http://informahealthcare.

com/dep
ISSN: 0968-7637 (print), 1465-3370 (electronic)

Drugs Educ Prev Pol, 2017; 24(1): 17–22

! 2016 Informa UK Limited, trading as Taylor & Francis Group. DOI: 10.1080/09687637.2016.1232371

Parental substance abuse and risks to children’s safety, health and

psychological development
Kirsimarja Raitasalo and Marja Holmila

National Institute for Health and Welfare, Alcohol and Drugs, Helsinki, Finland

Abstract Keywords
Aims: This study looks at the connection between parents’ substance abuse and their 0–6 years Parents, substance abuse, children’s health,
old children’s somatic and psychological health. Methods: A retrospective population-based register data
cohort study based on Finnish health care and social welfare registers. The participants were all
children born in Finland in 1997 (N ¼ 58,667) and 2002 (N ¼ 55,146) and their biological parents. History
Children were followed up for hospitalisations because of injuries, somatic illness and
psychiatric disorders. The association between hospitalisations and parents’ substance abuse as Received 1 March 2016
well as living with the abusing parent were estimated using logistic regression. Findings: Revised 30 August 2016
Children’s hospitalisations for all reasons were more prevalent if the mother or the father had a Accepted 31 August 2016
substance abuse problem. Mother’s substance abuse increased the children’s risk of Published online 19 September 2016
hospitalisations for somatic illness (OR ¼ 1.34) and psychiatric disorders (OR ¼ 1.33, father’s
substance abuse increased the risk of hospitalisation because of psychiatric disorders
(OR ¼ 1.18). The risks were even higher if both parents were substance abusers. Conclusions:
Parents’ substance abuse can cause a variety of harms to children, which may be related to
unsafe environment, long-standing stress, and non-adequate responding to the child’s needs.
Multi-professional work with substance abusing parents and their children is crucial in order to
reduce children’s risks for poor health.

