Drug Abuse as Child Abuse
Last October in Manhattan, a mother named Zoila Dominici told a courtroom: "To celebrate your child's birthday in a cemetery is not an easy thing." Her one-year-old son had died from fentanyl poisoning at a Bronx day care where the drug was being stored. This was, she said, "every parent's nightmare."
Though devastating, Dominici's case is not typical: For most young children endangered by drugs, the risk lies much closer to home. In September 2024, Tricia Cavanaugh was sentenced to 14 years in prison for neglect of a dependent resulting in serious bodily injury. The Indiana mother went to sleep with her infant after breastfeeding one night in 2016; when she woke up, her baby was lying face down, dead. According to officers who arrived on the scene, Cavanaugh appeared to be intoxicated, displaying unsteady balance and slow, slurred speech. A drug test found opioids and other drugs in her system.
Although many unsafe sleep deaths are categorized as accidents, parental intoxication is a common factor in these tragedies. Doctors recommend against co-sleeping with a baby, but the truth is that a baby's distress will almost always awaken a sober parent. Unfortunately, drugs and alcohol get in the way of that instinctive response.
Deaths by suffocation are one of a number of fatality types that have contributed to a recent spike in drug-related infant deaths. According to a study by researchers at Florida Atlantic University's medical school, such deaths more than doubled between 2018 and 2022. Even once children have reached their first birthdays and are no longer at great risk for sleep deaths, drugs are still creating tragedies. Last August, New Mexico police arrested parents Thomas Soto and Monique Sanchez after the death of their one-year-old son. Earlier that year, they had awakened after hosting a party to find that their child had died from ingesting fentanyl and methamphetamines. Two other children in the home also tested positive for drugs, which officers said the couple had a history of using.
Despite all the advances of modern medicine and the prevalence of safety devices like car seats, our society is going backward when it comes to keeping kids alive: Child and adolescent mortality rates jumped 18.3% between 2019 and 2021 — the largest such increase in at least a half-century. The secondary effects of drug use explain much of this regression. It's time to stop viewing drug use as merely a valid if unfortunate decision made by autonomous adults, and to recognize the heavy costs these adult habits impose on children.
HEALTH HARMS
Children of parents addicted to drugs face enormous challenges, beginning in the womb. A 2006 paper by Harvard University economist Roland Fryer estimated that the 1980s crack epidemic "can explain 20-100 percent of the observed increases in Black low birth weight babies, fetal death, child mortality, and unwed births in large cities between 1984 and 1989." The same is true of drug use today. According to the American Academy of Pediatrics, exposure to opioids either in utero or during the early neonatal period "is associated with negative consequences on the developing brain, which can lead to neurodevelopmental deficits." And it's not just the harder drugs: As Harvard Medical School's Bertha Madras points out, there is "very good evidence that exposure to THC in utero can cause a cascade of negative events for children, including low birth weight,...smaller head circumference and more still births."
These latter findings are especially troubling in light of the fact that, according to some child-welfare caseworkers, pregnant women seem to have increasingly gotten the message that cannabis is a safe alternative to alcohol. A Kaiser Permanente study in California found that rates of cannabis use by women in early pregnancy jumped 25% at the beginning of the pandemic, increasing from 6.75% of pregnant women in 2019 to 8.14% after the pandemic's start. "[P]regnant women are more likely to use cannabis if they are depressed, anxious, or have experienced trauma," reported lead author Kelly Young-Wolff. "It's very possible that more pregnant women are using cannabis in an attempt to self-medicate these issues."
In utero exposure to drugs, including alcohol, can also affect a child's development as he ages. The worst cases of fetal alcohol syndrome result in the loss of the baby, but as an article in the Harvard Gazette notes:
When the baby survives, the effects often go unnoticed until school age, when performance, behavior and even routines that children typically carry out independently — getting up in the morning, making the bed, putting on clothes — become a challenge. Over time, damage wrought by prenatal exposure to alcohol can affect memory, self-control, emotions, attention, and problem-solving.
