When a mandated reporter learns that a parent is using drugs, especially illegal drugs, they are likely to be concerned about the well being of the children under the care of that parent. As a result, they will probably ask themselves: Do I have to report parental drug use to child protective services (CPS)? This is a good question to ask, but the answer isn't always clear.
It is important to understand that, in most cases, just because a parent uses drugs (whether legal or illegal) does not mean that a report to CPS is required. This is because parental drug use does not always meets a definition of child abuse or neglect.
Parental use of illegal drugs, like cocaine or heroin, might be criminal, but it doesn't necessarily meet the definition of child abuse or neglect. While, parental use of legal drugs, like alcohol or prescription pain killers, isn't criminal, but might contribute to meeting the definition of child abuse or neglect. What's important to consider is not just the use of drugs, substances, or alcohol, but the impact that use has on the person's parenting.
When parental drug use (of any substance) negatively impacts a parent's ability to meet their child's basic needs, or results in other forms of child maltreatment defined under state law, then a mandated reporter would be required by law to make a report to CPS. However, the reporter is not technically reporting the drug use to CPS; they are reporting the suspicions of maltreatment.
Substance Use Disorders as a Risk Factor of Maltreatment
Research consistently shows that parents with substance use disorders are more likely to abuse or neglect their children. Substance use disorders impact the choices parents make about their own care, and the care of those around them. However, not all parents with substance use disorders will abuse or neglect their children.
"Substance use disorder" is a term that covers a range of issues related to the use and/or misuse of many substances. Substance use disorder is an appropriate diagnosis when the recurrent use of substances "causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home" (SAMHSA, 2020, para. 1).
As we consider our responses to parental substance use disorders, we need to be careful about the impact of our assumptions. Many professionals are on notice to look out for parent use of illegal drugs like heroin and methamphetamines. Marijuana use is more socially acceptable than it was in the past, as states adopt policies allowing for its medicinal and recreational use by adults. However, marijuana use is a major driver of reports to CPS across the country.
We judge parents quickly when we hear they use certain drugs; they must be "bad" parents. However, alcohol is THREE TIMES MORE LIKELY to be the substance likely to be related to substance use disorders in parents (Lipari & Van Horn, 2017). Additionally, we are most likely to offer negative judgment for mothers who have substance use disorders, but it is fathers who are most likely to be diagnosed with substance use disorders. (Lipari & Van Horn, 2017)
Prenatal Exposure to Drugs
In many states, if an expectant mother uses certain illegal drugs, their medical provider is required by law to make a report to child protective services or another government official (like the health department). However, not all mandated reporters are required to report prenatal exposure to drugs in all states. If you are unsure of your responsibilities to report prenatal substance use exposure, clarify your responsibility by familiarizing yourself with the law in your particular state.
When we learn about parental drug use, we're rightfully concerned that the drug use might harm the child. Prenatal exposure of certain substances can lead to risk of miscarriage, low birth weight, pre-term birth, and significant health complications and birth defects. However, we have to be careful about our assumptions, again.
I bet most readers of this blog will assume that the most dangerous substance for a mother to use during pregnancy is an opioid, like fentanyl or heroin. That's because we hear about these drugs all the time in the media. However, long-term research confirms that tobacco and alcohol use during pregnancy are most likely to cause birth defects, and long term health consequences for children. Alcohol and tobacco are also the substances most likely to be used by pregnant women, since they are legally obtainable. (Foray, 2016)
Supporting Families Impacted by Substance Use Disorders
When considering societal responses to prenatal drug exposure and parental substance use disorders, decades of reporting to CPS might have been be more harmful than helpful. For instance, many women, especially those in need of most support and compassionate intervention, instead fear judgment and reporting to CPS. As a result, they avoid prenatal medical care and other medical intervention for themselves and their children; they also don't seek help from other services when they know they need it most. Missing prenatal care can result in babies at higher risk of death before the age of 1, and mother's at higher risk of birth complications and death, as well. These conditions disproportionately impact poor women and women of color (Kavanaugh, 2015).
Traditionally, CPS interventions have resulted in removing children from their parent's care when there were concerns about parental substance use disorders. Research, however, has shown that family separations cause avoidable trauma, and can actually make it harder for parents to address their mental health issues likely to be underlying their substance use disorders. Decades of research have shown that efforts to help parents overcome substance use disorders are most successful when coupled with plans to keep families connected, if not together. Family-based and family-centered treatment programs are important to these efforts. (Usher, et al., 2015)
When a mandated reporter considers making a report to CPS when they encounter parental drug use, it's generally because they are genuinely concerned. Unfortunately, a rush to make a report to CPS when such is not required might cause more harm than benefit.
Before making a report to CPS for parental drug use, consider whether you are actually concerned about harm, or risk of harm to a child. Avoid making a report to CPS just because of judging a parent for a choice you would not have made for yourself.
No matter what decision you make about making a report to CPS, please support policies that focus on supporting families struggling with addiction to stay together, whenever possible.
For More Information:
Child Welfare Information Gateway. (2021). Domestic violence: A primer for child welfare professionals. U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. Available from: https://www.childwelfare.gov/pubPDFs/parentalsubuse.pdf
Drug Policy Alliance: https://drugpolicy.org/
Forray A. Substance use during pregnancy. F1000Res. 2016 May 13;5:F1000 Faculty Rev-887. doi: 10.12688/f1000research.7645.1. PMID: 27239283; PMCID: PMC4870985. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870985
Lipari RN, Van Horn SL. Children Living with Parents Who Have a Substance Use Disorder. 2017 Aug 24. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK464590/
Rise Magazine: https://www.risemagazine.org/
Substance Abuse and Mental Health Services Administration. (2020b). Medications for opioid use disorder for healthcare and addiction professionals, policymakers, patients, and families (Treatment Improvement Protocol 63). U.S. Department of Health and Human Services. https://store.samhsa.gov/product/TIP63-Medications-for-Opioid-Use-DisorderFull-Document/PEP20-02-01-006
Usher, A.M., McShane, K.E. & Dwyer, C. A realist review of family-based interventions for children of substance abusing parents. Syst Rev 4, 177 (2015). https://doi.org/10.1186/s13643-015-0158-4