Introduction drug use during pregnancy have more problems related to

cognitive and social development than other children (Autti-
Abuse of alcohol and illegal drugs can cause harms to people
Rämö, 2000; Bandstra, Morrow, Mansoor, & Accornero,
other than the abuser him/herself. In families where substance
2010). The early and longstanding risks in the child’s health
use dominates the life, children are particularly vulnerable.
are important factors causing health inequities in the society
Parents’ substance abuse can lead to insufficient ability to
(Dube et al., 2001; Harter, 2000).
provide a safe environment to their children, and to respond
Alcohol use has increased dramatically in Finland from
adequately to their physical and emotional needs. Woodside,
1968 to 2008 both among men and women, but especially
Coughey, and Cohen, (1993) in the USA and Sarkola, Gissler,
among women (Mäkelä, Tigerstedt, & Mustonen, 2012).
Kahila, Autti-Rämö, and Halmesmäki, (2011) in Finland
Also, the amount of young men and women, who at least
found that children of substance-abusing parents had more
occasionally have used some illegal drug, has increased
hospitalisations related to infections than other children.
during the 2000 s. (Hakkarainen, Karjalainen, Ojajärvi, &
Parental substance abuse has also been shown to be related to
Salasuo, 2015). Even though women drink and use other
disorders of psychological and behavioural development in
substances less than men – about one-third of all consumed
children (Bountress & Chassin, 2015; Lupien, McEwen,
alcohol – there are more families where the mother or both
Gunnar, & Heim, 2009; Nair, Schuler, Black, Kettinger, &
parents have substance abuse problems.
Harrington, 2003), and also to mental health problems and
There are several ways or mechanisms of how parental
substance abuse later in adolescence and adulthood (Jacob &
substance abuse harms the child’s health. Parents’ substance
Windle, 2000; Keller, Cummings, Davies, & Mitchell, 2008;
abuse can be connected to neglect of health care and hygiene,
Pitkänen, Kokko, Lyyra, & Pulkkinen, 2008; Pulkkinen,
thus leading to children’s increased risk of somatic illness.
2006). In addition, children exposed to maternal alcohol or
Also, it has been shown that longstanding stress can result in
various somatic illnesses (McEwen, 2008) and chronic health
problems (Leidy, 1989; McEwen, 2008; Rice, 2012). High
levels of stress hormones, including cortisol, can suppress
the body’s immune response, leaving the individual
Correspondence: Kirsimarja Raitasalo, National Institute for Health and
Welfare, Alcohol and Drugs, P.O. Box 30, 00271 Helsinki, Finland. vulnerable to a variety of infections and chronic health
Tel: +358 29 524 7005. E-mail: kirsimarja.raitasalo@thl.fi problems (Brunson, Grigoriadis, Lorang, & Baram, 2002;
18 K. Raitasalo & M. Holmila
Middlebrooks & Audage, 2008; National Scientific Council
on the Developing Child 2005/2014). Studies on harms to
family members of substance abusers have shown that living
with an addict usually creates long-standing stress due to fear,
stress and strain. Children experience the same stresses,
dilemmas and strains and even more as do adult family
members of substance abusers (Dube et al., 2001; O’Conner,
Forrester, Holland, & Williams, 2014; Orford et al., 2005).
Children can experience stress early, even before they are
born (National Scientific Council on the Developing Child,
2005/2014). Harmful stress results from intense adverse
experiences that may be sustained over long period of time –
weeks, months or even years. Children are unable to
effectively manage this kind of stress by themselves, and
this can lead to permanent changes in the development of the
brain (Middlebrooks & Audage, 2008; Rice, 2012).
Substance abuse can also create an unsafe environment for
a small child, leading to higher incidence of injuries. Earlier
studies on the effects of parental substance abuse have shown
that mother’s alcohol abuse increases the risk of injury among
young children (51 year) in a group of high-risk families
(Crandall, Chiu, & Sheehan, 2006). Risk of injuries has been
found to be over twofold among children of alcohol-abusing
mothers and almost threefold in families where both parents
abused alcohol compared with children of abstaining mothers
group (Bijur, Kurzon, Overpeck, & Scheidt, 1992). Brain
injuries have also been found to be twice as common among
children of alcohol-abusing parents compared with the control
(Winquist, Jokelainen, Luukinen, & Hillbom, 2007).
The effect of parental substance abuse on children’s
somatic health has not often been discussed in the context
of prevention of substance use, or in the context of social
work and child protection with the exception of foetal alcohol
syndrome. Lack of discussion on children’s somatic health is
surprising given the considerable impact that early age poor
health can have on a person’s learning, future life and his/her
active position in society.
In this study, we are interested to find out to what extent
the parents’ alcohol or drug abuse is reflected in small
children’s (less than 6 years of age) somatic and psychiatric
illness measured by hospital care. We are particularly
interested in finding out to what extent the effects of maternal
and paternal substance abuse differ, as mothers often have the
main responsibility of child care. In addition, we presume that
separation from the substance-abusing parent could protect
the child from the adverse effects of direct exposure to
parental substance abuse (Osborne & Berger, 2009).
The study has three hypotheses:
(1) Young (0–6 years old) children of substance abusing
mothers and/or fathers are hospitalised more often
because of injuries, somatic diseases or psychiatric
disorders than other children.
(2) Mother’s substance abuse has a more substantial associ-
ation with the young child’s risk of somatic and
psychiatric illness than the father’s substance abuse,
and the risks are the highest if both parents abuse
substances.
(3) The child’s risks of somatic and psychiatric illness as
well as injury are lower if the child is not living with the
substance-abusing parent.
Drugs Educ Prev Pol, 2017; 24(1): 17–22
Method
The study used population-level register data focussing on
small children. The data collection began with the Medical
Birth Register, from which we obtained the personal identity
numbers (assigned to all Finnish residents at birth or upon
taking up residency) of all children born in 1997 (N ¼ 58,667)
and 2002 (N ¼ 55,146) who had not died before their first
birthday, and their biological parents. These birth cohorts
were used as children born in 2002 was the latest cohort from
which data for the child’s first six years were available at the
start of the data collection in 2009, and those born in 1997
were then chosen to cover the period five years earlier. The
data for the total cohort was used rather than using a sample,
because the numbers of fairly non-frequent cases of substance
abuse problems reached sufficient statistical power. The
personal identity numbers for fathers were acquired from the
Population register. Children were followed from birth in
1997/2002 until the end of 2003/2009. We looked separately
at the effects of mothers’ and fathers’ substance use and the
substance abuse of both parents.
Data and measurements
Data were derived from nine sources: (1) Medical Birth
Register, (2) Population Register, (3) Inpatient Health Care
Register, (4) Care Register of Social Welfare, (5) Register
of Congenital Malformations, (6) Population register,
(7) Prescription Register, (8) Special Refund Entitlement
Register, and (9) Causes-of-Death Statistics. Data from
national health care and social welfare registers has been
shown to be reliable (Gissler & Haukka, 2004). Data
linkages were achieved via the personal identity numbers.
Data collection, register linkages and anonymization of
the data were carried out by the register keepers at the
National Institute for Health and Welfare (THL), the
Social Insurance Institution of Finland, and Statistics
Finland. The Ethical Review Board of THL approved the
study plan.
Parental substance abuse
Parents were classified as having substance abuse problems
(SA) if they during the follow-up time had register entries
on any primary or secondary ICD-10 diagnosis (the
International Classification of Diseases, 2016), or record of
inpatient or specialised outpatient treatment related to
substance abuse problems, or a register entry on purchases
of medication specifically for the treatment of alcohol or
drug addiction (N07BB, N07BC according to the
Anatomical Therapeutic Chemical Classification System,
ATC) (WHO, 2016), or had died with a diagnosis related to
alcohol or drug abuse, or their child had a diagnosis of
prenatal alcohol or drug exposure (mothers only). These
problems were identified using the Care Register for Health
Care, the Care Register for Social Welfare, the Prescription
Register, the Causes of Death Statistics and the Register of
Congenital Malformations. The time frame covered also the
four years prior to the child’s birth, as substance abuse
problems may have emerged before it (Holmila, Raitasalo, &
Kosola, 2013).
DOI: 10.1080/09687637.2016.1232371 Parental substance abuse 19

