Parental Substance 

Use and the Child 

Welfare System

Bulletin for 

Professionals

January 2009

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau

Child Welfare Information Gateway

Children’s Bureau/ACYF

1250 Maryland Avenue, SW

Eighth Floor

Washington, DC 20024

703.385.7565 or 800.394.3366

Email: info@childwelfare.gov

www.childwelfare.gov

What’s Inside:

• Statistics and costs

• Impact of parental substance use on 

parenting

• Impact on child outcomes

• Methamphetamine 

• Other substances

• Service delivery issues

• Promising practices

• Resources for further information

Parental substance use continues to be a serious 

issue in the child welfare system. Maltreated 

children of parents with substance use disorders 

often remain in the child welfare system longer 

and experience poorer outcomes than other 

children (U.S. Department of Health and Human 

Services [HHS], 1999). Addressing the multiple 

needs of these children and families is challenging. 
Parental Substance Use and the Child Welfare System

This bulletin provides a brief overview of 

some of the issues confronting families 

affected by parental substance use who enter 

the child welfare system, and it examines 

some of the service barriers as well as 

the innovative approaches child welfare 

agencies have developed to best meet the 

needs of these children and families.

It is estimated that 9 percent of children in 

this country (6 million) live with at least 

one parent who abuses alcohol or other 

drugs (Substance Abuse and Mental Health 

Services Administration [SAMHSA], 2003). 

Studies indicate that between one-third 

and two-thirds of child maltreatment cases 

involve substance use to some degree 

(HHS, 1999). 

It is difficult to determine the numbers of 

child welfare cases that involve substanceusing parents. One article notes that not 

all child welfare agencies systematically 

record information on parental substance 

use disorders, and many substance abuse 

treatment programs do not routinely ask 

patients if they have children (Young, 

Boles, & Otero, 2007). The article goes on 

to summarize available data from a number 

of national studies, estimating that 22,440 

children receiving in-home services for 

maltreatment and 128,640 to 211,720 

children in out-of-home care had a parent 

with a substance use disorder in 2004. In 

that same year, approximately 295,000 

parents receiving treatment for substance 

use had one or more children removed by 

child protective services.

Statistics and Costs

Expenditures related to substance use are 

significant, because maltreated children 

of parents with a substance use disorder 

may experience more severe problems and 

remain in the foster care system longer than 

maltreated children from other families 

(HHS, 1999). One study estimates that of the 

more than $24 billion States spend annually 

to address different aspects of substance 

use, $5.3 billion (slightly more than 20 

percent) goes to child welfare costs related 

to substance abuse (National Center on 

Addiction and Substance Abuse at Columbia 

University, 2001).

Parents with substance use disorders may 

not be able to function effectively in a 

parental role. This can be due to:

• Impairments (both physical and mental) 

caused by alcohol or other drugs 

• Domestic violence, which may be a result 

of substance use 

• Expenditure of often limited household 

resources on purchasing alcohol or other 

drugs

• Frequent arrests, incarceration, and court 

dates

• Time spent seeking out, manufacturing, 

or using alcohol or other drugs

• Estrangement from primary family and 

related support

 Impact of Parental 

Substance Use 

on Parenting

www.childwelfare.gov

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Parental Substance Use and the Child Welfare System

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Families in which one or both parents have 

substance use disorders, and particularly 

families with an addicted parent, often 

experience a number of other problems 

that affect parenting, including mental 

illness, unemployment, high levels of 

stress, and impaired family functioning, 

all of which can put children at risk 

for maltreatment (National Center on 

Addiction and Substance Abuse at 

Columbia University, 2005). The basic 

needs of children, including nutrition, 

supervision, and nurturing, may go unmet 

due to parental substance use, resulting in 

neglect. Depending on the extent of the 

substance use and other circumstances 

(e.g., the presence of another caregiver), 

dysfunctional parenting can also include 

physical and other kinds of abuse (HHS, 

1999).

 Impact on Child 

Outcomes

The impact of parental substance use 

disorders on a child can begin before the 

child is born. While the full effects of 

prenatal drug exposure depend on a number 

of factors, alcohol or drug use during 

pregnancy has been associated with infant 

mortality, premature birth, miscarriage, low 

birth weight, and a variety of behavioral and 

cognitive problems in the child (National 

Institute on Drug Abuse, n.d.; Maternal 

Substance Abuse and Child Development 

Project, n.d.). A 2007 study of children in 

foster care found that prenatal maternal 

alcohol use predicted child maltreatment, 

and combined prenatal maternal alcohol 

and drug use predicted foster care 

transitions (Smith, Johnson, Pears, Fisher, & 

DeGarmo).

