The Impact of Substance Abuse on Foster Care
The abuse of alcohol and drugs has had a dramatic effect on foster care, particularly in the past 20 years. With increasing frequency, children are coming into care because their parents are addicted to alcohol or drugs. Many children also are born to mothers who abused alcohol or drugs while pregnant. These children often are placed in foster care with Fetal Alcohol Syndrome or other drug-related conditions. Perhaps the most disturbing trend, however, is the number of children in foster care whose families were torn apart by substance abuse and who subsequently abuse alcohol or drugs themselves.
Here is a summary of each of these three trends, possible causes, the impact on foster care, options for prevention and treatment, and choices concerning how best to ensure the safety of children who are caught up in this deadly battle.
Of all the recent trends in child welfare, perhaps none has been more troubling than the increase in cases of child abuse and neglect resulting from parental abuse of alcohol and drugs. In 1995, nearly 3.1 million children were reported to child protective services as abused or neglected. Approximately one million of these reports were substantiated. Substance abuse was found to be a factor in a majority of these cases.
Studies by the Child Welfare League of America and other organizations have found that substance abuse is a factor in at least 75% of all placements in out-of-home care. Eighty percent of states now report that parental abuse of alcohol or drugs is one of the two most common problems in families reported for child maltreatment.
As a result, foster care today is quite different than it has been throughout most of American history. From colonial times through World War II, most children were placed in foster care because of parental death or illness. While children who are separated from their birth parents and placed in the care of strangers always have special needs, the needs of children whose families are affected by substance abuse are substantial. A parent's thoughts and perceptions may be impaired or distorted by the use of alcohol or drugs, having a profoundly adverse effect on memory, attention, and perception. Depression also frequently accompanies the use of cocaine and other drugs. Children in these families frequently suffer serious emotional and behavioral problems as a result of the erratic and abusive parenting behavior that often accompanies substance abuse. They frequently exhibit one or more of the following:
- diminished ability to concentrate
- nihilistic or fatalistic orientations toward the future
- poor attachment behavior, or
- a tendency to choose risky behavior, including the use of alcohol or other drugs later in life.
Substance abuse also creates a complex set of choices for child welfare professionals, who must determine the safest option for children whose parents may or may not recover from their addiction. The majority of children entering foster care eventually return to their parents. However, in recent years an increasing number of children have left foster care only to re-enter the system at a later date. For children who experience multiple placements into foster care because their parents are unable or unwilling to provide a stable, nurturing family environment, even when services are offered, agencies must pursue adoption or placement with relatives as a permanent plan for the children.
While parental abuse of alcohol and drugs is detrimental to a child of any age, the use and abuse of these chemicals by pregnant women is believed to be the most harmful. At least one in five pregnant women (800,000) drinks, smokes, or uses drugs, putting herself and her unborn child at risk. Each year, women in the United States give birth to nearly half a million babies who have been exposed to illicit drugs in utero. These infants are more likely to be born prematurely and have low birth weight as well as other medical complications at birth. As they grow older, children who were exposed prenatally to alcohol or drugs frequently exhibit impaired motor skills, delayed language development, attention deficit, hyperactivity, aggression toward others, and impulsiveness.
New mothers who are chemically impaired tend to be less sensitive, responsive, and accessible to their infants than mothers without drug involvement. They also are less accepting of their infants, and therefore more prone to abuse or neglect.
The cost of hospitalization for a very low birth weight baby in need of intensive care can be as high as $150,000 or more. The annual medical cost of caring for cocaine-exposed babies nationwide has been estimated at $33 million for neonates, and as high as $1.4 billion during the babies' first year of life.
Children born with Fetal Alcohol Syndrome need comprehensive long-term, integrated interventions that include social, health, emotional and educational services. These services place additional strain on the economic and social resources of society.
There is currently a shortage of foster parents trained to care for medically fragile infants, many of whom have been exposed to alcohol or drugs in utero. These infants often remain hospitalized for several months because foster care agencies cannot find families who are able and willing to care for them. Even after they are placed, they often are moved from one home to the next in search of foster parents with the patience and skill needed to care for them.
Increasing numbers of children and youths who enter foster care because of abuse and neglect by chemically involved parents bring with them their own substance abuse problems. In one study, 19% of adolescents surveyed reported drinking alcohol while in out-of-home care - a rate comparable to a random sample of high school students. However, 56% reported using street drugs, a much higher percentage than the general population of high school students. These youths also tend to continue their drug use after leaving care. The drug habits of youths in foster care can seriously impede their chances of continuing their education or finding employment, often with dire consequences. It is not known how many youths in foster care become homeless once they reach the age of emancipation, but many youths involved in substance abuse do experience bouts of homelessness. Federally funded runaway and homeless youth shelters report that 22% of homeless youths and 20% of runaway youths abuse alcohol and other drugs; urban studies report higher rates, ranging from 70% of runaways in New York City to 100% in San Francisco.
