Methamphetamine Use, Addiction Treatment Complexity, and Child Welfare Outcomes

Background and purpose: Parents who use methamphetamine and are involved with the child welfare system are more likely to have children placed in custody than parents who use other drugs. Further, parental methamphetamine use is associated with lower rates of reunification and higher rates of adoption compared to parents who use alcohol. Few studies have considered how addiction treatment may be related to child welfare outcomes among families involved with child welfare because of methamphetamine use. This study aimed to determine the relationship between methamphetamine use, addiction treatment services, and family unification at case closure.

Methods: The study design was a retrospective cohort comparison with families who entered child welfare because of substance use in one Midwestern state between 2014 and 2019 (N = 1,132 adults from 711 families). The independent variable was methamphetamine use, either as part of the index child welfare event or while the case was ongoing. The dependent variable was child placement at case closure (with parents vs. all other outcomes). Control variables included adult age and race, county, social services received, mental health services received, and the number of unique addiction treatment services received. Bivariate comparisons were conducted using chi-square and t-tests, followed by a multiple logistic regression to identify correlates of family unification at case closure.

Results: Of the 1,132 adults, 376 (33%) used methamphetamine and methamphetamine use was present in 39% of families. Overall, prevalence of methamphetamine use significantly increased from 26.4% in 2014 to 37.1% in 2019. Prevalence also significantly differed by county, with rates ranging from 19.3% to 67.1%. Compared to parents who used other drugs, parents who used methamphetamine received more social services, were more likely to receive mental health services, and had a higher number of addiction treatment services but were less likely to complete addiction treatment. Cases involving methamphetamine use were significantly longer than cases involving other drugs, and at case closure, a significantly lower percentage of parents who used methamphetamine retained custody of their children (51% vs. 65%). In the multiple logistic regression model identifying correlates of family unification at case closure, age (OR = 1.036; 95% CI 1.006-1.067), mental health treatment (OR = 1.727; 95% CI 1.061-2.810), methamphetamine use (OR = .509; 95% CI .356-.728), and number of addiction treatment services (OR = .901; 95% CI .848-.958) were significant.

Conclusions and Implications: Over the six-year study period, the prevalence of methamphetamine use among families involved with child welfare services because of substance use increased from one in four to more than one in three families. Methamphetamine use was associated with longer child welfare cases, and although parents received more social, mental health, and addiction treatment services, they were less likely to successfully complete addiction treatment. When controlling for other factors, the odds of family unification at case closure for parents who used methamphetamine were approximately half that of parents who used other substances. Contingency management programs, which are effective for people with methamphetamine use disorder but still uncommon in most addiction treatment facilities, should be expanded.