As discussed above, there are approximately 1.3 million parents with problem levels of illicit drug use (and many more alcoholic parents) who are living with children younger than age 18. These figures do not include children in foster care (because children in foster care are not living in their parents' households and are thus not picked up in a household survey). Most alcohol and drug using parents do not come into contact with the child welfare system, although they are more likely to do so than other parents. HHS's 1993 Study of Child Maltreatment in Alcohol Abusing Families reported that child maltreatment was three times as likely in alcohol abusing families compared with non alcohol abusing families. It also found that once child maltreatment was substantiated, children in alcohol or drug abusing families were more likely to enter foster care than were children in other maltreating families (30 percent versus 17 percent). Where child welfare cases were opened, 97 percent of cases involving drug abuse and 87 percent of cases involving alcohol abuse were closed within four months, indicating that the child welfare agency was satisfied that the safety issues had been resolved (HHS/NCCAN, 1993).
Other researchers found that child abuse occurred in 27 percent of families with an alcoholic parent and 19 percent of families with an opiate addicted parent. Serious neglect occurred in nearly a third of both alcoholic and opiate addicted families, and children in all families with an alcoholic or drug addicted parent experienced some degree of neglect (Black and Meyer, 1980).
The Maternal Lifestyles Study, a longitudinal study following 1,400 cocaine and/or opiate exposed children and a matched comparison sample in several cities, found that 42 percent of the drug exposed infants were reported to child protective services at the time of the child's birth. Reporting rates varied substantially among study sites depending on the State reporting policies. Of the drug exposed children, 82 percent were living with the biological mother at the time of hospital discharge and virtually all of those were still living with the mother at one month of age. Of the children not discharged to the mother, at one month of age 13 percent were back in the mother's care, 32 percent were in the care of relatives, 41 percent were in non-relative foster care, and 14 percent were in some other living arrangement (Maza et al, 1998).
The Center for Substance Abuse Treatment, within SAMHSA, is currently evaluating a grant initiative to provide residential substance abuse treatment for pregnant women and women with children. Early data show that about one-fifth of women in these programs were referred to treatment by a child welfare agency, probably because of issues related to child abuse or neglect. Far more had children living in foster care. Overall, 40 percent of women in the programs had at least one child living primarily in foster care during the 30 days prior to admission. Crack cocaine, methamphetamine, and alcohol were the most common drugs of abuse for these clients (Dowell and Roberts, 1998).
Studies of women in particular substance abuse treatment programs also show high rates of child welfare system involvement. Kearney reports that in a sample of heavy cocaine users, 69 percent had lost or given up custody of a child at some time (Kearney, 1994). Evaluators of a program in Arizona report that 33 percent of clients were involved with child protective services at the time of admission, although only 11 percent admitted to being the aggressor in a violent incident toward their children (Steven and Arbiter, 1995). A residential treatment center for women with children reports that only 37 percent of women enrolling in the program had custody of a child at intake (indicating that most clients' children were either in foster care or with relatives) (Wobie, 1997). And Brindis reports from another treatment program that for the mothers entering the program she studied, of the parents' youngest child under three years old, 43 percent were living with the mother, 19 percent lived with relatives, and 38 percent lived in foster care or other living situations outside the family (Brindis et al, 1997). The high rates of child welfare system involvement in these studies is in part due to the target client populations of these treatment programs and the recruitment techniques used.
Other studies have shown high protective service needs among families with substance abuse problems (Kelley, 1992). For instance, one study found that teachers have reported a need for protective services three times more often for children being raised by someone with an addiction than for other children (Hayes and Emshoff, 1993).