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Addictions: Treating the Family Struggling with Sobriety
10 CEUs Addictions: Treating the Family Struggling with Sobriety

Section 24
Indicators of Family Reunification with Substance-Affected Parents

Question 24 | Test | Table of Contents | Addictions CEU Courses
Social Work CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

Substance-Affected Families and Reunification
Child welfare caseworkers are often involved with parents with substance use disorders (U.S. General Accounting Office [GAO], 1994, 1998). An estimated 15% of women of childbearing age currently abuse substances (National Institute of Drug Abuse, 1995), and approximately 11% of children (8.3 million) are under the care of at least one drug- or alcohol-abusing parent (Wingfield, Klempner, & Pizzigati, 2000). Evidence from various national studies suggests 40% to 80% of all confirmed neglect and maltreatment cases involve substance abuse (Wingfield et al., 2000).

Working with substance-affected individuals can be difficult and frustrating. Recovery from addiction is an ongoing process with multiple pitfalls, setbacks, and formidable tasks (Brown & Lewis, 1999; M. Miller, Gorski, & Miller, 1992; GAO, 1998). The process of family reunification only adds to these tasks. Given the conflicting time clocks between child welfare policy and recovery, decisionmakers are confronted with the challenging task of identifying indicators for safe reunification or termination of parental rights.

The combination of overcoming addiction along with acquiring learning skills needed for effective parenting is difficult. The literature suggests that parents, predominantly women, face systemic problems, social attitudes, relapse, and their own individual histories as multiple challenges to their recovery and reunification.

Systemic Problems
One systemic problem for recovery and successful reunification is the potential conflict arising from the focusing on the child or the parent as the client. From the child welfare caseworker's perspective, the child is the client. Substance abuse counselors treat the substance-affected individual as the client. These opposing viewpoints often conflict with respect to suggested interventions and perceptions of success.

Additional systemic barriers include the particular obstacles faced by African American parents. One study found that pregnant African American women and those of lower socioeconomic status were found to be more likely to be reported to authorities for substance abuse than were Euro-American women (Chasnoff, Landress, & Barrett, 1990). In addition, the addiction treatment system is not responsive to the needs of African American families (Child Welfare League of America, 1992; Rebach, 1992).

Poverty is another barrier to recovery and reunification (Dore & Doris, 1997; Freundlich, 1997). Women with substance use disorders tend to be financially or psychologically dependent on drug-using or abusive partners (W. Miller & Cervantes, 1997). Their inability to move to a safer environment is a threat to prolonged abstinence. Related barriers are insufficient medical insurance, support from family or friends, and openings available at treatment centers for financially destitute people. Inadequate or nonexistent transportation and childcare characterize additional obstacles to both treatment and long-term recovery.

Social Attitudes
Numerous social attitudes inhibit women's recoveries and reunifications. Stigma prevents many women with substance use disorders from seeking treatment (Copeland, 1997; Royce & Scratchley, 1996). Ironically, professionals wishing to protect the image of female clients often make ineffective referrals, resulting in women's being denied access to appropriate care (Loneck, Garrett, & Banks, 1997). Society does not, however, release substance-affected mothers from the obligations of child-rearing or management of family affairs (Hanke & Faupel, 1993). Mothers with substance use disorders are considered unfit and, therefore, are subjected to societal disapproval for failing to meet the cultural standards of motherhood (Baker & Carson, 1999).

Social attitudes also suggest that substance abuse is a male disorder (Wilke, 1994). Most screening instruments were developed and validated with male samples (Karoll, 2000). In-depth assessment protocols also fail to investigate gender-specific issues relevant to women's life experiences and chemical use (Wilke, 1994). Finally, most treatment modalities focus on the needs of men (Goldberg, 1995), evidenced by the many treatment programs that are unwilling or unable to serve women who are pregnant (Blume, 1997).

Policymakers, judges, and child welfare caseworkers often do not understand the meaning and nature of relapse (Azzi-Lessing & Olsen, 1996). Women experience high recidivism rates, estimated to exceed 70% within the first year after treatment (Pagliaro & Pagliaro, 2000). Prochaska, DiClemente, and Norcross (1992) described relapse as a recycling process moving toward final, total behavioral change. Professionals in the field of substance abuse treatment recommend using relapse as a tool to help the substance abuser identify what triggers their substance use and from this develop new coping strategies (Katz & Ney, 1995).

Parenting requires a woman to take on additional demands that may force her to place greater focus on her children than on her own recovery, thus potentially contributing to relapse. Relapse challenges caseworkers to re-evaluate the case, and many may believe that the relapsing mother is hopeless and the child's safety is threatened. However, many women are capable of caring for their children during recovery despite an occasional relapse.

Individual and Family Histories
Individual characteristics and personal histories present still other obstacles to recovery and reunification. A history of childhood sexual and physical abuse has been identified as a major cause of relapse (Kang, Magura, Laudet, & Whitney, 1999). Frequently, recovery involves the return of traumatic memories, and these feelings often lead to relapse.

Women with histories of childhood abuse often lack effective parenting and other life skills (Kang et al., 1999). They have learned parenting through their parents' models, who may not have had good parenting skills (Young, 1990). In addition, women from substance-affected families tend to develop caregiving behaviors in lieu of self-care. Family roles are overtly and covertly imposed and enforced (Black, 1981; Wegscheider-Cruse, 1989). The rules of "don't talk," "don't trust," and "don't feel" are the norm. Women experiencing this parental modeling often repeat these same behaviors.
- Karroll, B., & Poertner, J. (Mar/Apr 2002). Judges’, Caseworkers’’, and Substance Abuse Counselors’ Indicators of Family Reunification with Substance-Affected Parents. Child Welfare, 81(2).

According to Karroll, what is one social attitude that inhibits women's recoveries and reunifications? Record the letter of the correct answer the Test.

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