Research finds substance abuse varies widely in association with child abuse, neglect
Alcohol and other drug use are regularly linked to child abuse or neglect in families, but simply assuming the former causes the latter is not taking a deep enough look. A University of Kansas professor has authored a pair of studies examining how a range of parental alcohol and substance use behaviors are related to abusive and neglectful parenting behaviors and argues that a more thorough understanding can help address the associated problems to better serve families.
Research has tended to view parental substance abuse as any harmful use or substance use disorder. That has limited understanding of how a range of behaviors can contribute to child maltreatment. Nancy Jo Kepple, assistant professor of social welfare, has authored two studies examining data on severity of alcohol and other drug use among parents and the type of child maltreatment behaviors associated with them. She argues that the current ways of studying substance abuse and child maltreatment are inadequate because they frame substance use behaviors too narrowly.
"Very few of us have tried to look beyond a basic way to measure substance use. Some of the confusion regarding the relationship between parental substance use and child maltreatment has been around the fact that we look at it as an either-or proposition," Kepple said. "By definition, drug use varies widely and along many dimensions."
For her studies, published in Substance Use & Misuse and Child Abuse & Neglect, respectively, Kepple analyzed data from the National Survey of Child and Adolescent Well-Being. The data is a panel survey of children sampled from nine regions across the United States identified as being at high risk for experiencing maltreatment based on child welfare investigation or involvement. For the studies, the sample included children who were not removed from their homes but had at least one investigation of child maltreatment conducted by a child welfare professional. The parents reported on their substance use, substance-related problems and parenting behaviors during three interviews conducted over three years.
The analysis showed that parents who reported at least light to moderate drinking of alcohol or more intensive alcohol and other drug use were associated with a higher annual frequency of physical or emotional abuse behaviors compared with those who reported no past year use of any alcohol or drugs. In contrast, only those who reported past year substance use disorders were associated with a higher annual frequency of neglect compared with other substance use behaviors. The findings show it is not enough to simply assume substance use alone will lead to the same problems for all families.
"If that were true, we should see more increasing frequency of abusive and neglectful behaviors with increasing substance use and associated problems in functioning. But I didn't," Kepple said. "When we look at different types of maltreatment, the findings showed different relationships between substance use behaviors and abuse than for neglect. These relationships are complicated and likely vary by type of parenting behaviors. You can't demonize the parents for the drug use alone; there has to be a connection between the substance use and how it impairs a parent's ability to care for their child. Practitioners and social service agencies working with these families could benefit from research re-thinking the ways we measure alcohol and drug use."
Many caseworkers and social work professionals are doing great work adopting a more nuanced view of substance use when working with families, Kepple said. But improving our approach in research could help provide practitioners with better data and support about how to screen and assess for potentially problematic behaviors before they escalate to maltreatment. Additionally, this information could help professionals in identifying families who may benefit from help early, preventing such negative behaviors before they happen, lessening the trauma to children and the need to remove them from their homes. Evaluating parents for early or high-risk substance use behaviors before they reach criteria for use disorders could greatly assist in efforts to prevent systems from being overburdened by escalating substance-related problems, such as the current opioid epidemic faced in the United States.
"Right now, the news is, 'What are we going to do with these kids who are losing parents or being removed from their families because of the opioid epidemic?'" Kepple said. "My argument is we should look at what we can do to help parents early on and help prevent these problems from escalating in the first place."
Increased understanding of the parenting behaviors associated with different aspects of substance use, such as frequency, type or associated problems in functioning, could help social work develop more effective screening, assessment and interventions. Families affected by substance-using parents may require flexible and adaptive response. Kepple said in future research she hopes to examine different aspects of substance use, such as the experiences of parents in long-term addiction recovery, and add to the body of literature on how and why certain aspects of substance use may contribute to problematic parenting behaviors.
Ultimately, Kepple said, the findings show the importance of studying the unique experiences of substance-using parents across a range of behaviors. This means thinking about them as a unique population rather than collapsing them into a general substance-using population or general parenting population. It's about combining the best approaches from addiction research and child maltreatment research to move our understanding forward.
"We can strive to improve how we measure both substance use and parenting behaviors in the research literature," Kepple said. "It's hard to do, and my studies are far from perfect. But if we make it a priority, we can greatly improve our understanding and give guidance back to the field in a way that helps to better serve families."