Child health outcomes Table 1. Prevalence of parents’ substance abuse (SA), the child’s living
arrangements, parents’ education and receipt of social assistance in the
Inpatient health care treatment and outpatient visits in public child cohorts born in 1997 and 2002, %(n).
hospitals are registered in the Inpatient Health Care Register.
This register contains two primary and four secondary ICD-10 1997 (N ¼ 58,667) 2002 (N ¼ 55,146)
diagnosis, information on reason for admittance, external Mother’s SA 1.7 (921) 2.0 (1059)
reasons for admittance and external reasons of injury. We Father’s SA 3.2 (1827) 2.8 (1488)
Both parents’ SA 0.4 (228) 0.53 (281)
looked separately at hospital care because of (a) any kind of Child living with mothera 92.9 (54,641) 92.1 (50,827)
somatic illness, (b) injuries and (c) psychiatric disorders Child living with fathera 92.0 (54,100) 91.2 (50,302)
(ICD-10 codes F3, F4, F5, F8 and F9). Child in custody care 1.7 (969) 1.9 (1054)
Family received long-standing 12.2 (7149) 10.5 (5774)
social assistance
Background variables Mother’s educationb 88.8 (52,183) 87.8 (48,440)
Father’s educationb 81.7 (48,042) 82.3 (45,552)
In order to study the independent impact of parental substance
a
abuse, parents’ education, long-standing poverty in the family At least one year.
b
More than basic.
and the child’s gender were standardised in the analysis.
Long-standing poverty was defined as having received social
assistance for more than three months per year for at least
Table 2. Children’s hospital treatment according to the parents’
three years during the child’s life. These data were obtained substance abuse (SA), % (n).
from the Social Assistance Register, which contains informa-
tion on the year of social assistance and the number of months SA Somatic illness Injury Psychiatric disorders
awarded. The parents’ education was obtained from the No 48.0 (50,916) 4.6 (4855) 6.9 (7339)
Register of Completed Education and Degrees and was used Mother only 58.5 (6677) 6.4 (73) 14.8 (169)
dichotomously: any recorded education after secondary Father only 51.0 (1430) 5.6 (16) 11.1 (312)
school or not. The Population Centre of Finland keeps Both parents 68.2 (162) 11.4 (58) 22.4 (114)
p(chisq) 5.0001 5.0001 5.0001
records on the residence history of Finnish citizens and
residents. In order to detect whether the child has lived with
the biological parents, we compared the unique building
codes and the dates of moving in and out of the specific hospitalisation of children of mothers and/or fathers with SA.
building. The children were divided into two categories Separate models were built for each outcome. The final
according to whether they had been living with the parent at models were adjusted for parents’ education and the long-
least one year of their lifetime or not. As we had data only on standing poverty in the family. The child’s gender was also
biological parents, we were not able to detect whether the standardised in the models. To study whether living with a
child had lived with a social parent. Children taken in foster substance abusing parent(s) has an effect on the child’s risks,
care at least once during the follow-up were excluded from we built three separate models for each outcome by using a
the analysis as for children who are not living with their composite variable of parental substance abuse and living
biological families it is unclear whether the cause of their with the parent. The categories of this variable were
health issues is parental substance abuse or foster care. (1) children living with non-SA mother and (2) children
Moreover, children may have been removed from their living with SA mother, (3) children with a SA mother but not
families for reasons other than parental substance abuse, living with her. Mother’s education, long-standing poverty in
and these factors could predict child health issues. the family and the child’s gender were again standardised.
Of all mothers who gave birth to children in 1997, 1.7% Similar models were built for fathers’ and for both parents’
(n ¼ 921) had substance abuse problems according to the SA. Analyses were conducted using SAS 9.3 statistical
register data. The figure for mothers with children born in package (2011).
2002 was 2.0% (n ¼ 1059). The corresponding figures for
fathers were 3.2% (n ¼ 1827) and 2.8% (n ¼ 1488), respect- Results
ively. In the analysis we combined the two cohorts of children
as the preliminary analyses showed that the cohorts were very Overall, about half of the children born in 1997 and 2002 had
similar in the topics examined (Table 1). been in hospital care because of some somatic illness before
their seventh birthday. The largest proportion of the children’s
diseases treated in hospitals was some kinds of respiratory
Statistical analysis infections and parasitic diseases, or injuries (Raitasalo,
Chi-squared tests were used to compare the percentages of Holmila, Autti-Rämö, Notkola, & Tapanainen, 2014). The
children who had been hospitalised because of injury or study gave support to hypothesis 1, showing that the figures
somatic disease in the groups of children (1) without a SA for somatic illness were significantly higher if either the
mother or father, (2) with a SA mother, (3) with a SA father, mother or the father had a substance abuse problem. Injuries
and (4) with SA both parents. Binary and multivariate logistic and psychiatric disorders leading to hospital care were also
regression were performed to examine the associations more common among children with the mother or the father,
between hospitalisation for different reasons and the parents’ or both with substance abuse (Table 2).
substance abuse. Odds ratios (OR) with 95% confidence To study the independent effect of the parents’ substance
levels (CL) were calculated in order to compare the risk for abuse on their children’s hospitalisations, we adjusted for
20 K. Raitasalo & M. Holmila Drugs Educ Prev Pol, 2017; 24(1): 17–22

