Elsevier

Child Abuse & Neglect

Volume 27, Issue 12, December 2003, Pages 1409-1425
Child Abuse & Neglect

The relationship between parental substance abuse and child maltreatment: findings from the Ontario Health Supplement

https://doi.org/10.1016/j.chiabu.2003.07.002Get rights and content

Abstract

Objective: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada.

Method: The sample consisted of 8,472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined.

Results: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem.

Conclusions: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families.

Résumé

Objectif: Cette étude a examiné la relation entre un signalement de danger de mauvais traitements et la notion d’abus de stupéfiants (alcool et drogues) par les parents dans un échantillon communautaire en Ontario, Canada.

Méthode: L’échantillon a comporté 8,472 sujets qui ont répondu au Ontario Mental Health Supplement (OHSUP) vaste enquête sur la santé mentale de la population. L’association d’une mention spontanée d’abus physiques et sexuels subis autrefois dans l’enfance et d’un abus antérieur de drogue et d’alcool par les parents a été examiné.

Résultats: Le taux d’abus physique et sexuel a été significativement plus élevé, avec plus de deux fois de risque parmi ceux qui rapportaient un abus de stupéfiants chez leur parents. Le taux n’était pas significativement différent selon les types ou la gravité des abus. On a trouvé une augmentation progressive du taux des abus chez les sujets qui rapportaient que leur père, mère ou les deux parents avaient des problèmes d’abus de stupéfiants. Ce risque était significativement élevé lorsqu’il s’agissait des deux parents en comparaison avec le père seul.

Conclusion: L’abus de stupéfiants est associé avec une augmentation d’un risque multiplié par plus de deux qu’il y ait danger d’abus physique et sexuel envers les enfants. Même si le mécanisme de cette association reste peu clair, les agences concernée par la protection des enfants ou le traitement des parents qui abusent des stupéfiants doivent être au courant de cette relation et se centrer sur la mise au point d’interventions au service de ces familles.

Resumen

Objetivo: Este estudio examinó la relación entre la exposición reportada al abuso infantil y una historia de abuso parental de sustancias (alcohol y drogas) en una comunidad como muestra en Ontario.

Método: La muestra consistı́a en 8,472 respuestas al Suplemento de Salud Mental de Ontario (OHSUP), una encuesta poblacional integral de salud mental. Se estudió la asociación entre el abuso fı́sico y sexual en la niñez autoreportado retrospectivamente y las historias parentales de abuso de drogas o alcohol.

Resultados: Las tasas de abuso fı́sico y sexual fueron significativamente más altas, con más del doble en el aumento del riesgo entre aquellos que reportaban historias de abuso parental de sustancias. Las tasas no fueron significativamente diferentes entre el tipo o la severidad del abuso. Se encontraron tasas de abuso sucesivamente en aumento para aquellos sujetos que reportaron que sus padres, madres, o ambos padres tenı́an problemas de abuso de sustancias; este riesgo fue significativamente más elevado cuando eran ambos padres comparado con el padre solo con un problema de abuso de sustancia.

Conclusiones: El abuso de sustancias de los padres está asociado a más del doble del aumento del riesgo de exposición tanto al abuso fı́sico como al sexual en la niñez. A pesar de que el mecanismo para esta asociación no aparece claro, las agencias involucradas en la protección infantil o en el tratamiento de padres con problemas de abuso de sustancias deben reconocer esta relación y enfocar el desarrollo de intervenciones para servir a éstas familias.

Introduction

The deleterious effects of parental alcohol and drug abuse on children’s lives have been well documented. Recent reviews, for example, have highlighted the intergenerational transmission of alcohol abuse (Johnson & Leff, 1999, Lieberman, 2000), the detrimental effects on child growth and development (Frank, Augustyn, Knight, Pell, & Zuckerman, 2001; Richter & Richter, 2001, Rydelius, 1997, Weinberg, 1997) and its effect on the care-giving environment (Das Eiden, Peterson, & Coleman, 1999). Data from the 1996 National Household Survey on Drug Abuse (NHSDA) reveal that 8.3 million or 11% of all children in the US live in households in which at least one parent is either alcoholic or in need of substance abuse treatment (US Department of Health and Human Services, 1999). An estimate of the prevalence of substance abuse in a Canadian community sample of adults was 5.2% (8.2% for males and 2.1% for females) (Offord et al., 1996).

Substance abuse by parents has been shown to be associated with higher rates of child abuse potential among drug-using pregnant women (Williams-Petersen et al., 1994) and parents with lifetime substance use disorders (Ammerman, Kolko, Kirisci, Blackson, & Dawes, 1999). Clinical studies also show an association between substance abuse and one or more types of child maltreatment (De Bellis et al., 2001; Famularo, Kinscherff, & Fenton, 1992; Jaudes, Ekwo, & Van Voorhis, 1995; Kaplan, Pelcovitz, Salzinger, & Ganeles, 1983; Langeland & Hartgers, 1998; Leventhal et al., 1997; Magura & Laudet, 1996, Wasserman & Leventhal, 1993) although research findings have been inconsistent (Widom, 1993, Widom & Hiller-Sturmhofel, 2001).