Even when children do not suffer from their parents' drug abuse directly, they can be harmed in other ways. A social worker at a hospital in Portland, Oregon, told me about a three-year-old boy who had ingested fentanyl and is now permanently outfitted with a tracheal tube because emergency responders were too late in administering Narcan (the medicine designed to reverse overdoses). From mid-June through September 2023, five children in Portland died from suspected fentanyl overdoses. Of the 358 fentanyl cases that the Oregon Poison Center handled in 2022 (a 220% increase from 2021), 46 were pediatric.
Too often, we react to these dangers when it's too late, or almost so. Everyone, it seems, is just supposed to carry around Narcan. According to the American Academy of Pediatrics, between 2017 and 2022, almost 60,000 prescriptions for naloxone were dispensed to youth aged 10 to 19. That represented a jump of 669%, with increases occurring each year. It's like watching an epidemic of heart attacks among children and telling schools and day-care centers to simply keep more defibrillators on hand.
STIFLING OPPORTUNITY
In his memoir Troubled, Rob Henderson, who spent 10 years of his childhood in various foster homes, recalled of the time: "My birth mom was able to get drugs, and it had a detrimental effect on both of our lives....All my foster siblings' parents were addicts, or had a mental health condition, often triggered by drug use." "That's something people don't think about," he observed. "Drugs don't just affect the user, they affect helpless children, too."
This context is missing not only from our conversation about the drug epidemic and legalization, but also from discussions of social and economic mobility. Many children in this country are able to move up the socioeconomic ladder, but pockets of deep, cyclical poverty and dysfunction still exist, and a lack of resources isn't the only reason.
Harvard's Opportunity Insights team, led by economist Raj Chetty, made headlines last summer with the finding that "[c]hildren's prospects of achieving upward economic mobility vary substantially across geography and demographic groups in America." The good news is that the gap between white and black children's mobility has shrunk in recent decades, by a whopping 27%. The bad news is that class gaps have widened, growing by as much as 28% between white low-income children and their higher-income counterparts.
The study's authors underline adult unemployment as the most important factor driving these numbers. If more adults in a community are employed, they say, children will be better able to improve their socioeconomic standing as they age. If the adults don't have jobs, children will be stuck.
This rationale, while plausible on the surface, overlooks an important factor driving chronic parental unemployment that also harms children: substance abuse.
To understand the role drugs play in unemployment, it's useful to think about the populations Chetty's team studied and the timing of their successes and struggles. As the researchers observed:
Between children born in 1978 and 1992, employment rates declined for low-income white parents compared to both low-income Black and high-income white parents. These changes influenced the social environments in which children grew up. Growing up in a thriving community — where the adults are employed, in good health, etc. — dramatically improves children's outcomes, even holding fixed their own family's situation. Black children are increasingly growing up in communities that are improving along these lines, while white children born to lower income parents are not — and this has driven the differential changes in economic mobility we see in recent decades.
The question is why: Why were lower-income black communities and the adults in them doing so poorly in the 1980s (the earlier cohort of Chetty's study), while poor white communities fell behind in the late 1990s and early 2000s (the later cohort)? Tax policies and work incentives may have affected various communities in different ways at different times. Family structure also changed during the periods studied, with black children growing up in more single-parent homes in the '80s and white children sadly catching up on this measure more recently.
But more than anything, each group was disproportionately affected by two different drug crises. The earlier black cohort (and its children) suffered most from the crack epidemic, which reached its peak in the mid-to-late 1980s. The opioid epidemic afflicted the later white cohort more severely. While most people think of that crisis as a post-2010 phenomenon, the misuse of OxyContin began much earlier. In 1999, 400,000 people admitted to using OxyContin for non-medical purposes; that number grew to 1.9 million in 2002 and to 2.8 million in 2003. Poor white children born in the early '90s cohort would certainly have felt the effects of growing opioid usage in their communities by the time they were in school.
