1. Child Maltreatment in the Context of Substance Abuse

2. Substance Abuse Legal drugs (alcohol, prescription and over-the-counter drugs Illegal drugs (cocaine, heroin, marijuana, methamphetamines Polysubstance abuse

3. Substance Abuse Substance-altered state of mind-less contingently accurate or relevant the behavior with the child Emotional availability/understanding disappear

4. Impact on Child Feels that parent can’t recognize/read attachment needs/emotional state Parent unavailable to deal with confusion and fear created by parent’s odd behavior Child’s distress escalates and goes unregulated Feels psychologically alone

5. Characteristics of Caregiving Environment History of loveless childhoods Many classified as avoidant, dismissing or disorganized/unresolved in their attachments Use drugs to escape feeling alone/unloved or even unlovable

6. Caregiving Environment 2 Alcoholic fathers more irritation and aggression with infants Alcoholic fathers higher mean levels of depression Low frustration tolerance Impulsivity Self-centeredness Emotional isolation Feelings of inadequacy

7. Caregiving Environment 3 Higher risk for abuse and neglect- particularly neglect Alcohol abuse in one neglect sample-75% of cases Children take care of selves; food in short supply; dirty children/clothes

8. Caregiving Environment 4 Spend little time in interaction with children 68% of cocaine users initiated less than one contact per day with sick newborn Interactions-insensitive, impulsive, lacking in empathy Low on supervision High on distraction

9. Caregiving Environment 5 Difficulty organizing own life Can’t control and regulate child’s behavior Leads to inconsistent disciplinary style- hostility/distress Helpless/angry shouting, sarcasm, belittlement covers feeling of impotence

10. Children’s Behavior, Development and Attachment Fetal Alcohol syndrome-1 in 1000 live births Low birth weight; prematurity Irritability Feeding difficulties Difficult to cuddle No support for pervasive long-term adverse effects of cocaine exposure Confounding factors-poor prenatal care/nutrition, prematurity, postnatal environment

11. Child’s Behavior, Development, Attachment “Difficult babies” further frighten parents 30% infants with problem drinking parents- disorganized attachment (vs.5%) with mother; avoidant pattern with fathers Children of substance abusers 4 to 10 times risk of substance abuse

12. Prevalence 85% of states report substance abuse as one of 2 leading problems associated with maltreating families Alcohol leading substance of abuse Half of all illegal abuse involves cocaine Significantly associated with both rereferral and substantiated recurrence of CM

13. Child Fatalities Associated with as many as 2/3 of all cases of child fatalities 25% child fatalities attributed to CM involved children prenatally exposed to alcohol and other drugs.

14. Prior Substance Abuse Mothers with past or current substance abuse more likely to abuse child Prospective study-substance abuse strongly associated with onset of abuse and neglect Substance abuse as a mediator of CM in persons with psychiatric disorders

15. Substance Abuse as an Antecedent to CM May contribute to low frustration tolerance and increased anger reactivity May cause disinhibition of aggressive impulses May interfere with parenting judgment Focus on obtaining and using