CHAPTER
4
Children
Living With Parental Alcohol and Substance Abuse
There
are 28 million children of alcoholics and several million
children of drug addicts and abusers in the United States.
The number of Americans who during their lives have been
neglected and/or physically and sexually assaulted by substance-abusing
parents is a significant portion of our population.[92]
In the
most comprehensive analysis ever undertaken of the impact
of substance abuse on child abuse and neglect, the National
Center on Addiction and Substance Abuse at Columbia University
documented the effects of parental abuse of alcohol and
drugs on children and its effects on the child welfare system.
In its 1999 report, No Safe Haven: Children of Substance-Abusing
Parents, the National Center reports that substance
abuse and addiction are the primary causes of the dramatic
rise in child abuse and neglect and the immeasurable increase
in the complexity of cases since the mid-1980s. Further,
it states that children whose parents abuse drugs and alcohol
are almost three times (2.7) likelier to be abused
and more than four times (4.2) likelier to be neglected
than children of parents who are not substance abusers.[93]
As part
of its two-year analysis, The National Center conducted
the first nationwide survey of child welfare agencies and
family courts on this issue. It found that:
- Nearly 80 percent of respondents report that substance
abuse causes or contributes to at least half of all cases
of child maltreatment; 39.7 percent say it is a factor
in over 75 percent of cases;
- Over 80 percent report that parents who abuse or neglect
their children most commonly abuse a combination of alcohol
and drugs; 7.7 percent cite alcohol alone;
- Overall, 89.3 percent of respondents recognize alcohol
as the leading substance of choice and abuse among parents;
- 45.8 percent say that cases of illegal drugs involve
crack cocaine. One in five (20.5 percent) say that cases
of illegal drugs involve marijuana;
- Three of four survey respondents (75.7 percent) say
that children of substance-abusing parents are likelier
to enter foster care, and 73 percent say that children
of substance-abusing parents stay longer in foster care
than do other children.[94]
Substance
Abuse and Child Neglect, Physical Abuse, and Sexual Abuse
Child Neglect
Child
neglect is a frequent problem among addicted parents.
The use of precious resources to pay for drugs and alcohol
often results in lack of food, heat, or adequate clothing
for these children. Poor child health and hygiene can
be the result when parents are so preoccupied with getting
high that they fail to attend to everyday issues, like
making sure their children are clean and that they get
regular medical and dental check ups.
Time
spent binging or recovering from hangovers or withdrawal
symptoms, or spent raising money to support addictions,
often leaves children to fend for themselves. This lack
of attention when parents are at home or the lack of supervision
when they spend extended hours or days outside the household
can have damaging psychological consequences for children
and place them in dangerous physical jeopardy as well.
Infants
in Massachusetts have died from being left alone for days
without nourishment and from fires and accidents that
occurred when substance abusing parents were away for
extended periods without arranging for competent child
care.
Sadly,
many children are the victims of alcohol and drug abuse
while they are still in the womb. Nationwide, 500,000
babies are born each year having been exposed to illicit
drugs and alcohol during pregnancy.[95] These children
tend to be medically fragile as newborns and are often
born prematurely or with low birth weight. For some, the
effects of Fetal Alcohol Syndrome and its related mental
retardation will become more pronounced as they grow older.
Because
the rate of HIV infection is higher among women who abuse
drugs, the children of these mothers are also at high
risk of contracting the AIDS virus before they are born.
Predictably, the special health and emotional needs of
these children and the extra demands they place on already
compromised parents often increase the likelihood that
they will suffer repeated and chronic abuse or neglect.
Physical
Abuse
According
to the National Center, the link between alcohol abuse
and physical child abuse is not surprising given that
almost half of all violent crime is connected with concurrent
alcohol abuse. The lowering of inhibitions and the heightening
of aggressive feelings that alcohol can cause are a damaging
combination for children trying to grow up in these homes.
Almost any type of normal childhood behavior, e.g. crying,
fussing, disobeying, can provide the justification for
a violent response.
Similarly,
abuse of cocaine and other illicit substances can cause
or contribute to violent behavior.[96] A 1998 National
Center report on substance abuse within the prison population
found that 60 percent of adults arrested in the U.S. for
violent crime tested positive for drugs.[97] The excitability,
irritability and paranoia induced by some illicit drugs
can place children at high risk of being abused or of
being exposed to violence and danger that are intrinsic
to the drug scene.
