Caregiver Substance Use and Child Trauma Implications for

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Shulamith Lala Straussner, DSW., is Professor at the New York
University Silver School of Social Work, USA, and Director of the Post-
Master’s Certificate Program in Clinical Approaches to Addiction. She is
also Editor of the Journal of Social Work Practice in the Addictions.
Caregiver Substance Use and Child
Trauma
Implications for Social Work Research and Practice

Edited by
Michele Staton-Tindall, Ginny Sprang and
Shulamith Lala Straussner
First published 2014
by Routledge
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Contents

Citation Information
Notes on Contributors
Introduction
Michele Staton-Tindall, Ginny Sprang and Shulamith Lala Straussner
1. Caregiver Substance Use and Child Outcomes: A Systematic Review
Michele Staton-Tindall, Ginny Sprang, James Clark, Robert Walker and
Carlton D. Craig
2. Family Structure, Substance Use, and Child Protective Services
Involvement: Exploring Child Outcomes and Services
Natasha Mendoza
3. Puerto Rican Parenting and Acculturation in Families Experiencing
Substance Use and Intimate Partner Violence
Cristina Mogro-Wilson, Lirio K. Negroni and Michie N. Hesselbrock
4. Caregiver Substance Abuse and Children’s Exposure to Violence in a
Nationally Representative Child Welfare Sample
Kristen D. Seay and Patricia L. Kohl
5. Advancing Trauma-Informed Systems Change in a Family Drug
Treatment Court Context
Laurie A. Drabble, Shelby Jones and Vivian Brown
6. African American Adult Children of Alcoholics: An Interview With J.
Camille Hall, PhD, LCSW
Interview Conducted by Lori Holleran Steiker

Endpage
7. Mentalization-Based Treatment: A Valuable Framework for Helping
Maltreating Parents
Christine H. Fewell
Index
Citation Information

The following chapters were originally published in the Journal of Social

Work Practice in the Addictions, volume 13, issue 1 (January-March 2013).
When citing this material, please use the original page numbering for each
article, as follows:

Chapter 1
Caregiver Substance Use and Child Outcomes: A Systematic Review
Michele Staton-Tindall, Ginny Sprang, James Clark, Robert Walker and
Carlton D. Craig
Journal of Social Work Practice in the Addictions, volume 13, issue 1
(January-March 2013) pp. 6-31

Chapter 2
Family Structure, Substance Use, and Child Protective Services
Involvement: Exploring Child Outcomes and Services
Natasha Mendoza
Journal of Social Work Practice in the Addictions, volume 13, issue 1
(January-March 2013) pp. 32-49

Chapter 3
Puerto Rican Parenting and Acculturation in Families Experiencing
Substance Use and Intimate Partner Violence
Cristina Mogro-Wilson, Lirio K. Negroni and Michie N. Hesselbrock
Journal of Social Work Practice in the Addictions, volume 13, issue 1
(January-March 2013) pp. 50-69

Chapter 4
 Caregiver Substance Abuse and Children’s Exposure to Violence in a
Nationally Representative Child Welfare Sample
Kristen D. Seay and Patricia L. Kohl
Journal of Social Work Practice in the Addictions, volume 13, issue 1
(January-March 2013) pp. 70-90

Chapter 5
Advancing Trauma-Informed Systems Change in a Family Drug
Treatment Court Context
Laurie A. Drabble, Shelby Jones and Vivian Brown
Journal of Social Work Practice in the Addictions, volume 13, issue 1
(January-March 2013) pp. 91-113

Chapter 6
African American Adult Children of Alcoholics: An Interview With J.
Camille Hall, PhD, LCSW
Interview Conducted by Lori Holleran Steiker
Journal of Social Work Practice in the Addictions, volume 13, issue 1
(January-March 2013) pp. 118-122

Endpage
Mentalization-Based Treatment: A Valuable Framework for Helping
Maltreating Parents
Christine H. Fewell
Journal of Social Work Practice in the Addictions, volume 13, issue 1
(January-March 2013) pp. 123-126
Notes on Contributors

