Drug Abuse and Child Maltreatment
Study Number: 14

This fact sheet initiates new public service from Prevent Child Abuse America that has been made possible through a grant from the Sigma Delta Tau Sorority. Fact sheets will be issued periodically on a variety of subjects as needs arise. Fact sheets may be reproduced without notice to NCPCA; however, we request that the author, if any, and Prevent Child Abuse America be credited as the source if reproduced in part or in whole in other publications or products.

The relationship between parental alcohol or other drug problems and child maltreatment is becoming increasingly evident. And the risk to the child increases in a single parent household where there is no supporting adult to diffuse parental stress and protect the child from the effects of the parent's problem. The following is a summary of what we know.

What is the scope of the problem?
Both alcohol and drug problems are widespread in this country. Almost 14 million adult Americans abuse alcohol1. The number of illicit drug users exceeds 12 million2. Illicit drugs include marijuana, cocaine, inhalants, hallucinogens, heroin, and non-medical use of psychotherapeutics2. With more than 6.6 million children under the age of 18 living in alcoholic households3, and an additional number of children living in households where parents have problems with illicit drugs, a significant number of children in this country are being raised by addicted parents.

Child maltreatment has become a national epidemic. More than one million children are confirmed each year as victims of child abuse and neglect by state child protective service agencies4. Every day at least three children die as a result of abuse and neglect4. State child welfare records indicate that substance abuse is one of the top two problems exhibited by families in 81% of the reported cases.

Do parental alcohol or other drug problems cause child maltreatment?
Recent research on the connection between these problems and child maltreatment clearly indicates a connection between the two behaviors. Among confirmed cases of child maltreatment, 40% involve the use of alcohol or other drugs5. This suggests that of the 1.2 million confirmed victims of child maltreatment, an estimated 480,000 children are mistreated each year by a caretaker with alcohol or other drug problems5. Additionally, research suggests that alcohol and other drug problems are factors in a majority of cases of emotional abuse and neglect. In fact, neglect is the major reason that children are removed from a home in which parents have alcohol or other drug problems. Children in these homes suffer from a variety of physical, mental, and emotional health problems at a greater rate than children in the general population6. Children of alcoholics suffer more injuries and poisonings than children in the general population. Alcohol and other substances may act as disinhibitors, lessening impulse control and allowing parents to behave abusively. Children in this environment often demonstrate behavioral problems and are diagnosed as having conduct disorders7. This may result in provocative behavior. Increased stress resulting from preoccupation with drugs on the part of the parent combined with behavioral problems exhibited by the child adds to the likelihood of maltreatment.

What characteristics do parents with alcohol and other drug problems and parents involved in child maltreatment share?
Histories of these parents reveal that typically both were reared with a lack of parental nurturing and appropriate modeling and often grew up in disruptive homes8. Family life in these households also have similarities. The children in often lack guidance, positive role modeling, and live in isolation. Frequently, they suffer from depression, anxiety, and low self-esteem. They live in an atmosphere of stress and family conflict. Children raised in both households are more likely to have problems with alcohol and other drugs themselves9.

Does the use of alcohol or other drugs by pregnant women affect their infants?
Pregnant women who use alcohol may bear children suffering from fetal alcohol syndrome (FAS). FAS is the leading known environmental cause of mental retardation in the western world10. Each year 4,000 to 12,000 babies are born with the physical signs and intellectual disabilities associated with FAS, and thousands more experience the somewhat lesser disabilities of fetal alcohol effects.11

How does a parent's alcohol or other drug problem affect children?
Children of alcoholics are more likely than children in the general population to suffer a variety of physical, mental, and emotional health problems.12 Similar to maltreatment victims who believe that the abuse is their fault, children of alcoholics feel guilty and responsible for their parent's drinking problem.13 Both groups of children often have feelings of low self-esteem and failure and suffer from depression and anxiety. It is thought that exposure to violence in both alcohol abusing and child maltreating households increases the likelihood that the children will commit and be recipients of acts of violence. Additionally, the effects of child maltreatment and parental alcohol abuse don't end when the children reach adulthood. Both groups of children are likely to have difficulty with coping and establishing healthy relationships as adults. In addition to suffering from all the effects of living in a household where alcohol or child maltreatment problems exist, children whose parents abuse illicit drugs live with the knowledge that their parents' actions are illegal. While research is in its infancy, clinical evidence shows that children of parents who have problems with illicit drug use may suffer from an inability to trust legitimate authority because of fear of discovery of a parent's illegal habits.

Are these patterns passed on from one generation to the next?
Some individuals can and do break the cycle of abuse. These resilient children share some characteristics that lead to their successful coping skills such as ability to obtain positive attention from other people, adequate communication skills, average intelligence, a caring attitude, a desire to achieve, a belief in self-help14. Additionally, the involvement of a caring adult can help children develop resiliency and break the cycle of abuse. However, a significant number of individuals fall victim to the same patterns exhibited by their parents. Those who have been severely physically abused often have symptoms of post-traumatic disorder and dissociation15. Individuals suffering from mental health disorders may use alcohol and illicit drugs to decrease or mitigate their psychological distress16. Research suggests that adults who were abused as children may be more likely to abuse their own children than adults who were not abused as children17.

