Parental Substance Abuse and Its Effects on Child Development


Parental Substance Abuse and Its Effects On Child Developement


An exploration of how parental substance abuse affects child development, and its implications for education professionals

Author: Kenzie Caudill





 Substance Abuse is defined by the World Health Organization (2016) as

The harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.




Justification for Research



If you were to walk into an elementary, middle, or high school cafeteria and ask students to raise their hands if they had someone in their immediate family or knew someone who was addicted or had abused drugs or alcohol, you would most likely see hands go up across the room. An article from the National Center on Addiction and Substance Abuse (2008) shared the following statistics:

  • Even though Americans only make up 4% of the world’s population, we consume ⅔ of the world’s illegal drugs.


  • 80% of America’s adult inmates and juvenile arrestees have committed offenses while high, violating laws on drugs and alcohol, stealing in order to buy drugs, or having a history of substance abuse.


  • 70% of abused and neglected children have alcohol or drug abusing parents.


More than 8 million children are living with parents who are substance abusers.

National Council of Child Abuse and Family Violence (2016) 



To make it more personal to the classroom, it is estimated that “one in six children in school today has a parent dependent on or addicted to alcohol or other drugs,” (Davies, 2010). With the national average class size being around 23 students (National Center for Education Statistics, 2008), that would mean that in each of our classrooms, around 3-4 students have a parent who is dependent on alcohol or drugs. This number is only continuing to rise, as the number of children three years old and younger having at least one parent who abuses drugs or alcohol is 10% (Osborne, C., Berger, L., 2009).


Teachers are on the frontlines when it comes to preparing the next generation for success, as well as being one of the most present adults in children's lives throughout the school year, therefore we as teachers must become more aware of this growing problem, and more knowledgable about the issue and how it effects our students in order to better ensure their success. A common paraphrase of a quote by George Santayana reads 



Those who fail to learn from history are doomed to repeat it.



We, as teachers, make our living by teaching our students to learn from what has happened, been written, or established before in history across all subject areas, but if we fail to do our part in this growing drug crisis in America by coming alonside our students who struggle with parental substance abuse, then history may only continue to repeat itself and substance abuse could become a generational pattern.




Goals of This Site



As teachers, we must become more aware of four things:


  • The prevalence of substance abuse in our country today.


  • The effects of parental substance abuse on these students, both prior to entering, while in, and after leaving our classroom.


  • How to identify these children in our classrooms.

  • What we can do to help them and their families as teachers, as well as knowing what resources are available to help them.


I. Prevalence in America


 General Substance Abuse Statistics


According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 National Survey on Drug Use and Health

  • There were 21.5 million people (12 and older) that had a substance abuse disorder (SUD) in 2013
    • 17,0 million with an alcohol disorder.
    • 7.1 million with an illicit drug use disorder.
    • 2.6 million who had both an alcohol and illicit drug use disorder.







According to the National Institute on Drug Abuse (2015) from 2001 to 2014, the number of overdose deaths included

  • Prescription drugs deaths increased by 2.8 fold from just under 10,000 to over 25,000.
  • Prescription opioid pain reliever deaths increased by 3.4 fold from under 6,000 to over 18,000.
  • Benzodiazepines deaths increased by 5 fold from under 2,000 to over nearly 8,000.
  • Cocaine deaths increased by 42 percent.
  • Heroin deaths increased by 6 fold from under 2,000 to just under 12,000.


According to the  Drug Abuse Warning Network (DAWN) via the National Institute on Drug Abuse (2011) in 2009 nearly one million Emergency Department (ED) visits involved the use of an illicit drug, both alone, and in combination with other drugs.

  • Cocaine was involved in 422,896 visits
  • Marijuana was involved in 376,467 visits
  • Heroin was involved in 213,118 visits
  • Stimulants such as amphetamines, methamphetamine were involved in 93,562 visits
  • The number of drug-related  ED visits increased from 2004 to 2009 by 81 percent.
  • ED visits involving the use of pharmaceuticals, specifically, increased by 98.4 percent from 2004-2009.



For an interactive map from Time Magazine showing the spread of drugs from 2002-2014 via information from the CDC, click here.

            For an interactive map from The Guardian showing the spread of drug overdose from 1999-2014 via information from the CDC, click here.







