Center for Development of Human Services

The Effects of Parental Alcohol and Drug Abuse on Children

Child Welfare Worker Handbook

Stephen Webster, Pharm.D. Candidate

University at BuffaloSchool of Pharmacy and Pharmaceutical Sciences

William A. Prescott Jr., Pharm.D.,

Clinical Assistant Professor

University at BuffaloSchool of Pharmacy and Pharmaceutical Sciences

James Brustman, CDHS Child Welfare Trainer

Phyllis Harris, CDHS UB Partnership Coordinator

William Rea, CDHS Child Welfare Trainer

David Peters, CDHS Senior Child Welfare Trainer

Funding for this research project was provided by NYS Office of Children and Family Services, Contract year 2005: Project1044698, Award: 34851; Contract year 2006: Project1052594, Award38452, through the Center for Development of Human Services, College Relations Group, Research Foundation of SUNY, Buffalo State College.

Table of Contents

Page(s)Section

1Introduction

2Explanation of Terms

3-4Frequently Asked Questions (FAQs)

5Signs and Symptoms of Drug Intoxication and

Withdrawal

6-10Commonly Abused Substances Quick Reference Chart

11Alcohol

12Cannabinoids

13Cocaine/Crack

14Dissociative Drugs

15Ecstasy/MDMA

16Hallucinogens

17Heroin

18Methamphetamine/Amphetamine

19-20Prescription Analgesics / Opioids

21-22Prescription Depressants

23Family-related Consequences of Parental Substance Abuse

24Website Resource Table

25-26References

Introduction

Overview:Child welfare workers are faced with decisions regarding the current safety of and future risk to children. When parents are actively involved in the use of drugs and/or alcohol, their behavior may cause the children to be in immediate danger of serious harm. Such behavior may result in interventions that include removal of children from their home. In order to strengthen decision making so that children are not being removed when they can remain at home and that they are not being left in situations that leave them in danger of serious harm, workers need to understand the behavioral and psychological aspects of drug/alcohol abuse.

When children have been placed in out of home care, caseworkers are required to pursue diligent efforts to reunite the family. Under the Adoption and Safe Families Act (ASFA), child welfare caseworkers are required to file for termination of parental rights if the children have been in foster care for 15 of the past 22 months. As a result, caseworkers are making decisions regarding family reunification fairly early in the treatment process, often after only 12 months of foster care. If the risk to the children is high, parental rights may be terminated. However, where risk can be reduced to acceptable levels, children may be returned home. In order to better assess the risk presented by parents with alcohol and/or other drug abuse or addiction, caseworkers can benefit from knowledge of the behavioral and physical changes that occur during the treatment period.

Purpose:This handbook is designed for use by CDHS child welfare workerswith the goal to improve the quality and efficiency of child welfare interventions.

Explanation of Terms

Drug Abuse: The use of a drug that results in cognitive, physical, or emotional impairment and adverse consequences.

Drug Addiction: Means that a drug user/abuser is unable to reduce the dose, discontinue using, or is unable to remain abstinent from using a drug because the brain has become chemically dependent on the drug.

Psychological Drug Dependence: Refers to compulsive drug-using behavior in which a person uses a drug for that’s drug’s effect, not necessarily due to a physical dependence, often in the face of known health risks.

Physical Drug Dependence: The physiological adaptation of the body to a drug when that drug is used for an extended period of time, such that when use is abruptly discontinued, certain withdrawal symptoms appear.

Tolerance: The body's need for increasing amounts of a drug to attain the desired effect and avoid withdrawal.

Withdrawal:Symptoms that occur after the use of specific addictive drugs are reduced or discontinued. The duration and type of withdrawal symptoms vary with the type of drug.

Relapse: The abuse of drugs and/or alcohol or the return of drug abusing behavior after a period of abstinence or recovery planning.

Potentiation: Occurs when the combined action of two or more drugs is greater than the sum of the effects of each drug taken alone.

Abused Child: A child less than eighteen years of age whose parent/caregiverinflicts or allows to be inflicted upon such a child physical or emotional injury by other than accidental means, orcreates or allows to be created a substantial risk of physical or emotional injury to such a child by other than accidental means.

(see NYS law section 412)

Child Neglect: Failure to provide for a child’s basic needs. Neglect can be physical, educational, or emotional. Neglect includes withholding of medically indicated treatment.

Child Maltreatment: An act or the failure to act on the part of a parent/caregiver that results in either death, serious physical or emotional harm, sexual abuse or exploitation, or an imminent risk of serious harm to a child.

Frequently Asked Questions

Why do individuals use mood-altering substances?

People start using illicit substances for a variety of reasons including but not limited to, depression, stress, boredom, peer pressure, traumatic life experiences, and curiosity. These individuals may continue to use mood-altering substances as a result of addiction and physical dependence.

How quickly can someone become addicted to a drug?

If and how quickly someone may become addicted to a drug depends on many factors including a person’s genetic make-up, the type of drug used, the dose of drug used, and the frequency of drug usage.

Why do some individuals become dependent/addicted and others not?

The likelihood that an individual user will advance to addiction is difficult to predict. Some people may experiment with drugs and then stop, while others may continue to use. The genetic predisposition to alcoholism has been well established, while genetic involvement with respect to addiction to other drugs has been less well-defined.

Why does recovery from substance dependency/addiction vary from individual to individual?

The ability of an individual to recover from addiction is difficult to predict. While certain persons may remain abstinent for life after a single treatment episode, others may experience a lifelong cycle of relapse and treatment. The type of drug addiction may play a role as certain drug addictions may be more difficult to overcome than others, namely drugs that lead to physical dependence as well as a psychological addiction.

Can individuals addicted to drugs quit without medical treatment?

A small proportion of persons addicted to drugs may be able to quit without medical treatment. However, those addicted to drugs suffer from a compulsive drug craving and usage, and most often cannot quit by themselves. Thus, treatment is generally necessary to end this compulsive behavior.

Are substance dependent parents more likely to abuse/neglect their children?

Research has demonstrated that compared with children in non-substance abusing households, children of substance abusing parents are more likely to experience neglect or physical, sexual, or emotional abuse. A parent’s inability to function in a parental role may be due to a disproportionate amount of time and money spent acquiring and using drugs.

What dangers are posed to childrenresiding near drugs of abuse?

The presence of drugs and drug paraphernalia (syringes, razors, etc.) in the household pose a significant risk to children. Most illicit and prescription drugs are toxic when orally ingested, especially by a small child. The effect on a small child could be fatal. Needles, syringes, and razor blades are types of drug paraphernalia that pose another danger to children. Households involved in drug production place children at risk as well, as the preparation of many drugs requires the useof highly volatile chemicals.

Are there effective treatments for all types of drug addiction?

All types of drug addiction can be effectively treated with behavioral-based therapies. Treatment will vary for each person depending on the type of drug(s) being used, and multiple courses of treatment may be needed to achieve success. Medications may assist in the recovery from physical dependence to certain.

How can the risk of relapse be lessened?

Cognitive-behavioral therapy based on the theory that learning processes play a critical role in the development of maladaptive behavioral patterns,is used to prevent relapse. The use of this therapy helps individuals to learn to identify and correct problematic behaviors. Relapse prevention encompasses several cognitive-behavioral strategies that facilitate abstinence as well as provide help for people who experience relapse. Prescription medications may also be useful to help prevent relapse.

How does a family history of substance abuse affect children?

Substance abuse by any member places a burden on the household. A family history of substance abuse places future generations at greater risk to develop substance abuse problems themselves.

Is it possible to be an effective parent while abusing drugs?

This question may be unanswerable. The central issue is that addiction to alcohol and other drugs can be a chronic relapsing disorder. Recovery can be a long term process. At the same time, children have an immediate need for a safe and stable home in which to live. Balancing these factors, as parents make sincere efforts to provide safe and loving homes for their children, represents a key challenge for the child welfare field and for judges making critical custody decisions.

Signs and Symptoms of Drug Intoxication and Withdrawal

1 2 3 4

Key:1 = Opiate (Heroin) or Sedative (Benzodiazepine, Barbiturate) Intoxication 2 = Stimulant (Cocaine, Methamphetamine) Withdrawal

3 = Opiate (Heroin) or Sedative (Benzodiazepine, Barbiturate) Withdrawal

4 = Stimulant (Cocaine, Methamphetamine, Ecstasy), Hallucinogen (LSD), Dissociative (Ketamine, PCP) Intoxication

* These are possible signs and symptoms of drug use, but all signs and symptoms listed may have a variety of other causes.

Commonly Abused Substances Quick Reference Chart

This reference can be used by CDHS trainers and child welfare workers when quick access to basic information on commonly abused substances is needed.

Key:Bolded = Most common intoxicating effects

Italicized = Parenting implications

Cannabinoids

Abused Substance / Street Names / Administered / Intoxication Effects / Health Consequences
Hashish / boom, chronic, gangster, hash, hash oil, hemp / smoked
swallowed / euphoria; slowed thinking and reaction time; confusion; impaired balance and coordination / cough, frequent respiratory infections; impaired memory and learning; increased heart rate; anxiety; panic attacks; tolerance; addiction
Marijuana / blunt, dope, ganja, grass, herb, joint, mary jane, pot, reefer, weed / smoked
swallowed

Hallucinogens

Abused Substance / Street Names / Administered / Intoxication Effects / Health Consequences
LSD
(lysergic acid diethylamide) / acid, blotter, boomers, cubes, microdot, yellow sunshines / swallowed
absorbed through mouth tissues / altered states of perception and feeling; nausea / flashbacks; paranoia
Also for LSD and Mescaline:
increased heart rate, blood pressure; sleeplessness; numbness; weakness; tremors; persistent mental disorders
Mescaline / buttons, cactus, mesc, peyote / swallowed
smoked
Psilocybin / magic mushroom, shrooms / swallowed

Depressants

Abused Substance / Street Names / Administered / Intoxication Effects / Health Consequences
Barbiturates
(Amytal, Nembutal, Seconal, Phenobarb) / barbs, reds, red birds, phennies, tooies, yellows, yellow jackets / injected
swallowed / sedation; drowsiness; dizziness; reduced anxiety; feeling of well-being; lowered inhibitions; slowed pulse and breathing; lowered blood pressure; poor concentration / fatigue; confusion; impaired coordination, memory,judgment; addiction; respiratory depression and arrest, death
Also for Barbiturates: depression; unusual excitement; fever; irritability; poor judgment; slurred speech; life-threatening withdrawal
Also for Flunitrazepam:
visual and gastrointestinal disturbances; urinary retention; memory loss for the time under the drug's effects
Also for GHB:
nausea/vomiting; headache; loss of consciousness; loss of reflexes; seizures; coma; death
Benzodiazepines
(Ativan-lorazepam, Halcion- temazepam, Librium-chlordiazepoxide, Valium-diazepam, Xanax-alprazolam) / candy, downers, sleeping pills, tranks / injected
swallowed
Flunitrazepam
(Rohypnol) / forget-me pill, Mexican Valium, R2, Roche, roofies, roofinol, rope, rophies / swallowed
snorted
GHB
(gamma-hydroxybutyrate) / G, Georgia home boy, grievous bodily harm, liquid ecstasy / swallowed

Opioids and Morphine Derivatives

Abused Substance / Street Names / Administered / Intoxication Effects / Health Consequences
Codeine
(Robitussin A-C, Tylenol w/ Codeine (#3 and #4) / Captain Cody, schoolboy; doors & fours, loads, pancakes and syrup / injected
swallowed / pain relief; euphoria; drowsiness
Also for Codeine: less analgesia; sedation; and respiratory depression than morphine
Also for Heroin: staggering gait / nausea; constipation; confusion; sedation; respiratory depression and arrest; tolerance; addiction; unconsciousness; coma; death
Fentanyl
(Actiq, Duragesic, Sublimaze) / Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash / buccal
injected
smoked
snorted
transdermal
Heroin / brown sugar, dope, H, horse, junk, , skunk, smack, white horse / injected
smoked
snorted
Morphine
(Kadian, MS Contin, Roxanol) / M, Miss Emma, monkey, white stuff / injected
swallowed
smoked
Opium / big O, black stuff, gum / swallowed
smoked
Oxycodone
(Endocet, Oxycontin, Percocet, Roxicet, Roxicodone) / Hillbilly heroin, Kickers, Blue, Oxy, O.C., Killer, Percs, Percodoms / injected
swallowed
snorted
Hydrocodone bitartrate
(Lorcet, Norco, Lortab, Vicodin) / Vike, Watson-387 / swallowed

Stimulants

Abused Substance / Street Names / Administered / Intoxication Effects / Health Consequences
Amphetamine
(Biphetamine, Dexedrine, Adderall) / bennies, black beauties, crosses, hearts, LA turnaround, speed, truck drivers,uppers / injected
swallowed
smoked
snorted / Increased heart rate; blood pressure; metabolism; feelings of exhilaration, energy; increased mental alertness
Also for Amphetamine:
rapid breathing; tremor
Also for Cocaine: increased temperature
Also for MDMA: mild hallucinogenic effects; increased tactile sensitivity; empathic feelings
Also for Methamph:
aggression; violence; psychotic behavior / irregular heart beat; weight loss, heart failure, nervousness, insomnia; tolerance; addiction
Also for Amphetamine: tremor; loss of coordination; panic; paranoia; impulsive behavior; aggressiveness; psychosis
Also for Cocaine: chest pain; respiratory failure; nausea; strokes; seizures; panic attacks
Also for MDMA: impaired memory and learning, cardiac, renal and liver toxicity
Also for Methamph:
memory loss; cardiac andneurological damage; impaired memory and learning
Cocaine/Crack / blow, bump, C, candy, Charlie, coke, flake, rock, snow, toot / injected
smoked
snorted
MDMA/Ectasy
(methylenedioxy-
methamphetamine) / Adam, clarity, Eve, lover's speed, peace, STP, X, XTC / swallowed
Methamphetamine
(Desoxyn) / chalk, crank, crystal, fire, glass, go fast, ice, meth, speed / injected
swallowed
smoked
snorted
Methylphenidate
(Ritalin, Metadate) / JIF, MPH, R-ball, Skippy, the smart drug, vitamin R / injected
swallowed
snorted

Dissociative Anesthetics

Abused Substance / Street Names / Administered / Intoxication Effects / Health Consequences
Ketamine
(Ketalar SV) / cat Valiums, K, Special K, vitamin K / injected
snorted
smoked / increased heart rate and blood pressure; impaired motor function
Also for Ketamine:
delirium; depression; respiratory depression and arrest
Also for PCP:
possible decrease in blood pressure and heart rate; panic; aggression; violence / memory loss; numbness; nausea/vomiting
Also for PCP:
Loss of appetite; depression
PCP and analogs
(phencyclidine) / angel dust, boat, hog, love boat, peace pill / injected
swallowed
smoked
snorted

Inhalants

Abused Substance / Street Names / Administered / Intoxication Effects / Health Consequences
Solvents
(paint thinners, gasoline, glues),
Gases
(butane, propane, aerosol propellants, nitrous oxide), nitrites (isoamyl, isobutyl, cyclohexyl) / laughing gas, poppers, snappers, whippets / inhaled through nose or mouth / stimulation; loss of inhibition; headache; nausea or vomiting; slurred speech; loss of motor coordination; wheezing / unconsciousness; cramps; weight loss; muscle weakness; depression; memory impairment; damage to cardiovascular and nervous systems; sudden death

Alcohol

Physiological EffectsSigns and Symptoms of Intoxication

DrowsinessDecreased blood pressureSevere drowsinessSevere respiratory depression

Slowed respirationFeeling of well-beingConfusionAggression

Slowed cognitionDecreased coordinationEmotional bluntingHypotension

Decreased heart rateDecreased body temperatureMemory impairmentPoor coordination

Slurred speechDecreased heart rate

Increased irritabilityDecreased body temperature

Complications of Abuse/Addiction

The most serious complication of alcohol abuse is addiction and physical dependence. Alcohol addiction can dominate a person’s life, such that all aspects of everyday living become increasingly affected.

After many years of heavy alcohol abuse, the liver becomes damaged and full of scar tissue. Subsequently, a person may develop liver cirrhosis, kidney damage, immune system impairment, gastric ulceration and cancer, heart disease, and high blood pressure. When alcohol is abruptly discontinued in patients with a long history of abuse, severe withdrawal symptoms result. Alcohol withdrawal is a serious medical condition, and can be life-threatening without medical supervision.

The combination of alcohol and other drugs can be extremely dangerous as alcohol may intensify the effects of other drugs.

Alcohol impairment can lead to a variety of mishaps that endanger the lives of the user/abuser and innocent bystanders. Within the United States, alcohol is a major cause of traffic accidents and on-the-job injuries.

Withdrawal

Onset: A person with a long history of regular alcohol intake who abruptlydiscontinues or drastically reduces alcohol consumption may experience withdrawal symptoms within 12 hours of their final drink. Major withdrawal symptoms peak between 24 and 72 hours after the last drink and last between 5 and 7 days.

Symptoms:Alcohol cravingElevated blood pressure