Abuse in America: Child, Substance, and Domestic Violence

Introduction: The Scope of Abuse in America

There are many forms of abuse that individuals encounter throughout their lives. Abuse produces long-lasting traumatic effects on its victims and creates drastic ramifications for society, including significant financial costs. It is crucial that America addresses abuse and its life-shattering effects. The statistics surrounding abuse are shocking and dreadful; unfortunately, these numbers continue to climb to record-breaking highs year after year. This research paper examines three major forms of abuse: child abuse, substance abuse, and domestic violence.

Throughout the human lifespan, the majority of Americans encounter some form of abuse. The effects of abuse can have a disturbing impact on victims, with trauma that tends to linger throughout the individual's life. These effects frequently extend beyond the nuclear family; extended family members may experience feelings of abandonment, anxiety, fear, anger, concern, embarrassment, and guilt.

As a nation, our ultimate goal should be to reduce the burden—especially the health burden—of abuse and addiction and their many related adverse consequences to individuals and society at large. By speaking out and addressing abuse, we can change society's perception and replace stigma and shame with a new understanding of abuse as a treatable condition, much like any other medical disease.

Child Abuse: Definitions and Statistics

Child abuse, broadly defined, refers to the mistreatment of a child by a parent or guardian. According to Dictionary.com, this includes neglect, beating, and sexual molestation. Federal law provides a more comprehensive definition: "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of serious harm." This definition refers specifically to parents and other caregivers. A "child" under this definition generally means a person who is younger than age 18 or who is not an emancipated minor (Child Welfare).

Child abuse in America is at an all-time high. Millions of children endure traumatic abuse that sometimes produces lifelong effects. Researchers and policymakers have long recognized that children living in families with limited economic resources are at higher risk for abuse than children from higher socioeconomic backgrounds (Gil 1970). The fundamental effect of income on child abuse risk is complex; because many factors such as poor parental mental health are known to increase both the probability of poverty and child maltreatment, separating out the causal role of income can be challenging (Gil 1970). Researchers found that the effects of untreated child abuse and neglect can profoundly influence a child's physical and mental health, their ability to control emotions and impulses, their achievement in school, and the relationships they form as children and adults (Schulte 2013).

Each year, child protective services receive reports of child abuse and neglect involving millions of children, and many more go unreported. The long-term consequences of child abuse and neglect impact not only the victims themselves but also their families, future relationships, and society. Statistics reveal the disturbing trend: in 1963, only 150,000 young victims of abuse or neglect came to the attention of authorities; by 1993, an estimated 3 million reports were made, with an estimated 1,016,000 children confirmed as victims of maltreatment (Landis, Quiram, and Jacobs 1995). This growing number is appalling and represents a serious crisis for Americans.

Research has identified three key risk factors that increase the likelihood of child abuse: parental depression, parental substance abuse, and whether the parents had been abused or neglected as children (Schulte 2013). Understanding these risk factors is essential for prevention efforts.

The National Children's Alliance is a nonprofit organization that provides accreditation to Children's Advocacy Centers (CACs). A CAC is a child-friendly facility where law enforcement, child protection, prosecution, mental health, medical, and victim advocacy professionals work together to investigate abuse, help children heal, and hold offenders accountable. In the Greater Kansas City area, organizations such as Sunflower House and Children's Mercy Hospital provide these services. Individuals can call 211 to find local assistance and CACs in their area.

In 2013, Children's Advocacy Centers served more than 290,000 children across the country. Of this total: 62 percent were involved in sexual abuse cases, 38 percent were not old enough to attend kindergarten, and 90 percent knew their perpetrator (National Children's Alliance). These facts are overwhelming and should move society to action. Working together, healthcare providers, community-based organizations, social services agencies, schools, faith communities, and concerned citizens can help strengthen families, foster healthy child development, and reduce child abuse.

Sexual Abuse and Its Consequences

Sexual abuse is one of the most prevalent forms of child abuse. The Federal Child Abuse Prevention and Treatment Act of 1974 defines sexual abuse as "the obscene or pornographic photography, filming, or depiction of children for commercial purposes, or the rape, molestation, incest, prostitution, or other such forms of sexual exploitation of children under circumstances which indicate that the child's health or welfare is harmed or threatened thereby" (Landis, Quiram, and Jacobs 1995). While difficult to discuss, it is important to acknowledge that sexual abuse of children of all ages, including infants, occurs every day.