According to the National Institute on Alcohol Abuse and Alcoholism (NIH) (2016)


  • 88,000 people die from alcohol-related causes annually, which makes it the fourth leading preventable cause of death in the United States


     According to the  Drug Abuse Warning Network (DAWN) via the National Institute on Drug Abuse (2011)

  • Alcohol (under 21 years of age) was involved in 199,429 Emergency Department visits




II. Effects on Child Development


Prevalence of Substance Abuse During Pregnancy





According to the National Institute on Alcohol Abuse and Alcoholism (NIH) (2016)

  •  In 1996 the prevalence of Fetal Alcohol Syndrome (FAS) was estimated to be between 0.5-3.0 cases per 1,000, however, more recent cases put that number closer to 2-7 cases per 1,000.
  • The prevalence of Fetal Alcohol Spectrum Disorders are reported to be as high as 20-50 cases per 1,000.


According to the Child Welfare Information Gateway (2014)


  • Prenatal substance use can be as high as 30 percent in some populations, with more than 400,000 infants each year (10 percent of all births) having been exposed to substances prenatally.
  • From 2011-2012 approximately 5.9 percent of pregnant women (ages 15-44) were current illicit drug users.
  • As high as 18.3 percent specifically between the ages of 15-17.
  • From 2011-2012 about 8.5 percent of pregnant women (ages 15-44) reported current alcohol use, and 3 percent reported heavy drinking.


For more information on the effect of alcohol on pregnancy, click here.

For more information on the effects of Fetal Alcohol Spectrum Disorders on child development, click



Effects From Birth Onward: General Effects


A study published in the Journal of Forensic Sciences (2010) by Palmiere, Staub, La Harpe, and Mangin found that


  • Substances that cause drowsiness or impair concentration and attention have the effect of reducing the level of parental supervision given to children, which in turn puts the children at risk for neglect both in immediate physical and emotional needs, as well as for accidents that could result in unintentional poisonings or death.
  • Substances that cause the parent to enter a state of agitation, restlessness, or impaired judgement can cause failure to appropriately regulate responses to children, which can cause the parent to misinterpret a child’s behavior and in turn react inappropriately.


The use of alcohol or drugs, or the abuse or dependence on them, can have effects on parenting including (Besharov, 1992 as quoted in Young, Gardner, and Dennis, 1998)


  • Interfere with thought processes and thus consistent parenting processes including a parent’s mental functioning, judgement, inhibitions, and protective capacity may become impaired.
  • Interfere with the ability to respond consistently and sensitively to a child which can decrease the development of secure attachments between mother and child
  • Leave a parent emotionally and physically unavailable to a child
  • Lower a parent’s threshold of aggression toward children.
  • Result in a parent spending household money needed for food, clothing, and other basic needs on alcohol or other drugs.
  • The parent being associated with criminal activity that may jeopardize a child’s health and safety.
  • Lead to the neglect of a child’s routine health care needs, including well-baby checkups and immunization schedules

According to a study done in 2009 by Cynthia Osborne and Lawrence M. Berger, there is a noteable  difference between which parent abuses substances, or if both abuse, on child development, as seen in the following figure



According to the Child Welfare Information Gateway (2014)


  • A 1999 study by the U.S. Department of Health and Human Services (HHS) found that studies showed between one-third to two-thirds of child maltreatment cases “were affected by substance use to some degree,” though research more recently is suggesting that the “range may be even wider.”
  • It is estimated that 12 percent of children in the United States live with a parent dependent on or abusing alcohol or other drugs.
  • According to a study by the Center for Behavioral Health Statistics and Quality (2015) reported in this bulletin, 8.3 million children under 18 live with at least one substance-dependent or substance-abusing parent.
    • 7.3 million with a parent dependent on or abusing alcohol
    • 2.2 million with a parent who was dependent on or abused illicit drugs.


According to the American Academy of Experts in Traumatic Stress (2014)



  • Children of alcoholics or substance abusers may struggle with the balance between loving their parents and worrying about their well-being, while also feeling angry or hurt that their parents do not love them enough to stop using.
  • Some children blame themselves for their parent’s substance abuse, and may try to control their situation through trying harder to receive A’s in school, working harder to keep the home clean and organized, get along with siblings, or may withdraw in order to not create disturbances that could cause their parent to abuse a substance.
  • Children of alcoholics or substance abusers may take on developmentally inappropriate responsibility within the household or with their siblings or parents, feeling that the responsibility lies on them.

