The blog of the Urban Institute
July 31, 2019

Helping Parents Overcome Unhealthy Substance Use

Substance use disorder (SUD) has far-reaching effects, including for the children of the 4.8 million parents with an SUD who live with their children. Parental SUD (considered a type of adverse childhood experience on its own) often co-occurs with neglect and puts children at elevated risk of poor health and other problems across their lifespan. Recent studies suggest that these problems are worsening, as the number of children entering foster care because of parental drug use has increased over the past decade.

In a new report, we find that US families with children from every population we studied are affected by SUDs, regardless of race or Hispanic origin. This includes 16.1 percent of American Indian/Alaska Native parents, 11.9 percent of multiple-race parents, 7.9 percent of Native Hawaiian/Pacific Islander parents, 7.5 percent of white parents, 7.2 percent of black parents, 5.4 percent of Hispanic parents, and 2.0 percent of Asian parents.

Black, Hispanic, and American Indian/Alaska Native parents with SUDs and their children may be particularly vulnerable, as evidence shows that unhealthy substance use may have more profound health and social consequences for them. But for all families, parental SUD represents a critical vulnerability that policymakers and direct service providers need to address.

Missed opportunities to help parents with substance use disorder

Although our previous research has pointed to the troubling lack of treatment for parents with SUD (including opioid use disorder specifically), our new report shows there is also ample opportunity to help parents.

Screenings at regular medical visits

The US Preventive Services Task Force recommends universal screening and brief behavioral counseling interventions for unhealthy alcohol use at medical visits, as they are proven to reduce unhealthy use. The effectiveness of drug screening for the general population is less clear, but the US Surgeon General (PDF), the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and others call for universal screening for unhealthy drug use at regular medical visits.

Even though four in five parents see a provider about their own health at least once a year, we find that many are not asked about their use of alcohol or drugs.

Even thoughfour in five parents see a provider about their own health at least once a year, many are not asked about their use of alcohol or drugs.

The share of parents not asked during medical visits about their drug use is even larger than the share not asked about alcohol use. The share not asked about drug use ranges from 27.3 percent among American Indian/Alaska Native parents to 55.6 percent among Asian parents.

Treatment rates

Our research also identified missed opportunities to treat parents with an SUD. Among parents with an SUD, we found very low rates of past-year treatment, especially among black and Hispanic parents: 8.7 percent among black parents, 8.6 percent among Hispanic parents, 12.9 percent among white parents, and 22.1 percent among multiple-race parents.

We also found distressingly high rates of parents with an SUD who were treated in the past but who had no treatment in the year before the survey. Among parents with an SUD, the study found that 25.8 percent of American Indian/Alaska Native parents, 19.0 percent of multiple-race parents, 17.0 percent of white parents, 10.8 percent of black parents, and 9.2 percent of Hispanic parents were treated in the past but had no treatment in the year before the survey.

Parents who were treated in the past and had a recurrence of unhealthy substance use represent a critical missed opportunity because they demonstrated an interest and willingness to address their substance use. SUDs are chronic conditions, and it is expected that people with SUDs stop and restart treatment multiple times before they are stabilized in recovery. But restarting treatment may be more challenging for parents because of the added complexity (i.e., the time and logistics involved in treatment and the effect of parental stress on children).

How to support families through better practice and policy

We can learn from policies and programs that have already boosted rates of screening, intervention, and treatment in specific settings.

The US Veterans Health Administration (VHA) increased its rates of screening and brief intervention by providing physicians more training, electronic reminders during medical visits, and financial incentives to screen patients. After the VHA implemented changes, a study found that among veterans who drink unhealthy amounts, those who received their health care from the VHA had more than twice the odds of getting a brief intervention and being advised to reduce or abstain from drinking.     

Raising treatment rates requires addressing a range of capacity and infrastructure issues related to the low availability of evidence-based SUD treatment programs in communities—especially in those that are predominantly black or rural (PDF). Strategies to increase treatment include addressing deficits in clinician education, improving referral networks, increasing supportive services, increasing the availability of family-centered and culturally competent services, reducing insurance-related barriers, and increasing Medicaid financing for treatment.

Ultimately, we see strong evidence that screening and brief interventions are effective at curbing unhealthy substance use. These services should be universal, but they’re not. And by missing these opportunities to support families struggling with unhealthy substance use or SUD, we are neglecting the needs of millions of children.

Equitably addressing gaps in community-based services, better following existing guidelines and protocols, and making treatment programs more available and family-friendly could make a huge difference for many parents and their children across all levels of income and across race, ethnicity, and geography.

Hillary Comparone holds her children in her bedroom on March 6, 2016 in Plainville, CT while marking the first anniversary of the death of the children's father, Benjamin, who died of a heroin overdose. (Photo by John Moore/Getty Images)

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