Table 3. Crude and adjusted odds ratios with 95% confidence levels for the children’s hospital care for somatic illness, injury and psychiatric disorders,
with reference to children with non-SA parents.

Somatic illness Injury

OR (95% CL) AOR (95% CL) OR (95% CL) AOR (95% CL) OR (95% CL) AOR (95% CL)
Mother’s SA 1.49 (1.30–1.70) 1.34 (1.19–1.57) 1.26 (0.94–1.68) 1.12 (0.84–1.50) 1.73 (1.40–2.14) 1.33 (1.07–1.65)
Father’s SA 1.10 (1.01–1.19) 0.99 (0.92–1.08) 1.16 (0.97–1.38) 1.03 (0.86–1.23) 1.57 (1.38–1.79) 1.18 (1.03–1.36)
Both SA 1.86 (1.40–2.49) 1.57 (1.17–2.11) 2.77 (1.80–4.28) 2.24 (1.44–3.49) 2.77 (1.91–4.03) 1.69 (1.15–2.48)
Mother’s educ. (ref ¼ no) 0.93 (0.85–1.02) 0.93 (0.85–1.02) 0.81 (0.75–0.87)
Father’s educ. (ref ¼ no) 0.98 (0.91–1.06) 0.98 (0.85–1.02) 0.85 (0.80–0.90)
Social assist. (ref ¼ no) 1.30 (1.19–1.43) 1.30 (1.19–1.43) 1.72 (1.60–1.85)
Child’s gender (ref ¼ girl) 1.33 (1.26–1.41) 1.33 (1.26–1.41) 2.15 (2.05–2.26)

Table 4. Crude and adjusted odds ratios with 95% confidence levels for the children’s hospital care for somatic illness, injury and psychiatric disorders,
with reference to children living with non-SA parents.

Somatic illness Injury Psychiatric disorders

OR (95% CL) AOR (95% CL) OR (95% CL) AOR (95% CL) OR (95% CL) AOR (95% CL)
Mother
SA + living 1.47 (1.28–1.68) 1.36 (1.18–1.56) 1.37 (1.03–1.81) 1.23 (0.92–1.63) 1.81 (1.46–2.23) 1.39 (1.12–1.72)
SA + not living 1.86 (1.45–2.38) 1.58 (1.23–2.03) 1.81 (1.16–2.83) 1.48 (0.94–2.32) 2.28 (1.61–3.21) 1.41 (0.99–2.01
Father
SA + living 1.15 (1.06–1.26) 1.06 (0.97–1.16) 1.27 (1.05–1.54) 1.15 (0.94–1.39) 1.50 (1.29–1.74) 1.18 (1.01–1.37)
SA + not living 1.08 (0.94–1.25) 0.91 (0.79–1.05) 1.25 (0.92–1.70) 1.03 (0.75–1.40) 2.04 (1.65–2.51) 1.29 (1.04–1.61)
Both parents
SA + living 1.84 (1.30–2.60) 1.56 (1.10–2.21) 2.59 (1.52–4.44) 2.10 (1.22–3.61) 1.96 (1.18–3.26) 1.19 (0.71–2.00)
SA + not living 1.93 (1.14–3.25) 1.58 (0.93–2.67) 3.18 (1.51–6.70) 2.45 (1.16–5.18) 4.92 (2.78–8.71) 2.82 (1.57–5.05)
Mother’s educ. (ref ¼ no) 1.00 (0.96–1.04) 0.94 (0.86–1.04) 0.82 (0.76–0.88)
Father’s educ. (ref ¼ no) 0.99 (0.95–1.02) 0.98 (0.91–1.06) 0.84 (0.79–0.89)
Social assist. (ref ¼ no) 1.30 (1.25–1.36) 1.34 (1.22–1.48) 1.77 (1.64–1.90)
Child’s gender (ref ¼ girl) 1.48 (1.44–1.52) 1.33 (1.26–1.42) 2.15 (2.04–2.26)

