Substance Abuse Among the Child-Rearing Population

In 2006, an estimated 20.4 million Americans over 11 years old were illicit substance users, with the highest rate among 18 to 20 year olds, or over 8% of this population. Almost 20% of young adults ages 18 to 25 report illicit drug use, 16.3% using marijuana, 6.4% prescription drugs, 2.2% cocaine, and 1.7% hallucinogens. In all people over 11 years of age, males were more likely to use illicit drugs than females (10.5% vs. 6.2%). In youth ages 12 to 17, rates were similar for males and females (9.8% and 9.7%). Education was a factor in illicit substance use as well. Full-time college students used less than others in the same age group (19.2% vs. 22.6%).

Illicit Substance Use and Pregnancy

According to the National Survey on Drug Use and Health (NSDUH) 2006 report, 4% of pregnant women used illicit drugs and 9% used alcohol in the month prior to the survey. In addition, among pregnant women 15 to 44 years old, 11.8% reported current alcohol use, 2.9% binge drinking, and 0.7% heavy drinking. Chasnoff et al studied more than 7800 pregnant women and found approximately one third had a positive drug or alcohol screen. Of pregnant women with a positive screen, 15% continued to use substances after learning of their pregnancy. NSDUH has estimated that past-month substance use is similar between new mothers and nonpregnant women. This report is concerning, since it implies new mothers are dealing with both the responsibilities and stresses of caring for a newborn while experiencing the impairments and negative effects of substance abuse.

Limitations of Available Data

Substance abuse prevalence data carry limitations, since it often relies on self-reports that are typically the “tip of the iceberg.” Substance abuse carries both social stigma and the potential for negative legal consequences for the addict. Thus, substance abuse is often underreported. For example, in a prospective study of more than 3000 children, 43% of infants were positive for illicit substances, and of these, only 11% of their mothers reported illicit substance use. Another limitation in prevalence data on in utero exposure is that screening of newborns lacks standardized criteria. Currently, newborns are screened for illicit substance exposure at the discretion of hospital staff. This creates great variability in screening practices among hospitals. Inconsistent screening practices could unfairly target minority women and women in poverty.

Marijuana

Marijuana is derived from the leaves of the hemp plant Cannabis sativa . It is a shredded green and brown mix of the plant’s flowers, stems, seeds, and leaves. The active chemical in marijuana is delta-9-tetrahydrocannabinol (THC). THC is passed from the lungs into the bloodstream. From the bloodstream, THC travels to the brain and other organs throughout the body. Marijuana is the most commonly abused illicit substance in the United States. ^, In 2006 marijuana was used by 72.8% of current illicit substance users, and exclusively used by 52.8% of these.

Marijuana works on specific receptors in the brain that cause a cascade of reactions, resulting in the “high” that users experience. These receptors are located in the parts of the brain that influence pleasure, memory, thoughts, concentration, sensory and time perception, and coordinated movement. According to the National Institute on Drug Abuse (NIDA), “… marijuana intoxication can cause distorted perceptions, impaired coordination, difficulty in thinking and problem solving, and problems with learning and memory.”

Chronic marijuana use can cause problems in daily life and exacerbate other problems. Research has shown that chronic marijuana use impairs several important measures of life achievement including physical and mental health, cognitive abilities, social life, and career status. One way marijuana does this is by negatively affecting learning and memory. According to the NIDA, these effects can last for days or weeks after the acute effects have worn off. Consequently, someone who uses marijuana daily can be constantly functioning at a suboptimal intellectual level.

Many studies have shown chronic marijuana use to be associated with increased anxiety, depression, and suicidal ideation. Current evidence suggests a link between marijuana use and schizophrenia, especially when an acute psychotic reaction is precipitated in a vulnerable person after high doses of marijuana. The relationship between chronic marijuana use and mental illness blurs when considering cause and effect. One question is, does marijuana cause mental illness, or do mentally ill people use marijuana as a form of self-medication?

Withdrawal symptoms following chronic marijuana use have reportedly included irritability, sleeplessness, decreased appetite, anxiety, and drug craving. These symptoms can begin 1 day after last marijuana use, peak symptoms occur at 2 to 3 days, and subside within 1 to 2 weeks of abstinence.

