Separating fact from fear in drug-related child welfare policy

Child welfare is a particularly difficult area of public policy. Interventions are frequently based on limited information and early warning signs, rather than on confirmed harm, and are carried out in the name of “protecting the children.” While the urgency may feel justified, these short-term decisions can have lasting negative consequences for families and the future of the children involved.

In recent years, Naomi Schaefer Riley, a senior fellow at the American Enterprise Institute (AEI), has argued that government-facilitated family separation should be the first response when authorities find parents have used drugs, both during pregnancy and while parenting. 

But parental drug use does not necessarily mean abuse or neglect of children. The incidence of reporting families to child protective services is high relative to the number of cases where actual abuse or neglect is ultimately found. A recent study found that child welfare agencies in 21 states referred at least 70,778 reports of alleged substance use during pregnancy to police or prosecutors between 2017 and 2023. In the 15 states where investigation outcomes were verified, about 55% of referred cases (around 22,000) were not found to involve abuse or neglect, meaning that though drug use may have occurred, it does not mean that child welfare was at risk.

The practice of automatically reporting parental drug use to child welfare agencies treats perceived risk as proof of harm and removal as prevention, but evidence for the effectiveness of this approach is thin. Research shows that separation itself can cause serious harm to children, such as severe anxiety, depression, post-traumatic stress disorder (PTSD), toxic stress, and delays in cognitive development, as well as harm to parents. And there is a demonstrated elevated risk of abuse in foster care, according to a recent meta-analysis. 

Despite the downsides, the impulse to separate children from parents continues to influence child welfare interventions around parental drug use, driven largely by misconceptions and myths. An examination of the evidence suggests that we would achieve better results with alternative approaches.

Myth 1: All parental drug use is dangerous

In a 2025 article in National Affairs, Riley argues that society must stop viewing drug use as “a valid if unfortunate decision” and instead recognize it as a “terrible blight on children and families.” Her article urges political and media leaders to reframe substance use from a personal choice to a primary driver of family instability. Riley’s overarching claim is that economic and social pressures will not prevent children from succeeding in life so long as they have at least one sober, self-sacrificing parent.

Truth: Drug use is not the same as drug abuse

Arguments that equate drug use with drug abuse fail to recognize the full spectrum of substance-using behavior and the spectrum of dependency that can include both legal drugs, like caffeine, nicotine, and prescription medications, as well as illicit substances. Alcohol’s central role in social life complicates rigid claims about “drugs” and parental fitness. 

Importantly, most drug use does not meet the criteria for a substance use disorder as set forth in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and different substances carry different levels of risk. 

Table 1 – Comparative substance risk and policy context.

Of course, having a glass of wine on a Saturday is totally different than spending every weekend on a cocaine bender. In order to justify the drastic and inherently harmful step of removing a child where a single drug test is the basis, decision-makers must determine that there are other indications of family dysfunction likely to harm children and that removal is the only safe option. If two parents attend a party and one agrees to be the designated driver while the other drinks alcohol, that may constitute responsible parenting despite the presence of “substance use” in the home.     

Interventions that can result in family separation should occur only when there is an actual danger in the family and no other alternatives are available. The presence of any substance use alone is simply not enough proof without further evidence of dysfunction. 

Research finds that children who are removed from their homes face 20 to 70% higher odds of adverse outcomes, including mental health challenges, poorer educational attainment, and increased involvement with the criminal justice system, compared to similarly situated children who remain with their families. Child welfare policies should reflect those nuances.

Furthermore, national survey data show that about 8% of caregivers meet criteria for alcohol dependence compared to roughly 3% for drug dependence, with approximately 11% meeting criteria for either alcohol or drug dependence. Researchers note that differences in reported prevalence may partly reflect lower stigma and greater social acceptability surrounding alcohol use, which can influence how substance use is reported. 

Substance use can appear alongside cases of harm to children, but reports do not show that drug use itself directly causes a large share of the negative outcomes attributed to it. In child welfare investigations, case reports and administrative records that cite parental substance use as a factor in family separation often classify the outcome simply as “neglect.” Context, co-occurring factors, and structural conditions are frequently omitted from these accounts. Realistically, families experiencing neglect or abuse are dealing with a web of problems, and drug use is often not the dominant factor driving the dysfunction.

Treating all parental drug use as equivalent ignores these meaningful distinctions. In practice, child welfare policies and reporting frameworks often still treat parental substance use as a monolith, not distinguishing between occasional alcohol use, prescription medication misuse, or high-risk illicit drug dependence. This approach fails to differentiate less dangerous behaviors from much more destabilizing ones, leading to unnecessary family disruption or separation.

The narrative that all parental drug use is dangerous inaccurately portrays parental sobriety as the decisive factor in child wellbeing, downplaying the effects of poverty, education, community safety, and access to services on childhood outcomes.

