Does Parental Substance Use Always Engender Risk for Children? Decomposing Substance Use By Behavior Patterns

Background and Purpose: Parent substance use disorder (SUD) is associated with added risk for all forms of maltreatment. Yet, little is understood about how substance use intensity (defined by a continuum of consumption and negative consequences) contributes to this risk. Substance use intensity is associated with varying levels of impaired neuropsychological functions that can compromise a parent’s ability to accurately process a child’s behaviors, increasing likelihood for more instances of maltreatment. These relationships may also differ by maltreatment type given unique processes contribute to acts of commission (e.g., verbal or physical assault) and acts of omission (e.g., neglect). This study aimed to examine (a) the association between substance use intensity and child maltreatment frequency, and (b) how these relationships vary across types of maltreatment.

Methods: This study used a sub-sample of permanent caregivers (n = 2,100) from the National Survey of Child and Adolescent Well-Being I (NSCAW I). Child maltreatment was measured by parent self-report frequency of maltreatment behaviors obtained from the Conflict Tactics Scale, Parent Child. Self-reported substance use behaviors from the Composite International Diagnostic Interview-Short Form were categorized into five that took into consideration substance use history from the past 4 years: (a) abstain/ex-use, (b) non-problematic use (i.e., light or moderate alcohol use only), (c) problematic use (i.e., heavy drinking and/or illicit drug use with no recent SUD history), (d) SUD (i.e., heavy drinking and/or illicit drug use with recent SUD history), and (e) in recovery (i.e., no use or light/moderate drinking with a SUD history within the past 4 years). Weighted negative binomial models were used to examine the relationship between parent substance use patterns and child maltreatment frequency by type.

Results: Any form of heavy drinking and/or illicit drug use (i.e. problematic use or SUD) was associated with a higher frequency of general maltreatment compared to lifetime abstinence or former use. Any current substance use was associated with a higher frequency of physical abuse compared to lifetime abstinence or former use. Higher intensity in substance use was associated with a higher frequency in emotional abuse. Specifically, non-problematic use, problematic use, and substance use disorder were associated with higher emotional abuse frequency than those reporting lifetime abstinence or former use. In addition, problematic use and SUD were associated with a higher expected emotional abuse frequency than non-problematic use. For neglect, only SUD was associated with a higher frequency.

Conclusions and Implications: Behaviors ranging from non-problematic use to SUD contribute to maltreatment risk; however, these relationships vary by type of maltreatment. Social work assessments would benefit from understanding substance-related risks occur at varying levels of use behaviors and also how they may vary by type of maltreatment. Substance use treatment models, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) may be useful to help mitigate harms among non-problematic and problematic users the general population and minimize need for child welfare involvement. Future research should incorporate more nuanced measures of substance use (e.g., drug type or poly use) and its effects (e.g., substance-related neuropsychological impairments).