The child welfare system serves children who come to its attention as the result of abuse and neglect reports. These children, however, are a small fraction of those who live in households in which a parent has a serious alcohol or drug problem. Data from the 1996 National Household Survey on Drug Abuse (NHSDA) reveal that an estimated 8.3 million children in the United States, 11 percent of all children in the U.S., live in households in which at least one parent is either alcoholic or in need of substance abuse treatment.
As shown in Figure 4-1, 2.1 million of these children live in families in which the predominant problem is illicit drugs; 3.8 million live in families in which the primary problem is alcohol, and 2.4 million of these children live with parents who abuse both alcohol and illicit drugs in combination. The children living in substance abusing households are evenly spread across the age spectrum, from infants to teenagers, as shown in Figure 4-2.
The substance abuser is the mother in about half these families, and the father in the other half. These figures include only those children residing with their parent(s) at the time of the survey and do not include children who had been removed to foster care (Huang et al, 1998). Figure 4.3 and Table 4-A illustrate the number of children living in families with varying levels of substance abuse problems.
Additional data on the characteristics of alcohol and drug using parents from the 1994 and 1995 National Household Surveys on Drug Abuse reveal that there were an estimated 649,000 women and 645,000 men with problem levels of illicit drug use who were living with children younger than 18 years of age. Problem drug users living with children represent 30 percent of all women with this level of drug problem and 18 percent of such men (SAMHSA, 1997d). As shown in Table 4-B, parents with problem levels of drug use look remarkably like parents without such problems demographically, particularly with regard to race.
Nearly three-quarters (72 percent) of problem drug using mothers and 65 percent of problem drug using fathers are white, 20 percent of these mothers and 15 percent of these fathers are black, and 10 percent of these fathers and 7.4 percent of these mothers are Hispanic. Figure 4-4 shows the racial/ethnic distribution of mothers with problem levels of illicit drug use.
As a group, parents with substance abuse problems have somewhat less education, are somewhat less likely to be employed full time, and are much less likely to be married and much more likely to participate in welfare programs than are other parents. Seventy-five percent of fathers with substance abuse problems are employed full time, as are nearly one-third of such mothers.
Prenatal drug abuse has been a particular focus of media, policy and research attention. Some 221,000 infants (5.5 percent) are born each year prenatally exposed to illicit drugs. Most of these have been exposed to marijuana (2.9 percent or 119,000 children), while 1.1 percent (45,000) are exposed to cocaine and 1.5 percent (61,000) pregnant women used prescription medications during pregnancy without physician direction (U.S. Department of Health and Human Services, National Institute on Drug Abuse [HHS/NIDA], 1994). In addition, some 140,000 pregnant women (3.5 percent of all pregnant women) each year drink heavily, placing their children at risk for Fetal Alcohol Syndrome and Fetal Alcohol Effects (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention [HHS/CDC], 1997). Figure 4-5 shows the number of women who use illicit drugs or drink heavily during pregnancy.
Table 4-C shows the numbers of women using illicit drugs by pregnancy and child rearing status. Substance abuse rates are considerably lower among women who have children in the home than among women who are not raising minor children, and pregnant women report lower substance use rates than non-pregnant women. Particularly notable, and encouraging, are the very low reported rate of binge drinking and of heavy drinking among pregnant women.
With respect to drug use by pregnant women and by parents, African American women have higher rates of illicit drug use and particularly cocaine use than do white women (HHS/SAMHSA, 1997d). However, there are many more white women, including white pregnant women and white parents, who use illicit drugs than there are minority women in these categories who use illicit drugs (HHS/SAMHSA, 1998a). The number of African American women who use cocaine during pregnancy, (30,000 in 1992) far exceeds the number of white and Hispanic women who used that drug prenatally (HHS/NIDA, 1994). Studies have shown, however, that African American children prenatally exposed to illicit drugs are much more likely than white children to be both reported to child protective services (Chasnoff, 1989) and to be placed in foster care, even after taking into account factors such as the family's previous child welfare involvement, the physical health of the child, and other related factors (Neuspiel et al, 1993).
Rates of both alcohol and illicit drug abuse are even higher among Native Americans than among other ethnic groups in the U.S., although most national data on substance abuse have insufficient samples to separately analyze data for Native Americans (HHS/SAMHSA, 1998a).
Child welfare agencies tend to focus their attention on infants and very young children of substance abusers, particularly children who have been prenatally exposed to illicit drugs. But as Figure 4-2 illustrated, children of all ages reside in substance abusing families, and prenatally exposed infants represent a very small proportion of children in such households. These data also illustrate how closely intertwined and inseparable alcohol and illicit drug abuse are.