Sexual Abuse
Sexual
abuse among these children is not uncommon since they
are often exposed to non-related addicted adults. Even
when substance-abusing parents are in the home, their
condition may not allow for any meaningful protection.
Because alcohol leads to a lowering of inhibitions in
many people, children of alcoholics face a higher risk
of sexual abuse by their own parents. It is estimated
that between 30 to 40 percent of all reported incest cases
involve an alcoholic parent.[98]
Intergenerational Links Between Child Abuse and Substance
Abuse
The
intergenerational effects of child abuse and substance
abuse are often interwoven. Children of substance-abusing
parents are at high risk of developing their own substance
abuse problems later on. For children growing up in these
homes who are entering adolescence or adulthood, alcohol
or drugs can be a way to cope with depression, low self-esteem
and other psychological effects of their victimization.
Their early use of substances may lead to aggressive,
delinquent or anti-social behaviors that are themselves
risks for substance abuse. Posttraumatic Stress Disorder,
often related to experiences of sexual abuse or violence,
is also correlated with substance abuse.[99] Young women
who abuse substances increase the chances that they will
in turn maltreat their children.
Many
addicted mothers are raising their children alone because
fathers have left their families. Among these women, substance
abuse most frequently occurs as one of a cluster of serious
problems including physical and sexual abuse, stress,
social isolation, financial crisis, unemployment, depression,
and family histories of these problems. Nearly half of
women seeking alcoholism treatment report a childhood
of physical or sexual abuse by a parent.[100] The prevalence
of sexual abuse histories among substance abusers is two
to four times higher than in the general population.[101]
The
increasingly early exposure of young adolescent women
to alcohol and drug abuse has led child welfare providers
to observe that these addicted women are more deeply troubled
than their counterparts 20 years ago. Their social skills
and emotional maturity have been so arrested that they
can rarely take on the challenges of raising children.[102]
As the National Center report makes clear, infants and
children need lots of time, attention and patience, three
things that an alcoholic or drug addict is likely to lack.
The
Fiscal Burden
According
to the 2001 report, Shoveling Up: The Impact of Substance
Abuse on State Budgets, in 1998 states spent $81.3 billion
dollars or 13 percent of their state dollars dealing with
the aftereffects of alcohol and substance abuse. (Federal
matching dollars or local or private sector costs were not
included.) Of that figure, $24.9 billion dollars was spent
specifically to deal with the impact of substance abuse
on children.
This
latest report indicates that in Massachusetts nearly $302
million dollars were spent of child welfare services that
year. Nearly 76 percent or approximately $228 million
dollars were spent on services that were provided to children
because of conditions that were "caused or exacerbated by
alcohol or drug abuse."[103]
Of each
$1 spent by the states, 96 cents is spent dealing with the
aftereffects of the problem while only 4 cents is spent
on prevention and treatment. This shortsighted approach
requires a revolution in thinking, according to Joseph Califano,
Jr., Chairman of the National Center and former U.S. Secretary
for Health, Education, and Welfare. A focused and sustained
prevention initiative would have enormous consequences since,
as Califano points out, "A child who reaches age 21 without
abusing alcohol or using drugs is virtually certain never
to do so."
Given
the strong links between child abuse and alcohol and drug
abuse described above, it is clear that the prevention of
these two devastating social problems are inextricably tied.
As Califano concludes: "Governors who want to curb child
abuse, teen pregnancy, and domestic violence and further
reduce welfare rolls, must face up to this reality: unless
they prevent and treat alcohol and drug abuse and addiction,
their other well-intentioned efforts are doomed."
The
recommendations put forth by the National Center on Addiction
and Substance Abuse in its seminal report, No Safe Haven,
are comprehensive and reflect an in-depth understanding
of how substance abuse impacts children and state systems
charged with their care and protection. Discussion of the
many specific recommendations is not possible here, however,
the following principles and general recommendations delineate
the areas in which change must occur.