Some studies have explored the connection between the opioid crisis and labor markets. In a 2020 article titled "Prescription Opioids and Labor Market Pains," researchers examined the impact of prescription opioids on regional labor-market outcomes and found that an increase in prescriptions caused a reduction in labor-force participation. Another paper published in 2017 found a positive relationship between unemployment and opioid-related deaths.
In other words, there is little question that higher levels of drug use and abuse within a community can result in lower levels of adult employment, which in turn harm the children residing there.
POVERTY VERSUS MALTREATMENT
Chetty and his team do cite the opioid epidemic as one cause of reduced adult employment rates and the harm children suffer as a result. Their implication, however, appears to be that adult drug use hurts children chiefly insofar as it feeds into poverty, and less as an immediate source of danger and disadvantage. The evidence we have suggests this might not be the whole story.
People often assume that drug abuse is both a cause and effect of poverty. But drug abusers make up only a fraction of the population of poor people in this country. According to the 2023 National Survey on Drug Use and Health, 29.9% of adults below the federal poverty line reported illicit drug use in the past year. For adults receiving government benefits, the rate was 33.3%. With marijuana excluded, those numbers drop to 11.2% and 12.2%, respectively. Moreover, less than a quarter of those in poverty or on government programs suffer from a substance-use disorder.
We do know, however, that drugs play a key role in child maltreatment. Among families involved with the child-welfare system and those in which child abuse and neglect has occurred, substance abuse is a common problem. Estimates vary, but a 2015 review of research found that up to 79% of child-welfare cases involve families affected by parental substance-use disorders. These data suggest that drug use is present in cases of child abuse and neglect much more often than in cases of poverty or dependence on government programs.
Further data reinforce this picture. Researchers in Texas, to take one example, identified communities by zip code with high rates of child maltreatment. Some of the factors they found to correlate with heightened maltreatment risk won't be surprising: a significant percentage of residents with less than a high-school diploma, increased rates of hospital-based deliveries to teen mothers, frequent infant emergency-room visits, etc. But by far, the factor most strongly correlated with child maltreatment was the percentage of adults aged 35 to 64 receiving Social Security benefits for a qualifying disability.
This may not seem relevant to a discussion about drug addiction. But community-health professor Dorothy Mandell notes that "if an adult is under age 65 and receiving disability, chances are very high that adult has mental-health problems or substance-use problems." Indeed, short of obtaining the IRS records that Chetty and his team used, measuring the prevalence of disability benefits might be the best way to measure community rates of substance abuse. Widespread use of disability benefits is not only an objective measure; it also suggests a chronic and serious condition. People don't get disability benefits for occasionally eating gummies.
It's becoming clear that drug abuse drives child maltreatment. Child maltreatment, in turn, drives the lack of social mobility for kids at the very bottom. Duke University economist Jason Baron points to research showing that childhood abuse and neglect impair a child's physical and mental health, increase rates of criminal activity, and reduce educational attainment and future earnings. "Given that maltreatment strongly correlates with poor long-term outcomes," he concluded, "it's reasonable to suspect it may also be linked to intergenerational mobility."
In forthcoming research, Baron and his colleagues found "a stark negative relationship between county-level Child Protective Services investigation rates and county-level social mobility rates." That is, counties with higher reports of child maltreatment tend to have significantly lower rates of absolute upward mobility. This factor is even stronger than the ones Chetty and his team linked to social mobility, which included the share of single mothers, racial segregation, and income inequality. Even after accounting for these factors, Baron found that "CPS contact remained one of the strongest predictors of lower social mobility rates."
Significant differences exist between children who grow up in poverty and those who are reported for maltreatment. In a 2020 paper, Sarah Anne Font of Pennsylvania State University and Kathryn Maguire-Jack of the University of Michigan looked at life outcomes ranging from high-school graduation to early pregnancy and imprisonment for almost 30,000 individuals born between 1993 and 1996 in Milwaukee County, Wisconsin. When they compared "individuals with CPS-investigated neglect, abuse, or both abuse and neglect in early childhood or adolescence to those who experienced poverty but not CPS involvement," they found that "children with alleged or confirmed neglect were statistically significantly worse in all domains than impoverished children without maltreatment allegations, and similar to children with alleged or confirmed abuse."