At the extreme end of the spectrum, sexual abuse includes sexual intercourse and its variations. However, "all offenses that involve sexually touching a child, as well as non-touching offenses and sexual exploitation, are just as harmful and devastating to a child's well-being" (Landis, Quiram, and Jacobs 1995). Sexual abuse robs children of their childhood and creates a loss of trust, along with feelings of guilt and self-abusive behavior.

The psychological consequences of sexual abuse are severe and long-lasting. Sexual abuse "can lead to antisocial behavior, depression, identity confusion, loss of self-esteem and other serious emotional problems. It can also lead to difficulty with intimate relationships later in life" (Gil 1970). The sexual victimization of children is ethically and morally wrong, and society must prioritize protection and healing for survivors.

Substance Abuse: Economic and Health Burden

Substance abuse is defined as a harmful pattern of use of any substance for mood-altering purposes that leads to frequent and serious problems. These problems typically affect performance at school, work, or home. Substance abuse is not limited to drugs; it also includes the use of inhalants, solvents, alcohol, caffeine, narcotics, and cigarettes.

According to Dr. Nora Volkow, Director of the National Institute on Drug Abuse, "Drug abuse and addiction are major burdens to society; economic costs alone are estimated to exceed half a trillion dollars annually in the United States, including health, crime-related costs, and losses in productivity. However, staggering as these numbers are, they provide a limited perspective of the devastating consequences of this disease" (National Institute on Drug Abuse).

Approximately 22 million Americans suffer from drug abuse and addiction, the effects of which are wide-ranging and affect people of all ages, including children growing up in homes with parents who struggle with addiction (National Institute on Drug Abuse). The U.S. must continue to design and develop public information, education, and materials on drug abuse, addiction, and recovery. Taking advantage of mainstream media vehicles and past successes such as Internet chats and television broadcasts could aid in campaigns against substance abuse. Such action will help ensure the best possible future for all Americans, regardless of their economic and social backgrounds.

Youth and Substance Abuse

There are many shocking facts about substance abuse that should move this nation to action. Each year, nearly half a million Americans die from alcohol, tobacco, and illicit drugs, making substance abuse the single largest preventable cause of death in the country (Brandeis University 1993). Additionally, a person dying from alcohol-related causes loses, on average, 26 years off the normal lifespan; from drug-related causes, over 37 years; and from smoking-related causes, about 20 years (Brandeis University 1993).

Young people who persistently abuse substances often experience an array of problems, including academic difficulties, health-related problems, mental health issues, poor peer relationships, and involvement with the juvenile justice system (Nowinski 1990). Declining grades, absenteeism from school and other activities, and increased potential for dropping out are problems associated with adolescent substance abuse (Nowinski 1990). Cognitive and behavioral problems experienced by alcohol- and drug-using youth may interfere with their academic performance and also present obstacles to learning for their classmates (Nowinski 1990).

The social and economic costs related to youth substance abuse are high, resulting from financial losses and distress suffered by victims of alcohol- and drug-related crime, increased burdens for the support of adolescents and young adults unable to become self-supporting, and greater demands for medical and treatment services (Nowinski 1990). Mental health problems such as depression, developmental lags, apathy, withdrawal, and other psychosocial dysfunctions are frequently linked to substance abuse among adolescents (Nowinski 1990).

Because most drug abuse problems develop during adolescence, it is vitally important that youth be made aware of the effects drugs have on their developing brains and bodies so they have the knowledge to choose not to use drugs (Brandeis University 1993). Given the scope of the public health burden of drug addiction, the number of lives affected, and the associated mortality, addiction prevention, treatment, and recovery must be a top priority.

Domestic Violence: Patterns and Costs

The United States Department of Justice defines domestic violence as "a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner." Domestic violence can be physical, sexual, emotional, economic, or psychological. This includes any behaviors that intimidate, manipulate, humiliate, isolate, frighten, terrorize, coerce, threaten, blame, hurt, injure, or wound someone (Department of Justice).