Estimates from US studies of the prevalence of chemical dependence among families in the child welfare system have ranged from approximately 50% (Curtis & McCullough, 1993, Murphy et al., 1991) to as high as 80% (Barth, 1994). It appears to be strongly related to reports of recurrent maltreatment (Wolock & Magura, 1996), child placement (Besinger, Garland, Litrownik, & Landsverk, 1999; Leventhal et al., 1997; Marcenko, Kemp, & Larson, 2000), child placement in kinship care (Beeman, Kim, & Bullerdick), and difficulties in achieving permanency planning (Sagatun-Edwards, Saylor, & Shifflett, 1995; Tracy, 1994). Children of parents with substance abuse problems were younger than other children in the child welfare system, were more likely to be the victims of severe and chronic neglect and to have families with more problems overall (US Department of Health and Human Services, 1999). Although there is no certainty regarding the extent of cases reported to child welfare with substance abuse problems (Barth, 2001), 85% of state administrators rated substance abuse as one of the top two problems exhibited by families reported for maltreatment (Peddle & Wang, 2001). Parental substance use as reported by social workers was considered to be a cause for concern in 52% of an inner-city British sample of families on the Child Protection Register (N=50) (Forrester, 2000).

The Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) provided national estimates of cases of child maltreatment reported to and investigated by child welfare authorities; according to workers’ reports, alcohol or drug abuse was a factor in 34% of all cases (substantiated, suspected, and unsubstantiated) with the highest rates reported in substantiated cases of emotional maltreatment (58%), neglect (50%) followed by physical abuse (40%) and sexual abuse (40%); in 70% of substantiated cases, the adults were referred to drug or alcohol counseling (Trocmé et al., 2001). Most data about the association between alcohol and illicit drug disorders among parents and child maltreatment have arisen from studies examining official reports of child abuse and neglect (Taylor et al., 1991). However, these samples are not representative of the general population (Kelleher, Chaffin, Hollenberg, & Fischer, 1994). Studies based on individuals from treatment, social services or court-based samples may over-estimate the strength of relationship between parental substance abuse and child maltreatment (Egami, Ford, Greenfield, & Crum, 1996).

Information on the link between parental substance abuse and child maltreatment in representative samples is focused primarily on the examination of child physical abuse and neglect using parent self-report. A US cross-sectional survey explored the link between parental substance use and child physical abuse using a community sample (Gelles, 1980, Wolfner & Gelles, 1993). The Second National Family Violence survey, with a probability sample of more than 3,000 US households, collected information on the relationship between respondents’ self-report of drug and alcohol use and use of punishment and abusive behavior (Wolfner & Gelles, 1993). No differences were found in rates of violence in relationship to alcohol use; however, respondents who reported using drugs in the past year reported 20% more minor violence and 46% more severe violence than abstainers.

The National Institute of Mental Health (NIMH) Epidemiologic Catchment Area (ECA) surveys (Eaton & Kessler, 1985) explored the relationship between parental substance abuse disorder, harsh parental discipline (Holmes & Robins, 1987) and physical abuse using cross-sectional (Egami et al., 1996, Kelleher et al., 1994) and prospective approaches (Chaffin, Kelleher, & Hollenberg, 1996). Among a total sample of 9,841 adults, 1.5% reported abusing children, 32.7% had a lifetime history of alcohol abuse or dependence and 10.2% had a lifetime history illicit drug use (Egami et al., 1996). Self-reported alcohol abuse or dependence disorder significantly increased the risk of physical abuse perpetration (odds ratio (OR) 3.40, C.I. 2.40–4.82) and illicit drug use or dependence significantly increased the risk of physical abuse perpetration (OR 2.00, C.I. 1.17–3.44). Using a nested case-control design for the NIMH ECA surveys, 376 adults who reported physically abusing or neglecting a child were matched with control subjects drawn from the same community-based survey (Kelleher et al., 1994). A higher lifetime prevalence of alcohol or drug disorders was found among respondents who reported physically abusive behavior compared to their non-abusive counterparts after controlling for confounding factors (depressive disorder, antisocial personality disorder, household size, and social support). Adults with a history of alcohol or drug problems were almost three times more likely to have reported committing child physical abuse and more than four times more likely to report committing neglect compared to the control subjects. In the second wave of the ECA study, parents who did not self-report physical abuse or neglect of their children were followed for one year prospectively to determine risk factors associated with onset of physical abuse or neglect (Chaffin et al., 1996). Social and demographic variables such as socioeconomic status, age, education, and availability of social support were limited predictors of maltreatment, while substance abuse disorders were strongly associated with physical abuse (OR 2.90). The authors concluded that of the psychiatric disorders studied, “substance abuse disorders appear to be the most common and among the most powerfully associated with maltreatment … approximately tripling the risk of [committing] maltreatment when other factors were controlled” (p. 200).

