Children's Voice Article, September 2001
Substance Abuse and Child Abuse
by Heather Banks and Steve Boehm
Substance abuse and child maltreatment are tragically and undeniably linked. Legislation pending in Congress would provide needed, comprehensive treatment for families being destroyed by alcohol and other drugs.
"All children wake up in a world that is not of their own making, but children of alcoholics and other drug-addicted parents wake up in a world that doesn't take care of them." (1)
The use and abuse of alcohol and other drugs (AOD) has a profound effect on millions of children and their families and poses a challenge to the capacity of the child welfare system. More than 8 million children in this country live with substance-abusing parents. (2) The impact on child welfare is undeniable: Children whose parents abuse alcohol and other drugs are nearly three times as likely to be abused, and more than four times as likely to be neglected, than are children whose parents are not substance abusers. (3)
Child abuse and neglect and substance abuse are inextricably intertwined. An estimated 40%-80% of the 3 million children who come to the attention of the child welfare system each year live in families with AOD problems, according to numerous surveys of child welfare agencies nationwide. (4) Approximately 1 million of these children are confirmed to be abused or neglected. According to the National Child Abuse and Neglect Data System, more than three children die each day-more than 1,100 each year-as a result of abuse and neglect.
A 1997 CWLA study of state child welfare agencies estimated that 67% of parents in the child welfare system required substance abuse treatment services, but child welfare agencies were able to provide treatment for only 31% of the families who needed it. (5) In most states, when treatment was available, parents had to wait up to 12 months to get it. Exacerbating the problem, few child welfare professionals are trained to identify and treat substance abuse.
Caring for children in substance-abusing families is a major factor in child welfare and has other social costs as well. According to a 1999 survey by Prevent Child Abuse America, 85% of states identified substance abuse as the problem most frequently exhibited by families reported to child protective service agencies for maltreatment.
Alcohol Abuse Is Widespread
With all the media hype on "the war on drugs," we tend to lose sight of the fact that alcohol abuse is the more common problem. The National Clearinghouse for Alcohol and Drug Information (NCADI) and the National Association of Children of Alcoholics (NACoA) say more than 76 million people-including 11 million under age 18-have been exposed to alcoholism in their families. In a 1999 national Gallup poll, 36% of respondents, and 42% of those ages 18-29, said drinking had caused trouble in their families.
In its 1999 National Household Survey on Drug Abuse, the Substance Abuse and Mental Health Services Administration (SAMHSA) found that half of the alcohol consumed in this country is consumed by the 10% of the population that drinks most heavily. Of the 105 million current users of alcohol in 1999, 45 million were binge drinkers (five or more drinks per occasion), and 12 million were heavy drinkers (five or more drinks per occasion on five or more days in the past month).
In addition to abuse and neglect that may be reported to authorities, children suffer injuries and death due to accidents related to alcohol and drug use. According to the National Highway Traffic Safety Administration (NHTSA), in 1999:
- An average of 7 children, birth to age 14, were killed, and 872 injured, in motor vehicle crashes every day.
- Twenty-one percent of the fatal crashes were alcohol-related; half of these children were passengers in vehicles with drivers who had been drinking.
- Eighty-three child pedestrians or bicyclists were killed or injured by drivers who had been drinking.
An Intergenerational Problem
Children of alcoholics are four times more likely than children of nonalcoholics to develop alcoholism themselves, according to NACoA and NCADI. The costs of young people's use of drugs and alcohol is incalculable in terms of lost educational opportunities, lost income, and involvement with the juvenile justice system.
Underage drinking is a serious problem. SAMHSA has found that 10.4 million youth age 12-20 consume alcohol. Nearly half (5.1 million) are binge drinkers, and 22% (2.3 million) are heavy drinkers.
Children begin abusing drugs and alcohol, including binge drinking, at early ages, and AOD use increases with age. In the 2000 Monitoring the Future Study (MTF), 14% of 8th graders and 30% of 12th graders reported binge drinking in the preceding two weeks. Similarly, according to the 1998 MTF, drug use in the preceding 30 days more than doubled between 8th graders (12%) and 12th graders (26%). (6)
The earlier in life a child begins drinking, the greater the odds he or she will become alcoholic. According to the Robert Wood Johnson Foundation (RWJF), more than 40% of those who start drinking at age 14 or younger later develop alcohol dependence, compared with only 10% of those who begin drinking at age 20 or older.
A 2001 RWJF study reports that nearly one-third of youth of driving age drink. Many drink and drive, causing injuries and fatal accidents. According to NHTSA, motor vehicle accidents are the leading cause of death among youth age 15-20. In 1999:
Finally, children who drink are more likely to use other drugs. The RWJF study found that, of youth age 12-17, 30% who had at least one drink in the last month (but not heavy or binge drinking) had used an illicit substance, compared with 3% of those who did not drink.