Child welfare professionals generally agree that these statistics understate the problem. Yet, a majority of state child welfare agencies are not equipped to deal with substance abuse among youths in care. They currently lack the resources and/or expertise to train staff and foster parents in how to identify and treat substance abuse problems among these youths. For example:
- 94% of states cannot identify the number of children and youths in out-of-home care who have substance abuse problems.
- Only 13% of states have a written policy requiring parents in foster care to report a child's substance abuse.
The factors that predispose a person to the abuse of alcohol or drugs have been debated at length and by a variety of professionals. As with all great scientific debates, numerous theories have emerged, but these theories can be summarized in three basic scientific models. The scientific models emphasize that substance abuse is a disease, not a moral failure:
- The medical model stresses the importance of genetic factors predisposing an individual to drug use or alcohol dependency. This model examines the addictive properties of the chemicals themselves, and the changes they produce in the central nervous system of the user. It also examines the use of chemicals to self-medicate other conditions.
- The behavioral model examines positive and negative reinforcing factors either in the user's environment or in the properties of the chemical that contribute to psychological or physical dependency and cause patterns of use, abuse, addiction, recovery, and relapse.
- The social model emphasizes the importance of external influences such as drug availability, peer pressure, social stress, and other psychosocial factors.
In adolescents, peer and community social influences generally are considered the best predictors of use. However, other factors related to use include parent and sibling drugs use, inconsistent family relationships, social deprivation, school failure, frequent moves, skill deficits, and antisocial behavior. For adolescents in foster care who come from families involved in substance abuse and subsequently become involved with drugs or alcohol themselves, the cycle of substance abuse can seem hopeless.
In recent years, professionals have used a variety of prevention and treatment programs, with mixed results. Professionals in child welfare and those who work in drug treatment know little about each other's work. In a survey of alcohol and drug therapists, for example, almost 40% expressed concern that reporting suspected child maltreatment would harm their relationships with their patients.
Similarly, child welfare workers have not been educated to understand chemical dependency and its impact on family functioning. Too often, they have not been trained to ask about or respond to substance abuse problems. Therefore, professionals from both fields now are being asked to consider a more collaborative approach to treatment, one that combines the expertise of individuals from both disciplines.
Successful substance abuse treatment programs also need to be comprehensive. While programs differ in how they treat the chemical addiction itself, successful programs for women generally offer a wide array of tangential services, like transportation, job training and placement, primary medical care for the woman and her children, education programs, prenatal and ob/gyn services, child care, family planning, and legal assistance.
Similarly, adolescents require prevention and treatment techniques that are comprehensive and developmentally appropriate. These include peer education and counseling, family therapy, recreational activities, mentoring, education programs, and health counseling.
Comprehensive programs are expensive, however, and funding has not kept pace with demand. As a result, the programs that are considered most effective often have long waiting lists. Child welfare experts estimate that the vast majority of their clients are not receiving treatment for their substance abuse problems. For example:
- A 1997 survey of child welfare professionals by the Child Welfare League of America estimated that 67% of parent caregivers required substance abuse treatment services, yet they agencies were able to provide treatment for only 31%.
- Only 14% of all women and 12% of all pregnant women who need substance abuse treatment receive it.
How Treatment Affects Placement Options For Children
The lack of effective and affordable substance abuse treatment programs is affecting placement options for children. Child welfare professionals generally agree that a child should be removed from his home only when the risk of abuse or neglect is imminent, and that all available family strengthening services should first be explored. However, when effective substance abuse treatment programs are not available in the community, then workers often have no choice but to place the child in foster care.
Partly because effective treatment programs are in short supply, children in foster care whose parents are addicted to alcohol or drugs also tend to remain in care longer than children whose parents have no such addiction.
- The average length of time spent in out-of- home care for a child whose parent is not chemically dependent is 10 months.
- For a child whose parent is chemically dependent, the average is 26.8 months.
A number of suggestions have been offered to improve the prospects for families and children at risk of being torn apart by substance abuse. Among them:
- Child welfare agencies should require all foster parents to report any drug use among the children in their care to the foster care agency so that treatment can be sought.
- Child welfare workers and substance abuse specialists should be jointly trained in assessment and case management of families involved in substance abuse.
- All parents referred to child protective services should be screened for abuse of alcohol and drugs.
- If the screening indicates possible substance abuse, parents should be referred immediately to a substance abuse specialist for a more in-depth assessment.
- If substance abuse is confirmed, the substance abuse counselor and child welfare agency should collaborate in finding a comprehensive treatment program that fits the needs of the family.