Vivian Brown, Founder and Former CEO, PROTOTYPES Centers for

Innovation in Health, Mental Health and Social Services, Manhattan
Beach, California, USA
James Clark, Professor, School of Social Work, University of Cincinnati,
Cincinnati, Ohio, USA
Carlton D. Craig, Associate Professor, College of Social Work, University
of Kentucky, Lexington, Kentucky, USA
Laurie A. Drabble, Professor, School of Social Work, San Jose State
University, San Jose, California, USA
Christine H. Fewell, Adjunct Professor, Silver School of Social Work, New
York University, New York, USA
Michie N. Hesselbrock, Emeritus Professor, School of Social Work,
University of Connecticut, West Hartford, USA
Lori Holleran Steiker, Associate Professor, School of Social Work,
University of Texas at Austin, Texas, USA
Shelby Jones, Graduate Research Assistant, School of Social Work, San
Jose State University, California, USA
Patricia L. Kohl, Associate Professor, Brown School of Social Work,
Washington University in St. Louis, Missouri, USA
Natasha Mendoza, Assistant Professor of Social Work, College of Public
Programs, Arizona State University, Phoenix, Arizona, USA
Cristina Mogro-Wilson, Assistant Professor, School of Social Work,
University of Connecticut, West Hartford, USA
Lirio K. Negroni, Associate Professor, School of Social Work, University
of Connecticut, West Hartford, Connecticut, USA
Kristen D. Seay, Doctoral Candidate, Brown School of Social Work,
Washington University in St. Louis, St. Louis, Missouri, USA
Ginny Sprang, Professor, University of Kentucky College of Medicine,
USA
Michele Staton-Tindall, Associate Professor, University of Kentucky
College of Social Work, USA
Shulamith Lala Straussner, Professor, New York University Silver School
of Social Work, USA
Robert Walker, Assistant Professor, College of Social Work, University of
Kentucky, Lexington, Kentucky, USA
Introduction