In a community-based study of 2,000 randomly selected adult residents of Edmonton, Alberta, the increased risk of self-reports of abusing one or more children was 5.9 (p<.001) for those with a diagnosis of substance abuse or dependence; the risk increased substantially when combined with the comorbid conditions of major depressive episode and/or antisocial personality disorder (OR 12.5, p<.005) (Bland & Orn, 1986). These findings are based on parental self-report of both substance abuse and child maltreatment.

A study which combined three large databases of clinical, community, and family study subjects concluded that self-identified child abusers (child battery) have increased lifetime rates of alcoholism (Dinwiddie & Bucholz, 1993).

In a retrospective community-based case-control study of 144 females, who had experienced sexual abuse compared to non-sexually abused controls (N=566), the presence of an alcoholic father predicted familial sexual abuse (OR 5.0, C.I. 1.7–14.9); having an alcoholic mother increased the risk of non-familial sexual abuse (OR 9.5, C.I. 1.3–70.9) (Fleming, Mullen, & Bammer, 1997).

A longitudinal nested case-control study of 14,138 children followed antenatally for 8 years identified maternal and paternal risk factors distinguishing those children who had been investigated (N=162) or registered (N=162) for possible child maltreatment compared to non-registered children (N=13,976). Self-reported paternal and maternal alcohol or drug abuse was significantly related to registered child maltreatment (physical abuse, sexual abuse, emotional abuse and neglect) (Sidebotham & Golding, 2001). These associations, however, were non-significant in the multivariate analysis. The authors proposed that substance abuse may be “related to other background factors rather than being a causal factor in itself”(p. 1194).

Although a number of community-based studies have been conducted to explore this relationship, differences in approaches and methodological weaknesses limit our understanding of the risk posed to children of substance-abusing parents. Many studies have combined categories of maltreatment rather than analyzing separate types; it is likely that different types of abuse have different etiologies (Jones & McCurdy, 1992). No study employing a representative sample has examined the effects of parental substance abuse on both physical abuse and sexual abuse independently. Only one study has considered the gender of the child and males were excluded from the sample (Fleming et al., 1997). Others have failed to examine the risk posed by having maternal, paternal, or both parents with substance abuse problems. Finally, studies relying on respondents self-report of substance abuse and child abuse perpetration suffer from bias related to undereporting due to social stigma. The present study was conducted to overcome these limitations. It examines the effects of maternal, paternal and both parents substance abuse on child physical and sexual abuse in a representative community sample. The effects of parental substance abuse are analyzed separately for male and female victims.

Section snippets

Sample

In 1990, the Ontario Ministry of Health sponsored the Ontario Health Survey (OHS), a comprehensive population health survey, to gather information about the physical health of provincial residents. The target population was individuals aged 15 years and older who resided in private dwellings. Excluded from the OHS were homeless persons, people in institutions, foreign service personnel, First Nations people living on reserves, and persons residing in extremely remote locations. Rural households

Results

Of the 14,758 households eligible for the OHS, 13,002 (88.1%) participated. Of those, 9,953 (76.5%) took part in the Supplement for an overall response rate of 67.4%. Non-participation was due primarily to the inability to contact the occupant, followed by unwillingness to participate. Participation rates were higher among females, younger subjects and individuals living in rural areas. A detailed description of the sample is provided elsewhere (Boyle et al., 1996). Briefly, 45.4% of the

Discussion

In the present study, parental substance abuse was associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. The magnitude of the risk for child physical abuse is similar to studies in the US employing adult self-report (Chaffin et al., 1996, Egami et al., 1996, Kelleher et al., 1994) and lower than the other Canadian study which found a fivefold increase. It is difficult to compare the findings with respect to child sexual abuse. The only

Conclusion

This study provides further evidence to suggest that children in homes in which one or both parents have substance abuse problems are at increased risk of child physical abuse and sexual abuse. However, more prospective longitudinal research into the complex and multidimensional factors driving this associated is needed, as well as further investigation into the other major forms of child maltreatment—emotional abuse and neglect. Findings from the OHSUP regarding the relationship between

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    This work has been supported by the Canadian Institutes of Health Research (CIHR), Institutes of Gender and Health; Aging; Human Development, Child and Youth Health; Neuroscience, Mental Health and Addiction; and Population and Public Health.

    1

    Supported by an Ontario Graduate Student Scholarship.

    2

    Supported by the Wyeth-Ayerst Canada Inc., Canadian Institutes of Health Research Clinical Research Chair in Women’s Mental Health.

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