Fetal alcohol spectrum disorders (FASD) are 

among the most well-known consequences, 

affecting an estimated 40,000 infants 

born each year. Children with FASD may 

experience mental, physical, behavioral, and 

learning disabilities (National Organization 

on Fetal Alcohol Syndrome, 2006). Children 

with the most severe disorders may suffer 

from fetal alcohol syndrome, alcohol-related 

neurodevelopmental disorder, or alcoholrelated birth defects. 

Research has demonstrated that children 

of parents with substance use disorders are 

more likely to experience abuse (physical, 

sexual, or emotional) or neglect than 

children in other households (DeBellis 

et al., 2001; Dube et al., 2001; Hanson 

et al., 2006). As infants, they may suffer 

from attachment difficulties that develop 

because of inconsistent care and nurturing, 

which may interfere with their emotional 

development (Tay, 2005). As growing 

children, they may experience chaotic 

households that lack structure, positive role 

models, and adequate opportunities for 

socialization (Hornberger, 2008). 

In addition, children of parents who use or 

abuse substances have an increased chance 

of experiencing a variety of other negative 

outcomes (HHS, 1999): 

• Maltreated children of parents with 

substance use disorders are more likely to 

have poorer physical, intellectual, social, 

and emotional outcomes.

• They are at greater risk of developing 

substance use problems themselves.

www.childwelfare.gov
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• They are more likely to be placed in foster 

care and to remain there longer than 

maltreated children of parents without 

substance use problems.

Over the last decade, there has been an 

increase in the manufacture and use 

of methamphetamine. From 1995 to 

2005, the percentage of substance abuse 

treatment admissions for primary abuse of 

methamphetamine/amphetamine more 

than doubled from 4 percent to 9 percent 

(National Clearinghouse for Drug and 

Alcohol Information, n.d.).

Parental use of methamphetamine has 

many of the same effects on children as 

other kinds of drug use. Prenatal exposure 

can produce birth defects and low birth 

weight and may lead to developmental 

disorders (Brown University, 2006). Parents 

who use methamphetamine may suffer 

physical and psychological effects that 

lead to abuse and neglect of their children 

(National Institute on Drug Abuse, 2006). 

In addition, some methamphetamine users 

also are producers of the drug, which can 

be manufactured using common household 

products. These home “labs” put children 

in additional danger from exposure to the 

drugs and the conditions under which they 

are manufactured and distributed (Swetlow, 

2003).

Surveys conducted by the National 

Association of Counties indicate that 

methamphetamine has increased the 

burden of child welfare agencies in many 

areas of the country (National Association 

Methamphetamine

of Counties, 2005). In addition to increasing 

caseloads in some areas, the unique dangers 

of methamphetamine labs have prompted 

many jurisdictions to develop specific 

protocols for meeting the needs of children 

who may have been exposed to the drug 

(Swetlow, 2003). 

While methamphetamine continues to 

garner much attention, other drugs actually 

account for the bulk of substance use 

disorders. According to SAMHSA (2007):

• 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, a figure that remained the same 

from 2005 but was an increase from 2002 

(at 2.0 million). 

• The number of heroin users increased 

from 136,000 in 2005 to 338,000 in 2006, 

and the corresponding prevalence rate 

increased from 0.06 to 0.14 percent.

• The most widely used substance 

continues to be alcohol. In 2006, heavy 

drinking was reported by 6.9 percent 

of the population (17 million people), 

while binge drinking was reported by 23 

percent (57 million people).

Other Substances
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www.childwelfare.gov

Child welfare agencies face a number of 

difficulties in serving children and families 

affected by parental substance use disorders:

• Inadequate funds for services and/or 

dependence on client insurance coverage

• Insufficient service availability or scope of 

services to meet existing needs

• Lack of training for child welfare workers 

on substance use issues

• Lack of coordination between the child 

welfare system and other services and 

systems, including hospitals that may 

screen for drug exposure, the criminal 

justice system, and the courts

• Conflicts in the time required for 

sufficient progress in substance abuse 

recovery to develop adequate parenting 

potential, legislative requirements 

regarding child permanency, and the 

developmental needs of children (Young 

& Gardner, 2003)

