Maternal Substance Abuse: Protecting the Child, Preserving the Family

Maternal substance abuse has sparked an intense debate among child welfare practitioners and policymakers. What is the best way to work effectively with substance-abusing mothers, to protect children from harm that might result from the parents' addiction, and to preserve a family in which the child can be reared? Some question the ability of the child welfare system to cope with the magnitude of problems associated with maternal substance abuse, particularly illegal drug abuse (Besharov, 1989, 1990). Current child welfare policies mandate child protection within the context of family preservation, that is, keeping parents and children together whenever possible (Adoption Assistance and Child Welfare Act of 1980). This responsibility is difficult to carry out under the best of circumstances but becomes even more complicated when substance abuse is added as an intervening factor. Substance abuse is but one challenge facing what many consider an already stressed child welfare system (Kamerman & Kahn, 1990). A number of reports and studies on substance abuse have been conducted both by voluntary agencies and governmental bodies. Some of the information gathered to date is conflicting and difficult to compare. This article discusses and evaluates the scope of the maternal substance abuse problem, its effect on the delivery of child welfare services, obstacles to service delivery, and implications for service provision. Scope of the Problem It is widely accepted that children living with a substance-abusing parent are at higher risk for child maltreatment than other children. Many studies have found a correlation between child maltreatment and alcohol and other drug abuse (Murphy et al., 1991; Orme & Rimmer, 1981; Williams & Collins, 1986). In 1989 the National Committee for Prevention of Child Abuse (NCPCA) estimated that 9 million to 10 million children were affected by substance-abusing parents and that 675,000 children were maltreated each year by an alcoholic or drug-addicted caretaker. Among confirmed cases of child maltreatment, the estimated percentage involving substance abuse averages 40 percent nationwide (Daro & McCurdy, 1991). Local estimates of the proportion of new protective services cases involving drug use are as high as 80 percent to 90 percent (Feig, 1990). According to a 1988 study of the NCPCA, substance abuse has become the dominant characteristic in the child abuse caseloads of 22 states and the District of Columbia (Besharov, 1989). Data from a 1989 survey of 35 states conducted by the American Public Welfare Association indicated that in eight states (Arizona, Hawaii, Iowa, Maryland, North Carolina, Oregon, South Dakota, and Utah) one out of four substantiated reports of child abuse and neglect involved parental drug abuse or alcoholism (Tatara, 1990). In New York, over 73 percent of neglect-related child fatalities in 1987 were attributed to parental alcohol and drug abuse (Besharov, 1989). Despite federal legislation promoting family preservation, the population of children in out-of-home placements has shown steady increases since 1985, with communities hardest hit by crack addiction showing the most dramatic increases (McCullough, 1991; Tatara, 1990). Even more disturbing, however, are the difficulties in achieving permanency planning for children from substance-abusing families as evidenced by low discharge rates, multiple placements, low rates of reunification with biological parents, and low rates of adoption. Several reports have documented that once children from substance-abusing families enter placement, they tend to remain in care and are less frequently reunified with their biological parents or freed for adoption compared with children placed for reasons unrelated to substance abuse (Besharov, 1990; Fanshel, 1975; Feig, 1990; Walker, Zangrillo, & Smith, 1991). This appears to be particularly the case for children from minority families. …