- Motor vehicle crashes accounted for 35% (6,209) of all deaths in this age group.
- Of these, more than one-third involved alcohol.
- More than 75% of the people who died in crashes in which young drivers were drinking were young people themselves.
Abused and neglected children and their substance-abusing parents need more help. Many of these parents also have personal histories of childhood abuse. The lack of adequate, comprehensive treatment for the parents is a major barrier to breaking the cycle of addiction and abuse that leads to the break up of families.
SAMHSA's Services Research Outcome Study, a five-year follow-up of more than 1,800 substance abuse treatment clients, showed that:
The most effective treatment requires dialogue between professionals in the child welfare system and their counterparts in many different disciplines. Such cooperative efforts lead to innovations in policies, programs, and practices at the local level. Collaborative, coordinated, culturally competent, community-based services are most likely to emerge when professionals and caregivers possess a common base of knowledge about child welfare concerns and AOD problems.
- Substance abuse declined substantially in the study period.
- The number of clients who reported losing custody of their children declined 30% five years after treatment, compared with the five years before treatment, indicating that many clients had been reunited with absent children.
Programs that provide substance abuse treatment-and a continuum of treatment for parents and their children-can do much to improve lives of these vulnerable families. These programs not only improve outcomes for children and families but also reduce costs to society.
Comprehensive services, provided over 6 to 18 months, specific to the treatment needs of substance-abusing women, and developmentally appropriate for their infants and children, have shown positive results. Consequently, women in such programs as Prototypes in California and Meta House in Wisconsin
Some of the most innovative and successful programs, such as those described on page 41, are family care residential programs, where mothers remain with their children, receive treatment, and learn new approaches to parenting, budgeting, household management, job readiness, and other tasks. If such programs are available in the period immediately before and after birth, they can capitalize on the mother's urgent biological bond with her baby.
- improve their parenting skills, including knowledge of growth and development, nutrition, safety, and positive discipline;
- reduce or eliminate their drug use;
- are not involved with the criminal justice system;
- are employed;
- have their children living with them or are reunited with their children;
- receive counseling separately and with their children; and
- participate in ongoing peer support groups.
...But More Help Is Needed
In 1999, an estimated 568,000 children were in family foster care-a 35% increase since 1990. (7) In 1997, state child welfare agencies estimated that 67% of the parents of children in foster care had AOD abuse problems but that they were able to serve less than one-third of those parents. (8)
According to SAMHSA, among parents receiving substance abuse treatment, 44% of women and 15% of men report they entered treatment to retain or regain custody of their children.
In 1998, slightly more than 1 million clients received substance abuse treatment in the United States. Of these, 26.7% were treated for drug abuse, 23.8% were treated for alcohol abuse, and 49.9% were treated for both. Of people receiving substance abuse treatment in 1998,
SAMHSA estimates an additional 1 million people need substance abuse treatment; more than 50,000 are on state waiting lists.
- 31.1% were women,
- 9.7% were youth under age 18,
- 17.6% were ages 18-24,
- 27.2% were ages 25-34, and
- 28.3% were ages 35-44. (9)
To ensure appropriate AOD treatment for these individuals-and safety and permanence for their children-we must direct increased treatment and other services to their special needs. This will require us to develop more resources and new partnerships among child welfare and AOD agencies, other service providers, the courts, community leaders, and family members.
Addressing the Need
Bipartisan legislation introduced in Congress earlier this year would address these needed additional resources and partnerships. The Child Protection/Alcohol and Drug Partnership Act (S. 484/H.R. 1909) would provide grants to state child welfare and alcohol and drug agencies to address-together-the impact of alcohol and drug abuse on children and families who come to the attention of the child welfare system.
The legislation builds on the foundation of the Adoption and Safe Families Act (ASFA) of 1997. Recognizing that the health and safety of children are paramount, ASFA accelerated the timetable for states to move children in foster care to permanent homes. To make appropriate, timely decisions about safety and permanence for children, agencies must provide treatment and other services immediately for families with AOD problems when their children enter foster care.
When enacted, the Child Protection/Alcohol and Drug Partnership Act will promote safety and permanence for children and recovery for their parents. With funding of $1.9 billion over five years, the legislation will allow states to implement a range of activities to improve treatment.
State child welfare and AOD agencies would be able to apply together for five-year grants under a new Title IV-B of the Social Security Act to expand treatment for families with AOD problems who come to the attention of the child welfare system.
Funds would be distributed to states based on the number of children under age 18 who reside in that state. A minimum grant for small states will ensure each state receives sufficient funding to develop useful activities. To encourage state investment, the bill requires a state match of 15% for the first two years, 20% for the next two years, and 25% for the fifth year. The bill sets aside 3%-5% of the total funds for grants to tribal governments and 2% for grants to the territories.
