The Complex Reality of Social Connections: Examining the Moderating Role of Social Companionship on Parent Substance Use and Neglect Frequencies

Background and Purpose: Child neglect is the predominant type of child maltreatment identified by child welfare agencies. While parental substance misuse increases risk for neglect, not all substance misusing parents neglect their children. The social environment likely interacts with substance misuse in ways that can alter substance-related risk. For example, social engagement by those in a parent's network may improve his/her functioning through a sense of belonging. However, it could also exacerbate risk among a substance misusing parent, who is more likely to engage in networks prone to high-risk behaviors. This study aimed to examine how social companionship may moderate the relationship between parent substance use and neglect behaviors.

Methods: This study used a sub-sample of permanent caregivers (n = 2,100) from Wave 4 of the National Survey of Child and Adolescent Well-Being I (NSCAW I). The dependent measure of neglect was measured by parent self-reported frequency of past year neglect 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 four substance use patterns defined by increasing frequency and associated problems. Social companionship was defined by the number of people respondents could count on for an invitation to go out and do things and was categorized into low, medium, and high levels. Weighted negative binomial models were used to regress neglect frequency on parent substance use intensity, social companionship, and the interaction of substance use intensity and social companionship. The model controlled for average number of resource-based supports (i.e., tangible and emotional social supports), parent risk factors (i.e., arrest history, mental health, and physical health), prior service history, and demographic characteristics.

Results:  Substance use was directly related to neglect frequency: problematic substance use (i.e., heavy drinking and/or illicit drugs use) and substance use disorder (i.e., continued heavy drinking and/or illicit drug use despite a recent history of substance-related problems in functioning within the past 4 years) were associated with higher neglect frequencies than abstinence or former use.  Moderate levels of social companionship were directly associated with higher neglect frequencies than low levels of social companionship support. When interacted with substance use, moderate levels of social companionship among parents with substance use disorder was associated with higher neglect frequency than moderate levels of social companionship among those with problematic use or non-problematic use (i.e., light to moderate drinking). Within substance use groups, problematic use was the only group where the expected neglect frequency was highest at low levels of social companionship and significantly lower at moderate levels of social companionship.

Conclusions and Implications: Social companionship may not always be protective of substance-related harms. At moderate levels, social companionship may exacerbate neglect risk for parents with SUD and mitigate neglect risk for problematic users. Assessment and prevention efforts should factor in the complexity of these relationships when engaging substance-using parents.  Future research would benefit from incorporating more nuanced measures of substance use and exploring what aspects of the social context exacerbates or mitigates substance-related harms.