Children of Substance Users

This webpage identifies the major literature in the field of perinatal and family services: children of substance users. The time frame is from January 2000 through December 2014.

Bergin, C., & Mccollough, P. (2009). Attachment in substance-exposed toddlers: The role of caregiving and exposure. Infant Mental Health Journal, 30(4), pp. 407-423.

According to the authors, adverse outcomes in infants prenatally exposed to substances may result from insecure attachment and low-quality caregiving rather than from substance exposure. In this study, the authors, looked low-income mothers (n = 41) with their substance-exposed 12-month-olds and compared them to a non-exposed group case-matched for other risk factors. According to the findings, attachment security and quality of caregiving were quite low for both groups, with no significant differences. In addition, regression analyses revealed that quality of caregiving predicted attachment, but amount of alcohol and cocaine exposure did not. These results suggest that among toddlers with social risk, substance exposure may not predict insecure attachment. Previous research linking attachment to exposure may be better explained by low-quality caregiving. Implications are that substance-exposed children, and non-exposed children with comparable social risk, are likely to need intervention to enhance maternal sensitivity and involvement to improve psychiatric outcomes.

Burlew, A. K., Johnson, C., Smith, S., Sanders, A., Hall, R., Lampkin, B., & Schwaderer, M. (2012). Parenting and problem behaviors in children of substance abusing parents. Child and Adolescent Mental Health, 18(4), pp. 231-239.

This study examined parenting practices, parental stress, and problem behaviors among urban children of substance abusing parents. Children completed the Child Rating Scale and the Children’s Depression Inventory, and parents completed the Parenting Practices Scale-Parent Version, Parenting Stress Index, and internalizing and externalizing scales on the Parent Observation of Classroom Adaptation. Results of the study show that unfavorable parenting practices predict parental stress and parental stress predicts internalizing and externalizing behaviors in children. The findings suggest that parenting practices affect development of problem behaviors.

Conners, N. A., Bradley, R. H., Mansell, L. W., Liu, J. Y., Roberts, T. J., Bergdorf, K., & Herrell, J. M. (2004). Children of mothers with serious substance abuse problems: An accumulation of risks. American Journal of Drug and Alcohol Abuse, 30(1), pp. 85-100.

The purpose of this study was to offer some insight into the life circumstances and experiences of a large group of children affected by maternal addiction. The study addresses the characteristics of their caregivers, the multiple risk factors faced by these children, their health and development, and their school performance. Researchers collected data from mothers at intake into 50 publicly funded residential substance abuse treatment programs for pregnant and parenting women. Findings from this study suggest that children whose mothers abuse alcohol or other drugs confront a high level of risk and are at increased vulnerability for physical, academic, and social-emotional problems. Children affected by maternal addiction are in need of long-term supportive services and programs fully address the array of immediate, transitional, and long-term needs of these children as individuals or members of a family. Treating the complex needs of children requires a team of professionals that extends well beyond the kind of team found in a traditional treatment setting.

Conners-Burrow, N. A., Kyzer, A., Pemberton, J., McKelvey, L., Whiteside-Mansell, L., & Fulmer, J. (2013). Child and family factors associated with teacher-reported behavior problems in young children of substance abusers. Child and Adolescent Mental Health, 18(4), pp. 218-224. DOI: 10.1111/camh.12010

The authors examined the impact of four family risk factors, cumulatively and individually, on children’s behavior and explored children’s engagement of adults as a protective factor. Results of the study show that family risks were associated with increased problems, whereas the presence of a father in the home and the child’s ability to engage adults were protective. The results of this study reflect findings from current literature on risk and protective factors. Authors suggest future research look at the role of the father in a family affected by maternal substance use.

