Does Legal Vs. Illegal Drug Use Affect the Decision to Substantiate Child Abuse or Neglect Among Social Work Professionals?

Background. Currently, little is known about how social workers perceive both legal and illegal parental substance use during the substantiation process for abuse or neglect. Theoretically, parental substance use should only be a factor in substantiating a case if the use directly affects their ability to parent the child safely or to keep the child from harm. However, substance use has the same physiological effects (e.g., impaired short term memory in the case of marijuana) regardless of whether or not it is used legally. How CSWs perceive legal and illicit substance use, and whether the illegality of a substance being used by a parent may affect the decision to substantiate. This study uses case vignettes to assess caseworker attitudes about two different types of substances – marijuana (an illegal substance about half of the states, but available with a medical recommendation in others) and opioids (a legal substance with a prescription, but being used illegally across the U.S.). The study will assess whether rates of substantiation of child abuse or neglect cases vary by whether a parent is using drugs and whether the use of these substances is legal or illegal.

Methods. 512 social work professional were recruited via online listservs, Facebook, and Linkedin pages serving social work professionals.  Respondents were primarily women (79.3%) and had a MSW degree or higher (53.7%). About 60% of the sample was white, 26% Latino, and 8.6% African American. Respondents read and answered questions about two vignettes; one for physical abuse and one for child neglect. The vignettes were randomized to five drug use conditions: (1) No drug use; (2) Opioid drug use with a prescription; (3) Opioid use without a prescription; (4) Marijuana use with a medical recommendation/prescription; and (5) Marijuana use without a medical recommendation/prescription. The online survey took about 10 to 15 minutes to complete.  Data were analyzed using multinomial logistic regression models.

Results. Caseworkers significantly substantiated a case differentially based drug use. In the neglect condition all drug use conditions had were substantiated 2 to 3 times more often than the no drug use conditions, regardless of whether or not the drugs were being used legally. In the physical abuse condition, all drug use conditions except for prescription opioid were substantiated at higher rates. More specifically, not having a prescription for opioids vs. having a prescription resulted in twice the rate of substantiation.

Conclusions. The results suggests that any drug use, regardless of legality, affects the decision to substantiate a case. In the case of opioid use, having a prescription reduces the likelihood that the case will be substantiated. Given the rapidly changing drug policy context, including legal access to marijuana and the epidemic of opioid abuse and overdoses, caseworkers need to have better information about how substance use may affect parenting. For example, understanding the physiological effects of drugs (e.g., are they agitators, do they promote inattention), regardless of legal or illegal use, could aid caseworkers in making better decisions about the true risk of harm for children.