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Journal Issue: Preventing Child Maltreatment Volume 19 Number 2 Fall 2009

Prevention and Drug Treatment
Authors: Mark F. Testa Brenda Smith

Does Parental AODA Place Children at Increased Risk of Maltreatment?

Selective prevention, as distinct from universal prevention,23 refers to interventions that target groups that exhibit above-average risks, such as children exposed to parental AODA. Several studies document a link between parental AODA and child maltreatment, particularly neglect.24 However, establishing a causal relationship between parental substance abuse and child maltreatment is difficult. Most investigations of the link between substance abuse and child maltreatment start with a sample of parents involved with either child welfare or substance abuse services. For example, a sample of parents who have been found to abuse substances might be assessed for child maltreatment reports and the report rate may be compared with that of the general population or a matched comparison group without substance abuse problems. Sometimes such studies factor in other potential influences on child maltreatment, such as parental mental health or education. Such studies often find higher child maltreatment rates among parents in a substance abuse group than in the comparison group or, conversely, higher substance abuse rates among parents in a child welfare services group than in a comparison group.

Using similar methods, researchers have identified an association between parental substance abuse and child maltreatment as measured by scores on a child abuse potential index,25 parental self-reports,26 CPS reports,27 and incidents of maltreatment noted in medical records.28 In a rigorous study that is among the few prospective studies to assess the risk of child maltreatment among parents who abuse substances, Mark Chaffin and several colleagues29 followed for one year parents from a community sample. The researchers compared parents identified as having a substance use disorder and parents without a substance use disorder in self-reports of child maltreatment. Parents with a substance use disorder were three times more likely than those without one to report the onset of child abuse or neglect within the one-year follow-up period. About 3 percent of parents with a substance abuse problem reported child abuse or neglect within the year compared with 1 percent of parents without a substance abuse problem. The researchers found that the influence of substance abuse on maltreatment was maintained even when the parents being compared were similar with respect to such characteristics as parental depression, obsessive-compulsive disorder, household size, age, race, marital status, and socioeconomic status.

The Chaffin study is rigorous and convincing. It offers the best type of evidence for demonstrating a link between substance abuse and child maltreatment. And similar patterns are found in repeated studies that control for other co-existing risk factors. Such studies, however, cannot rule out the possibility that other co-factors associated with substance abuse, such as parental depression, social isolation, or domestic violence, are more directly responsible for higher maltreatment rates. Targeting interventions on a “spurious” association between drug use and maltreatment without attending to the underlying direct causes of both will be ineffectual. For example, researchers studying the effects of crack cocaine use during pregnancy found that the deleterious consequences originally attributed to substance abuse were actually related to the environments and associated hazards in drug users’ lives.30

In the Illinois experiment on “recovery coach” services in promoting drug treatment and family reunification, among parents who were identified as having a substance abuse problem and having a child placed out of the home, substance abuse was the sole problem for only 8 percent. The vast majority of the parents experienced co-existing problems with mental health, housing, or domestic violence.31 The best studies attempt to control for these other risk factors, but even multiple-regression and matched-sample studies are challenged to control adequately for the myriad of social, environmental, and other variables that can “confound” the association between parental substance abuse and threats to child safety. Differences attributed to substance use can also arise from other unobserved factors that affect the detection or identification of substance use, maltreatment reporting (including self-reports), and the likelihood of child welfare involvement.

The role of substance abuse in increasing risks for child maltreatment will become clearer as researchers succeed in identifying exactly what it is that explains the link between parental substance abuse and child maltreatment. Researchers have proposed a range of potential explanations. For example, substance abuse may strain social support relationships, leading to social isolation and heightening the risks that family, friends, and neighbors will refrain from lending a hand or stepping in when child-rearing problems arise.32 Substance abuse may promote impulsivity or reduce parental capacity to control anger under stressful situations.33 Substance abuse may also distract parents from meeting children’s needs or impair their ability to supervise them.34 The links between parental substance abuse and child maltreatment surely warrant further study because different causal mechanisms call for different ways to conceptualize the problem and determine how to intervene. As one example, different substances may have different consequences for parenting and child safety. The ways in which a sedative, such as alcohol, impairs parenting or threatens child safety could be quite different from the ways in which a stimulant, such as methamphetamine, impairs parenting and threatens child safety. Perhaps child safety will be promoted most effectively by specifically targeted interventions for different types of substance abuse. Likewise, different mechanisms may explain different pathways to child neglect and physical abuse, or mechanisms may differ in different social or economic contexts.