Family Composition and Circumstance

Substance abuse is a family disease, one that can be transmitted both genetically and through the family environment. Children in families are affected by substance abuse in several ways, as illustrated in Figure 1. This chart shows that legal and illegal use of alcohol, tobacco, and other drugs (ATOD) can affect children through a number of avenues, including prenatal exposure in utero. This has very powerful policy implications, including its message that prenatal drug exposure, while very important in its effects on younger children, is only one of the several ways that children can be affected by these substances. Children are also exposed through their parents' and caretakers' use and abuse, through commercial media messages advertising alcohol and tobacco, and through community norms and regulations regarding substance use. The legality of a substance, as well as the way in which children are exposed to its use, plays a significant role in its effect on a child. Often, an emphasis is placed on the effects of illicit drugs, rather than on the harmful effects of tobacco and alcohol. At the federal level, for example, there is an annual "National Drug Policy Strategy" document; no such documents exist for alcohol or tobacco.

FIGURE 1

Both prenatal and postnatal exposure to alcohol, tobacco, and other drugs can affect children in lasting ways. Children who fail to form secure attachments to their parents or caregivers because of their parents' or caregivers' inability to give them sustained attention, children who live in a home where violence and substance abuse are frequent, children who grow up in neighborhoods where there are ten times as many liquor outlets and ads as in the rest of the community, adolescents who receive daily messages that to use alcohol is to be surrounded by attractive people having fun–all of these situations can have a lasting effect on the children involved.

According to the California State Commission on Children and Families, "prenatal exposure to tobacco, alcohol, and illicit drugs increases a child's risk of mental retardation, neurodevelopmental deficits, attention deficit disorders with hyperactivity, fine-motor impairment, as well as more subtle delays in motor performance and speech. Maternal smoking and infant exposure to environmental tobacco smoke has been linked to asthma, low birth weight and an increased risk of sudden infant death syndrome" (p. 56).

As important as these effects are, however, a 1999 report of the U.S. Department of Health and Human Services cited data showing that 11 percent of all children in the nation live with a parent who is either alcoholic or in need of treatment for their abuse of illicit drugs. According to this report, "children prenatally exposed to drugs and alcohol represent only a small proportion of the children affected and potentially endangered by parental substance abuse" (p. ix).

Thus, as important as prenatal exposure is, a much larger number of children are exposed to milder effects of substance abuse than those exposed to its extreme effects in utero such as fetal alcohol syndrome, which has definite facial and other characteristics. The policy and practice questions this raises include whether measurable results will be more readily achieved by targeting severe or milder risk cases; and for which children, and at which points in their development, intervention should be attempted. It may be more appropriate to think of treatment funds being allocated to the most affected children and families, early intervention funds being allocated to those that are at risk of becoming seriously involved, and prevention funds being allocated to a much wider group of children whose needs are not as severe.

How Are Schools Affected?

For schools, the issues of substance abuse in families arise at many levels of the preschool and school experience. These include:

• The mandated responsibility of schools to identify younger preschool-age children with disabilities, some of whom have been affected by exposure to alcohol and drugs.
• The effects of parental substance abuse on early learning, such as parents' willingness and ability to read to their children regularly.
• The effects of parental substance abuse on the home learning environment, such as whether there is a quiet place to study and a predictable schedule for homework.
• The effects of parental substance abuse on the development of peer-resistance skills that address the learned techniques of responding to negative pressure from peers.
• The effects of adolescent substance experimentation, use, and abuse on learning and social skills.

A 2001 analysis of the impact of substance abuse on schools conducted by researchers at Columbia University found that "substance abuse and addiction will add at least $41 billion–10 percent–to the costs of elementary and secondary education this year, due to class disruption and violence, special education and tutoring, teacher turnover, truancy, children left behind, student assistance programs, property damage, injury and counseling" (Center for Addiction and Substance Abuse, p. 6).

Schools' Responses

Schools have responded with a variety of practices and policies, ranging from zero-tolerance zones to drug resistance education and individual counseling. Recent assessments of "what works" have emphasized the following ingredients in successful school-based and school-linked programs:

• They are developmentally appropriate.
• They are culturally sensitive.
• They include the perspectives of young people.
• They have sufficient dosage (and when needed, booster features) to make a difference. In this context dosage refers to the intensity of the program; some models of prevention programs provide as little as 17 hours of instruction during the fifth grade year, which has been shown to be an inadequate dosage to achieve any lasting impact.
• They are multifaceted, reflecting the dimensions of peers, parents, and the larger community.
• They are evaluated in enough depth to make midcourse corrections possible.

The U.S. Department of Education has rated several programs "exemplary" and "promising," based on seven criteria developed by the department.

It should also be pointed out that from birth to age eighteen children spend only 9 percent of their lives physically at school, suggesting that one of the most important things schools can also do to respond to the problems of substance abuse is to support effective family-and community-focused prevention and intervention programs.

Conclusions

The effects of family substance abuse on schools and learning are pervasive. However, as concerns about adolescent tobacco, drug, and alcohol use have grown, so have the tools available to respond with both preventive and intervention activities. Schools should not venture into these arenas alone, but need to understand the available approaches and the literature on what works.