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Parental Substance Abuse and Its Effects on Children
Rizwan Z. Shah, MD, FAAP
Blank Children’s Hospital, Des Moines
Summer 2000
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The wellbeing of children depends upon the constant presence of understanding and nurturing parents
or other caregivers. They supervise and protect the child during vulnerable times of physical and
emotional growth. Many circumstances can compromise the ability of a parent to fulfill this role,
including the use of alcohol and drugs. Recent epidemics of substance abuse in the US are raising
concerns about protecting children in such families.
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Substance abuse and parenting
Drug addiction is a chronic, progressive disorder. It is characterized by cycles of
abuse, decreased use, relapse and more abuse. For an addicted parent, the day revolves
around the need to procure and use the drug of choice, and then to recover from its
affects. Important activities -- familial, social, occupational -- are given up or
reduced because of the substance abuse. For these parents, the responsibility to protect
and sustain their children is less important than the parent’s need for the
euphoria produced by the drug.
As a result of substance abuse, children may be left alone or unsupervised for long
periods of time. Often young children make a valiant effort to parent even younger
children. Some children care for their incapacitated parents. Family resources needed
for food and other necessities may be bartered for drugs. In extreme cases, children
are offered for drugs.
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Families, children,
and substance abuse
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About 12 million Americans use illicit drugs (National
Committee to Prevent Child Abuse, 1997).
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Substance abuse is the most common factor associated with abuse,
approximately tripling the risk of abuse when other factors are
controlled (National Institute of Mental Health).
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About 4.3 million women between the ages of 15 and 44 use
drugs:
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1.6 million women have children living with them.
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400,000 of these women live with children younger than
two (National Clearinghouse for Drug and Alcohol
Information,1995).
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Between 9-10 million children in the US live with
parents who are substance abusers Mitchell and Sawyer,1991 ).
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Alcohol abuse appears to be the drug most often associated with physical abuse. Greater degrees
of alcohol abuse appear to correlate with increased physical violence. Cocaine abuse by parent
puts children at increased risk for sexual abuse due to a lack of boundaries, and to exposure to
non-family contacts in houses where drug dealing takes place.
Out-of-home placements
A 1994 study by the US Department of Health and Human Services found that 28% of the children
receiving child welfare services tested positive as newborns for exposure to drugs. Iowa
legislation passed in 1993 states that if a child tests positive for the presence of illegal
substances in the body, this constitutes a founded child abuse report.
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Iowa Foster Children, FY99
- $1.6 million was spent to support children and families in Iowa last year.
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5,099 Iowa children were placed in family foster care; more than 3,110 were younger
than 12.
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3,467 of these children were in foster care due to abuse or of parenting issues
that included alcohol or substance abuse.
- Each will change foster homes an average of four times during their childhood.
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Last year, Iowa spent $1.6 million to assist children and families. During that time,
5,099 children between the ages of birth and 20 were placed in family foster care. More
than half of these children are younger than 12. Nearly 70% -- about 3,500 children --
are in foster care as the result of abuse or parenting issues that include alcohol or
substance abuse. In Iowa, foster children change homes an average of four times. Such
instability in the early years has a profound effect on a child’s sense of
security and attachment.
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The lessons of the last decade in Iowa have taught us that there are no easy answers to this complex
problem. Efforts to deal with it have included:
- Expansion of child abuse statutes
- Court-mandated treatment for parents who are substance abusers
- Family support programs
To date, all have fallen short of insuring the care of children of addicted parents. We need to find
new ways to forge interagency collaboration. Healthcare providers, substance abuse treatment
programs, and Iowa’s child protective system must work together to ensure the health and
safety of children while their parents get treatment for chemical dependency. Such an approach
will require the training of professionals who work with children and families, and policy that
deals in a balanced way with the delicate issues of family preservation and child protection.
Resources on domestic violence and substance abuse
Iowa Referral Resources for Victims of Domestic Violence and Substance Abuse
http://www.medicine.uiowa.edu/uhs/epsdt/sum00/referdv.htm
AMA: Facts about the Mental Health Effects of Violence
http://www.ama-assn.org/public/releases/assault/effects.htm
North Caroline Medical Society.
Preventing Domestic Violence
Screening for domestic violence in the community pediatric setting.
Pediatrics 1999; 104:874-877.
The role of the pediatrician in recognizing and intervening on behalf of abused
women. Pediatrics 1998;101:1091-1092.
The role of the pediatrician in youth violence prevention.
Pediatrics 1999; 103:173-178.
Substance abuse among women and parents.
US Department of Health and Human Services
http://aspe.hhs.gov/hsp/cyp/xsfamdrg.htm
Improving Your Health Care Health Care Response to Domestic Violence
University of Wisconsin Family Medical Practice
Witnessing domestic violence during childhood and adolescence: Implication for pediatric
practice
Pediatrics 1994;94:594-599.
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