The relationship between substance use disorders (SUDs) and child maltreatment is compelling and undeniable. More than eight million children in the United States live with at least one parent who abused or was dependent on alcohol or an illicit drug during the past year.1 These children face a heightened risk of maltreatment.2 One study, for example, showed that children of parents with SUDs are nearly three times more likely to be abused and more than four times more likely to be neglected than children of parents who do not abuse substances.3
According to the National Child Abuse and Neglect Data System (NCANDS), in 2006, an estimated 3.3 million referrals were made to child protective services (CPS), representing 6 million children. From this population, approximately 905,000 children were found to be victims of child abuse or neglect. Of the maltreated children, 66.3 percent were neglected (including medical neglect), 16.0 percent physically abused, 8.8 percent sexually abused, and 6.6 percent psychologically maltreated. Additionally, 15.1 percent of victims were associated with “other” types of maltreatment, such as abandonment or congenital drug addiction. A child could be identified as a victim of more than one type of maltreatment.4 Additionally, while estimates vary, most studies suggest that parental SUDs are a contributing factor for between one- and two-thirds of children involved with CPS.5
Overview of the Connection Between Substance Use Disorder and Child Maltreatment
SUDs often affect the way people live, including how they function, interact with others, or parent their children. Studies suggest that SUDs, by impairing parents’ judgment and priorities, can influence parental discipline choices and child-rearing styles and have negative effects on the consistency of care and supervision provided to children.6 The time and money parents spend on seeking out or on using drugs or alcohol may limit the resources available in the household to meet their children’s basic needs. In addition, families affected by SUDs often experience a number of other problems—including mental illness, domestic violence, poverty, and high levels of stress— which also are associated with child maltreatment.
Children of parents who have SUDs and who are also in the child welfare system are more likely to experience emotional, physical, intellectual, and social problems than children whose parents do not have SUDs. Additionally, abused and neglected children from families affected by substance abuse are more likely to be placed in foster care and to remain there longer than maltreated children from families not affected by substance abuse.7
CPS caseworkers and SUD treatment providers also report conflicting pressures that arise from trying to meet concurrently:
The timeframes required by the Adoption and Safe Families Act to promote permanency for abused and neglected children
The time required to access open treatment slots
The time necessary for successful treatment participation
The developmental needs of children.8
These challenges underscore the need for quick and effective screening, assessment, and treatment, if necessary, of SUDs among families in the child welfare system. Further, they point to the need for partnerships between the CPS and SUD treatment systems to support parents in obtaining the services they need, while ensuring the safety and well-being of children.
Organization of the Manual
To assist families experiencing SUDs as well as child maltreatment, CPS caseworkers must recognize and address each problem and their interaction. This manual is structured first to provide CPS caseworkers and other readers with the groundwork for understanding SUDs and their dynamics, characteristics, and effects. The manual then places parental SUDs into the context of child protection and describes its impact on children, as well as its relationship to child maltreatment. Several chapters are devoted to helping CPS caseworkers understand how to recognize and to screen for SUDs in child maltreatment cases, to establish plans for families experiencing these problems, and to support treatment and recovery, as appropriate. The manual also addresses ways in which CPS and SUD treatment providers can coordinate their work, which is critical to improving outcomes for both parents with SUDs and their children.
Specifically, the manual addresses:
The nature of SUDs
The impact of parental SUDs on children
In-home examination, screening, and assessment for SUDs
Treatment of SUDs
The role of the CPS caseworker when an SUD is identified
Similarities and differences between CPS and SUD treatment providers
“Putting it all together”—making the systems work for families.
Readers should note that no single publication can address all the intricate factors and interactions related to the connection between SUDs and child maltreatment, but this manual can contribute to an increased understanding of the issues and identify avenues for enhanced services to families. Professionals should supplement it with other information, training, and professional development activities.