African–American women who use crack cocaine: a comparison of mothers who live with and have been separated from their children☆,☆☆,★
Introduction
It is estimated that one in four children lives with a parent who regularly uses alcohol or other drugs (Child Welfare League, 2001). Children of substance abusers are at increased risk of experiencing health, behavioral, psychological, and academic problems, including becoming substance abusers themselves (Kumpfer, 1999). Parents challenged by addiction and associated drug-seeking behaviors and lifestyles are at increased risk of having their children being placed in out-of-home care (Johnson & Leff, 1999; Kumpfer, 1987; Wilens, Biederman, Kiely, Bredin, & Spencer, 1995). In fact, parental drug use contributes to as many as 90% of child placements in the welfare system (GAO, 1997). Child neglect secondary to substance use has been cited as the primary reason for out-of-home placements (GAO, 1994; Zlotnick, Kronstadt, & Klee, 1998).
Despite this strong link between parental substance use and child welfare, many parents who use drugs have their children living with them (Beckwith, Howard, Espinosa, & Tyler, 1999; Kearney, Murphy, & Rosenbaum, 1994; Nair et al., 1997, Pilowsky et al., 2001; Tyler, Howard, Espinosa, & Doakes, 1997). Among clinical samples, between 66% and 85% of parents who abuse substances have been found to retain care or custody of their children (Hohman, Shillington, & Baxter, 2003; Tyler et al., 1997), while among community samples of drug-using mothers and fathers, 37% to 57% have been found to retain care of their children (Nair et al., 1997, Pilowsky et al., 2001).
The multiple environmental risk factors present in many families with parental substance abuse may exacerbate poor parenting and increase poor child outcomes (Dunn et al., 2002; Kettinger, Nair, & Shuler, 2000). A recent study of fathers who were entering drug treatment, had spouses who did not abuse alcohol or other drugs, and whose children were not exposed to drugs prenatally identified a number of risk factors in the child-rearing context created by parental drug users that affected their children (Fals-Stewart, Kelley, Cooke, & Golden, 2002). The study found that paternal substance use, as well as socio-demographic factors, parental relations, and parents’ psychological adjustment each contributed independently to child adjustment.
Given the traditional role of women as caretakers, mothers, in particular, are significantly more likely than fathers to be primary caregivers of at least one child. In a study of parents who were injecting drug users (IDUs) and not in treatment, 69% of mothers cared for their children, compared with 24% of fathers (Pilowsky et al., 2001). Substance-abusing mothers face their own challenges and stressors in their lives that compromise their parenting. Compared with non-addicted mothers, studies have demonstrated poorer parenting attitudes and behaviors among drug-using women (Ammerman, Kolko, Kirisci, Blackson, & Dawes, 1999; Hien & Honeyman, 2000; Kelley, 1998, Tyler et al., 1997). Numerous environmental and psychosocial risk factors have been associated with maternal substance abuse that likely contribute to poor parenting and compromised child outcomes in this population, including poverty, family dysfunction, and violence (Amaro, Fried, Cabral, & Zuckerman, 1990; Burns & Burns, 1990; Chasnoff, 1988, Colten, 1980, Finnegan, 1982; Ladwig & Anderson, 1989; Regan, Erlich, & Finnegan, 1987; Stein, Newcomb, & Bentler, 1993; van Baar, 1990). Substance-abusing mothers are also more likely than non-substance-abusing mothers to experience psychological symptoms, such as depression, anxiety, and antisocial personality disorders (Kelleher, Chaffin, Hollenberg, & Fischer, 1994; Kelley, 1998).
Research suggests that psychosocial and environmental risk factors exert both direct and indirect influences on outcomes of substance-abusing mothers and their children. Children of substance-abusing mothers who were homeless were more likely to have been removed from maternal care than substance-abusing mothers with housing (Zlotnick, Robertson, & Tam, 2002). Within maternal drug-using populations, comorbid maternal psychopathology predicted whether children remained in maternal care (Nair et al., 1997) as well as children's perceptions of parenting status and developmental outcomes (Beckwith et al., 1999; Hans, Bernstein, & Henson, 1999). Studies also suggest that the cumulative effects of environmental risk related to substance abuse may moderate effects on parenting in the population. Among a sample of substance-abusing mothers, those with high levels of environmental risk were more likely than those with low levels of environmental risk to report poor parenting attitudes and skills (Kettinger, Nair, & Schuler, 2000). Although limited, these studies provide evidence that while maternal substance use places mothers at increased risk of losing care of their children, the psychosocial and environmental factors associated with maternal drug use may exert independent and unique influences on caregiver status and child outcomes above and beyond parental drug abuse alone. These findings suggest that it may be possible to mitigate the adverse effects of maternal drug use on parenting by addressing other psychosocial and environmental risks and protective factors.