the parents’ education and long standing poverty in the
family and the child’s gender by using multivariate logis-
tic regression. Separate models were built to study the effect
of SA of mother, father and both parents (Table 3). The results
supported our hypothesis 2, indicating that the mother’s SA is
a higher risk to the child’s health than that of the father and
the risks are the highest among children with both parents
with SA.
The children’s risks of hospitalisations due to all studied
disease categories were higher among children with SA
mothers than in the comparison group of children without
mother’s SA. In the unadjusted models, the risk of hospital-
isation because of somatic illness was 1.49-fold if the mother
had a SA problem. Also, if the father had a substance abuse
problem, the child’s risk of somatic illness increased the risk
by 1.10-fold. The risk was the highest, 1.86-fold, if both
parents had a SA. However, when the parents’ education,
longstanding poverty and the child’s gender were standar-
dised, the risk was significantly higher among children with
mothers (OR ¼ 1.34, 95% CL ¼ 1.19–1.57) or both parents’
with SA (OR ¼ 1.57, 95% CL ¼ 1.17–2.11) but not if the
father only had these problems. In case of injuries, the risk
was statistically significantly higher only if both parents had a
substance abuse problem (OR ¼ 2.24, 95% CL ¼ 1.44–3.49,
adjusted).
The risk of hospitalisation because of psychiatric dis-
orders was 1.33-fold (95% CL ¼ 1.07–1.65) among children
with SA mothers, and 1.18-fold (95% CL ¼ 1.03–1.36) among
children with SA fathers. The risk was highest among the
children with both parents with SA (OR ¼ 1.69, 95%
CL ¼ 1.15–2.48).
Regardless of the reason of hospitalisation, longstanding
poverty in the family (measured by receipt of longstanding
income support) increased the risk of hospitalisation. In
contrast, if the parents had more than basic education, the risk
of hospitalisation because of psychiatric disorders was lower,
but the effect of parental education on other reasons of
hospitalisation was not statistically significant. Further, boys
had a higher risk of hospitalisation because of all reasons
than girls.
To study the effect of living with the SA parent, we looked
separately at the effects of living with the mother or living
with the father as well as both of these together (Table 4). The
results showed that the child’s risk of hospitalisation because
of somatic illness increased both if the child did (OR ¼ 1.36,
95% CL ¼ 1.18–1.56) or did not live (OR ¼ 1.58, 95%
CL ¼ 1.23–2.03) with the substance-abusing mother. In case
of both parents’ substance abuse, the risk of illness increased
if the child was living with either one or both of the parents
(OR ¼ 1.56, 95% CL ¼ 1.10–2.21). The risk of injury
increased over 2-fold if both parents had substance abuse
problem regardless of the child’s living arrangements. In case
of psychiatric disorders, the risk was higher if the mother only
had a substance abuse problem and the child was living with
her (OR ¼ 1.39, 95% CL ¼ 1.12–1.72). If the father had a SA
problem and the mother did not, the child’s risk of psychiatric
disorders regardless of the living arrangements increased.
However, if both parents had SA problems, the risk increased
DOI: 10.1080/09687637.2016.1232371
only if the child did not live with either of the parents
(OR ¼ 2.82, 95% CL ¼ 1.57–5.05). These results did support
our hypothesis 3, as the child’s risks were same regardless of
his/her living arrangements. In case of psychiatric disorders,
the results were contrary to this hypothesis.
Discussion
The study shows that parents’ substance abuse is significantly
associated with small children having an increased risk of
injuries as well as somatic and psychiatric illness in early
childhood. The increased risk of injuries among children with
substance-abusing parents indicates lack of care and surveil-
lance as well as active maltreatment and even violence in
some cases.
The observed higher risk of somatic illnesses and psychi-
atric disorders among small children of substance-abusing
parents can be related to many factors. Poor home environ-
ment, nutrition and hygiene, poverty, social disadvantage,
witnessing conflict and violence and child abuse are all
commonly reported experiences for children living with
substance-abusing parents (Dube et al., 2001; Staton-Tindall,
Sprang, Clark, Walker, & Craig, 2013). Besides having direct
detrimental effects on the child’s safety and health due to poor
care and supervision, they create long-standing stress, which
additionally taxes the child’s health. The negative effects of
