Current Substance Abuse Issues
Impacting Child Abuse and Neglect

Nancy K. Young, Ph.D.
Cathleen Otero, M.S.W., M.P.A.

Presented at the 15th National Conference on Child Abuse and Neglect
– April 2005

Current Substance Abuse Issues Impacting Child Abuse and Neglect


A Program of the
Substance Abuse and Mental Health
Services Administration
Center for Substance Abuse Treatment

and the

Administration for Children and Families
Administration on Children, Youth and Families
Children’s Bureau
Office on Child Abuse and Neglect


Key Barriers Between Substance Abuse, Child Welfare, and the Courts

The Five Clocks

Biggest challenge: Clocks Still Running

The Four Clocks

ASFA Timetable

Timeliness of intervention versus “Call me Tuesday.”

CFSR’s have documented

TANF Timetable

Recovery Timetable

“A day at a time for the rest of your life”

Recovery is a lifelong process requiring a disease management approach rather than emergency care

Child Development Timetable

Potential Consequences for Children

Areas of Child Development Affected by Parental Substance Use Disorders

Research has shown that these effects can manifest themselves in multiple areas, including:

Children Living With One or More Substance Abusing Parent

(In Millions)

Used Illicit Drug in Past Year 10.6
Used Illicit Drug in Past Month 8.4
Depending on Alcohol and/or Needs Treatment for Illicit Drugs 8.3
Abused or Dependent on Alcohol or Illicit Drug in Past Month 6.0
Dependent on AOD 7.5
Dependent on Alcohol 6.2
Dependent on Illicit Drugs 2.8
Need Treatment for Illicit Drug Abuse 4.5

Number of Children Prenatally Exposed to Substances

SAMHSA, OAS, National Survey on Drug Use and Health, 2002 and 2003 reported:

Substance Used (Past Month)
1st Trimester
2nd Trimester
3rd Trimester
Any Illicit Drug 7.7% women
315,161 infants
3.2% women
130,976 infants
2.3% women
94,139 infants
Alcohol Use 19.6% women 802,228 infants
6.1% women
249,673 infants
4.7% women
192,371 infants
Binge Alcohol Use 10.9% women 446,137 infants
1.4% women
57,302 infants
0.7% women
28,651 infants

State and local prevalence studies report 10-12% of infants or mothers test positive for alcohol or illicit drugs at birth5,6

Number of Children Prenatally Exposed to Substances

Total births = 4,093,000 (2002)
10% of total births = 409,300
Total substantiated reports for children 0-1 = 142,026 (2002)

Total age 0-1 in OOHC = 22,957 (2001)

Where did they all go?

Most Go Home

80-95% are undetected and go home without assessment and needed services.

A Graphic Overview

73 million children age 0-17
7.3 million children born substance-exposed
4.093 million births annually
2.5 million CPS reports annually
409,300 estimated substance-exposed births annually

Estimated substance-exposed births reported to CPS: 5.6% of all SEBs = 22,957

Screening and Assessment of Consequences for Children

The complexity of screening and assessment for these children is compounded by at least two realities:

The importance of identifying infants prenatally exposed to substances

Child Abuse Prevention and Treatment Act (CAPTA) 2003 Amendments

2003 Keeping Families Safe Act Amendments

Children and Parents - Intervention Points

Trends in State Policies

Special Issue: Methamphetamine

Concern Regarding Children

Worker Safety Issues

Issues Specific to Methamphetamine

Women’s Issues

Average Age First Use of Substance

Treatment Outcomes

Treatment Outcomes

Of 10 MA-abusing women entering treatment:

Treatment Outcomes

Screening for Prenatal Substance Exposure and Parental Substance Use Disorders (SUDs)

Identifying Infants with Prenatal Substance Exposure

Prenatal substance exposure can be screened for in several ways. The most common methods, used alone or in combination, are:

Verbal Screening Tools 4Ps Plus

  1. Did either of your parents ever have a problem with drinking or using drugs?
  2. Does your partner have any problem with alcohol or drugs?
  3. Have you ever had any beer or wine or liquor?
  4. In the month before you knew you were pregnant, how much beer/wine/liquor did you drink?
  5. In the month before you knew you were pregnant, how many cigarettes did you smoke?

Identifying Parental Substance Use Disorders

Screening for Parental Substance Use Disorders: UNCOPE

Identifying Parental Substance Use Disorders

Check list for Identifying SUDs:4

Getting the Clocks in Sync

Introduction to a Framework and Policy Tools for Practice and Policy Changes

Navigating the Pathways
published by CSAT1


Framework and Policy Tools for Systems Change

Elements of System Linkages

Policy Tools

Available at

Models of Improved Services

Models of Family Drug Treatment Courts

The Fifth Clock


The Voice of a Child

Nothing But Silence

By Ashley G.
Age 12
January 2005

People all around me
Calling out my name
But no I cannot hear them
For my heart is filled with shame
Nothing but silence

But only till the break of dawn
Will I be feeling sad
For wandering out on the streets
Are my birth mom and dad

Why’d she do this to her and me
With this we’ll have to cope
But while she’s clean you never know
There still could be hope

But in the perfect world I know
There’s no harmful stuff
But now I’ve come to realize
It’s just a bunch of bluff

Nothing but silence

Sitting by the widow sill
A tear rolls down my cheek
Although it hurts I can’t express
My heart is just too weak
Nothing but ache
It’s funny what one pill can do
To a mother or a kid
And now I know that for a fact
I won’t do what she did

Nothing but ache

Now I live a better life
And drugs…I wouldn’t dare
Away from all the harmful things
With a family who cares

Nothing but love

I know it hurts, it sure hurt me
And that’s why I’ll remain drug free

Nothing… but hope

The Fifth Clock



  1. Young, N.K. and Gardner, S.L. (2002). Navigating the Pathways: Lessons and Promising Practices in Linking Alcohol and Drug Services With Child Welfare. SAMHSA Publication No. SMA-02-3639. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.
  2. Chasnoff, I.J. (1997). Prenatal Exposure to Cocaine and Other Drugs: Is there a Profile? In: Accardo, P.J., Shapiro, B.K., & Capute, A.J. (Eds.), Behavior Belongs in the Brain. Baltimore, MD: York Press, 147-163.
  3. Lester, B.M., Andreozzi, L., & Appiah, L. (2004). Substance Use During Pregnancy: Time For Policy to Catch Up With Research. Harm Reduction Journal, 1(5).
  4. Young and Gardner, Navigating the Pathways, p. 132.
  5. Vega et al (1993). Profile of Alcohol and Drug Use During Pregnancy in California, 1992.
  6. SAMHSA, OAS. (2003). Results from the 2002 National Survey on Drug Use and Health: National findings.
  7. NIAAA (2000). Tenth Special Report to Congress on Alcohol and Health.
  8. NIDA (1998). Prenatal Exposure to Drugs of Abuse May Affect Later Behavior and Learning