Principles
That Should Underlie Public Policy and Program Efforts:
|
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Every
child has a right to have his or her substance-abusing
parents get a fair shot at recovery with timely and
comprehensive treatment. |
|
|
Every
child has a right to be free of drug-and alcohol-abusing
parents who are abusing or neglecting their children
and who refuse to enter treatment or despite treatment
are unable to conquer their abuse and addiction. |
|
|
Every child has a right to have precious and urgent
developmental needs take precedence over the timing
of parental recovery. |
|
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The
goal of the child welfare system is to form and support
safe, nurturing families for children - where possible
within the biological family and where not possible
with an adoptive family.
|
The
National Center makes the following proposals:
 |
Start
with Prevention.
Prevention of alcohol and substance abuse among adolescents
should be the top priority. Secondly, for parents involved
with substances, preventing child maltreatment within
their families is essential. Social service providers,
health professionals, and treatment providers should
capitalize on pregnancy as an opportunity to prevent
child maltreatment by offering comprehensive and appropriate
treatment to substance-abusing pregnant women. Linking
these women to home visiting services should be a priority. |
|
Reform
Child Welfare Practice.
Child welfare officials and family court judges must
employ practices that respond effectively to substance
abuse including: protocols to screen and assess for
parental substance abuse in every investigation of child
abuse and neglect; timely and appropriate treatment
for parents; strategies to motivate parents; prevention
of and planning for relapse; and facilitating adoption
for children when parents fail to engage in treatment. |
|
Fund
comprehensive treatment.
Comprehensive treatment that is timely and appropriate
for parents is the linchpin of strategies to prevent
further maltreatment by substance-abusing parents. The
supply of treatment must be greatly increased to meet
the serious demand. It is essential that treatment include
interventions targeted at the children of parents in
treatment in order to break the tragic cycle of maltreatment
and addiction. |
|
Provide
substance abuse training.
Social service providers, from agency directors to frontline
child welfare workers; judicial officials, from judges
to lawyers; and health and social service professionals
who serve these families need training in the nature
and detection of substance abuse and addiction, and
what to do when they spot it. Substance abuse training
should be a required element in certification and licensing
requirements for child welfare professionals. |
|
Evaluate
outcomes, increase research and improve data systems.
Child welfare officials and family court judges need
to collect better data so that the outcomes of their
efforts and decisions can be evaluated in cases involving
substance-abusing parents that maltreat their children.
Investments in research are also required to better
understand the causes of substance abuse and addiction
and improve treatment outcomes. |
RECOMMENDATIONS
- Develop a comprehensive statewide plan for Massachusetts
aimed at preventing alcohol and substance abuse and treating
affected parents and children.
To develop this state plan, a Task Force including lay
persons and professionals with expertise in the areas
of substance abuse and child maltreatment should be convened
by an appropriate state agency or the legislature. The
plan should identify immediate and long-range strategies
to prevent the abuse of substances within the adolescent
and young adult population; ensure comprehensive treatment
of parents and children affected by these addictions;
and establish training programs for workers in the social
service, health care and judicial systems. This plan should
be coordinated closely with parallel efforts aimed at
preventing and treating child abuse and neglect.
- Establish within the Department of Social Services
a unit of Substance Abuse Specialists to provide consultation
to each local DSS Area Office and training to frontline
workers.
The Department has become a national leader in coordinating
domestic violence and child abuse training and protocols
for practice. Applying the same successful strategies,
it must now work to establish a parallel level of expertise
and coordination to improve outcomes for children and
families affected by alcohol and substance abuse. It should
explore partnerships with national groups, including the
National Center on Addiction and Substance Abuse, which
is seeking to establish pilots within state child welfare
agencies.
Return
to Top
Section
II: Key Causes and Links:
- Section
II: home
- Chapter
3: Children Living in Homes With Domestic Violence
- Co-occurrence
of Child Abuse and Domestic Violence
- Integrating
Child Welfare and Domestic Violence in Massachusetts
- RECOMMENDATIONS
- Chapter
4: Children Living With Parental Alcholo and Substance
Abuse
- Substance
Abuse and Child Neglect, Physical Abuse, and Sexual
Abuse
- The
Fiscal Burden
- RECOMMENDATIONS
- Chapter
5: Children Living Without Homes
- Homelessness
and Child Neglect
- Homelessness
and Mental Health Problems
- Homelessness
and Educational Neglect
- Homelessness
and Substance Abuse
- RECOMMENDATIONS
|