Researchers have increasingly examined the economic effects of domestic violence, both in terms of financial costs to victims and broader impact on national economies. A 2003 study by the Centers for Disease Control and Prevention estimated that domestic violence cost the U.S. economy more than $5.8 billion in a single year (CDC 2014).

The costs of domestic violence fall into several distinct categories. The most easily quantified category is "direct costs," which measure the value of goods and services used to respond to domestic violence. "Direct costs are usually consumption-related and include the costs of healthcare services, social and welfare services, counseling, police and criminal justice services, legal services, transportation costs, and housing and other refuge services used by victims of domestic violence and special education services used to treat children of abused women" (CDC 2014). The cost of replacing property damaged by an abuser is also a direct cost of domestic violence.

The cost of healthcare services consumed as a result of domestic violence—including emergency room and clinic visits, hospital stays, mental health services, medication, and physical therapy—is one of the most significant cost components. The CDC estimated that the annual cost for healthcare services used to treat victims of domestic violence in the United States is at least $4.1 billion, based on 1995 cost figures (CDC).

Physical and Psychological Effects on Victims

Domestic violence affects not only those who are abused but also has a substantial effect on family members, friends, coworkers, other witnesses, and the community at large. Children who grow up witnessing domestic violence are among those seriously affected by this crime (Department of Justice). "Children in families experiencing domestic violence are more likely than other children to exhibit aggressive and antisocial behavior or to be depressed and anxious. Other researchers have found higher levels of anger, hostility, oppositional behavior, and disobedience; fear and withdrawal; poor peer, sibling, and social relationships; and low self-esteem" (Child Welfare).

Many physical injuries sustained by victims cause medical difficulties as the victim ages. Arthritis, hypertension, and heart disease have been identified by battered women as directly caused or aggravated by domestic violence early in their adult lives (Davis 1998). Medical disorders such as diabetes or hypertension may be aggravated in victims of domestic violence because the abuser may not allow them access to medications or adequate medical care (Davis 1998).

Along with depression, domestic violence victims may experience Post-Traumatic Stress Disorder (PTSD), which is characterized by symptoms such as flashbacks, intrusive imagery, nightmares, anxiety, emotional numbing, insomnia, hypervigilance, and avoidance of traumatic triggers (Davis 1998). Researchers who examined the relationships among psychological abuse, severity of violence, and PTSD found a significant correlation between domestic violence and PTSD (Davis 1998). In one study, women in each group examined (psychological abuse only, moderate violence, and severe violence) scored in the significant range for PTSD. Overall, 55.9 percent of the sample met diagnostic criteria for PTSD (Davis 1998).

Victims often lose their jobs because of absenteeism due to illness from violence. Because victims may need to move multiple times to avoid violence, and moving is costly and can interfere with continuity of employment, the economic burden extends beyond direct medical costs. The entire nation pays the price of domestic violence. This crime has affected American society for far too long, and it is time to find solutions and heal.

Conclusion: A Call to Action

As a nation, our ultimate goal should be to reduce the burden—especially the health burden—of abuse and addiction and their many related adverse consequences to individuals and society at large. By speaking out and addressing abuse, we can change society's perception and replace stigma and shame with a new understanding of abuse as a treatable condition, much like any other medical disease.

Americans should not remain ill-informed about the nature, prevalence, and severity of abuse that characterizes our families, neighborhoods, and communities. The reality and consequences of abuse make most Americans uncomfortable, but it is time to face the issue of violence directly. Abuse is everyone's problem. It is an issue that will not disappear on its own. It is prevalent in our families, churches, and communities. It is time to step out of our comfort zones and admit that we have been hiding from the problem, which sometimes contributes to it.

Regardless of one's religious belief, ethnicity, economic status, or gender, it is the duty of everyone to take a stand against abuse. All over America, families are under attack through injuries, demeaning humiliation, cursing, verbal and emotional abuse, bloodshed, sexual violence, and many other painful ways. As Americans, we must face these oppressors and say no more. We must reclaim our lives and society. Abuse affects everyone, and it is a crisis that has solutions. Now is the time to act.