stress can be lessened with the support of caring adults. The
attachment theory posits that a safe attachment style in
childhood buffers the effects of high-risk environments,
although insecure attachment with other risk factors is
associated with the development of psychiatric disorders in
children (Flaherty & Sadler, 2011).
We also found a difference between the effects of mother’s
and father’s substance abuse. The difference was mostly in
accordance with our hypothesis, as well as with previous
research (Christoffersen & Soothill, 2003; Rognmo, Torvik,
Ask, Røysamb, & Tambs, 2012; Jääskeläinen, Holmila,
Notkola, & Raitasalo, 2016). Our results showed that the
mother’s substance abuse has a more harmful effect on
the small child’s wellbeing than the father’s substance abuse.
The result emphasises the mother’s role in children’s
wellbeing in our culture. This is perhaps because daily care
of infants and pre-school children still tends to be more often
the mother’s than the father’s main responsibility, even if
families differ here. However, the risks of hospitalisations due
to all reasons were the highest if both parents had a substance
abuse problem. This is true, especially in case of injury. It is
likely that when one parent has a substance abuse problem,
the other parent takes the main responsibility of looking after
the child’s safety.
Our hypothesis 3 suggested that living with the substance-
abusing parent increases the risks compared to not living with
him/her. The child’s risk of somatic illness increased regard-
less of living arrangements if the mother had substance abuse
problems. This may be partly related to prenatal alcohol or
drug exposure (Autti-Rämö, 2000; Bandstra et al., 2010). In
case of psychiatric disorders, the results indicate that being
separated from both parents even if they have substance abuse
problems is more likely to increase the small child’s risks for
psychiatric illness rather than to reduce them.
Parental substance abuse 21
More research is needed here as the situations in families are
likely to vary a lot according to, for instance, family economics,
emotional relations in the family, health of the other parent and
the behaviour of the substance-abusing parent towards the
children. Family separation may have different effects on
children depending on these factors. Also, it is likely that the
parents with worst problems are the ones most likely to
divorce, die or have their children taken into custody.
Strengths and limitations
Register data offer an exceptional possibility to study whole
cohorts without the problems of response rates. The data in
registers are based on evaluation and diagnoses made by
professionals, which eliminates social desirability bias. There
may, however, be deficiencies in the data. Some parents with
substance abuse problems may be under-represented because
they have not used the services included in the registers.
Including the four years before the child’s birth in the
definition of substance abuse in parents raises the question on
whether the parents with register entries on substance abuse
only before the birth of the child may have cured their
substance abuse problems prior to this point. On the other
hand, even if there were register entries on substance abuse
only before the birth of the child but not after it, we do not
know if the problem has been solved. However, the majority
of parents who had register entries before the child’s birth had
them also after it. There are also some parents in the data who
have substance abuse-related register entries only after the
child has been hospitalised. This should not affect the results
as substance abuse problems typically take some time to
develop and have a history before appearing in registers. One
more limitation is that it was not possible to control for all
relevant sociodemographic factors, such as the parents’
employment status, region of the country (city vs. rural),
and housing quality/crowding in our data.
Conclusions
Parental substance abuse creates a considerable risk for the
small child’s health, safety and wellbeing. Several health and
social welfare institutions can support the child even if the
parental substance abuse problem cannot be solved during
the child’s crucial infant years. Further studies should look at
the potential of interventions and help.
Interventions that help children to overcome their
difficulties caused by parental substance abuse are possible,
but they require cooperation between different professionals
and the family. It is important that the needs of these
children are recognised at an early stage in family clinics,
child welfare services, school health care services, by day
