Substance Use Disorder – A Family Disease

Holistic and comprehensive support is needed to heal the whole family

March 24, 2020

The US is currently facing a drug epidemic of historical proportions.  Not only are those with a Substance Use Disorder (SUD) impacted by this epidemic, but so are their families and loved ones – specifically children whose parent or parents have a SUD.  While the main focus of all child welfare agencies must be to protect children and ensure their best interests are being served, child welfare agencies must move away from a presumption that removal of children, and minimal parenting time for parents with SUD, fulfills that obligation. There must be a recognition of the trauma to the child associated with removal and of the harm the isolation and lack of connection will cause to the parent pursuing recovery (Rivera & Sullivan , 2015).  Using a multidisciplinary approach, stakeholders can do much more to protect high-risk families when they work together across specialties and disciplines without automatically resorting to removal of the children.

It is not contested that as a result of the current drug epidemic, the burdens to the child welfare system have multiplied exponentially in the last decade, especially in light of the opioid epidemic.  According to the National Center on Substance Abuse and Child Welfare, parental alcohol or other drug use as a contributing factor for reason for removal increased from 18% to over 35% in the last 16 years; younger children make up a larger percentage of children in out-of-home care, with children under five representing over 41% of children in care.  This alarming rate of young children coming into care is especially troubling, as children ages 0 – 3 are especially vulnerable.  However, the question which arises from this data is what do these numbers really show?  Perhaps these numbers are a warning sign that the current paradigm of treating parents with SUD is not working and may actually be causing harm to the very children the system was designed to protect.

When a parent has a SUD, the whole family should be part of the treatment and recovery process, and each household member may need support.  More specifically, recent research has clearly shown that where parents receive treatments and comprehensive services that were specifically matched to them, reunification and successful remission could be attained (Murphy, Harper, Griffiths & Jackson, 2017).  As a nation we must remove stigma and blame surrounding addiction and by doing so, not only will the person with the SUD recover, but harm for those who love the person with the SUD will be averted, as well.  There must be a realization that when appropriate treatment and support is provided, permanent family separation can be averted without any risk of harm to the children.  Maintenance of the family unit and avoiding removal – in all except the most warranted cases – will protect children from experiencing the trauma of removal.  At the same time, this will increase the likelihood that parents will complete treatment and recover.

A recent study in the Journal of Public Child Welfare examined four evidence-based interventions used for families where the parent (or parents) has a SUD and there is child maltreatment.  This study revealed that Family Treatment Drug Court, Family Treatment Drug Court Plus, Comprehensive Services, and Strengthening Families were all very effective models for serving this population and preventing removal and family dissolution (Murphy, et al., 2017). The common components in these programs included recovery specialists, intensive judicial monitoring, wrap around services (parenting training, career and vocational counseling, trauma and domestic violence counseling, mental health treatment, housing and transportation), substance use assessment and treatment, and a team approach consisting of representatives from all the various systems involved, including the judicial system, child welfare agency, and the treatment system.  When families received substance abuse treatment and appropriately matched comprehensive services, the outcomes were markedly more successful, families remained intact, and trauma to children was avoided.

Because drugs and alcohol are only a symptom of an underlying issue, as opposed to a moral failure or poor choices, the idea of punishing and demoralizing people with SUD must be abandoned if we are to successfully combat this epidemic.  This is especially critical when the person with the SUD is a parent and a child may be damaged by outdated views on those suffering with SUD.

– Nikki Tierney


Murphy, A. L., Harper, W., Griffiths, A., & Joffrion, C. (2017). Family Reunification: A Systematic Review of Interventions Designed to Address Co-Occurring Issues of Child Maltreatment and Substance Use. Journal of Public Child Welfare, 11(4/5), 413–432.

Rivera, M., & Sullivan, R. (2015). Rethinking child welfare to keep families safe and together: Effective housing-based supports to reduce child trauma, maltreatment recidivism, and re-entry to foster care. Child Welfare, 94(4), 185-204. Retrieved from 


Nikki Tierney is in sustained remission from substance use disorder.  She is a single mom to four children including 20-year-old triplets and a 16 year old.  In 2006, she had her children removed from her custody and shortly after had a no-contact order issued for nine months.  Her family began the process of reunification in 2008 where she began gradual supervised visits, individual and group counseling, and meetings with parental mentors.   By 2011, she regained full legal and physical custody of all of her children. Her family truly reunited because of comprehensive care they all received. 

Nikki graduated with honors from Rutgers School of Law in Newark in 1997.  She was a practicing attorney for 10 years but voluntarily consented to disbarment in 2007.  Despite her sustained recovery and rehabilitation, in 2017 the Supreme Court denied her application to withdraw her voluntary consent to disbarment. Pending a change in the law, she remains unable to practice law.  She is currently pursuing her master’s degree in clinical mental health counseling at Monmouth University and is an intern at CPC Behavioral Care.

The Ammon Foundation believes that when individuals are holistically and strategically supported to build purposeful lives, the likelihood of them maintaining their recovery substantially increases. We provide this support via our Ammon Recovery Scholars Program. Our program goals include: removing financial barriers through financial scholarships; providing strategic support for recipients through offering personal, professional and academic support; and creating a supportive peer community committed to combating the stigma associated with addiction by promoting that recovery is possible. We are committed to giving away at least $150,000 in scholarships annually and are looking to fund education as a stepping stone to stable employment, safe housing and adequate healthcare. To find out more about our programs, or to apply for an educational scholarship, please click here or email