According to Akin, Brook, Lloyd (2015), parental substance abuse

  • Heightens the risk for both physical and emotional safety of the child.
  • Is an detriment to a child’s overall development and well-being
  • Increases a child’s chances of witnessing violence and experiencing trauma
  • Increases a child’s chances of exhibiting behavioral health problems


Because parental substance abuse can go hand in hand with a variety of other traumatic childhood experiences such as parental separation or divorce, parental mental illness, physical or emotional neglect, domestic violence, incarceration, physical, emotional, or sexual abuse, the following TED talks are incredibly relevant to this topic. The following video shows speaker Nadine Burke Harris at a TED MED event in which she presents the topic, "How Childhood Trauma Affects Health Across a Lifetime." In her presentation she discusses a study done in the late 1990s in which two researchers explored the correlation between health issues in adults who had suffered from ACEs, or Adverse Childhood Experiences. The study conducted had participants identify whether or not they had experienced a variety of ACEs similar to the ones listed at the beginning of this paragraph, and then observed the correlation between the number of ACEs identified, and the increased risk of a variety of health issues. Harris weaves this information in with her personal experiences as a medical professional observing patients in which she began to see a connection, and provides insight into the seriousness of this subject and the importance of spreading this information and giving recognition to this framework for approaching medical practices. One quote that stood out from this talk that Harris shared was from Dr. Robert Block, former president of the American Academy of Pediatrics, "Adverse Childhood Experiences are the single greatest unnadressed public health threat facing our nation today." Take a look at this talk by clicking here or by scrolling to the bottom of this page and selecting the first video.




The following TEDx Talk was given by Dr. Allison Jackson. She also discusses the implications and issues surrounding ACEs, but her talk focuses on the personal call and connection for individuals to the children affected by this, including teachers. She discusses how many individuals cross paths with children affected by ACEs, yet feel it is not their place, it is not their role. Her challenge, however, is that, for the sake of these children's health, it is our place, and it is our role. You can take a look at this talk by clicking here, or scrolling to the bottom of this page and selecting the second video.




Effects From Birth Onward: Behavioral Effects


According to the American Academy of Experts in Traumatic Stress (2014)


  • There is a higher prevalence of depression, anxiety, suicide attempts, and eating disorders among children of substance abusers compared to their peers.
  • Living with substance abusers can often create a high conflict home, in which children are more likely to have a lower self-esteem and less of a feeling of control within.
  • They may have a higher difficulty in school, inability to focus on their school work due to these unstable home lives.
  • They are more likely to have learning disabilities, be truant, repeat more grades, and transfer schools or be expelled when compared to their peers.
  • The prevalence of anxiety and depressive disorders were more common in adolescents and adult children of alcoholics.

              According to a book published by the Substance Abuse and Mental Health Services Administration (SAMHSA) titled Substance Abuse Treatment and Family Therapy (2004)


  • Inconsistency in parental rule setting and enforcement can leave children feeling confused as to what the boundaries of right and wrong are. Therefore chlidren are unsure of what their limits are, or what actions will cause what responses in their parents.



Effects From Birth Onward: Physical Effects


According to the American Academy of Experts in Traumatic Stress (2014)


  • Children of parents with a drinking or drug problem can develop stress-related health problems such as gastrointestinal disorders, migraines or headaches, and asthma, as well as numerous other health problems and dangers that can occur due to lack of supervision.

  • Studies of these children have documented increased rates of physical illnesses believed to be due to stress including enteritis, colitis, and asthma.

  • Children of alcoholics were found to be three to four more greater at risk for developing alcoholism when compared to children of non-alcoholic parents.



Effects From Birth Onward: Emotional Effects


According to the American Academy of Experts in Traumatic Stress (2014)

  •  Children of alcoholics or substance abusers may experience unpredictable behavior or mood swings from parents in the home, leading to feelings of mistrust both with their parents and with other adults.
  • Related to feeling the need to perform better academically or behave better, these children may feel guilty for “setting off” their parent’s problem or causing angry outbursts.
  • Because of the feeling of needing to hide their parent’s behavior, a child may feel a sense of shame in that their friends cannot come over due to possibility of witnessing the embarrassment of having an alcoholic or substance abusing parent.

