Editor's Note: Although the extensive demonstration program described in this article is not yet at the point of outcome findings, the problems it undertakes to help are both tenacious and growing. The lessons learned so far, and the readiness of the staff to alter the program accordingly, are useful for other agencies working with the same client population.
There is no question that the prevention of child abuse is difficult, but the problems become exponential when members of the household are substance abusers [Hampton 1991; Hampton et al. 1993; Hayes and Emshoff 1993]. This article reviews the scant literature identifying substance abuse as a primary contributing factor to child abuse and neglect. It describes a federally funded research demonstration project currently in its second trial year, and sets forth the conceptual perspective of the project. The article concludes with impressions of the successes and tribulations of the project to date.
NATURE OF THE DOUBLE PROBLEM: CHILD ABUSE AND SUBSTANCE ABUSERS
Although child welfare professionals have been aware for years of the increased risk of violence for children of alcoholic parents [DeLuca 1981], it has only been recently that the true dimensions of the interaction between substance abuse and violence against children have begun to surface in the professional literature. In a sense this is surprising, given the data that two of every ten Americans are social users of alcohol and drugs, five are misusers, and one is alcohol or chemically dependent [Hayes and Emshoff 1993]. In another and sadder sense, it underscores the continued failure of professionals within specialty fields to extend themselves beyond the limits of their specialty. That is, experts have been identified in chemical dependency, child abuse, and violence, but cross-fertilization in these highly correlated fields seldom occurs.
As an illustration of the importance of an integrated philosophy, the National Committee for the Prevention of Child Abuse  estimated that upwards of 10 million children were living in households with an addicted caregiver; of this number, an estimated 675,000 children per year were suspected of being abused. Evidence to support this estimate can be found in one study of 190 randomly selected records from the caseload of a large juvenile court. In each of these cases, the state took legal custody of the children following a finding of child maltreatment. Evidence was also obtained about substance involvement by the child's caregiver. Serious chronic substance abuse was denoted by at least two social service or mental health professionals, and by parental self-report. Using these criteria, the authors reported that 67% of the reviewed cases involved parents who would be considered substance abusers [Famularo et al., cited in the Federal Register, July 11, 1991].
Other reports have established similar links between substance abuse and the victimization of children. For example, in one review of the literature, five studies identified parental alcohol abuse as a significant factor in child victimization incidents. Depending upon the study, between 25% and 84% of the abusing parents misused alcohol [Leonard and Jacob 1988]. In a study of 146 children in out-of-home care, Roy  reported that nearly half had been abused. Of these children, 41% reported their fathers as having drinking problems. Smith and Kunjukrishnan  reported that alcohol was a factor in 71% of childhood sexual assaults. This finding has appeared to a lesser extent in other studies and reviews by Duncan , Finkelhor , and Morgan . Examining drug use during pregnancy, Chasnoff  reported that 50% of the 1987 child abuse and neglect incidents in New York City were substance involved. This author also reported estimates that at least 11% of the pregnant women in the United States use substances during pregnancy, and that more than 300,000 infants per year are born to cocaine/crack-abusing mothers. …