NDARC Technical Report No. 242 (2006)
EXECUTIVE SUMMARY
Aims
- The aim of this project was to undertake a comprehensive review of the research evidence related to the utility and cost of parental drug-testing in child protection cases.
- Articles were located via databases: APAIS – Health, MEDLINE and PsycINFO, and using keywords: ‘drug testing’ and ‘parent#’, and for more specific research questions ‘child protection’, ‘workplace’, ‘gender’, ‘rehabilitation’, ‘screening’, and ‘assessment’. Searches were also conducted using reference lists of existing related literature reviews and reports. Documents were also accepted from the Department of Community Services, resulting from their own literature searches.
- Assessment of alcohol misuse has not been included in the report, although it is acknowledged that alcohol is a substance of concern in parental substance abuse.
Findings
The extent of the evidence
- The potential effects of parental substance abuse range widely and, while the causal relationship between parental substance abuse and child abuse or neglect could be considered at length, suffice to state that there is an increased risk of potential negative effects on the family. Drug use in the context of true drug dependence is of greater concern than lower levels of consumption.
- The literature on the value of parental drug-testing in the context of child protection is small, but suggests its appropriate use is feasible and that it can promote better outcomes in child-at-risk cases, as long as monitoring and compliance with testing and treatment entry are supported.
- Similarly, the use of drug-testing as a broad sweep approach to drug use in the workplace is not consistently found to be useful, and is best used in the context of additional supports to provide treatment for drug problems that occur therein.
- Overall, it seems practical to recommend the use of parental drug-testing, assuming there is reasonable suspicion of substance abuse, multiple tests are undertaken over periods ranging between two to six months or more (depending on level of use), confirmation testing is undertaken on all positive results, and parents who are seeking treatment or found to be drug abusing/dependent are immediately referred to treatment in a supportive fashion.
Best practice in drug-testing
- Drug-testing is limited in its ability to determine dependence and/or impairment in relation to parenting ability; however, drug-testing may have some utility in leading to treatment and/or confirmation of self-reports of use.
- Urine or hair testing are the recommended methods of drug-testing in the context of child protection. The use of regular frequent urine testing, which is best conducted on a random basis, is a preferred method, but is expensive. Less expensive is hair testing, as hair can be easily harvested and analysed in Australia for a long observation window.
- The use of frequent (weekly or more often), regular, monitored urine testing is one best practice model with good reliability and validity. Hair testing has significant benefits that should be weighed up in terms of convenience and the desired window of observation. Both are best practice and reliable methods for assessing the extent of ongoing illicit drug use.
- Given the evidence (albeit limited) on the role of drug-testing assisting in management of parents with problematic drug use patterns and children at risk, hair testing seems to be a viable and useful tool for management of these cases, although hair testing is currently not common practice in drug treatment agencies and is mainly used in the workplace and for court purposes.
- It has been suggested that the therapeutic relationship between caseworker and client may be jeopardized if the caseworker is also the person responsible for collecting the specimen for drug detection. For this reason, it seems preferable that a third party be responsible for collection.
Drug use and parenting capacity
- There is no level of illicit drug use that can be claimed to be reasonable, if it inhibits parents’ ability to effectively and safely parent their children, although regular daily use and preoccupation with use is the most debilitating. Binge use for consecutive days will cause dysfunction for the period of the binge use and for the subsequent days of recovery. If use is to occur, then infrequent use (weekly to monthly or less often) is the pattern least likely to compromise parenting skills.
- Children of different ages will be affected differently by substance using parents. Infants and young children will be more prone to suffer the effects of neglect, such as malnourishment and poor parental bonding. In addition to experiencing these effects, older children may also take on the role and responsibilities of the parent, or imitate the parent’s behaviour.
- It is important to note that not all substance using parents experience impaired parenting capacity; however, it seems reasonable to assume that longer term dependent parents may be diminished in their capacity to parent effectively, due to the significant amount of time given to drug seeking and taking.
- There is a high level of mental health disorders among drug dependent people. In particular, there are high levels of post-traumatic stress disorder, borderline and antisocial personality disorder and anxiety and depression. It is likely these will also impact on ability to parent.
Treatment issues
- There are a variety of treatment modalities available, although overall evidence suggests the longer a person remains in treatment the better the outcome, with respect to diminished drug use.
- There are no gender differences in treatment compliance; however, there is some evidence to suggest women may benefit more from treatment catering for women only, and family-focused treatment may be beneficial to parents with children.
Citation: Wood, E., Mattick, R.P., Burns, L. and Shakeshaft, A. (2006) The costs and utility of parental drug-testing in child protection: A review of the available literature and commentary. Sydney: National Drug and Alcohol Research Centre.