Agencies are faced with timeframes imposed 

by the Adoption and Safe Families Act of 

1997 (ASFA) that may not coincide with 

substance abuse treatment. Although ASFA 

requires that an agency file a petition for 

termination of parental rights if a child 

has been in foster care for 15 of the past 

22 months, unless it is not in the best 

interest of the child, many States cannot 

adhere to this timeframe due to problems 

with accessing substance abuse services in 

a timely manner. This results in delayed 

permanency decisions for children in the 

foster care system (U.S. General Accounting 

Office [GAO], 2003). For example, despite 

a Federal mandate that pregnant and 

parenting women receive priority for 

accessing substance abuse treatment 

services, States report it is often difficult for 

these parents to access an open treatment 

slot quickly (GAO, 2003). Once a slot is 

available, treatment itself may take many 

months, and achieving sufficient stability to 

care for their children may take parents even 

longer. In addition, relapse is often part of 

the recovery process for parents undergoing 

treatment, especially in the early phases, so 

it is especially important that parents access 

treatment quickly (HHS, 1999). Custodial 

parents who require residential treatment 

may face an additional barrier since many of 

these programs do not allow children to live 

in the facility. 

There is a growing movement toward 

collaboration among the child welfare, 

substance abuse, courts, and other systems 

that provide services for children and 

families affected by substance use by their 

parents. Communication, understanding, 

and active collaboration among service 

systems are vital to ensuring that child 

welfare-involved parents in need of 

substance abuse treatment are accurately 

identified and receive appropriate treatment 

in a timely manner (Child Welfare League of 

America, 2001; HHS, 1999).

Some examples of effective approaches 

include:

Promising Practices

Service Delivery Issues
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Prevention and Treatment

• Focusing on early identification of at-risk 

families in substance abuse treatment 

programs so that prevention services can 

be provided to ensure children’s safety 

and well-being in the home

• Providing coaching or mentoring to 

parents for their treatment, recovery, and 

parenting (Ryan, 2006)

• Offering shared family care in which a 

family experiencing parental substance 

use and resulting child maltreatment is 

placed with a host family for support and 

mentoring (National Abandoned Infants 

Assistance Resource Center, n.d.)

• Giving mothers involved in the child 

welfare system priority access to 

substance abuse treatment slots

• Providing inpatient treatment for 

mothers in facilities where they can have 

their children with them

• Motivating parents to enter and complete 

treatment by offering such incentives as 

support groups or housing (Voices for 

America’s Children, November 2004).

Systems Changes

• Stationing addiction counselors in child 

welfare offices or forming ongoing teams 

of child welfare and substance abuse 

workers

• Developing or modifying dependency 

drug courts to ensure treatment 

access and therapeutic monitoring of 

compliance with court orders

• Developing cross-system partnerships to 

ensure coordinated services (e.g., formal 

linkages between child welfare and other 

community agencies to address each 

family’s needs)

• Providing wraparound services that 

streamline the recovery and reunification 

processes

• Conducting cross-system training

• Recruiting and training a diverse 

workforce and including training in 

cultural competence (National Center 

on Substance Abuse and Child Welfare, 

2005)

• Exploring various funding streams to 

support these efforts (e.g., using State or 

local funds to maximize child welfare 

funding for substance abuse-related 

services or using Temporary Assistance to 

Needy Families [TANF] funds to support 

substance abuse treatment for families 

also involved with the child welfare 

system) (Young and Gardner, 2002)

The Children’s Bureau has funded a 

number of discretionary grants to promote 

demonstration projects with a goal of 

improved outcomes for children growing 

up in families in which one or more parents 

has a substance use problem. These grants 

have included:

• Family Support Services for Grandparents 

and Other Relatives Providing Care for 

Children and Substance Abusing and 

HIV-Positive Women (awarded in 2001 

with six grantees)

• Family Support Services for Grandparents 

and Other Relatives Providing Caregiving 

for Children of Substance Abusing and/

or HIV-Positive Women (awarded in 2004 

with four grantees)
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www.childwelfare.gov

• Model Development or Replication to 

Implement the CAPTA Requirement to 

Identify and Serve Substance Exposed 

Newborns (awarded in 2005, with four 

grantees)

• Targeted Grants to Increase the WellBeing of, and to Improve the Permanency 

Outcomes for, Children Affected by 

Methamphetamine or Other Substance 

Abuse (awarded in 2007, with 53 grantees 

under four program options)

(For more information on these awards, 

visit the Children’s Bureau Discretionary 

Grants Library online at http://basis.caliber.

com/cbgrants/ws/library/docs/cb_grants/

GrantHome.)

Replication or adaptation of any of the 

above approaches requires a careful 

assessment of State or local capacity, 

including needs and strengths of families 

served, as well as a careful assessment of 

the evaluation findings to ensure funds are 

targeted toward effective programs. Agencies 

also should focus on the specific needs 

of the families they serve when selecting 

among these (and other) approaches.