Cocaine and Methamphetamine

Cocaine is a powerful stimulant derived from the leaves of the Coca plant. Cocaine can come in two forms: the powdered hydrochloride salt form, or a rock crystal called “crack.” “Crack” cocaine gets its name from the crackling sound it makes when heated. According to NSDUH, in 2006 there were 977,000 people ages 12 and older who tried cocaine for the first time (about 2700 initiates per day). The average age of first use was 20.3 years. In 2006, there were 2.4 million current cocaine users.

Cocaine is a strong central nervous system (CNS) stimulant. It works by blocking the reuptake of the chemical messenger dopamine. Dopamine is associated with pleasure and movement. The euphoria reported by cocaine abusers is due to the nonstop stimulation of dopamine-receiving neurons. The “high” is affected by the rate of drug absorption, although rapid absorption also shortens the drug’s duration of action. The high from snorting cocaine can last 15 to 30 minutes, whereas that from smoking lasts 5 to 10 minutes. Other acute effects of cocaine use include reduced hunger with resultant weight loss and reduced perceived need for sleep.

Cocaine binging, in which cocaine is used repeatedly in increasingly higher doses, can lead to irritability, restlessness, and paranoia. If continued, cocaine binging can lead to full-blown paranoid psychosis. Physical symptoms of chronic cocaine abuse can include malnourishment from chronic appetite suppression, cardiac disease, and destruction of the nasal septum for those who “snort” the drug.

Cocaine use in conjunction with other substances poses additional hazards, especially when combined with alcohol. Research has shown that the human liver combines cocaine and alcohol to create a third substance, cocaethylene. Cocaethylene is postulated to increase the euphoria of the cocaine high, while potentially increasing the user’s risk of sudden death.

Like cocaine, methamphetamine is a powerful CNS stimulant. Methamphetamine’s effects are similar to cocaine, but the effects last longer and it costs less. Consequently, methamphetamine has been labeled the “poor man’s cocaine.” Methamphetamine is typically a white, odorless powder, but its appearance changes depending on how it is used. Methamphetamine can be “snorted,” smoked, injected, or taken orally.

Methamphetamine can be manufactured using commonly obtained materials. The term “meth lab” is used for clandestine facilities that produce methamphetamine. In 2006, approximately 731,000 people in the United States aged 12 or older were users of methamphetamine, about 0.3% of the population. Methamphetamine appears to be a substance commonly used by females. In one study, 45% of people admitted for methamphetamine abuse treatment were female. In 2005 an estimated 1.3 million people aged 12 or older had used methamphetamine in the past year, and an estimated 556,000 (42%) were female. The Iowa Case Management Project’s analysis of 1095 clients in drug treatment showed females reported amphetamine as their substance of choice at a rate of 14%, twice the rate for male clients. The study found that methamphetamine was favored by white females in their 20s.

Methamphetamine is similar to cocaine in that it blocks dopamine reuptake in the brain and produces a sense of increased alertness and euphoria. In addition, methamphetamine promotes the release of dopamine into the synaptic cleft. Similar to cocaine, methamphetamine decreases fatigue and appetite. The reduced hunger can lead to weight loss, and the reduced perceived need for sleep can lead to difficulty sleeping and rapid onset of fatigue as the drug wears off. Methamphetamine users can sleep for extended periods when the drug’s effects wear off, potentially leaving their children unattended or in the care of potential abusers for days. Methamphetamine also reduces thirst, which can lead to dehydration.

Methamphetamine also increases the user’s sexual drive, which can lead to unsafe sex practices. According to the U.S. Office for Victims of Crime, children who live with methamphetamine users often are exposed to pornographic materials or overt sexual activity. Methamphetamine abuse is associated with poly-drug use, since users often use other sedating drugs such as marijuana to diminish the negative effects of the methamphetamine. This poly-drug concoction does not typically include alcohol, since users have reported that simultaneous methamphetamine and alcohol use causes an unpleasant taste.

