Treatment of co-occurring child maltreatment and substance abuse

doi:10.1016/j.avb.2005.08.007

Aggression and Violent Behavior

Volume 11, Issue 6, November–December 2006, Pages 626-640

https://doi.org/10.1016/j.avb.2005.08.007 Get rights and content

Abstract

Despite high prevalence and severe negative consequences of child maltreatment (e.g., Brown, G. R., & Anderson, B., (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55–61; Jaudes, P. K., Ekwo, E., & Van Voorhis, J.V., (1995). Association of drug abuse and child abuse. Child Abuse and Neglect, 19, 1065–1075; Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., & Goshkom, M., (1991). Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15, 197—211), the treatment of perpetrators and victims of child abuse and neglect remains grossly understudied (Behl, L. E., Conyngham, H. A., & May, P. F., (2003). Trends in child maltreatment literature. Child Abuse and Neglect, 27, 215–229). More than half of parentes founded for the abuse and neglect of their children have evidenced drug abuse, yet no treatments have been validated that concurrently address these problems. The reciprocal interaction between substance abuse and child maltreatment supports the need to concurrently treat these problems. This article illustrates the relationship between child maltreatment and parental substance abuse and proposes a behavioral model to explain the reciprocal influence of drug abuse and child maltreatment. A behavioral treatment plan that is designed to concurrently address drug abuse and child abuse is proposed and suggestions are made for future directions in this area.

Section snippets

Brief prevalence and description of child neglect and physical abuse

Approximately 4% of children are reportedly victims of child maltreatment (McCurdy & Daro, 1993), with child neglect accounting for about 60% of the founded incidents of child maltreatment, and child physical abuse accounting for most of the remaining cases (Scannapieco & Connell-Carrick, 2002, U.S. Department of Health and Human Services, 1998). Unlike other forms of child maltreatment, child neglect involves an omission of protective behaviors that may result in harm to the child. Several

Strong relationship between drug abuse and child abuse and neglect

Co-occurring substance abuse and child maltreatment in parents is evidenced in both substance abuse treatment and child protective service settings. Perpetrators of child maltreatment have been identified to abuse illicit substances in the majority of substantiated cases (e.g., Murphy et al., 1991). Indeed, parental substance abuse appears to negatively influence at least 70% of reported cases of child maltreatment (see Brown & Anderson, 1991, Famularo et al., 1992, Locke & Newcomb, 2003), and

Characteristics and consequences of co-occurring drug abuse and child abuse and neglect

Family constellations of maternal substance abusers that physically abuse and neglect their children are rather untraditional. As indicated by Chance and Scannapieco (2002), the households of these mothers tend to be unstable, as mothers are often the single heads of the household, and there tends to be multiple male father figures and other significant others who transiently reside with the mother, such as parents, aunts, other relatives, friends and roommates. In “providing a portrait of a

A behavioral model to explain the need to treat substance abuse and child maltreatment concurrently

As previously reviewed, there are several stimuli (e.g., stress) that occur prior to, or are associated with, substance abuse, child abuse and child neglect. Indeed, these antecedent stimuli and events usually have a negative influence on all three problems, sometimes concurrently (see Table 1 for a few examples). Thus, targeting the elimination of these antecedent conditions, as well as the factors maintaining them, is crucial to the effective amelioration of both substance abuse and child

Treatment

Absence of controlled treatment outcome studies in substance abusing mothers who have been found to abuse and neglect their children is a significant problem (e.g., see Blau et al., 1994, Chavkin et al., 1993, Conners et al., 2001). Proposed interventions for this population include family skills training (Magura & Laudet, 1996) and home-based interventions (Jaudes et al., 1995, Wolfe, 1993). As emphasized by Donohue, Ammerman, and Zelis (1998), home-based family therapies permit efficient

Concluding comments

The treatment of child abuse and child neglect has been grossly understudied in controlled treatment outcome studies, although both of these maltreatment types are relatively prevalent. Perhaps more deplorable, substance abuse plays a significant role in up to 70% of cases referred to child protective services, however, no controlled treatment outcome studies have been conducted in this population. Moving towards the development of treatment specific to this population, this paper provides the