  • Some of these children live in a state of fear due to the unpredictability of what their parent is capable of while drunk or on drugs, possibly being able to harm them.

  • Some may struggle with feelings of insecurity in their hard home environment, leading to feelings of low self-esteem, high tension at home, anxiety, depression, and acting out.



According to Leah Davies (2010), children in families with parental drug abuse:

  •  Are often confused, frightened, and lonely.
  • Can end up struggling with anxiety, depression, rigidity, and relationship difficulties as they grow older.


According SAMHSA (2004)

  • Children of parents abusing alcohol may feel guilty and responsible in some way for their parent’s drinking problem.
  • Children whose parents abuse illicit drugs may struggle with living with the knowledge that their parents’ actions are illegal, or that they may be forced to engage in some kind of illegal activity for their parents.
  • They have a greater risk for mental disorders such as depression, anxiety, and low self-esteem.


III. Relationship Between Substance Abuse and Foster Care


Whatever the prevalence of children exposed to drugs and alcohol in the general population, there can be little doubt that the vast majority of children entering foster care are affected by living in substance-abusing families

(Cole et al. 1996, as quoted in Young, Gardner, & Dennis, 1998)



According to (Young, Gardner, & Dennis, 1998)


  • It is estimated that substance abuse is a factor in three-fourths of all foster placements

  • Parental substance abuse was a factor for 78% of the children going into foster care in Los Angeles, New York City, and Philadelphia County

  • Substance abusing related families are much more likely to reenter the child welfare system over a five year period according to more than 67% of state welfare agencies


According to the Office of Adolescent Health (2016)


  • Children of parents with substance use issues are more likely to end up in out-of=home care, as well as more likely to stay in this care longer than other children.

  • The National Survey of Child and Adolescent Well-Being (NSCAW) estimates that 61 percent of infants and 41 percent of older children in out-of-home care are from families with active alcohol or drug abuse.

  • For nearly 31 percent of all of the children placed in foster care in 2012 the reason documented for why they were removed from the home was parental alcohol or drug use.

    • In some states this number was higher than 60 percent.


IV. Effects on Academic Performance






According to the American Academy of Experts in Traumatic Stress (2014)

Children from substance abusing families are more likely to

  • Have learning disabilities
  • Repeat more grades
  • Attend more schools
  • Be truant
  • Be delinquent
  • Drop out of school because of pregnancy, expulsion, or institutionalization


Children of alcoholics or substance abusers may

  • Be distracted or have less energy because of their home lives, making it hard to concentrate in school

  • Work below their potential because of the energy expelled worrying about the substance abusing or alcoholic parent

  • Be unable to focus on or complete homework due to fighting, tension, or worry at home


According to SAMHSA (2004)


  • A documented life-long problem that children of substance abusing parents may struggle with is an impaired learning capacity.
  • Children of women who abused substances during their pregnancy were found to have a greater risk of school-related problems such as truancy.



V. The Educator's Role



Many professionals in the area push for education on prevention of substance abuse, including The National Center on Addiction and Substance Abuse (Califano, 2008). Programs like D.A.R.E. strive to give students skills they need to prevent involvement in drugs, gangs, and violence, as well as not having to be led by a teacher, but the teacher inviting a D.A.R.E. officer in to their classroom or school to educate students from kindergarten to 12th grade (2016). For more information on how to invite a D.A.R.E. officer to your school, click here.


The first thing a teacher should realize when looking for signs that a student is struggling with parental substance abuse is that they can come from all socioeconomic groups, and their range of academic abilities can vary widely (Davies, 2010). There is no one specific identifier that applies to every child in these situations. It is also important to not presume a child from a lower Socioeconomic Status (SES) as automatically at risk, as well as not presuming a child from a higher SES as being automatically exempt. Parental substance abuse and the indicators can be transferrable across multiple SES levels.