The users and the producers of methamphetamine are often the same people. As a result, the addict is subjected to the effects of the drug as well as the harmful effects of the “meth lab” environment. Methamphetamine toxicity (from the drug itself as well as from by-products of its manufacture) can lead to myocardial infarction and stroke. The physical damage of chronic methamphetamine use is difficult to conceal. Skin lesions, such as excoriations and abrasions, can be seen in users picking off “meth bugs.” These “bugs” are the result of methamphetamine-induced delusional parasitosis. ^, In addition, oral disease and dental decay (“meth mouth”) is commonly seen among chronic users of the drug. Dental lesions are the result of several different mechanisms, including chronic dry mouth, heavy sugar intake, and bruxism (teeth grinding) from sympathetic nervous system overstimulation.

According to the Department of Justice , parents and caregivers who are dependent on methamphetamine often become careless, irritable, and violent, and can lose their capacity to nurture their children. While under the influence of methamphetamine, speech can become disorganized and difficult to understand, with abrupt shifts in thought. When used chronically, the user can suffer from memory and learning impairment. ^, This cognitive impairment is especially obvious in areas of decision making. Chronic methamphetamine use disrupts normal sleep patterns and can cause paranoia, which can contribute to violent episodes while under the influence. Chronic use can lead to mood lability ranging from extreme depression to euphoria. These negative effects intensify as the methamphetamine addict progresses through their binge-crash cycles, which last from 1 to 3 weeks.

Srisurapanont et al examined 168 inpatients with methamphetamine psychosis in the United Kingdom, Australia, Japan, the Philippines, and Thailand. Their most common psychotic symptom (found in over 77% of patients) was persecutory delusions. This was followed by auditory hallucinations (over 44%), strange or unusual beliefs, and “thought reading.” Negative symptoms were found in over 21% of patients. These findings are consistent with other findings in the literature.

Methamphetamine withdrawal can be described in two phases: acute and subacute. The acute effects of methamphetamine include increased sleeping and appetite and depression-related symptoms and sometimes anxiety, irritability, and craving of methamphetamine. The subacute phase includes marked sleepiness (“the crash”) followed by insomnia. Paradoxical withdrawal symptoms can include anxiety, irritability, and craving of methamphetamine. A “crash period,” which involves oversleeping, begins after about 3 days of the acute withdrawal phase. Beginning on about the sixth day, a phase of insomnia follows withdrawal until about the twentieth day of methamphetamine abstinence. The symptoms of methamphetamine withdrawal are not conducive to good parenting.

Heroin

Heroin is processed from morphine, which is extracted from the seedpod of the poppy plant that can be found in Asia, Mexico, and Colombia. Heroin is a brown or white powder, which is typically injected, although it can be “snorted” as well. In 2006, heroin was used by an estimated 338,000 Americans, which is more than double the 2005 estimated use by 136,000. The corresponding prevalence rate increased from 0.006% to 0.14% during this period.

The effects of heroin begin shortly after a single dose and can disappear after a few hours. After injecting heroin, the user feels a surge of euphoria (a “rush”) accompanied by flushing of the skin, a dry mouth, and a feeling of heaviness in the extremities. The initial euphoria is followed by alternating wakeful and drowsy (“going on the nod”) states.

Chronic injection of heroin can lead to collapsed veins. In addition, chronic intravenous heroin abuse places the user at increased risk of endocarditis, abscesses, cellulitis, and liver disease. Street heroin can include impurities and additives that do not readily dissolve. These additives can clog circulation to the lungs, liver, kidneys or brain. Heroin is a CNS depressant, and chronic depression of the CNS can obscure proper mental functioning.

Heroin withdrawal can begin as quickly as a few hours after the last use. Withdrawal symptoms peak at 2 to 3 days into abstinence and subside after about 1 week. Withdrawal symptoms can include drug craving, restlessness, muscle and bone pain, insomnia, diarrhea, and vomiting. Some commonly seen withdrawal symptoms are cold flashes with goose bumps (“cold turkey”) and kicking movements (“kicking the habit”).