State child welfare and AOD agencies would have flexibility to decide how best to use these funds to develop or expand comprehensive, individualized AOD prevention and treatment services that include
States also could use these funds to
- prevention and early intervention for parents at risk for alcohol and drug abuse problems;
- programs for children that address their mental, emotional, and developmental needs;
- comprehensive home-based, outpatient, and residential treatment programs;
- aftercare support for recovering families to promote child safety and family stability; and
- services and supports that promote parent-child interaction and focus on children and other family members.
Expanding collaboration between child welfare and AOD treatment professionals will improve state and tribal efforts to address the complex needs of families suffering the effects of substance abuse. The Child Protection/Alcohol and Drug Partnership Act would increase these collaborative efforts.
- improve screening and assessment tools;
- implement effective strategies to get parents into treatment and keep them there;
- train child welfare and AOD staff, judges, and court staff; and
- improve data systems to monitor family progress and evaluate services and treatment to identify what works and what doesn't.
These families face inadequate housing and homelessness; health and mental health problems; domestic violence; obstacles to education; and employment difficulties-in addition to the tragedy of abuse and neglect and the lost custody of their children. Coordinating services that address these many needs helps reduce the stress on these families. More importantly, communities must have the resources necessary to provide treatment and support long enough to be effective.
Treatment for drug and alcohol addiction is cost-effective, both socially and financially. Treatment cuts drug use in half, reduces criminal activity as much as 80%, increases employment, decreases homelessness, improves physical and mental health, reduces medical costs, and reduces risky sexual behavior. (10) According to conservative estimates, every $1 invested in addiction treatment programs saves $4 to $7 in reduced drug-related crime, criminal justice costs, and theft. When health care costs are included, the savings can exceed costs by a ratio of 12 to 1. (11)
Numerous model programs have demonstrated that the most effective social services are rooted in collaborative efforts within the community. As a nation, and as members of our communities, we must reshape our public response to the crisis of families facing substance abuse problems. The Child Protection/Alcohol and Drug Partnership Act will help communities build quality, capacity, and resources that protect children by investing in treatment for parents with severe alcohol and other drug problems. The result will be more effective ways to secure and support one of America's most valuable resources-our families.
Heather Banks is CWLA's Research-to-Practice Editor. Steve Boehm is Editor-in-Chief of Children's Voice. For more information on the statistics cited in this article, and their sources, contact Heather Banks at 202/639-4917 or firstname.lastname@example.org. CWLA Senior Policy Analyst Barbara Allen contributed to this article.
- Jeannete L. Johnson and Sis Wenger. (2001, January/February) "Why?" NACoA Network, 17(1), 4. Published by the National Association of Children of Alcoholics, www.nacoa.org.
- Paula Jaudes, Edem Ekwo, & John Van Voohis. (1995, September). "Association of Drug Abuse and Child Abuse." Child Abuse and Neglect, 19(9), 1065-1075. Also, U.S. Department of Health and Human Services. (1999). Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection. Washington, DC: Government Printing Office.
- Jeanne Reid, Peggy Macchetto, & Susan Foster. (1999). No Safe Haven: Children of Substance-Abusing Parents. New York: National Center on Addiction and Substance Abuse at Columbia University. Available online in PDF format at www.casacolumbia.org/publications1456/publications.htm.
- Nancy Young, Sidney Gardner, & Kimberly Dennis. (1998). Responding to Alcohol and Other Drug Problems in Child Welfare. Washington, DC: CWLA Press.
- Alcohol and Other Drug Survey of State Child Welfare Agencies. (1997). Available online at www.cwla.org/programs/chemical/1997stateaodsurvey.htm.
- The MTF is conducted by the University of Michigan's Institute for Social Research and funded by the National Institute on Drug Abuse (NIDA), National Institutes of Health. MTF findings are available online from NIDA's Infofax website at www.drugabuse.gov/Infofax/HSYouthtrends.html.
- U.S. Department of Health and Human Services, Children's Bureau. (2000). The AFCARS Report. Available online at www.acf.dhhs.gov/programs/cb. Washington, DC: Administration for Children and Families, U.S. Department of Health and Human Services.
- Alcohol and Other Drug Survey of State Child Welfare Agencies. (1998). Washington, DC: Child Welfare League of America.
- Substance Abuse and Mental Health Services Administration. (1998). SAMHSA Uniform Facility Data Set Survey. Available online at www.dasis.samhsa.gov/98ufds/Resource-550/t24.htm.
- Office of Evaluation, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. (1997). The National Treatment Improvement Evaluation Study: Highlights. (HHS Publication No. SMA 97-3159). Rockville, MD: Author.
- National Institute on Drug Abuse, National Institutes of Health. (1999, 2000). Principles of Drug Addiction Treatment: A Research-Based Guide. (NIH Publication No. 00-1480). Bethesda, MD: Author.
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