It turns out that children's ability not only to survive, but to thrive, depends on more than just their parents' capacity to remain employed or afford basic necessities. In order for children to be properly fed, nurtured, clothed, supervised, educated, and kept out of jail, parents need more than a steady income or government benefits; they need to be present and engaged in their children's lives.
Parents are responsible for providing their children with the basic foundations of a safe and healthy childhood. These include not only material necessities like food and stable housing, but attention and care. This is especially true for newborns, who need round-the-clock feeding, burping, diaper changing, and consoling from caregivers. Rashes, fevers, and even small changes in eating habits can be a sign that something is seriously wrong. And unlike other deficits that public or private programs can make up for by paying for clothing or housing or medical care, there is no substitute for the kind of nurturing that parents offer a newborn.
Even older children need care and supervision. They cannot procure food on their own or get medical help or tell someone that their mom is passed out or failed to come home last night. No one is getting these kids to school or telling them to go to bed. No one is ensuring that they are not left in dangerous situations or with dangerous men. Sometimes other relatives will step in, but often those relatives are suffering from addiction as well. As a result, more and more children are being left without parents, or with parents who simply cannot care for them.
Children who are poor but have parents who care still have a good chance at social mobility. Avoiding becoming pregnant as a teen, engaging in criminal activity, or dropping out of high school will give them a shot. But for their peers who suffer neglect, whose parents are out of commission for some significant part of their childhood, these adverse outcomes will hinder any chance at mobility.
A FAILURE OF LEADERSHIP
Mistakenly assuming that adult unemployment and resulting financial struggle are the chief obstacle to kids' social mobility, we take approaches that primarily aim to alleviate poverty. For the left, that typically means offering larger child-tax credits. On the right, that often means incentivizing work. Both sides of the aisle attempt to bring good jobs to communities, and to address resource shortages that may handicap educational opportunities. The right does this by offering school vouchers, charter schools, and more vocational-education programs for parents. The left offers more money for public schools or loan forgiveness for college tuition.
We have to grapple with the possibility that none of these policies will move the needle very much for parents suffering from addiction. Adults who are dealing with serious substance abuse will not be able to prioritize the well-being of their children over their own habits. Even if they are given stronger incentives to work, it will be hard for them to hold down jobs. They can apply for public housing, but they will struggle to afford minimal payments or abide by building rules. They will not be able to consistently provide the basic care and immediate attention their children need, let alone take advantage of longer-term opportunities like charter-school lotteries or voucher programs.
The failures of these dysfunctional and disadvantaged families to meet minimal requirements for housing or work or education has led policymakers to adopt increasingly wrongheaded solutions — including, most recently, universal-basic-income programs. Illinois, for instance, is experimenting with a pilot program that grants 400 families involved in the child-welfare system monthly cash payments for a year, no strings attached. Given the prevalence of drug use among this population, the money is unlikely to improve childhood outcomes, and may even harm families by giving addicts access to unrestricted cash.
It's much easier to blame low social mobility among children on a shortage of resources and a lack of economic opportunities for adults than on parental substance abuse. There is less stigma attached to the label of poverty, and it is much easier to offer solutions to poverty than to addiction: Even with sufficient beds in rehabilitation centers, medically assisted treatments for addiction, and billions of dollars pouring in from lawsuits against drug companies, we still have no foolproof way of keeping parents sober.
A first step toward that end would require our leaders in politics and the media to acknowledge that drugs are not just another choice that adults can make, but a terrible blight on children and families. Despite all of the stresses on lower-income families today — from inflation to crime to poor schools — the truth is that children with one (or ideally two) parents who are willing to work hard and sacrifice for the next generation have a decent chance of success. Without at least one sober adult in their corner, the future looks bleak.