Myth 2: People who use drugs are dangerous and unsafe parents

This myth operates less as a claim about behavior and more as a shortcut for decision-making. In practice, drug use is often treated as a stand-in for risk, where its mere presence is used to justify concern, intervention, or removal without fully assessing what is actually happening in the home. It is commonly supported by citing child fatality or neglect cases where parental substance use is mentioned as a contributing factor and presenting those cases as evidence that drug use itself leads to harm. 

Tragic outcomes involving infants and children are recounted in detail, including prenatal drug exposure, unsafe sleep environments, accidental ingestion of drugs by children, and lack of supervision. These examples are used to imply a direct causal link between parental drug use and child injury or death. As an example, a 2024 Manhattan Institute piece by Riley and Rafael A. Mangual asserted that “drug abuse drives child maltreatment,” which in turn “drives the lack of social mobility for kids at the very bottom.” 

Truth: Parental drug use alone is not a reliable indicator of child safety risk

Proponents of more punitive child welfare policies often treat parental drug use as evidence of unsafe parenting, using dramatic accounts of extreme cases to suggest that people who use drugs are inherently dangerous caregivers. These narratives rely on outlier incidents to generalize risk, despite the fact that most drug use in households does not result in harm to children. In fact, in more than 82% of child physical and sexual abuse cases, there are no reported alcohol or drug use problems. 

Claims that drugs and bad mothering drive child maltreatment are largely fueled by a single research paper published more than 18 years ago. That study established a correlation between parental substance use and outcomes such as child maltreatment and foster care placement, but it did not demonstrate that substance use causes maltreatment. While substance use and child maltreatment often occur in tandem, this does not mean that drug use causes the maltreatment. In reality, parental drug use overlaps with numerous other factors that impact child welfare, such as housing instability, poor access to healthcare, and poverty. 

This disconnect between correlation and causation is reflected in how these assumptions are translated into practice. As reported by The Marshall Project, hospital drug testing and reporting practices routinely funnel families into the child welfare system without reliable evidence of harm. In 2022 alone, more than 35,000 infants were reported as substance-exposed, often relying on tests that are not fully reliable.

These results point to a system that too often substitutes suspicion and stigma for evidence, nuance, and proportional response. 

Reports often point to conditions such as congenital malformations, preterm birth, low birth weight, and sudden infant death syndrome (SIDS) as leading contributors to infant mortality, and these outcomes are sometimes attributed to simple parental fault. Research does find associations between prenatal substance exposure and elevated risks, including higher rates of preterm birth, impaired fetal growth, neonatal mortality, and SIDS or sudden unexpected infant death (SUID), even after adjusting for other factors. However, these associations reflect complex biological, medical, and social conditions and do not justify treating every instance of prenatal substance exposure as evidence of abuse or neglect. 

Critically, elevated risks associated with prenatal substance exposure are often interpreted as evidence of parental fault, even though similar outcomes can arise from a wide range of medical and social factors. Conditions such as low birth weight, preterm birth, and neonatal intensive care unit (NICU) admission are not unique to illicit substance use and do not, on their own, indicate neglect or abuse.

The narrative also suggests that parents who do use drugs are not as loving or attentive as other parents and have less desire to care properly for their children, which is overwhelmingly not the case. 

In her book Curious, foster mother Christina Dent describes her initial confusion when caring for an infant whose birth mother had used drugs during pregnancy, noting the fierce commitment she observed from the mother: “This whole-hearted, vulnerable affection and emotion is not at all what I was expecting. Isn’t this the same woman who used drugs while she was pregnant? How can a mom who would do that also love her child this much? I don’t know much about addiction, but I have some experience with motherhood, and I have no category for this.”

In a study out of two drug treatment centers in Southern Florida, mothers identify concern for the well-being of a child as a powerful motivator for them to engage in treatment and abstain from substance use. In this qualitative study with 20 mothers, findings show that even amid substance use, mothers remain deeply motivated to care for their children and often view their caregiving role as central to their identity and recovery. The inaccurate perception that mothers who use drugs are indifferent to their babies may explain why people who make these arguments frequently downplay the value and efficacy of lesser interventions that don’t separate families.

Myth 3: Stigma is necessary to dissuade drug use

Riley asserts that the dramatic decline in smoking in the United States was driven primarily by stigma, arguing, “How did we drastically reduce smoking in America? It was stigma.”

Truth: Stigma is not necessary to dissuade drug use. Instead, what dissuades drug use is accurate information, honest education, and access to services and treatment

Stigma is ever-present for people who use drugs and their families, and that stigma is compounded by stigma associated with being involved in the child welfare system, to a persistent and pernicious effect. 

But stigma is not what dissuades drug use, nor is it what drove declines in smoking. The evidence consistently shows that behavior change is driven by accurate information, sustained public education, and access to services and treatment. Public awareness of health risks is not the same as public stigmatization. Smoking rates fell alongside decades of data-driven education, warning labels, advertising restrictions, and cessation support, not through social exclusion or moral condemnation. 

By contrast, stigma toward people who use drugs is associated with worse outcomes, including delayed treatment-seeking, reduced engagement with care, lower access to harm-reduction services, and higher overdose risk—outcomes that also undermine family stability and harm children. 

