Child Welfare and Substance Abuse. Erica Tarasovitch, MSW Central Florida Behavioral Health Network

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1 Child Welfare and Substance Abuse Erica Tarasovitch, MSW Central Florida Behavioral Health Network

2 Parental Substance Use Marijuana was the most commonly used illicit drug in 2006, accounting for 72.8 percent of illicit drug use. In 2006, there were 2.4 million cocaine users, an increase from 2002 (at 2.0 million) The number of heroin users increased from 136,000 in 2005 to 338,000 in 2006 The most widely used substance is alcohol; in 2006, 6.9 % of the population 17 million people report heavy drinking, and 23% 57 million people report binge drinking SAMHSA, 2007

3 Effects of Parental Substance Abuse Children of substance abusing parents are at more risk of physical, social, intellectual, and emotional problems May suffer physical effects of prenatal substance exposure Higher incidence of depression and anxiety Family disruption Lack of consistency and structure Greater risk of economic instability Possibility of parental incarceration The children of incarcerated women are at higher risk of entering the foster care system

4 Cont. At more risk of truancy and dropping out Substance abuse is estimated to be a factor in 7 of 10 incidents of child abuse and/or neglect Nationally, more than half the children in foster care have a parent who abuses substances When a parent abuses substances, the median length of stay in foster care is 11 months vs. 5 months Children of substance abusers are estimated to be about four times as likely to become substance abusers

5 How Parental Substance Use Disorders may Affect Child Development Physical health consequences Lack of secure attachment Language delays and communication disorders Psychopathology Behavioral problems Poor social relations and skills Deficits in motor skills Cognition and learning disabilities

6 Parents: They Really are the Anti Drug! SAMHSA studied correlation between use of marijuana within the last year for ages and whether parents never used, used but quit over a year ago, or used within the last year Ages Parents never used Parents used but quit Parents used in last year % 5.4% 12.8% % 27.4% 33.2% % 36.5% 54.5%

7 Alcohol vs. Other Drugs Does it make a difference? Illegal vs. Legal Pattern, Drug, Rate, Parents Gender, Child s Age

8 Domestic Violence and Parental Substance Abuse Researchers have found that one fourth to one half of men who commit acts of domestic violence also have substance abuse problems. Children of substance abusers are six times more likely to witness spousal abuse. Research also indicates that women who abuse alcohol and other drugs are more likely to become victims of domestic violence and that victims of domestic violence are more likely to receive prescriptions for and become dependent on tranquilizers, sedatives, stimulants, and painkillers and are more likely to abuse alcohol. About 40 percent of children from violent homes believe that their fathers had a drinking problem and that they were more abusive when drinking. Fifty percent of batterers are believed to have had "addiction" problems. A study conducted by the Department of Justice of murder in families found that more than half of defendants accused of murdering their spouses as well as almost half of the victims had been drinking alcohol at the time of the incident. SAMSA.gov

9 Legal Standards for When Parental Substance Use is Child Neglect or Abuse Evidence of extensive, abusive, chronic use of a controlled substance or alcohol by a parent when the child is demonstrably adversely affected by such usage. Drug tests detect presence of alcohol or a controlled substance (not intended for medical treatment) at birth Giving a child alcohol or drugs, including prescription drugs not prescribed for that child, that substantially affect the child s behavior, motor coordination, or judgment or that result in sickness or internal injury.

10 Assessing the Problem: Seek First to Understand... Ask specific questions about patterns of use Frequency, duration, intensity Assess how much time, money, and energy is devoted to use Talk to parent and to child (age appropriate) to determine how much the child knows about use Look for changes in patterns of use over time Assess current psychosocial stressors

11 Assessment, cont. Tools to try Timeline Follow Back Marijuana Problem Scale Reasons for Quitting Listen to person s perceived benefits of use Ask about parent s personal and family goals

12 A Few Words about Drug Tests Oral fluid or saliva testing mimic that of blood. Urine cannot detect current drug use. It takes approximately 6 8 hours or more post consumption for drug to be metabolized and excreted in urine. Similarly, hair requires two weeks, and sweat, seven days. Hair testing

