Families involved with the child welfare system are among the most troubled in our society. In maltreating families, child abuse and neglect are rarely the only issues. Even addiction, while among the most common of the co-occurring problems, is rarely the only serious problem. Mental illness is often present, as are domestic violence and HIV/AIDS. Most families involved with child welfare agencies have very low incomes, and inadequate or unsafe housing are very significant issues, particularly in urban areas. These difficulties combine in the lives of these families to produce extremely complex situations and relationships that are challenging to resolve. The presence of so many serious problems also implies that addressing the substance abuse alone is not likely to produce the changes in a family that are necessary to ensure a healthy family environment for a child. Unless the whole of a family's situation is addressed, substance abuse treatment is unlikely to be successful - and even if a parent achieves abstinence, the other issues present may continue to pose safety problems for the child.
No less complex than the problems of substance abusing parents are their children's needs. The two main research findings regarding children of parents with substance abuse problems are that (1) these children have poorer developmental outcomes (physical, intellectual, social and emotional) than other children, although generally in the low-normal range rather than severely impaired; and (2) they are at risk of substance abuse themselves. Prenatal abuse of alcohol appears to have more severe and long-lasting effects on development than do cocaine and other illicit drugs, including serious intellectual and behavioral consequences in many children. Babies who were prenatally exposed to cocaine or other drugs may experience a range of problems, however, including some that can be long-lasting and serious. These physical and mental deficits are not seen in infants to the overestimated extent that earlier expert warnings and media reports regarding "crack babies" had predicted . Most research finds that factors in the postnatal environment mediate prenatal factors. It is now recognized that the older a child gets, the more important the home environment is in predicting developmental outcome, including how the environment interacts with any direct effects of prenatal drug exposure.