Dual Diagnosis Increases Risk for Child Abuse

Parents dealing with the simultaneous presence of drug problems and mental illness are more likely to abuse their children, researchers say.

People affected by dual diagnosis have serious, co-occurring problems with both drug or alcohol intake and an independent mental health issue. Current evidence clearly indicates that the combination of these problems produces an unusually severe degree of life disruption in affected individuals. In a study published in 2014 in the journal Advances in Dual Diagnosis, researchers from three Australian institutions used a large-scale project to determine if a person affected by dual diagnosis has unusually elevated chances of engaging in child abuse.

Substance and Mental Health Problems

Dual diagnosis can involve any form of diagnosable substance abuse or substance addiction (known together as substance use disorder). It can also involve any separately diagnosable form of mental illness, including typically severe conditions such as major depression, bipolar I disorder, schizophrenia or panic disorder or other anxiety disorders. In any given person, several potentially interconnected factors can at least partially explain the simultaneous presence of substance problems and mental illness. The most prominent acknowledged factors include the misguided use of alcohol or drugs as self-administered treatment for mental health problems, the potential for a pattern of substance abuse or addiction to significantly intensify an individual’s existing mental health issues and the potential for a pattern of substance abuse/addiction to trigger or substantially contribute to the development of previously unencountered mental illness symptoms.

People with a dual diagnosis commonly experience a range of problems that can seriously degrade their chances of receiving proper care and/or regaining an ongoing sense of well-being. Examples of these problems include a generally difficult time gaining access to treatment resources that address substance problems and mental illness, a reduced chance of following program guidelines after gaining access to appropriate treatment, a statistically higher chance of experiencing highly damaging health complications during the course of recovery and a statistically higher chance of dying years or decades earlier than the rest of the adult population.

Child Abuse

Public health experts use the term child maltreatment to identify any active behaviors that produce damaging physical or mental outcomes for minor children, as well as any passive behaviors that produce such outcomes. Active behaviors that fall under the definition of maltreatment include intentional or unintentional physical abuse (e.g., kicking or punching a child), intentional or unintentional sexual abuse (e.g., exposing a child to adult sexual behavior or involving a child in such behavior) and intentional or unintentional emotional/psychological abuse. Passive behaviors that qualify as child maltreatment include intentional or unintentional failure to fulfill a child’s basic medical, material, educational or emotional requirements, as well as intentional or unintentional failure to shield a child from physically or emotionally damaging environments.

Impact of Dual Diagnosis

In the study published in Advances in Dual Diagnosis, researchers from the University of Melbourne and two other Australian institutions used an analysis of the family histories of 29,445 children exposed to verified incidents of abuse to determine if parents and other caregivers affected by a dual diagnosis have higher chances of committing such maltreatment than parents and caregivers only dealing with substance problems or only dealing with separately diagnosable mental illness. All of the verified incidents of child maltreatment occurred in the Australian state of Victoria between the years 2001 and 2005.

After reviewing the gathered data, the researchers found that serious alcohol problems, drug problems and mental health problems all separately increase the odds that a parent or some other caregiver will repeatedly commit an active or passive form of child maltreatment. They also found that the simultaneous presence of drug problems and mental illness increase the odds of recurring child abuse even further. The researchers additionally concluded that the simultaneous presence of alcohol problems and mental illness apparently does not further add to the chances that a parent or caregiver will have continuing involvement in active or passive maltreatment. However, crucially, they found that the separate impact of alcohol problems creates a risk for recurring child maltreatment roughly equal to the risk associated with a drug-based dual diagnosis.

The study’s authors believe their large-scale results contribute meaningfully to the general comprehension of the ways in which drug-based dual diagnosis and separate issues with alcohol abuse/addiction, drug abuse/addiction and mental illness affect the odds that acts of child maltreatment will occur.

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