With this in mind, we can examine ways taht teachers may begin to observe their students by (Davies, 2010):

  • Seeing how they interact with their peers
  • Paying close attention to their drawings or stories they tell or write
  • Being cautious as they as much information as possible before seeking help for a child in order to ensure there is, in fact, a problem going on at home
  • Observing any behavioral indicators such as:
    • Appear unkempt or dressed inappropriately
    • Be tardy or absent frequently
    • Complain of psychosomatic symptoms such as stomach or headaches
    • Exhibit inconsistent academic work
    • Seem unusually sad, hopeless, indifferent and/or withdrawn
    • Be the “class clown”
    • Have emotional tirades or other disruptive behaviors
    • Seem uncomfortable during a discussion of alcohol or other drugs
    • Have a parent that is difficult to contact, or fails to keep scheduled conferences
    • Have a parent who seems indifferent toward their child
    • Be teased by peers who know of parent’s drug use
    • Have a parent who is observed at school or in the community under the influence of alcohol or another drug

Dr. Adele M. Brodkin (2016) provides some of the following suggestions of how a teacher can help support both the student, and possibly the partner of the parent having an alcohol-abuse issue (though this is applicable to any substance abuse situation) such as


  • If the teacher’s uncertain of what is going on at home, invite the parent that is not battling substance abuse issues in to discuss and compare noticeable changes in the child’s behavior.
  • Including the school-recommended social worker to join in a meeting to discuss possible local agencies or specialists to provide support.
  • Reassure the parent that they will be making special efforts to make sure the child sees the classroom as a safe, stable, and reliable place to be.
  • Be a calm and available presence to the child.
  • Try to get the child involved in some kind of activities that allow them to express their feelings, such as art, dance, or poetry therapy.

An important practice that a teacher can implement that is wonderful for children not only of parental substance abuse situations, but applicable to so many other problems a child may be facing can be to be the adult who will listen, support, and help them stay safe. Children need someone in their lives who will encourage them through saying things like, “You are a special person and I care about you. What is happening is not your fault. I will be glad to listen when you need to talk to someone,” (Davies, 2010).




Above all else, the most important thing to take away from all of this is to realize that the educator has a role in this situaiton.



There is something that teachers can do for these children whether it be a deep involvement such as intervening by talking with the parent and sharing resources, or reporting the situation to a superior and getting help for the child, or something on a smaller scale like simply letting the student know you are there for them if they need you. With the rise in substance abuse continuing, our chances of having these students in our professional lifetimes is high, so taking the time to be prepared for when it happens, not if it happens, is a great way to get started. This page serves as that springboard for awareness and initial introduction, but by no means is it the ending point. From here, teachers should take what they have learned, build upon it, apply it, share it, and take a more active role in their school community in order to get the help these students need to succeed.




VII. It's Not All Bad: Positive Effects, Concluding Thoughts, and Call to Action


According to SAMHSA (2004)

  • Resiliency is an example of something positive that can arise from children growing up in homes involving substance abuse. In other words, these children have a higher ability to recover from difficult or painful situations, they are better able to “bounce back” from things that may set others back.
  • They are better able to cope than others.

  • They develop tools they need to respond to extreme stress, disruption, and change, have mature judgement, a capacity to tolerate ambiguity, autonomy, and a willingness to shoulder responsibility as well as moral certitude.

           One last reminder that teachers must walk away from this information with is that not all students have negative effects that come with being a child of a substance abuser. Resiliency is such a beautiful effect that students can take and spin into numerous positve outcomes. In your classroom you may be tempted to automatically assume the student struggling, or showing signs of many of the negative effects discussed earlier, is the child of a substance abuser and therefore this is a child you put your focus on. The student who aspires to be a counselor one day, who pursues high grades, who is involved in numerous student activities in the school to avoid being at home, the student who goes on to college determined not to repeat the cycle they grew up in, the child who has good grades and hardly ever has behavior issues, these students can still very well be children of substance abusers and deserve support to.

          In fact, I have witnessed these very kind of students in my own life, both personally and as a teacher. I have seen some children come from very broken homes, but because of their resiliency and determination they were able to overcome and not let these negative effects hold them back from what they aspired to be and do with their lives. Not every child and adult I have witnessed has been a success story. I have seen some of these stories end in funerals, and I have sat through those funerals. I have seen them tear their families apart and put their children through what they themselves went through. But the reason why I did this research, the reason why I believe in this awareness, the reason why I wanted to present this message and shed light on this subject for teachers is because I want to see these students. Part of researching to create this page was researching to educate myself, to see what differences I can make, to give me the eyes to see these kids in my classroom and know what I can do for them. My only hope is that the same has been done for you.