Alcohol

More than half of Americans (159 million people) over 12-years-old reported drinking alcohol in 2006. More than one fifth (23%) were binge drinking at least once in the 30 days prior to the NSDUH 2006 survey. The 2006 rates of alcohol use were 29.7% among 16- to 17-year-olds, 51.6% among 18- to 20-year-olds, 68.6% among 21- to 25-year-olds, and 63.5% among 26- to 29-year-olds. The rate of binge drinking peaks among 21- to 23-year-olds; 57.9% of females and 65.9% of males (age 18- to 25-years-old) reported drinking in 2006.

Alcohol’s effects on behavior are complex. It works in many different ways on many different neurotransmitters and networks. Like cocaine and methamphetamine, alcohol increases the neurotransmitter dopamine, which plays a role in the motivating and rewarding effects of alcohol. The sedating effect of alcohol is due to its potentiating effects on gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the brain. Acute alcohol use can release previously inhibited behaviors and cause the user to act impulsively and inappropriately by disrupting the normal inhibitory functions in the prefrontal networks of the brain. Many neurotransmitters are involved including serotonin, which is essential to emotional expression, and the endorphins, which can be responsible for both the “high” of alcohol intoxication and the craving to drink. “Blackout,” or alcohol-induced amnesia, is thought to be caused by its interference of several brain functions including memory.

Chronic alcohol abuse has a wide range of effects, depending on the amount of alcohol consumed, the age at which the person began drinking, malnutrition, and psychiatric conditions such as depression and anxiety. Alcohol is considered toxic to the brain, and alcohol’s neurotoxic effects are hypothesized to cause shrinkage of areas of the brain. Strikingly, approximately half of the nearly 20 million alcoholics in the United States have some form of neuropsychological difficulties, which can range from mild to severe. Examples of diminished cognitive effects include alcohol-induced persisting amnesic disorder (also known as Wernicke-Korsakoff syndrome) and dementia. Compounding these problems is poor dietary habits in some alcoholics, which can lead to thiamine deficiency (vitamin B ₁ ), contributing to damage to the brain and severe cognitive deficits.

Chronic alcohol abuse can affect behavior as well as cognition. The addict can become less reactive emotionally, thus appearing “flat.” In addition, alcoholics can have impaired emotional processing, including interpreting nonverbal emotional cues and recognizing facial expressions.

Prolonged abuse of alcohol reduces the number of GABA (inhibitory neurotransmitter) receptors. When the alcoholic stops drinking, decreased inhibition, along with a deficiency of GABA receptors, can contribute to overexcitation throughout the brain, thus leading to withdrawal seizures within a day or two.

Prescription Substances for Nonmedical Use

The National Institute on Drug Abuse (NIDA) reports that the inappropriate use of prescription medications is a serious public health concern. In 2006, over 5 million people were users of nonprescribed prescription pain relievers. The three most commonly abused classes of drugs are opioids, central nervous system (CNS) depressants, and CNS stimulants. Examples of opioids include morphine, codeine, oxycodone, methadone, and fentanyl. In addition to treating pain, these drugs affect regions of the brain that control the perception of pleasure, resulting in a sense of euphoria. Examples of CNS depressants include tranquilizers and sedatives. They act by decreasing brain activity, thus causing a drowsy or calming effect. The two main groups of CNS depressants are barbiturates and benzodiazepines. Barbiturates include mephobarbital and pentobarbital sodium. Examples of benzodiazepines are diazepam, chlordiazepoxide, and alprazolam.

Prescription stimulants increase the user’s energy, alertness, and attention. These stimulants are also associated with a sense of euphoria. Paradoxically, unpleasant feelings of paranoia or hostility can occur if these stimulants are taken at high doses repeatedly over a shorter period than prescribed. If the user repeatedly takes high doses of some prescription stimulants over a short period, feelings of hostility or paranoia can occur.

Substance Abuse and Pregnancy

As mentioned previously, of 7800 pregnant women studied, one third had a positive drug screen; of those with a positive drug test, 15% continued to use substances after learning of the pregnancy. Only 25% of substance abusers register for prenatal care prior to labor, mostly in the last trimester. Fewer methamphetamine users, relative to nonusers, get prenatal care (89% vs. 99%). They have fewer prenatal visits (11 vs. 14) and later first prenatal visits (15 vs. 9 weeks’ gestational age). Methamphetamine and cocaine reduces hunger and thirst and the need for sleep, resulting in malnutrition, weight loss, and dehydration in the pregnant addict. Heroin use disrupts normal menstrual cycles, therefore delaying the female addict’s awareness of her pregnancy and her seeking of medical care.

The pregnant heroin addict can have repeated episodes of withdrawal and overdose that are potentially fatal for the fetus. Maternal opioid withdrawal is associated with increased muscular activity, metabolic rate, and oxygen consumption. Fetal activity, in turn, increases, raising oxygen demands for the fetus that might be unmet, especially in the third trimester of gestation. Unmet oxygen requirements can be dangerous for the fetus and lead to fetal demise.

Early childhood is a time of close bonding of the child with the parent. Important developmental tasks including secure attachment depend on a “good fit” between the child and the parent. Children need good parenting from conception through adolescence. A substance-using pregnant woman will expose her unborn fetus to medical and psychosocial complications associated with her substance abuse, including lack of prenatal care, poor nutrition, use of drugs and/or alcohol, and existing diseases. Substance-using women often do not seek adequate prenatal care, neglect their fetuses’ nutritional needs, use multiple legal and illegal substances, and suffer from coexisting chronic illnesses such as HIV infections or hepatitis. Women using heroin or other opiates during pregnancy will cause their newborn to experience drug withdrawal symptoms, including feeding difficulties, irritability, sleep problems, and prolonged high-pitched crying. These infants can be challenging to nurture, especially for a mother who is struggling with her own addiction and depression.

Prenatal alcohol exposure leading to recognizable patterns of malformations and developmental disability or fetal alcohol effect is a well-defined entity. Children with alcohol-related neurodevelopmental disorders, alcohol-related birth defects, fetal alcohol syndrome, or fetal alcohol effect require special care, patience, and understanding from adult caregivers, along with complex medical and rehabilitation needs. Failure to provide for such essential services can result in significant secondary disabilities for the affected child.

Polydrug use is a common occurrence among drug-abusing women, exposing their unborn children to multiple drugs, making it difficult to isolate effects of exposure to an individual drug. Cocaine and methamphetamine are drugs commonly used by drug abusing women during pregnancy. Early literature on infants exposed to cocaine in utero reported alarming developmental outcomes for the infants, with predictions of irrevocable brain damage requiring lifelong institutional care. These opinions, which lacked a sound scientific basis, resulted in misguided policies and a tendency toward a punitive approach to pregnant women who used cocaine. The Maternal Lifestyle Study (MLS), a longitudinal, NIH-funded national prospective study, began in the 1990s. This study provided more accurate data about the development of drug-exposed children, disproving many of the myths associated with “crack babies.”

The MLS researchers studied 1388 mother–infants dyads (658 exposed and 730 unexposed) and reported effects of small magnitude in 5% of drug-exposed children. These effects include lower birth weight and decreased head circumference relative to birth weight, lower arousal, poor quality of movement and self regulation, higher excitability, increased tone, and poorer reflexes. An infant and maternal feeding study at 1 month of the infants 1 month after birth found cocaine-using mothers to be less engaged and less flexible in response to their infant’s cues, whereas opiate-using mothers show higher level of activity, independent of the feeding problems shown by their infants. Mothers using both cocaine and opiates along with tobacco are most likely to be at risk of insensitive, inflexible parenting during feeding.

Maternal behaviors that overstimulate, control, and potentially limit feeding opportunity have been shown to compromise energy intake and future weight gain and lead to mother–infant conflict.

Methamphetamine use has reached epidemic levels in the last 10 years. According to the 1999 NSDUH survey, methamphetamine use was equal among pregnant and nonpregnant women. A study funded by the National Institutes of Health (the Infant Development Environment and Lifestyle Study [IDEAL]) examined the effects of methamphetamine use during pregnancy. Subjects were recruited from seven hospitals from four clinical sites across the United States. Based on the self report of 1632 eligible mothers, the 6% of participating mothers used methamphetamine during pregnancy. Methamphetamine-exposed infants were 3.5 times more likely to be small for gestational age than nonexposed infants. Methamphetamine use during the third trimester is associated with poor quality of movement. The exposed newborns were less arousable, with an apparent dose-related effect on CNS.

These and other subtle but identifiable neurobehavioral characteristics of infants exposed to drugs could contribute to increased parental stress in substance-using women. Infants exposed to drugs prenatally often continue to live in environments with the compounding risks of parental depression, antisocial behavior, paranoia, family violence, lack of family support, and parents’ unresolved child abuse issues. All of these factors have been associated with both poor parenting skills and poor attachment, which puts the children at risk for neglect and abuse. The Keeping Children and Families Safe Act of 2003 (Public Law 108-36) requires states to have policies and procedures in place ensuring that child protective services are notified of substance-exposed newborns, and to establish safety plans for newborns with symptoms resulting from prenatal drug exposure.

The Home Environment in Substance-Abusing Families

Characteristics of the home environment of substance-using families that put their children at increased risk include poverty, dangerous living conditions, environmental stress, social isolation, and overcrowding. Other grave risks face children living in homes where methamphetamine is used and manufactured. The 2006 National Drug Threat Survey by the National Drug Intelligence Center found that in 2004, 2474 children were found to be affected by living in homes where methamphetamine was manufactured, and 3 children were killed. The ease with which methamphetamine can be manufactured at home, using easily available ingredients, has resulted in an epidemic of clandestine “meth labs” across the Midwest and Western United States. Children from these homes require removal to a safe environment, resulting in increased demand for foster placements. Although the developmental impact of living in a home with “meth lab” toxins present has not been determined, many cases of severe neglect are reported from such homes. In addition, multiple case reports of “accidental” methamphetamine poisoning have been published. Children have also suffered severe burns in household fires related to cooking methamphetamine in homes and are exposed to toxic chemicals. Often “meth lab” homes have stockpiles of weapons, guard dogs, and rigged “booby traps” to protect against unwanted entry of law enforcement officials. In addition, children are exposed to criminal behavior, such as the recruitment of adolescents into the drug manufacture and delivery process. Children can be exposed to violence related to the sales and distribution of methamphetamine, or by acts of retribution and efforts to eliminate competition, which are often part of the methamphetamine trade.

Many states have expanded their child abuse and neglect statutes to cover household drug use and activity, States have included the following types of conditions as actionable causes for intervening to protect children :

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  Manufacturing a controlled substance in the presence of a child or in a home where a child resides.

  
  
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  Allowing a child to be present where the chemicals or equipment for the manufacture of controlled substance are used or stored.

  
  
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  Selling, distributing, or giving drugs to a child.

  
  
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  The use of controlled substance by a caregiver that impairs the caregiver’s ability to adequately care for the child.

  
  
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  Exposure of child to drug paraphernalia.

  
  
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  The exposure to criminal sale or distribution of drugs.

  
  
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  The exposure to other drug-related activity.

Substance Abuse and Social Stressors

Studies of parents whose children are abused or neglected show parental depression and substance abuse as underlying problems in many cases. Families affected by substance abuse frequently have issues around boundaries, communication, problem-solving styles, and role assignments. In addition, drug and alcohol abuse can disrupt family rituals (holidays, meals, etc.), which affect children’s social development and well-being.

Stress can deplete a parent’s coping reserve and with a preexisting substance abuse disorder, this insult can sometimes be enough to tip the balance toward abusive responses aimed at the child. Trying to balance addictive lifestyle with demands of parenting can produce high levels of stress in women with inadequate social support and limited economic resources. Factors that challenge a parent’s ability to provide for the needs of their children include lack of education, unemployment, and homelessness.

Unemployment appears to correspond with illicit substance abuse. The NSDUH showed that current illicit drug use was higher among the unemployed (18.5%) than in those employed full-time (8.8%) or part time (9.4%). Conners et al studied mothers entering 50 publicly funded substance abuse recovery programs. Most of the women were unemployed (88.9%), lacked a high school degree or GED (51.7%), and relied on public assistance for financial support (70.6%). In addition, 32% had been homeless in the 2 years before beginning treatment. Only 13% of mothers in this study reported receiving child support from their children’s fathers.

