Policy changes in one system can have major and sometimes unintended effects on other systems. This is the case in the United States, where the child welfare, substance abuse and mental health fields all service high-risk families who have problems in all three areas. At highest risk is the group whom the legislation was designed to protect, the children. The solution is to have all three systems work together to strengthen the parenting skills of the adults in their care.

Legal context
With the passage in the United States of the 1997 Adoption and Safe Families Act (ASFA), P.L. 105—8.9, child protective workers are under intense pressure to assess safety and to institute permanency planning within an extraordinarily short timeframe. Although permanency planning — a plan that addresses the need of the child to live in a permanent home, and not be moved from foster home to foster home — is a key concept in the child welfare field, it is a new concept to most alcohol- and drug-abuse prevention and treatment providers. Although ASFA identified the need for addiction treatment, the law provided few new resources to meet this need. Child protection workers are required to work with and find treatment for parents/caregivers with drug abuse problems, but if this is not successful, they are mandated to terminate clients’ parental rights and free their children for adoption. Therefore, substance abuse treatment providers are trying to encourage parents/caregivers to choose sobriety while their clients are facing losing their children.

Being freed for adoption is a traumatic event in the life of a child, and the loss of parental rights is usually a traumatic event in the life of the parent. This phenomenon, therefore, must be fully understood by both child protection workers and substance abuse treatment providers. Now that the law requires that parental rights be terminated if reunification does not occur during a specified period of time, a major shift has occurred in our thinking about the needs of both children and their families/caregivers when substance abuse is involved. The old standard was that it is always best to try to reunite a child with his or her biological family, no matter how long it took. But ASFA reflects the realization that attempts toward reunification that stretch beyond a reasonable timeframe may be harmful to both children and their parents. Such attempts, if fruitless over a long period, harm children by prolonging their stay in foster care and may also harm parents by sending them the message that they have an unlimited time to address the issues that are interfering with their ability to nurture and care for their child.

ASFA has created a host of challenges for the child welfare, juvenile justice, and substance abuse treatment fields. The foster care system, which has always had children from addicted families, has experienced a new onslaught of children of addicts into the system as states have implemented ASFA. And the substance abuse treatment field, which is not designed for the current influx of addicted women and their children into drug-treatment systems, is only beginning to consider how best to provide treatment to this previously underserved group. The passage of this federal law requires a common language that will create a bridge of services between these two systems.

Unfortunately, few child protective and juvenile justice workers have extensive training in substance abuse treatment, and many have none at all. Most substance abuse professionals are unfamiliar with the child welfare and juvenile justice fields and are not aware of the new pressures being placed on parents/caregivers in their care. To further complicate matters, many of these parents/caregivers are unmotivated, destitute, or homeless, and may sincerely believe their drug use is not a problem. And their children are caught in the middle of the treatment gap, with no one system tasked with the mandate of helping their parents/caregivers, who are addicted, become better parents.

Addiction and co-morbid conditions
Many professionals outside of the substance abuse field believe that alcohol and drug dependence is caused by a failure of the will or by deliberate misconduct; a learned behavior that can be modified through specific behavioral techniques and changes in lifestyle; or just as a symptom of an underlying emotional problem. While it is understood within the field that drug addiction is a disease — with alcoholics genetically predisposed to their addiction — and new advances in brain science discovering that the brain of an addict is permanently changed once addiction occurs, this information has not always traveled successfully to other fields.

The treatment process for addicts is less understood in its complexity. The roles that age, gender, drug of choice, socioeconomic status, and physical health play in considering treatment options — the types of treatment that exist, including detoxification, long- and short-term inpatient treatment, methadone maintenance, intensive and non-intensive outpatient treatment, and the reality that progression of treatment is not smooth, happens over time and may include relapse episodes as part of the recovery process — are not well known by other professionals.

The fact that treatment is further complicated by mental health factors, such as Post-traumatic Stress Disorder (PTSD) is another area that needs to be communicated. PTSD can have many sources, such as sexual assault or violence. For example, many women in treatment have been sexually abused. And because of lifestyle issues and the impaired judgment that frequently accompanies addiction, most addicts and their children have witnessed or have been victims of domestic violence and other forms of violence, or have witnessed violence in their communities, such as drive-by shootings. These terrorizing events often create PTSD or other psychiatric problems, such as depression, which, if left untreated, may lead to relapse. In addition, adding children to this process can be a volatile mix, but one that could be successfully intervened in, if we had support for addicts as parents as they go through treatment.