Cunningham, S., & Finlay, K. (2013). Parental substance use and foster care: evidence from two methamphetamine supply shocks. Economic Inquiry, 51(1), pp. 764-782. DOI: 10.1111/j.1465-7295.2012.00481.x

This article looks at the causal effect of meth on foster care admissions using two meth markets for identification. The results reflect that meth use appears to cause an increase in foster care caseloads through higher numbers of neglect and physical abuse. The authors suggest specific child welfare policies be implemented to address the needs of children of meth-using parents.

Farst, K., Bolden, B. B. (2012). Substance-exposed infants and children: forensic approach. Clinical Pediatric Emergency Medicine, 13(3), pp. 221-228.

This article address the recognition and response to substance-exposed infants and children by reviewing the definition of a substance-exposed infant or child, differences in screening vs confirmatory drug testing modalities, and responses to consider once an infant or child is recognized as substance exposed.

Farokhzadi, F., Mohammadi, R. M., Alipur, A., Rostami, R., & Dehestani, M. (2012). Substance abuse disorders in the parents of ADHD Children, and parents of normal children. Acta Medica Iranica, 50(5), 319-327.

This study compared the attention-deficit/ hyperactivity, and substance abuse disorders background in the parents of children with attention-deficit/ hyperactivity disorder (ADHD), and the parents of normal children ages 6-18 years old. The results indicated that substance abuse in parents of children with ADHD is 21% more prevalent, and parents of children with ADHD compared to parents of normal children have 2% ADHD, 9% attention deficit disorder, and 1% hyperactivity disorder more in their background. The authors conclude that there exists a significant difference between the above mentioned disorders in the parents of children with ADHD, and parents of normal children. The high prevalence rate of disorders and background of ADHD in families of individuals with ADHD shows the probability of effect of inheritance in the disorder. Also, it shows that parents of children with ADHD have more substance abuse and history of ADHD in their background.

Gregoire, K. A., & Schultz, D. J. (2001). Substance-abusing child welfare parents: treatment and child placement outcomes. Child Welfare League of America, 80(4), pp. 433-452.

This article presents findings of a study of 167 child welfare parents referred for substance abuse assessments. Findings indicate that significant others’ support positively influences outcomes while court involvement did not appear to make a difference. The authors argue that clients and their partners need multiple sources of support especially in the early stages of recovery.

Harwin, J. (2008). Focusing on parental and young people's substance misuse: Exploring the links. Child Abuse Review, 17(6), pp. 365-370.

The author reflects on the issue of parental substance misuse and the effect that it has on young children. The author argues that this is an important subject to look into for a number of reasons, including the growth of research in the field, the types of harm that parental substance misuse has on childhood development and the impact this issue has on child welfare services. The article references various changes that have taken place in the fields of health and social services in order to integrate parental substance misuse.

Jansson, L. M., & Velez, M. L. (2011). Infants of drug-dependent mothers. Pediatrics in Review, 32(1), pp. 5-13.

After completing this article, readers should be able to:
  1. Recognize the effects of maternal substance use on the developing fetus, neonate, and growing child.
  2. Describe the effect of maternal substance use on the mother-infant dyad.
  3. Discuss the factors that may serve as mediators and moderators of the effects of maternal substance use on the child.
  4. Understand the complex context within which the substance-abusing mother and her infant be considered.
  5. Evaluate and manage the substance-exposed dyad.

Jones, H. E., Deppen, K., Hudak, M. L., Leffert, L., McClelland, C., Sahin, L., Starer, J…& Creanga, A. A. (2014). Clinical Opinion: Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers. American Journal of Obstetrics & Gynecology, April, pp. 302-310.

This article reviews clinical care issues related to illicit and therapeutic opioid use among pregnant women in the postpartum period and outlines the major responsibilities of obstetric providers who are for these patients during the antepartum, intrapartum, and postpartum periods. The authors highlight select patient treatment issues, and provide case examples as well.

Konijnenburg, E., Sieswerda-Hoogendoorn, T., Brilleslijper-Kater, S. N., Lee, J., & Teeuw, A. H. (2013). New hospital-based policy for children whose parents present at the emergency room due to domestic violence, substance abuse and/or a suicide attempt. European Journal of Pediatrics, 172(2), pp. 207-214. DOI: 10.1007/s00431-012-1869-3

This article looks at a 2010, hospital-based policy developed in Amsterdam, The Netherlands that asked all adults presenting at emergency room (ER) departments due to DV, SA and/or suicide if they had children in their care. If patients had children in their care, recommendations were made for them to visit the outpatient pediatric department with all of their children. An evaluation of their problems took place during the visit, and voluntary referrals arranged to different care organizations. Reports to the Dutch Child Abuse Counseling and Reporting Centre were made in cases where parents refused to cooperate. The study aimed to describe (1) characteristics of the identified families and (2) the referrals made to different voluntary and involuntary care organizations during the first 2 years after implementation of the policy. According to the researchers, the policy seems successful in arranging voluntary support for the majority of identified children.

Kyzer, A., Conners,-Burrow, N. A., & McKelvey, L. (2014). Environmental risk factors and custody status in children of substance abusers. Children and Youth Services Review, 36(1), pp. 150-154.

This study sought to examine changes in children's living situations before and after their mother's treatment experience. Authors examined pre- and post-treatment changes in the legal and physical custody status of children, as well as neighborhood and household factors that can impact children's physical or emotional health and safety. Mothers who had at least one child living with them reported a significant decrease in problems in the home and neighborhood environments. Authors also examined whether treatment completion predicted healthier living situations for children. Results of the study indicated that treatment graduates were 2.5 times more likely to have at least one child living with them after treatment. In addition, non-graduates experienced more unwanted moves compared to graduates. These findings suggest that the homes and neighborhoods families return to post-treatment are, on the whole, relatively safe.

Moe, J., Johnson, J. L., & Wade, W. (2008). Evaluation of the Betty Ford children's program. Journal of Social Work Practice in the Addictions, 8(4), 464-489.

This article reports on a program evaluation of the Betty Ford Center Children's Program, a program specifically designed for the children of substance abusers. The study evaluated approximately 160 participating children (aged 7-12) pretest and posttest using a comprehensive psychological battery; a subsample of 50 children participated in a follow up telephone interview 6 months later. Results showed that children of substance abusers benefit from brief, intensive program efforts that serve their special circumstances and highlight the important role social workers and other clinicians have in helping children reevaluate the impact of parental substance use.

Morton, C. M. (2013). The moderating effect of substance abuse service accessibility on the relationship between child maltreatment and neighborhood alcohol availability. Children and Youth Services Review, 35(12), pp. 1933-1940.

This study investigates how the relationship between dense concentrations of alcohol retailers and high rates of child maltreatment may be moderated by the presence of substance abuse service facilities. Research findings suggest that child maltreatment rates were higher in neighborhoods with lower socioeconomic status and those with greater alcohol outlet density. Neighborhoods with easily accessed substance abuse service facilities had lower rates of child maltreatment. The presence of substance abuse service facilities is a moderator in the relationship between child maltreatment and alcohol outlet density. The study findings highlight the relevance of making primary prevention approaches readily available and using multi-sector collaboration to reduce child maltreatment.

Office of Applied Studies (2003, June). The NHSDA report: Children living with substance-abusing or substance-dependent parents. Rockville, MD: Substance Abuse and Mental Health Services Administration.

The SAMHSA’s National Household Survey on Drug Abuse is the primary source of information on the prevalence, patterns, and consequences of drug and alcohol use and abuse in the general U.S. civilian non institutionalized population, age 12 and older. This report focuses on biological, step, adoptive, and foster children younger than 18 years of age who were living with one or both parents at the time of the survey interview. This report found that in 2001, more than 6 million children lived with at least one parent who abused or was dependent on alcohol or an illicit drug during the past year. Past year substance abuse or dependence by parents involved approximately 10 percent of children aged 5 or younger. Among parents who lived with one or more children, fathers were more likely than mothers to abuse or be dependent on alcohol or an illicit drug.