Why are these patterns so hard to break?
One explanation for the continuing cycle is the secrecy, denial, and stigma involved in both problems. Many child maltreatment cases do not get reported and many children of alcoholics go unidentified. Within both populations, victims often are afraid to speak up because they do not think anyone will believe them. Often they do not realize that what seems to be normal behavior is indeed maltreatment, and learn to repeat these behaviors unconsciously. The lack of positive parental role modeling and lack of development of coping skills increases the difficulty of establishing healthy relationships as an adult. It may not be until they seek help as disturbed adults that they are made cognizant of the root of their emotional problems.

Can we treat child maltreatment when alcohol or other drugs are a problem?
Research has shown that when families exhibit both of these behaviors, the problems must be treated simultaneously in order to insure a child's safety. Although ending the drug dependency does not automatically end child maltreatment, very little can be done to improve parenting skills until this step is taken. It should be noted that the withdrawal experienced by parents who cease using alcohol or other drugs presents specific risks. The effects of withdrawal often cause a parent to experience intense emotions, which may increase the likelihood of child maltreatment18. During this time, lasting as long as two years, it is especially important that resources be available to the family.

How can we prevent these problems?
Aside from promoting awareness of the link between parental alcohol or other drug problem and child maltreatment and cross-training professionals in the recognition and treatment of both problems, prevention services need to be available for all. Among the preventive efforts Prevent Child Abuse America believes to be most effective are:
prevention education for all children, adolescents, and young adults.
direct access to supportive services for all children of parents with alcohol or other drug problems before child maltreatment occurs, with an emphasis on validation of feelings, supporting self-esteem, and intensive parenting and prevention education and support for all new parents.
access to self-help groups and other supportive services for all parents under stress and all victims and survivors of abuse.
education of all who work with children and families, including teachers, service providers, obstetricians, pediatricians, and emergency room personnel, regarding the interplay between a parent's alcohol or other drug problems and child maltreatment.

1National Institute of Alcohol Abuse and Alcoholism. 1994. Alcohol health & research world 18(3):243.
2Substance Abuse and Mental Health Services Administration, U. S. Department of Health and Human Services. 1995. National household survey on drug abuse: Population estimates 1994. Research Triangle Park, NC: Research Triangle Institute.
3Russell, M., C. Henderson, and S. B. Blume. 1984. Children of alcoholics: A review of the literature. New York: Children of Alcoholics Foundation, Inc.
4Lung, C. T. and D. Daro. 2006. Current trends in child abuse reporting and fatalities: The results of the 2006 annual fifty state survey. Chicago, Illinois: Prevent Child Abuse America.
5Children of Alcoholics Foundation, Inc. 1996. Collaboration, coordination and cooperation: helping children affected by parental addiction and family violence. New York: Children of Alcoholics Foundation.
6Bijur, P.E., M. Kurzon, M.D. Overpeck, and P.C. Scheidt. 1992. Parental alcohol use, problem drinking and child injuries. Journal of the American Medical Association 23:3166-3171.
7West, M., and R Prinz. 1987. Parental alcoholism and childhood psychopathology. Psychological Bulletin 102(2):204-218.
8Behling, D.W. 1979. Alcohol abuse as encountered in 51 instances of reported child abuse. Clinical Pediatrics 18(2):87-91.
9Children of Alcoholics Foundation, Inc. 1992. Help for inner-city children of addicted parents. New York: Children of Alcoholics Foundation, Inc.
10National Institute of Alcohol Abuse and Alcoholism.1993. Eighth special report to U.S. Congress on alcohol and health. (March):221.
11SAMHSA, Center for Substance Abuse Prevention. 1993. Toward preventing perinatal abuse of alcohol, tobacco and other drugs. USDHHS, Technical Report, No. 9 p. 1.
12Children of Alcoholics Foundation, Inc.1990. Children of alcoholics in the medical system: Hidden problems, hidden costs. New York: Children of Alcoholics Foundation, Inc.
13Russell, M., C. Henderson, and S. Blume. 1985. Children of alcoholics: A review of the literature. New York: Children of Alcoholics Foundation, Inc.
14Werner, E.E. 1986. Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol 47(1):34-40.
15Briere, J. 1996. A self-trauma model for treating adult survivors of severe child abuse. In The APSAC Handbook on Child Maltreatment (pp. 140-157) edited by J. Briere, L. Berliner, J.A. Bulkley, C. Jenny, and T. Reid. Newbury Park, CA: Sage.
16Kelley, S.J. 1996. Do substance abusing mothers experience increased parenting stress? Paper presented at the International Congress of the International Society on the Prevention of Child Abuse and Neglect. Dublin, Ireland.
17Ziegler, E., and J. Kaufman. 1987. Do abused children become abusive parents? American Journal of Orthopsychiatry 57(20):187-192.
18Zuskin, R., and D. DePanfilis. 1987. Working with CPS families with alcohol or other drug (AOD) problems. The APSAC Advisor 8(1): 7-11.

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