care professionals and teachers. Early help to the whole
family is important in order to prevent having to take the
child into custody. However, custody care can be a good
option if these kind of light interventions are not enough to
help the children.
Looking for help can be hampered by the stigma often
attached to substance abuse problems. Public discussion on
the harms to children is necessary, so that parents and children
themselves are encouraged to talk about their problems with
helping agencies.
22 K. Raitasalo & M. Holmila
Declaration of interest
The authors declare no conflict of interest.
References
Autti-Rämö, I. (2000). Twelve-year follow-up of children exposed to
alcohol in utero. Developmental Medicine and Child Neurology, 42,
406–411. doi: 10.1017/S0012162200000748.
Bandstra, E.S., Morrow, C.E., Mansoor, E., & Accornero, V.H. (2010).
Prenatal drug exposure: Infant and toddler outcomes. Journal of
Addiction Disorders, 29, 245–258. doi: 10.1080/10550881003684871.
Bijur, P.E., Kurzon, M., Overpeck, M.D., & Scheidt, P.C. (1992).
Parental alcohol use, problem drinking, and children’s injuries. JAMA,
267, 3166–3171. doi: 10.1001/jama.1992.03480230058028.
Bountress, K., & Chassin, L. (2015). Risk for behavior problems in
children of parents with substance use disorders. American Journal of
Orthopsychiatry, 85, 275–286. doi: 10.1037/ort0000063.
Brunson, K.L., Grigoriadis, D.E., Lorang, M.T., & Baram, T.Z. (2002).
Corticotropin-releasing hormone (CRH) downregulates the function
of its receptor (CRF1) and induces CRF1 expression in hippocampal
and cortical regions of the immature rat brain. Experimental
Neurology, 176, 75–86. doi: 10.1006/exnr.2002.7937.
Christoffersen, M.N., & Soothill, K. (2003). The long-term consequences
of parental alcohol abuse: A cohort study of children in Denmark.
Journal of Substance Abuse Treatment, 25, 107–116. doi: 10.1016/
S0740-5472(03)00116-8.
Crandall, M., Chiu, B., & Sheehan, K. (2006). Injury in the first year of
life: Risk factors and solutions for high-risk families. Journal of
Surgical Research, 133, 7–10. doi: 10.1016/j.jss.2005.11.058.
Dube, S.R., Anda, R.F., Felliti, V.J., Croft, J.B., Edwards, V., & Giles,
W.H. (2001). Growing up with parental alcohol abuse: Exposure to
childhood abuse. Neglect, and Household Dysfunction. Child Abuse &
Neglect, 25, 1627–1640. doi: 10.1016/S0145-2134(01)00293-9.
Flaherty, S., & Sadler, L. (2011). A review of attachment theory in the
context of adolescent parenting. Journal of Pediatric Health Care, 25,
114–121.
Gissler, M., & Haukka, J. (2004). Finnish health and social welfare
register in epidemiological research. Norsk Epidemiologi, 14,
113–120.
Hakkarainen, P., Karjalainen, K., Ojajärvi, A., & Salasuo, M. (2015).
Huumausaineiden ja kuntodopingin käyttö ja niitä koskevat mielipi-
teet Suomessa vuonna 2014 [Drug use, doping and public opinion in
Finland: results from the 2014 Drug Survey]. Yhteiskuntapolitiikka,
80(40), 319–333.
Harter, S. (2000). Psychosocial adjustment of adult children of
alcoholics: Review of the recent empirical literature. Clinical
Psychology Review, 20, 311–337. doi: 10.1016/S0272-
7358(98)00084-1.
Holmila, M., Raitasalo, K., & Kosola, M. (2013). Mothers who abuse
alcohol and drugs: Health and social harms among substance abusing
mothers of small children in three child cohorts. Nordic Studies on
Alcohol and Drugs, 30, 361–373. doi: 10.2478/nsad-2013-0030.
International Statistical Classification of Diseases and Related
Health Problems. (2016). ICD-10, 10th revision. Retrieved from
http://apps.who.int/classifications/icd10/browse/2016/en
Jacob, T., & Windle, M. (2000). Young adult children of alcoholic,
depressed and nondistressed parents. Journal of Studies on Alcohol,
61, 836–844. doi: 10.15288/jsa.2000.61.836.
Jääskeläinen, M., Holmila, M., Notkola, I.-L., & Raitasalo, K. (2016).
Mental disorders and harmful substance use in children of substance
abusing parents: A longitudinal register-based study on a complete
birth cohort born in 1991. Drug and Alcohol Review, [Epub ahead of
print]. doi: 10.1111/dar.12417
Keller, P.S., Cummings, E.M., Davies, P.T., & Mitchell, P.M. (2008).
Longitudinal relations between parental drinking problems, fam-
ily functioning, and child adjustment. Development and
Psychopathology, 20, 195–212. doi: 10.1017/S0954579408000096.
Leidy, N. (1989). A physiological analysis of stress and chronic illness.
Journal of Advanced Nursing, 14, 868–876. doi: 10.1111/j.1365-
2648.1989.tb01473.x.
Lupien, S.J., McEwen, B.S., Gunnar, M.R., & Heim, C. (2009). Effects
of stress throughout the lifespan on the brain, behaviour and cognition.