13 Substance Urine Hair Blood/Oral Fluids Alcohol 6 24 hours Up to 90 days 12 hours Amphetamines 1 to 3 days Up to 90 days 12 hours Methamphetamine 3 5 days Up to 90 days 1 3 days MDMA (Ecstasy) 4 days Up to 90 days 25 hours Barbiturates 4 days Up to 90 days 1 2 days Phenobarbital 2 3 weeks Up to 90 days 4 7 days Benzodiazepines Therapeutic use: 3 days. Chronic use: 4 6 weeks Up to 90 days 6 48 hours Cocaine 2 5 days Up to 90 days 2 5 days Codeine 2 3 days Up to 90 days 2 3 days Morphine 2 days Up to 90 days 1 2 days Herion 3 4 days Up to 90 days 1 2 days LSD hours Up to 3 days 0 3 hours Methadone 3 days Up to 97 days 24 hours PCP 3 7 days for single use; up to 30 days for chronic use Up to 90 days 1 to 3 days

14 Specific Issues for Women with Substance Use Disorders Different social perceptions of female substance abusers, especially mothers More often responsible for dependent children Research indicates about half of women refuse treatment if required to leave their children with other caregivers Often feel guilty about their parenting In one study, 73% of substance abusing mothers rated their own parenting skills as either fair or poor Greater fear of losing custody of children In one study, 56% of mothers but only 15% of fathers were concerned about loss of custody if they entered treatment As of 2002, less than 9% of treatment programs offered child care services

15 Women with Substance Use Disorders, cont. Women are more likely to start using after trauma or family disruption 69% of women vs. 12% of men in treatment report childhood sexual abuse 10.7% of divorced/separated women abuse substances, compared to 4.1% of married women Greatest risks of use occur at major transition points in life Illicit drug use starts later, seek treatment earlier More likely to be in an abusive relationship More likely to have a partner who is a substance abuser, and to have a family history of addiction

16 Women with Substance Use Disorders, cont. Higher rates of co occurring mental health issues, including eating disorders More likely to abuse prescription medications than other drugs More likely to use alone and to be socially isolated More transportation barriers in accessing treatment Public transportation may not be kid friendly Higher risk for HIV Drug abuse twice as likely associated with HIV for women then men Greater incidence of physical problems related to substance abuse, including liver damage, hypertension, and infertility Sources: National Survey on Drug Use and Health, SAMHSA, 2003, Substance Abuse Treatment Care for Women, United Nations Office of Drugs and Crime, 2004, Drug and Alcohol Services Information System Report, October 2002, American Journal of Drug and Alcohol Abuse, Feb and May 2003

17 Effective Gender Specific Programs Values positive, authentic relationships and women s ability to nurture and work collaboratively Celebrates a woman s individual and collective history, culture, and heritage Provides positive female role models Addresses gender role stereotypes and attitudes that keep a woman from reaching her potential Encourages identification of unhealthy and oppressive elements in a woman s environment and teaches her how to cope with them effectively Addresses healthy sexuality

18 Gender specific Programs, con t Strength based and empowering Builds assertiveness skills Builds self esteem and self validation Promotes activities that develop physical capabilities Provides chances to practice goal setting and experience achievement Uses a variety of therapeutic approaches that integrate emotional and spiritual issues with skill acquisition Involves the family as part of treatment

19 Coordinated and Comprehensive Intervention A full array of services is used to support recovery based on the client and family needs

20 Intervention with the Family Works Family focused intervention helps improve parenting skills, stable family functioning, and substance abuse issues for both mothers and fathers Research indicates that having the chance to experience supportive relationships with other caring adults helps children of substance abusing parents develop better coping skills Peer group programs with other children of substance abusing parents reduce feelings of shame and isolation

21 Some Barriers to Quitting Adversarial relationship and defensiveness with professionals Fear of consequences of quitting May be primary coping skill May be part of financial support for family Co occurring mental or emotional issues Negative emotions about current situation Hopelessness, anger, fear, frustration Important relationships may support or require use For all humans, change is a challenging process For the good that I would do, I do not; but the evil which I would not do, that I do Romans 45:07, verse 19

22 Understanding Challenges Challenges are often an unconscious test to see how you handle the issues that people most want you to help them learn how to resolve