The Association Between Substance Abuse and Child Welfare and Research-Based Interventions

Mark StanfordMark Stanford, PhD, Director, Addiction Medicine and Therapy Services, Stanford University School of Medicine

Summary: The author describes why collaborative approaches such as family drug treatment courts outperform traditional child welfare and dependency court systems in terms of child protection, parental rehabilitation and reunification.


The connection between crime and substance abuse is well documented (US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2010.). Additionally, there is little question that substance-use disorders (SUD) are major factors confronting families involved with child welfare services. Alcohol and drug abuse is associated with more severe child abuse and neglect and is indicated in a large percentage of neglect-related child fatalities. Research indicates that up to 80% of child abuse and neglect cases involve SUD by a custodial parent or guardian (Young et al., 2007). Continued SUD by a custodial parent is associated with longer out-of-home placements for dependent children and higher rates of child revictimization and terminations of parental rights (Brook & McDonald, 2009; Connell et al., 2007; Smith et al., 2007). The good news is that parents who complete treatment for their SUD are significantly more likely to be reunified with their children, and their children spend considerably fewer days in out-of-home foster care (Green et al., 2007; Smith, 2003).

Understanding the Compulsive Nature of Substance Use Disorders
People take addictive drugs to elevate mood, but repeated use of these drugs produces serious unwanted effects. The most serious consequence of repetitive drug taking, however, is addiction: a persistent state in which compulsive drug use escapes control, even when serious negative consequences ensue. There is evidence that compulsion and its persistence are based on pathological brain deficit mechanisms that are normally involved in memory (Hyman SE, Malenka RC, 2001). These deficits inhibit response-control functions dependent on prefrontal-executive functions and lead to impulsive, compulsive drug taking (Eastman P, 2008).

Echoing this research is the American Psychiatric Association’s diagnostic criteria of addiction, with its reference to the continued use despite adverse consequences (DSM-5, 2013). This research-based diagnostic feature explains why obtaining and sustaining sobriety is often extremely difficult without professional intervention, even for those who have the best of intentions and with the genuine hope of family reunification as an outcome of staying clean and sober.

Research-Based Best Practices in the Treatment of SUD
Without professional intervention, the SUD-crime cycle jeopardizes public health and public safety and taxes an already over-burdened criminal justice system. It follows then that reducing drug use can reduce crime and improve not just the health, safety and well-being of the individual, but of communities and society as a whole. Research findings show unequivocally that treatment for SUD works and that this is true even for individuals who enter treatment under legal mandate from the courts including family drug courts. Interestingly, the outcomes are as favorable as those who enter treatment voluntarily.

Research on best practices in the treatment of SUD, those professional interventions that have produced the most favorable outcomes compared to other approaches, include the following:

  1. A balance of rewards and sanctions encourages pro-social behavior and treatment participation. Nonmonetary “social reinforcers,” such as recognition for progress or sincere effort, can be effective, as can graduated sanctions that are consistent, predictable, and clear responses to noncompliant behavior. (NIDA, 2012)
  2. Collaborative comprehensive treatment for justice-involved persons is of proven effectiveness. Longitudinal outcome studies find that those who participate in community-based SUD treatment programs commit fewer crimes than those who do not participate (Prendergast et al. 2002; Butzin et al. 2006; and Kinlock et al. 2009).
  3. Family drug courts (FDCs) have emerged as one of the most promising models for improving treatment retention and family reunification rates in the child welfare system (cf. Green et al., 2009; Oliveros & Kaufman, 2011).

According to the National Association of Drug Court Professionals (NADCP), research has demonstrated convincing evidence that FDCs can produce clinically meaningful benefits and better outcomes than traditional family reunification services for substance-abusing parents. These positive benefits do not appear to be limited to low-severity or uncomplicated cases and indeed may be larger for parents presenting with more serious clinical histories and other negative risk factors for failure in standard treatment programs (Marlowe, 2012).

Conclusions
The compulsive nature of SUD is not to be underestimated in persons experiencing SUD, and there are specific brain deficits involved in perpetuating the severity of this compulsion. Taken in this light, it begins to be understandable that even in spite of the well intended and motivated person with SUD, all too often, relapse is common. Without professional intervention, continued use despite adverse consequences is predictable. The good news is that research science has also demonstrated there are best practices in the treatment of compulsive illicit drug use and they include interagency collaborations, including partnerships with the courts and especially family drug courts.

Ignoring the evidence-based results of best practice interventions for SUD and continuing to spend public dollars on programs and approaches that have not been tested or that have been discredited is unjustifiable. Research is clear that collaborative approaches with justice services, including family drug courts, outperform the traditional child welfare and dependency court systems in terms of protecting vulnerable children and rehabilitating and reuniting dysfunctional families.

References used in this article on request.

Author biography:

Mark Stanford, Ph.D. is the director of Addiction Medicine and Therapy Services for the nation’s ninth largest county health and hospital system. He is an associate clinical professor at Stanford University School of Medicine Addiction Medicine and Dual Diagnosis Clinic and an educator in behavioral neurosciences at UC Berkeley Extension. Dr. Stanford is the author of three books including the text, Foundations in the Behavioral Pharmacology of Substance Use and Mental Health Disorders. Website: www.DrNeurosci.com

 

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