The impact of addiction on the child welfare system
Addiction has finally been recognized as a major contributing factor to the increased need for child welfare services.
• Kelleher, Chaffin, Hollenburg, & Fisher (1994) state that “children whose parents/caregivers abuse drugs and alcohol are almost three times likelier to be abused and more than four times likelier to be neglected than children of parents/caregivers who do not abuse alcohol or drugs.
• Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection (USDHHS, 1999) asserts that “11 percent of U.S. children, 8.3 million, live with at least one parent who is either alcoholic, or in need of treatment for the abuse of illicit drugs. Of these, 3.8 million live with a parent who is alcoholic, 2.1 million live with a parent whose primary problem is with illicit drugs, and 2.4 million live with a parent who abuses alcohol and illicit drugs in combination.”
• It has been estimated that between 50 percent and 90 percent of all child welfare cases is alcohol- or drug-involved. Substance abuse or addiction causes or directly contributes to child maltreatment in an estimated 70 percent of cases, and substance abuse is estimated to be a factor in three-fourths of all placements (Young, Gardner, & Dennis, 1998).
• The U.S. General Accountability Office (GAO) found that parental substance abuse was a factor for 78 percent of the children entering foster care in Los Angeles, New York City, and Philadelphia County (GAO, 1994).
• One survey estimated that parental chemical dependency was a contributing factor in the out-of-home placement of at least 53 percent of the child protection cases. In another survey of families reported to Child Protective Seervices, in 55 percent of the families followed, one or both of the caretakers were identified as having a substance abuse problem, and recurrences were reported in just over half of these families (Wolock & Magura 1996).
• Other studies revealed, according to Young, Gardner and Dennis (1998), 40 percent to 80 percent of families in the child welfare system have problems with alcohol and other drugs and that those problems are connected with the abuse and neglect experienced by their children.
• Of the nearly one million children found to be substantiated victims of child abuse and neglect in 1995, at least 50 percent had chemically involved caregivers (CWLA, 1997). Famularo and colleagues found that more than two-thirds (67 percent) of child maltreatment cases involved a substance-abusing parent (Jaudes et al., 1995). Wang and Daro (1997) found that for two consecutive years, more than three-fourths of states (80 percent in 1995; and 76 percent in 1996) reported substance abuse was among the top two conditions assessed as problems for families reported for maltreatment.
• The cost of this problem is immense, according to the National Center on Addiction and Substance Abuse at Columbia University (1999). Substance abuse and addiction account for some $10 billion in U.S. federal, state and local government spending.

The policy-treatment lineup
Five major policy and developmental issues impact the children in drug-affected families:
1. In most states, the child welfare system requires a permanency hearing after 12 months; some states have a timetable of six months. This means that in most cases, caseworkers are trying to do permanency planning, parenting education, and arrange for drug treatment simultaneously.
2. The Temporary Assistance for Needy Families (TANF) mandates clients to find work in 24 months, meaning that federal dollars available to help troubled families are time-limited.
3. Treatment and recovery has its own timetable. Recovery is a process that happens over time, and sometimes takes years. Drug treatment is not a process that fits neatly into a predictable, organized timeframe. Often relapse is part of the recovery process.
4. Parents who are addicted also experience delays in the development of social skills and emotional development. This can result in a parent becoming sober who has a younger developmental age than his or her child. This argues for the very resources that are least available, family treatment and parenting classes in early recovery.
5. Finally, children, especially young children, have a developmental timetable. The current research on brain development shows that the first 18 months of an infant’s life are critical to his or her future development. This is also the key time for bonding and attachment to caregivers. Any disruption during this critical time can result in problems with the infant and toddler learning how to develop attachments. This puts a special onus on the importance of securing a consistent and safe home for the child. The longer permanency planning is postponed, the more likely it is that a child’s healthy development will be compromised, thus potentially creating future difficulties for children who are already severely challenged.

Given these concerns, it would seem that the only way to effectively deal with the impact that substance abuse has on the child welfare, juvenile justice, mental health, and foster care systems is for these systems to work compatibly with these troubled families. The single point that all systems share is the welfare of the children. By working together to increase the skills of parents as they go through the services offered by each separate system, we can begin to break the cycle for the next generation by creating healthy families.

Acknowledgement
This article contains information first published in The Lowdown On Families Who Get High. Copyright 2004, Child Welfare of America. Reproduced by special permission of the Child Welfare League of America, Washington, D.C., U.S.A. (http://www.cwla.org)

Patricia O’Gorman, PhD, Chief Psychologist of Berkshire Farm Center and Services for Youth in Canaan, N.Y., is the co-author of The Lowdown on Families Who Get High: Successful Parenting for Families Affected by Addiction.

Philip Diaz, MSW, past CEO of Gateway Community Services, Inc., in Northeast Florida, is the co-author of The Lowdown On Families Who Get High: Successful Parenting for Families Affected by Addiction. For more information or to contact them directly, visit www.ogormandiaz.com.

References
Child Welfare League of America. (1997). Alcohol and Other Drug Survey Of State Child Welfare Agencies. Washington, DC: Author.
Jaudes, P., Ekwo, E., & Van Voohis, J. (1995, September). Association of drug abuse and child abuse. Child Abuse and Neglect, 19(9), 1065-1075.
Kelleher, K., Chaffin, M., Hollenburg, M., & Fisher, E. (1994). Alcohol and drug disorders among physically abusive and neglectful parents in a community-based sample. American Journal of Public Health, 84, 1586-1590.
National Center on Addiction and Substance Abuse at Columbia University. (1999). No safe haven: Children of substance-abusing parents. New York: Columbis University. Available at http://www.casacolumbia.org or by calling (212) 841-5227.
U.S. Department of Health and Human Services. (1999). Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection. Washington, DC: Government Printing Office. Available online at http://aspe.hhs.gov/hsp/subabuse99.
subabuse.htm.
U.S. General Accounting Office. (1994). GOA/HEHS-94-89: Foster Care: Parental Drug Abuse Has Alarming Impact on Young Children. Washington, DC: Author. Available online at http://161.203.16.4/t2pbat3/
151435.pdf.
Wang, C., & Daro, D. (1997). Current Trends in Child Abuse Reporting & Fatalities: The Results of the 1996 Annual Fifty State Survey. Chicago, IL: National Center on Child Abuse Prevention Research, National Committee to Prevent Child Abuse.
Wolock, I., & Magura, S. (1996). Prenatal Substance Abuse as a Predictor of Child Maltreatment Re-reports. Child Abuse and Neglect, 20, 1183-1193.
Young, N. K., Gardner, S.L., & Dennis, K. (1998). Responding to alcohol and other drug problems in child welfare: Weaving together practice and policy. Washington, DC: Child Welfare League of America.

This article is published in Counselor,The Magazine for Addiction Professionals, December 2005, v.6, n.6, pp.12-19.

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