Nature Reviews Neuroscience, 10, 434–445. doi: 10.1038/nrn2639.
Drugs Educ Prev Pol, 2017; 24(1): 17–22
McEwen, B.S. (2008). Central effects of stress hormones in health and
disease: Understanding the protective and damaging effects of stress
and stress mediators. European Journal of Pharmacology, 583,
174–185. doi: 10.1016/j.ejphar.2007.11.071.
Middlebrooks, J.S., & Audage, N.C. (2008). The effects of childhood
stress on health across the lifespan. Atlanta (GA): Centre for disease
Control and Prevention, National Centre for Injury Prevention and
Control
Mäkelä, P., Tigerstedt, C., & Mustonen, H. (2012). The Finnish drinking
culture: Change and continuity in the past 40 years. Drug and Alcohol
Review, 31, 831–840. doi: 10.1111/j.1465-3362.2012.00479.x.
Nair, P., Schuler, M.E., Black, M.M., Kettinger, L., & Harrington, D.
(2003). Cumulative environmental risk in substance abusing women:
Early intervention, parenting stress, child abuse potential and child
development. Child Abuse & Neglect, 27, 997–1017. doi: 10.1016/
S0145-2134(03)00169-8.
National Scientific Council on the Developing Child. (2005/2014).
Excessive Stress Disrupts the Architecture of the Developing Brain:
Working Paper No. 3. Updated Edition. Retrieved from
www.developingchild.harvard.edu
O’Conner, L., Forrester, D., Holland, S., & Williams, A. (2014).
Perspectives on children’s experiences in families with parental
substance misuse and child protection interventions. Children and
Youth Services Review, 38, 66–74. doi: 10.1016/
j.childyouth.2014.01.008.
Osborne, C., & Berger, L.M. (2009). Parental substance abuse and child
well-being. Journal of Family Issues, 30, 341–370. doi: 10.1177/
0192513X08326225.
Orford, J., Natera, G., Copello, A., Atkinson, C., Tiburcio, M.,
Velleman, R., . . . Walley, G. (2005). Coping with alcohol and drug
problems: The experiences of family members in three contrasting
cultures. London & NewYork: Routledge
Pitkänen, T., Kokko, K., Lyyra, A.L., & Pulkkinen, L. (2008). A
developmental approach to alcohol drinking behaviour in adulthood:
A follow-up study from age 8 to age 42. Addiction, 103, 48–68. doi:
10.1111/j.1360-0443.2008.02176.x.
Pulkkinen, L. (2006). The Jyväskylä longitudinal study of personality
and social development (JYLS). In: Pulkkinen, L., Kaprio, J., Rose,
R.J. (Eds.), Socioemotional development and health from adolescence
to adulthood (pp. 29–55). New York: Cambridge University Press.
Raitasalo, K., Holmila, M., Autti-Römö, I., Notkola, I-L., & Tapanainen,
H. (2014). Hospitalizations and out-of-home placements of children of
substance abusing mothers: A register-based cohort study. Drug and
Alcohol Review, 34(1), 38–45. doi: 10.1111/dar.12121.
Rice, V.H. (2012). Theories of stress and its relationship to health. In:
Rice, V.H. (Ed.), Handbook of Stress, Coping and Health.
Implications for nursing. Research, Theory and Practise
(pp. 22–42). Los Angeles: Sage.
Rognmo, K., Torvik, F.A., Ask, H., Røysamb, E., & Tambs, K. (2012).
Paternal and maternal alcohol abuse and offspring mental distress in
the general population: The Nord-Trøndelag health study. BMC Public
Health, 12, 448–459. doi: 10.1186/1471-2458-12-448.
Sarkola, T., Gissler, M., Kahila, H., Autti-Rämö, I., & Halmesmäki, E.
(2011). Early healthcare utilisation and welfare interventions among
children of mothers with alcohol and substance abuse: A retrospective
cohort study. Acta Paediatrica, 100, 1379–1385. doi: 10.1111/j.1651-
2227.2011.02317.x.
SAS Institute, Inc. SAS/STATÕ 9.3 User’s Guide. Cary, NC: SAS
Institute, Inc.; 2011.
Staton-Tindall, M., Sprang, G., Clark, J., Walker, R., & Craig, C.D.
(2013). Caregiver substance use and child outcomes: A systematic
review. Journal of Social Work Practise in the Addictions, 13, 6–31.
doi: 10.1080/1533256X.2013.752272.
WHO Collaborating Centre for Drug Statistics Methodology. (2016).
Guidelines for ATC classification and DDD assignment. Retrieved
from http://www.whocc.no/atc_ddd_index/
Winquist, S., Jokelainen, J., Luukinen, H., & Hillbom, M. (2007).
Parental alcohol misuse is a powerful predictor for the risk of
traumatic brain injury in childhood. Brain Injury, 21, 1079–1085. doi:
10.1080/02699050701553221.
Woodside, M., Coughey, K., & Cohen, R. (1993). Medical costs of
children of alcoholics-pay now or pay later. Journal of Substance
Abuse, 5, 281–287. doi: 10.1016/0899-3289(93)90069-N.
Copyright of Drugs: Education, Prevention & Policy is the property of Taylor & Francis Ltd
and its content may not be copied or emailed to multiple sites or posted to a listserv without
the copyright holder's express written permission. However, users may print, download, or
email articles for individual use.