Qualitative research further shows that stigma plays a distinct and often overlooked role in shaping child welfare involvement, particularly for parents who use drugs. Studies of affected families document that mothers report being treated as inherently unfit, regardless of actual caregiving behavior, and describe avoiding healthcare, prenatal care, and social services out of fear of surveillance and child removal. 

Providers, in turn, acknowledge that substance use can trigger heightened scrutiny and reporting thresholds that are not applied consistently across substances or contexts. This dynamic can distort decision-making, where stigma, rather than clear evidence of harm, influences perceptions of risk. In this way, stigma does not simply accompany substance use, but can actively shape pathways into the child welfare system and contribute to findings of neglect or maltreatment that are not always grounded in demonstrated harm.

Myth 4: Removal is necessary to protect child welfare 

This argument by Riley is grounded in the belief that child welfare systems err on the side of inaction, with proponents pointing to cases of severe abuse and neglect to argue that stronger intervention, including removal, is necessary to prevent serious harm or death.

Truth: The risk of removal must be weighed against the harms, and we should adopt evidence-based alternatives that yield better outcomes

Though removing children from potentially unsafe homes can feel like a safe approach, family separation is not without its own risks. Removing children from the home itself causes harm to children that must be weighed carefully when assessing a child’s best interests. These harms include emotional and psychological harms, separation and attachment disorders, trauma inherent to the removal process, grief and confusion, and other long-term consequences that may be more harmful to children than leaving them at home. 

Parents are a central part of a child’s life, and many of the most effective child welfare responses involve supporting parents who are willing and able to address challenges that affect caregiving. The purpose of these interventions is to improve the family’s overall functioning and support the most conducive environment possible for raising the child. 

Federal policy reflects this understanding of the value of family cohesion. The Families First Prevention Services Act, a bipartisan bill passed by Congress and signed by President Donald Trump in 2018, increased federal funding for services to prevent the need for children to enter the foster care system at all.

The act recognized that access to funding for in-home services, treatment, and other concrete assistance to parents who may be struggling reduces the risk of child maltreatment and child welfare involvement. 

A growing body of evidence shows that alternatives to removal can produce equal or better outcomes when properly implemented, compared to standard child welfare practice, which typically relies on case monitoring, service referrals, and court oversight without intensive, family-centered support. These alternatives include models such as family drug treatment courts, peer mentorship and parent partner programs, intensive in-home reunification services, and wraparound approaches that integrate substance use treatment, parenting support, and case management. 

One systematic review shows that roughly 20% of children who reunify with their families reenter foster care, with the risk of reentry highest in the first few months following separation, highlighting the instability created by repeated removals. By contrast, targeted, family-centered interventions have demonstrated measurable improvements. In one program, children receiving peer mentorship support had a 13.4% reentry rate within 12 months compared to 21.8% among those receiving standard services. Family drug treatment court models have reduced reentry rates to as low as 2% compared with 12% in traditional court processing, while also reducing subsequent child protective service investigations from 64% to 33% in some cases. Intensive in-home reunification services have similarly reduced re-referral rates, from 32.5% to 25.2%. 

While results vary across studies, the overall pattern is clear. Interventions that stabilize families and address underlying needs can outperform default reliance on removal.

Myth 5: To protect unborn children, expectant mothers should be routinely drug-tested, and results should inform child welfare or legal action

Many hospitals routinely test mothers or newborns for drugs, and many report those results to child welfare agencies.

Truth: Testing should be consensual, and given known accuracy limitations, a positive test should not be relied on alone as evidence of problematic drug use

As documented by The Nation, many prosecutions and child removals hinge on positive toxicology screens that may be inaccurate, reflect prescribed medications, or indicate substance use without demonstrating harm. For this reason, leading medical organizations, including the American College of Obstetricians and Gynecologists, the American Medical Association, and the American Academy of Pediatrics, oppose using drug testing as a punitive or criminal tool during pregnancy. 

Evidence suggests that health-centered approaches are more effective. For example, when hospitals limit nonconsensual drug screening and use testing to support care rather than build criminal cases, family surveillance declines without harming infant outcomes. This was demonstrated in New York City, where toxicology-only reports to child welfare departments fell by 80% following such reforms without leading to increased harm to infants.

Conclusion

Riley advances oversimplified and often inaccurate narratives about child welfare, particularly when it comes to mothers with substance use disorder or mothers who have used drugs. These myths are frequently presented as settled facts, despite conflicting evidence and a growing body of research that points to far more complex realities. 

Supporting families through accessible treatment, economic stability, and coordinated care is more consistent with both the data and the long-term interests of children than reflexive surveillance and removal. Reason has crafted a model bill for states that wish to improve their approach in this way. Separating fact from fear is a prerequisite for building a child welfare system that is both humane and effective.

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Source: https://reason.org/commentary/separating-fact-from-fear-in-drug-related-child-welfare-policy/