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Childhood maltreatment, including physical, emotional, and sexual abuses, and neglect, is a strong risk factor for psychiatric disorders across the human lifespan (Norman et al., 2012). Increasing evidence showed that childhood maltreatment has several adverse psychological and behavioral consequences, such as anxiety, post-traumatic stress disorder, depression, conduct disorder, attention deficit hyperactivity disorder (Gilbert et al., 2009; Hussey, Chang, & Kotch, 2006; Runyan, Wattam, Ikeda, Hassan, & Ramiro, 2002), drug abuse, and drug addiction (Donohue, Romero, & Hill, 2006; Hadland et al., 2012; Kilpatrick et al., 2000; Longman-Mills et al., 2013; Rosenkranz, Muller, & Henderson, 2012; Tripodi & Pettus-Davis, 2013). The experience of childhood maltreatment is established to cause the increasing rate of drug addiction (Herrenkohl, Hong, Klika, Herrenkohl, & Russo, 2013).
Childhood maltreatment is widely accepted as a risk factor for drug addiction from adolescence to adulthood. However, the influence of childhood maltreatment on drug treatment related variables, such as drug abstinence motivation and self-concept, as well as self-efficacy, remains unclear. This study aims at exploring whether self-concept mediates the relationship between childhood maltreatment and abstinence motivation, as well as self-efficacy, among drug addicts.
This study involves 816 (550 males, 226 females, mean age = 34.59, range = 16–58 years) drug addicts from compulsory detoxification units. Participants completed questionnaires, including the childhood trauma questionnaire 28 - item short form (CTQ - SF), Tennessee self-concept scale (TSCS), general self-efficacy scale (GSES), and drug abstinence motivation questionnaire (DAMQ).
The structural equation model (SEM) analysis, including total and specific forms of maltreatment scores, showed that childhood maltreatment was negatively associated with self-concept, self-efficacy, and abstinence motivation. Self-concept was positively associated with self-efficacy and abstinence motivation. Conversely, significant association between self-efficacy and abstinence motivation did not exist. An indirect analysis showed that self-concept mediated the relationship between childhood maltreatment and self-efficacy. Critically, self-concept arbitrated the relationship between childhood maltreatment and abstinence motivation. The indirect effect of self-concept between childhood maltreatment and abstinence motivation still existed when the total scores of maltreatment were replaced by the scores of specific forms of maltreatment.
These results demonstrated that self-concept is a critical factor in understanding the relationship between childhood maltreatment and abstinence motivation, as well as self-efficacy, among drug addicts. Improving the sense of self-worth may be an effective intervention therapy among drug addicts with childhood maltreatment history.
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The deleterious effects of childhood abuse have been a focus of much research; however, the causes of parental physical abuse are less well documented. Research with clinical samples suggests that individuals who display abusive behaviors are more likely to have a history of childhood abuse and higher rates of internalizing and externalizing disorders. Whether childhood abuse and psychopathology contribute independently to parental abusive behaviors or if the association between childhood abuse and the parental physical abuse is mediated by the individual's psychopathology has not been studied empirically.
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Childhood emotional maltreatment and later psychological distress among college students: The mediating role of maladaptive schemas
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Treatment of co-occurring child maltreatment and substance abuse

Abstract

Section snippets

Brief prevalence and description of child neglect and physical abuse

Strong relationship between drug abuse and child abuse and neglect

Characteristics and consequences of co-occurring drug abuse and child abuse and neglect

A behavioral model to explain the need to treat substance abuse and child maltreatment concurrently

Treatment

Concluding comments

Behaviour Research and Therapy

Behaviour Research and Therapy

Child Abuse and Neglect

Child Abuse and Neglect

Child Abuse and Neglect

Children and Youth Services Review

Child Abuse and Neglect

Journal of Substance Abuse Treatment

Behavior Therapy

Journal of Substance Abuse Treatment

Journal of the American Academy of Child and Adolescent Psychiatry

Journal of Behaviour Therapy and Experimental Psychiatry

Child Abuse and Neglect

Child Abuse and Neglect

Journal of American Academic Child and Adolescent Psychiatry

Children and Youth Services

Drug and Alcohol Dependence

Children and Youth Services Review

Children and Youth Services Review

Child Abuse and Neglect

Child and Youth Services Review

Child Abuse and Neglect

Methodological issues in child maltreatment research

Child psychical abuse and neglect

Youth drug abuse treatment: A controlled outcome study

Journal of Child and Adolescent Substance Abuse

A controlled evaluation and description of individual-cognitive problem solving and family-behavioral therapies in conduct-disordered and substance dependent youth

Journal of Child and Adolescent Substance Abuse

Home safety with families being treated for child abuse and neglect

Behavior Modification

Is abuse during childhood a risk factor for developing substance abuse problems as an adult?

Journal of Developmental and Behavioral Pediatrics

The prevention and treatment of child abuse in households of substance abusers: A research demonstration report

Child Welfare League of America

Multisytemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence

Journal of Consulting and Clinical Psychology

Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse

American Journal of Psychiatry

Comparison of multi systemic therapy and parent training in the brief treatment of child abuse and neglect

Journal of Consulting and Clinical Psychology

An ecological model of maternal substance abuse and child neglect: Issues, analyses, and recommendations

American Journal of Orthopsychiatry

Parent–child interaction therapy with physically-abusive parents: Efficacy for reducing future abuse reports

Journal of Consulting and Clinical Psychology

Ecological correlates of child maltreatment: Similarities and differences between child fatality and nonfatality cases

Child and Adolescent Social Work Journal

Reframing the debate: Toward effective treatment for inner city drug abusing mothers

Bulletin of the New York Academy of Medicine

A critical review of the empirical literature: Identifying correlates of child neglect

Child and Adolescent Social Work Journal

Family interventions with child physical abuse and neglect: A critical review

Children and Services Review

Relationships at risk

Self-esteem and depression in abusive, neglecting, and non-maltreating mothers

Infant Mental Health Journal

Current trends in child abuse reporting and fatalities: The results of the 1991 annual fifty state survey

The effects of adult and peer social initiations on the social behavior of withdrawn and aggressive maltreated preschool children

Journal of Family Violence

Cognitive problem solving training to improve the child-care judgment of child neglectful parents

Journal of Family Violence

A social information-processing model of social competence in children

Child physical abuse and neglect

Improving initial session attendance in conduct disordered and substance abusing adolescents: A controlled study

Journal of Child and Adolescent Drug Abuse

Family behavior therapy

Development of an ecobehavioral treatment program for child maltreatment

Behavioral Interventions

An ecobehavioral approach to child maltreatment