3. LITERATURE REVIEW
Nature and extent of the problem
Although estimates vary on the percentage of child maltreatment reports that involve parental substance abuse (from 40% to 80%), the numbers indicate a widespread problem (Young, Gardner & Dennis, 1998). Western and rural states, such as Idaho, are seeing an alarming trend toward increased abuse and use of methamphetamines, to the point that some are calling it an epidemic (Altshuler, 2005). For example, in the neighboring state of Washington, adult methamphetamine admissions have increased from 13% in 2000 to 21% in 2004 (Stark, 2005).
Parental substance abuse contributes to a wide range of problems that call for child welfare intervention. A recent study found that substance users were three times more likely to subject children to abuse and neglect than non-users, regardless of psychiatric, demographic, and social variables (Lundgren, Peloquin, & Schilling, 2005). Children of substance abusers tend to stay in out-of-home placements longer than children whose parents do not have this problem (Doran, Marshal, & McAlpine, 2001). According to the National Institute of Drug Abuse, the effects of methamphetamine abuse can be mood swings, anxiety, anger, violence, paranoia, isolation, depression, insomnia, hallucinations, convulsions, kidney failure, and suicide. Parents who abuse this substance may present with weight loss, teeth grinding, dry itchy skin, and facial picking, and resort to lies, denial, and manipulation to avoid the consequences of their use. Brain scans of people who use methamphetamines show damage that persists months and even years after they stop using the drug (NIDA, 2006). Consequently, methamphetamine abusers may be even more difficult to engage than other, more “tradi- tional” substance abusers.
Because of differences in philosophy, funding streams, training, and treatment focus, substance abuse and child welfare systems historically have been independent, even though their populations overlap. Collaboration between systems has become a priority since the enactment of the ASFA in l997, which requires states to file a termination petition if children have been in out-of-home care for 15 of the last 22 months (Doran, et al., 2001). Because recovery from substance abuse can be a long process interrupted by frequent relapses, the shortening of timelines by ASFA puts pressure on the child welfare system to respond quickly with adequate treatment resources.
Unfortunately, substance abuse treatment retention rates and rigorous outcome studies on parents with substance abuse problems are scarce. A number of studies have shown that males remain in treatment longer than females, but there is inconsistent and meager data about the retention rate among women (Brady & Ashley, 2006). In findings of the Alcohol and Drug Services Study (2,395 treatment facilities), the authors indicate that among adult clients discharged from outpatient non-methadone, non-hospital residential facilities, 54% completed planned treatment. Women from minority racial groups, women whose primary source of referral to treatment was not the criminal justice system, and women whose presenting substance abuse problem was drug abuse only were less likely to complete treatment (Brady & Ashley, 2006).
Idaho Pre-Treatment Program