Although crack use is present among all ethnic groups (Weinstein, Roberts, & Pflugh, 1992), it is most prevalent among African–Americans (Havassy, Wasserman, & Hall, 1993), particularly low-income inner-city African–Americans (Carlson & Siegal, 1991). Crack use often leads to unstable and chaotic lifestyles. Psychosocial and environmental risk factors of homelessness, unemployment, lack of social support, a difficult childhood, childhood and adult victimization, criminal involvement, and depression, anxiety, and traumatic stress symptoms are especially prevalent in the lives of African–American women who use crack cocaine (Roberts, Wechsberg, Zule, & Burroughs, 2003; Wechsberg et al., 2003).
Boyd (1993) examined the relationships between age of first sexual abuse, first depressive symptoms, family drug use and age of first drug use among African–American women. Overall, Boyd found that a history of sexual abuse, depression, and family drug use were common antecedents to crack use. Cohen (1999) similarly reported that a history of physical and sexual abuse and parental drug use are common antecedents to crack use among African–American women. African–American women (92% of whom were mothers) who used crack and had a history of sexual abuse reported addictions to more substances and negligent parenting because of their drug use than women without such a history (Young, Boyd, & Hubbell, 2001). The strong associations among women between histories of child sexual and/or physical abuse and substance abuse (Harrison, Fulkerson, & Beebe, 1997; Wolock & Magura, 1996; Young et al., 2001) and increased psychological difficulties (Medrano, Hatch, Zule, & Desmond, 2002) are particularly concerning for maternal substance users, who are at increased risk of subsequently abusing or neglecting their own offspring (Brown, Cohen, Johnson, & Salzinger, 1998; Dunn et al., 2002, Kelleher et al., 1994, Leventhal et al., 1997).
Most research on drug-abusing parents targets clinical samples receiving treatment or identified through the courts (Hogan, 1998). A limited number of studies have begun to focus on drug-abusing parents who are not in treatment, examining factors that may affect the likelihood that they retain care of their children. A recent study of a community sample of parents who were IDUs found that 69% of mothers had their children living with them. Those living with children under 14 years of age were more likely to be female, have health insurance, engage in no- or low-risk drug practices, and be in better physical health than parents who were separated from their children (Pilowsky et al., 2001). In a comparison of mothers who remained primary caregivers of their child after 18 months (57%) and those who did not, Nair et al. (1997) identified maternal factors assessed within 2 weeks of the postpartum hospital stay that predicted disruptions in primary care of their infants at 18 months of age. These authors found that mothers who experienced disruptions in primary care of their infants by 18 months had tested positive for heroin use at their first child's birth, had two or more children, were younger, and reported more depressive symptoms than mothers who retained primary care of their child. Few studies, however, have identified the independent and unique effects of postnatal drug use and risk behaviors and associated environmental and psychosocial risks on caregiving status.
Given that over half of mothers who use illicit drugs may retain care of their children, understanding the contexts in which these children and mothers live is important for advancing research and practice in the fields of substance use and child welfare. The purpose of the present study is to describe characteristics of African–American mothers who use crack cocaine, comparing women who have their children living with them with those mothers who have been separated from their children on measures of socio-economic characteristics, drug use, risky sex practices, psychological symptoms, and victimization and aggressive experiences, and to determine whether current risk behaviors, psychosocial, and environmental factors influence caregiver status. This study fills an important gap in the literature by examining factors that affect whether mothers retain care of their children among a rarely studied sample of African–American women who actively abuse crack cocaine but are not connected to formal service or welfare systems.
Section snippets
Study population and recruitment
The sample was drawn from an intervention research study funded by the National Institute on Drug Abuse that was conducted in the Raleigh-Durham area of North Carolina. This study, the NC Women's CoOp, targeted African–American women who used crack but were not in drug treatment and were at risk of HIV. The program provided an HIV risk-reduction intervention that was tailored more closely to culturally- and gender-based needs than previous HIV prevention interventions. Study and data collection
Demographic characteristics
Table 2 presents the background characteristics of the mothers in the study. Caregiver mothers were somewhat younger (33.7 years, SD = 5.6) than those who were separated from their children (34.5 years, SD = 5.9) (p = .072). On average, women in each group had between two and three children, and were comparable regarding marital status, education levels, and employment status. Mothers living with and without their children were equally likely to be involved with the child welfare system. Mothers who
Discussion
In this study, 40% of African–American mothers who used crack cocaine had at least one of their children living with them, a lower proportion than the 46% to 69% found in other studies of non-clinical samples of mothers who use illicit drugs (Beckwith et al., 1999, Nair et al., 1997, Pilowsky et al., 2001). Findings suggest that the challenging and risky contextual environments in which African–American mothers who use crack cocaine may live have stronger influences on caregiver status than
Acknowledgments
We wish to thank all the women participants, field staff and RTI staff for their dedication to the study.
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This work was supported by the National Institute on Drug Abuse (NIDA) Grant No. 1 R01 DA 11609, Wendee M. Wechsberg, Principal Investigator.
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The interpretations and conclusions do not necessarily represent the position of NIDA or the U.S. Department of Health and Human Services.
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Preliminary analyses for this paper were presented at the Victimization of Children and Youth: An International Research Conference, August 4–7, 2002.