       May we see these children, may we let them know they are seen, understood, heard, and given voice to. May we, as teachers, let them know that these negative effects, they do not have to own them, they do not have to let them define them, label them, or set a course for their lives. We, as teachers, have an ability, a responsibilty, a role to play in their lives. May we play it well.

VII. Resources






  • Creating Safe Schools: A Guide for School Leaders, Teachers, Counselors, and Parents by Franklin P. Schargel (2014)

  • Broken Bottles, Broken Dreams: Understanding and Helping Children of Alcoholics by Charles Deutsch (1982)

  • Children, Families, and Substance Abuse by G. Harold Smith, Claire D. Coles et al. (1995)

  • School Interventions for Children of Alcoholics by Bonnie K. Nastasi and Denise M. Dezolt (Guilford)



VIII. Bibliography


 About. (2016). D.A.R.E. America. Retrieved 18 October 2016, from



Alcohol Facts and Statistics. (2016). Retrieved 18 October 2016, from


Alcoholism, n.. (2016). Retrieved 18 October 2016, from


Akin, B. A., Brook, J., & Lloyd, M. H. (2015). Co-Occurrence of Parental Substance Abuse and Child Serious Emotional Disturbance: Understanding Multiple Pathways to Improve Child and Family Outcomes. Child Welfare, 94(4), 71-96.


Brodkin, A. (2016) Between Teacher & Parent: Helping a Child of an Alcoholic. Scholastic Teachers. Retrieved 18 October 2016, from


Califano, J. (2008). High Society: How Substance Abuse Ravages America and What to Do About It. The National Center on Addiction and Substance Abuse. Retrieved 18 October 2016, from


Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from data/


Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (SAMHSA) (US); 2004. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 2 Impact of Substance Abuse on Families. Available from:


Child Welfare Information Gateway. (2014). Parental substance use and the child welfare system. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved 18 October 2016 from


Davies, L (2010. An Educator’s Guide to Children Affected by Parental Drug Abuse. Education Digest, 75(8) 62-64.


Drug-Related Hospital Emergency Room Visits. (2016). Retrieved 18 October 2016, from


Effects of Parental Substance Abuse on Children and Families. (2014). American Academy of Experts in Traumatic Stress. Retrieved 18 October 2016, from

Osborne, C., and Berger, L. (2009). Parental substance abuse and child well-being. Journal Of Family Issues, 30(3), 341-370.

Overdose Death Rates. (2015). Retrieved 18 October 2016, from


Palmiere, C., Staub, C., La Harpe, R., & Mangin, P. (2010). Parental substance abuse and accidental death in children. Journal Of Forensic Sciences, 55(3), 819-821. doi:10.1111/j.1556-4029.2010.01349.x

Parental Substance Abuse A Major Factor  In Child Abuse And Neglect. (2016). Retrieved 18 October 2016, from

Protecting Children in Families Affected by Substance Use Disorders. (2009) (1st ed.). Retrieved from 3 How Parental Substance Use Disorders Affect Children

Schools and Staffing Survey. (2008). Retrieved 18 October 2016, from

Substance abuse. (2016). World Health Organization. Retrieved 18 October 2016, from

Young, N., Gardner, S., & Dennis, K. (1998). Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy (1st ed.). Washington, DC: Child Welfare League of America, Inc. Retrieved from




Drugs/Pills: E. (2010, June 27). Pills 2 [Digital image]. Retrieved November 25, 2016, from

Alcohol: Adrien, B. (2008, April 11). What's next? [Digital image]. Retrieved November 25, 2016, from

Pregnant Woman: Vdb, T. (2013, March 9). Pregnancy [Digital image]. Retrieved November 25, 2016, from

Empty Classroom: Harder, D. (2010, December 2). Empty classroom [Digital Image]. Retrieved November 25, 2016, from

Teacher and Students: US Department of Education (2009, August 27). _LBW7152 [Digital Image]. Retrieved November 25, 2016, from




Embedded Video: