking the medications? This information is particularly relevant to making an appropriate substance abuse treatment referral because some chemical dependency treatment programs may be reluctant to accept clients who are currently taking psychotropic medications. In addition, a lapse in taking necessary medications or the mixing of psychotropic medications with other substances may exacerbate psychiatric symptoms that can place a child at risk of maltreatment.

Do the parents have a history of violence toward others? Is there a history of domestic violence? Substance abuse, psychiatric problems, and problems with impulse control can be closely intertwined.

About the Author

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