MICHELE STATON-TINDALL, GINNY SPRANG AND

SHULAMITH LALA STRAUSSNER

Research has consistently shown that there is a link between caregiver

substance use and child maltreatment (Drapela & Mosher, 2007; Dube, et
al., 2001; Kelleher, Chaffin, Hollenberg, & Fischer, 1994; Magura &
Laudet, 1996; Suchman, Rounsaville, DeCoste, & Luthar, 2007; Sprang,
Clark, & Staton-Tindall, 2010; Staton-Tindall, Sprang, & Clark, 2012;
Yampolskaya & Banks, 2006). Of particular interest to social workers, one
longitudinal analysis examining reasons for re-referrals to Child Protective
Services (CPS) found that children whose caregivers abused substances
were significantly more likely to be re-reported for child maltreatment, and
those claims were more likely to be substantiated (Fluke et al., 2008). The
Adverse Childhood Experiences (ACE) study found that individuals who
grew up in households where the parents abused substances experienced
nearly four lifetime adverse childhood experiences compared to 1.4 events
among those whose parents did not abuse substances (Dube et al., 2001).
Negative consequences of caregiver alcohol and drug use may be due to
such familial dynamics as “communication problems, conflict, chaos and
unpredictability, inconsistent messages to children, breakdown in rituals
and traditional family rules and boundaries, and emotional, physical and, at
times, sexual abuse” (Straussner, 2011, p. 5). In addition, the life style
associated with caregiver illicit drug use is often characterized by illegal
activities, a series of live-in partners and incarcerations, as well as high risk
for HIV and other serious medical problems, all of which tend to have a
severe negative impact on the children.
While the existing research consistently documents the deleterious
consequences of caregiver substance use for children, little work has
examined the impact through the lens of trauma. Empirical trauma research
reveals that infants and children are often traumatized when they are
exposed to events that directly threaten their well-being or the health and
welfare of those they love (Christopher, 2004; Scheeringa & Gaensbauer,
2000). Traumatic events experienced by children whose caregivers use
substances – including accidents, unintentional injuries, and caregiver-
inflicted harm – are common. For example, Maxson et al. (2009) found that
among a sample of pediatric trauma patients, about a third of their
caregivers engaged in risky or hazardous levels of alcohol use. This
prevalence rate is considerably higher than 16% of caregivers who
acknowledged alcohol or drug use in a primary pediatric clinic (Lane et al.,
2007).
Trauma exposure experienced by children of substance-involved
caregivers is frequently generated by interpersonal violence within the
family, producing powerful, long-term impressions on the child’s sense of
self and potentially impacting their basis for future relationships (Ciccheti
& Toth, 2000). The consequences for children of prolonged trauma
exposure can include chronic guilt, helplessness and terror, which in turn,
may increase their sense of powerlessness and vulnerability, risk for re-
victimization and/or identification with the perpetrator, as well as substance
use later in life. In other words, adult psychological structures can be
profoundly shaped by childhood trauma exposure and by a child’s
responses to these events (Herman, 1992; James, 1994). Moreover, more
recent research by Perry (2009) and Zeanah (2009) suggest that the impact
of a stressful environment on the neurological development of children can
serve as a primary indicator for later health, mental health, and socio-
behavioral consequences. Thus, caregiver substance use can have a
powerful influence on a child’s development, and subsequently on their
responsiveness to treatment.
While the co-occurrence of caregiver substance misuse and child trauma
exposure is a prevailing problem that has confounded prevention, protection
and treatment efforts with both children and adults for years, there has been
minimal empirical and clinical literature focusing on child trauma as an
outcome of caregiver substance use (Sprang et al., 2010; Staton-Tindall et
al., 2012). This work is designed to be the catalyst for sustained intellectual
inquiry about how caregiver substance use, child maltreatment, and
violence exposure can be understood in theory and practice. To this end,
this collection highlights the state of the science, the impact of the
phenomenon, and the policy and practice questions that must be addressed.
Implications for social work practice are highlighted in order to attenuate
these deleterious and pervasive problems in the future.
This book begins with a systematic review that examines how well the
extant literature synthesizes and builds upon findings from the child
maltreatment and substance use fields to address the impact of caregiver
substance use and trauma exposure. Noting a silo effect in how relevant
literature has developed over time, Dr. Staton-Tindall and colleagues
discuss differences in perspectives between child protective interests and
adult substance abuse treatment and rehabilitation efforts, and how the
current state of the science in measurement and research design contribute
such silo effects. The authors note the paucity of research that bridges the
gap between these two perspectives, and how integrated interventions that
address caregiver substance misuse and safe and effective parenting might
advance the policy and practice agendas in both areas.
One method of such integration involves the infusion of trauma-informed
perspectives into systems of care that serve children and substance-using
adults. A key aspect of any trauma-informed approach is implementing
proper procedures for identifying children at risk for exposure to traumatic
events. Mendoza and colleagues, and Mogro-Wilson, Negroni &
Hesselbrock provide insights into the treatment needs of these complexly
troubled families, by documenting the impact of caregiver substance misuse
on family acculturation, victimization and structure, parenting, and child
well-being outcomes. Understanding how families organize themselves to
create risk or protection for their children, and how these youth respond to
different types of parental and family functioning provides insights into
how to tailor appropriate interventions. A study by Seay and Kohl presents
one of the first examinations of the relationship between substance abuse
and children’s exposure to violence in a large, diverse, and nationally
representative sample of child-welfare involved families. This study
outlines specific predictors of child exposure to violence (direct or through
witnessing), and, as such, provides a risk profile of vulnerable children and
families that should be targeted for comprehensive trauma assessments.
Drabble, Jones & Brown examine the implementation of a trauma
framework and trauma-specific services into family drug court. This
investigation is particularly relevant as this is the arena where a wide
variety of players (e.g. the judiciary, child welfare, mental health, addiction
science) come together to address the needs of families where substance
misuse and child trauma co-occur. The utilization of a trauma-informed
approach to guide the work of an interdisciplinary team is an exemplar of
how to structure integrated, trauma-informed treatments for caregiver
substance misuse and child traumatic stress.
This collection also includes an interview with Dr. J. Camille Hall – a
prominent researcher who has devoted a significant amount of work to
understanding the experiences of adult African American children of
alcoholics – particularly the role of ethnicity and culture. A review of a
book focusing on impact of substance abuse on children and a brief
discussion of two videos that can help educate social work students to the
dynamics of growing up with a substance-abusing parent are included. The
work concludes with an Endnote discussion of mentalization-based
treatment, a promising new intervention for helping those in substance
abuse treatment become better parents.
This book highlights how the field of social work is uniquely qualified to
respond to the policy and practice challenges presented by the complexities
associated with substance use within families. Social work as a discipline
emphasizes cross-systems collaborations and the integration of
interdisciplinary knowledge to benefit the most vulnerable populations. It is
therefore paramount that we harness the collective interest and expertise of
the social work profession towards the dissolution of silos that make it
difficult for cross-fertilization and collaboration among the fields of
addiction science, traumatic stress, child welfare and children’s mental
health.

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