Child Welfare Information Gateway

www.childwelfare.gov/systemwide/

service_array/substance/

The Substance Abuse web section of the 

Information Gateway website links to 

information on prevention and treatment 

services for families affected by parental 

 Resources for Further 

Information

substance use and involved with the child 

welfare system.

Children’s Bureau

www.acf.hhs.gov/programs/cb

The Children’s Bureau funds a variety of 

programs and initiatives that promote 

the safety, permanency, and well-being 

of children and their families, including 

initiatives designed to address parental 

substance use. 

Children and Family Futures

www.cffutures.com

Children and Family Futures’ mission is to 

improve the lives of children and families, 

particularly those affected by substance use 

disorders. CFF advises Federal, State, and 

local government and community-based 

agencies, conducts research on the best ways 

to prevent and address the problem, and 

provides comprehensive and innovative 

solutions to policy makers and practitioners.

MethResources.Gov

www.methresources.gov

This agency is part of the White House 

Office of National Drug Control Policy, 

U.S. Department of Justice, & the U.S. 

Department of Health and Human 

Services. The website offers factsheets, 

FAQs, and information and resources on 

prevention, intervention, and treatment for 

methamphetamine use. 

National Abandoned Infants Assistance 

Resource Center 

http://aia.berkeley.edu

The National Abandoned Infants Assistance 

Resource Center’s mission is to enhance 
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the quality of social and health services 

delivered to children who are abandoned 

or at-risk of abandonment due to the 

presence of drugs and/or HIV in the family. 

The Resource Center, which is funded by 

the Children’s Bureau, provides training, 

information, support, and resources to 

service providers who assist these children 

and their families.

National Center on Substance Abuse and 

Child Welfare 

www.ncsacw.samhsa.gov

NCSACW was formed to improve systems 

and practice for families with substance 

use disorders who are involved in the child 

welfare and family judicial systems by 

assisting local, State, and Tribal agencies. 

NCSACW is jointly funded by the Children’s 

Bureau and SAMHSA.

National Clearinghouse for Alcohol & 

Drug Information

http://ncadi.samhsa.gov

Sponsored by SAMHSA, NCADI is a one-stop 

resource for information about substance 

abuse prevention and addiction treatment; 

resources include the Prevention Materials 

database, with more than 8,000 preventionrelated materials, and the Treatment 

Resources database, available to the public 

in electronic form.

National Institute on Alcohol Abuse and 

Alcoholism

www.niaaa.nih.gov

Part of the National Institutes of Health, 

the NIAAA is the primary U.S. agency for 

conducting and supporting research on 

the causes, consequences, prevention, and 

treatment of alcohol abuse, alcoholism, and 

alcohol problems and disseminates research 

findings to general, professional, and 

academic audiences. 

National Institute on Drug Abuse

www.nida.nih.gov

The National Institute on Drug Abuse 

supports over 85 percent of the world’s 

research on the health aspects of drug abuse 

and addiction. NIDA works to ensure that 

the foundation for the nation’s drug abuse 

reduction efforts are based on science.

National Organization on Fetal Alcohol 

Syndrome

www.nofas.org 

NOFAS works to raise public awareness 

of Fetal Alcohol Syndrome (FAS) and to 

develop and implement innovative ideas in 

prevention, intervention, education, and 

advocacy in communities throughout the 

nation.

National Registry of Evidence-Based 

Programs and Practices

www.nrepp.samhsa.gov

SAMHSA sponsors this searchable database 

of interventions for the prevention and 

treatment of substance abuse and mental 

health disorders. 

The Rocky Mountain Quality 

Improvement Center

www.americanhumane.org/site/

PageServer?pagename=pc_best_practice_

rmqic_homepage

The Rocky Mountain Quality Improvement 

Center (RMQIC) has completed its 

Children’s Bureau-funded project, but 
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www.childwelfare.gov

the website continues to offer resources 

and information on providing safety, 

permanency, and well-being for children of 

families with substance abuse problems. 

Self-Help Groups

http://ncadistore.samhsa.gov/catalog/

referrals.aspx?topic=83&h=resources

SAMHSA provides this list of national 

self-help groups with contact information 

so that local meetings and resources can 

be identified. Groups include Alcoholics 

Anonymous, Al-Anon, National Association 

for Children of Alcoholics, Women for 

Sobriety, and more.

Substance Abuse and Mental Health 

Services Administration

www.samhsa.gov

SAMHSA is the Federal agency charged with 

improving the quality and availability of 

prevention, treatment, and rehabilitative 

services in order to reduce illness, death, 

disability, and cost to society resulting from 

substance abuse and mental illnesses.

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