Fathers are noticeably absent from the lives of children growing up in substance-abusing homes. In the above study, 30% of children never saw their father in the year prior to treatment entry. An additional 15% saw their fathers only once or twice in this period. The mothers in this study reported that over half (51%) of their children’s fathers used illegal drugs.

Substance Abuse and Parental Mental Health

The Conners study reported the following historical factors in women in substance abuse treatment: depression (40.1%), psychological trauma (10.7%), bipolar disorder (6.7%), and attempted suicide (29.8%). The NSDUH showed adults with serious psychological problems were more likely to use illicit drug (27.2% vs. 12.3%) and to be binge drinkers (28.8% vs. 23.9%) compared with adults without psychological problems. In addition, adults experiencing major depressive episode were more likely to use illicit substances (27.7% vs. 12.9%) and to drink heavily (8.6% vs. 7.3%) compared with nondepressed adults.

To examine the association of childhood physical and sexual abuse and parental histories of drugs or alcohol use, Walsh and colleagues conducted a population-based survey of 8472 adults in Ontario, Canada. Nineteen percent of respondents were ages 15 to 24. Males reporting parental substance abuse were 1.5 times more likely to be physically abused and three times more likely to be sexually abused than those reporting no parental history of substance abuse. For girls, physical abuse was doubled, and sexual abuse was 2.5 times higher.

Addiction and Parenting

Addiction can overwhelm parents and leave them preoccupied with acquiring drugs (and other illegal behaviors), leaving little time to spend on parenting, leading to serious child neglect. For example, methamphetamine users can fall into a deep sleep, sometimes for days, during which time their children are left defenseless to physical dangers in their environment as well as to abuse by other substance-abusing adults in the household. Coyer asked 11 women in recovery what parenting was like while using cocaine. From the mothers’ responses, five themes emerged:

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  Lack of structure—although some of the “structure” mothers provided was physical punishment and striking out at the children.

  
  
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  Abandonment—Mothers knew they would not be dependable while on drugs, so they would leave children with other people indiscriminately. Similarly, adult methamphetamine addicts have reportedly drugged their children with antihistamines or benzodiazepines to keep them asleep and “safe,” while their parents “crash” from their high.

  
  
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  Impatience and anger—Some women reported that while taking drugs, this would lead to violence against their children.

  
  
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  Lack of parenting knowledge—Mothers reported needing help recognizing problems in their children’s growth and development that were caused by exposure to cocaine.

  
  
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  Repeating family of origin dysfunctional practices—It is not unusual for substance abuse to occur in an intergenerational context.

According to the NSDUH, alcohol-dependent or alcohol-abusing parents were more likely to report that people in their households often insulted or yelled at each other and had more serious arguments than parents who were not abusing drugs or alcohol. Miller et al examined 170 mothers with and without current alcohol and drug problems to determine discipline styles for each group. Their findings suggest that women with alcohol and drug problems are more likely to be punitive toward their children. Other factors such as mothers’ histories of partner or parental violence seemed to contribute as well.

Parental Substance Abuse and Children’s Behavior

The effects of parental substance abuse can be seen in the behavior of their children. Infants who are exposed to cocaine in utero can be irritable and tremulous and can show state lability on the Brazelton Neonatal Behavioral Assessment Scale. These neurobehavioral effects are postulated to be due to increased catecholamine activity. When parents or caretakers are preoccupied with their addictions, they often fail to respond to infants’ basic needs or to do so unpredictably. This can cause children who live in a substance-abusing environment to exhibit attachment disorders.

Older children are not blind to their parent’s substance abuse; by age 7 or 8, most children have developed accurate perceptions of the role of substance abuse in their family. In addition, older children in substance abusing homes may often assume the roles of caretakers, causing additional stress.

Scannapieco et al compared families with a history of substance abuse who did and did not abuse and neglect their children. The abusive and neglectful families had fewer parental resources, less parental capability, fewer parenting skills, and less knowledge of child development. The children in the abusive families were found to be more vulnerable and fragile. In addition, the maltreating parents provided a poorer quality of physical and emotional care, and demonstrated a lack of empathy for and attachment to their children.