Osborne, C., & Berger, L. M. (2009). Parental substance abuse and child well-being: A consideration of parents' gender and co-residence. Journal of Family Issues, 30(3), pp. 341-370.

Existing research, however, has not fully explored the relative magnitude of the associations between maternal, paternal, and both parents' substance abuse and child outcomes, nor has it examined these associations in regard to substance abuse among nonresident fathers. We use data from the Fragile Families and Child Wellbeing Study (N = 3,027) to explore these issues among a cohort of 3-year-old children. Authors found that children living with a substance-abusing parent are at considerable risk for poor health and behavior outcomes, that such risk is not moderated by parent gender, and that it is substantially larger when both parents have substance abuse problems. Moreover, children with substance-abusing fathers are at a potentially higher risk of health and behavior problems when their fathers live with them, although this risk is still substantial when they do not.

Palusci, V. J. (2011). Risk factors and services for child maltreatment among infants and young children. Children and Youth Services Review, 33(8), pp. 1374-1382. DOI: 10.1016/j.childyouth.2011.04.025

The authors used NCANDS data to study child maltreatment report for infants and young children. The authors found that for the years for 2003–2007 there were 1.2 million confirmed maltreatment reports to state child protective services agencies in 22 states during 2003–2007 in NCANDS, including 177,568 infants and young children under five years. 19.3% had a second confirmed CM report within 5 years. White race, inadequate housing and receiving public assistance were associated with significantly increased risk of CM recurrence. Infants and young children received more services and had less recurrence than did older children. Infants and young children have different risk factors and receive different services than do older children in the CPS system.

Sperry, D. M., Widom, C. S. (2013). Child abuse and neglect, social support, and psychopathology in adulthood: A prospective investigation. Child Abuse & Neglect, 37(6), pp. 415-425.

The objective of this study was to determine whether child abuse and neglect predicts low levels of social support in middle adulthood and understand whether social support acts to mediate or moderate the relationship between childhood abuse and neglect and subsequent outcomes. Results reflect that individuals with documented histories of child\ abuse and neglect reported significantly lower levels of social support in adulthood, belonging, tangible, and self-esteem support than controls. Findings suggest that social support mediated the relationship between child abuse and neglect and anxiety and depression in adulthood. Authors suggest that more research is needed to better understand the timing and mechanisms involved in these relationships that guide preventive interventions and treatment.

VanDeMark, N. R., Russell, L. A., O’Keefe, M., Finkelstein, N., Noether, C. D., & Gampel, J. C. (2005). Children of mothers with histories of substance abuse, mental illness, and trauma. Journal of Community Psychology, 33(4), pp. 445-459.

Children exposed to parental substance abuse, mental illness, and violence face profound challenges, including increased risk for emotional and behavioral problems, substance abuse, and victimization. In this article, the authors describe the characteristics of a sample of children of women entering treatment. The children had been exposed to domestic violence, frequent child welfare involvement, and residential instability. Parental entry into treatment affords treatment providers an opportunity to intervene early with these children, enabling them to offer supportive and preventive services and to help children build skills to avoid problems later. Treatment providers are encouraged to offer assessment and services to children of parents entering treatment, capitalizing oil the opportunity to intervene early with a group of children who are at risk for problems with significant individual and social consequences.

Welsh, J., Precey, G., & Lambert, P. (2008). Parents of children at risk—a multi-agency initiative to address substance misuse amongst parents whose children are at risk of neglect. Child Abuse Review, 17(6), pp. 454-462.

The article presents information about parents as substance abusers and the impact that this behavior has on young children. The authors comment on the report called "Hidden Harm" that was released in 2003 by the Advisory Council on the Misuse of Drugs. The report shows that the cities of Brighton and Hove in England have some of the highest percentages of parental drug abusers. The report also considers the needs of children affected by these circumstances and the health and developmental consequences that they face in such environments.

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