INTRODUCTION

This case highlights the danger of allowing courts to diagnose parents with “substance abuse” problems based on their own subjective judgments rather than objective, scientific, evidence-based criteria. As this case illustrates, such subjective, standard-less judicial determinations can cause significant harm, including unnecessary judicial intervention into families’ privacy and the wrongful separation of parents from their children. While the medical field strives to keep pace with scientific advancements in the field of substance use and substance use disorders (“SUDs”), progress is often hampered by myopic cultural attitudes. Unfounded assumptions and stigma—against substance use and individuals with SUDs—pose critical barriers to proper diagnosis and treatment and can cause significant harm, particularly when they are used as a basis to deprive parents of their fundamental rights and separate families.

Amici, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (“AMERSA”) and the California Society of Addiction Medicine (“CSAM”), are associations of individuals who have devoted their professional lives to understanding and treating SUDs. Amici submit this brief to emphasize the importance of applying consistent, evidence- based criteria, free from harmful assumptions and stigma, to diagnose SUDs and determine whether a parent’s substance use poses a risk of substantial harm to that parent’s minor children.

This brief argues that the Court of Appeal and Juvenile Court (together the “Lower Courts”) in this case erroneously conflated “substance use” with “substance abuse.” The term “substance abuse”1 is stigmatizing and outdated, and should be properly interpreted to refer to a substance use disorder, which can only be accurately diagnosed by a trained professional. Amici herein describe the significant distinctions between substance use and a substance use disorder, and explain that frequency, duration, and/or amount of substance use alone do not constitute diagnostic criteria for substance use disorders. Appellate courts have split over how to define “substance abuse,” and Amici urge the Court to adopt the test developed in Drake M., in which a finding of “substance abuse” can only be found by a trained professional or based on objective, scientific criteria.2 Amici also explain that a urine drug test alone cannot diagnose a SUD—nor indicate whether or not the person was actively inebriated at the time of testing. Finally, Amici explain that scientific evidence does not support equating substance use with a “substantial risk of harm,” and that parental substance use and substance use disorders do not automatically create a substantial risk of harm to children.

Welfare and Institutions Code § 300(b)(1) authorizes a juvenile court to exercise dependency jurisdiction over a child if “[t]he child has suffered, or there is substantial risk that the child will suffer, serious physical harm or illness, as a result of . . . the inability of the parent or guardian to provide regular care for the child due to the parent’s or guardian’s mental illness, developmental disability, or substance abuse.” California Courts of Appeal have adopted different standards for what qualifies as “substance abuse” under this provision. In Drake M., the Second District Court of Appeal, Division Three adopted objective, scientifically-based criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (“DSM-IV-TR”) for assessing whether a parent’s substance use constitutes “substance abuse.”3 However, in Christopher R., the Second District Court of Appeal, Division Seven held that Juvenile Courts were not required to use objective, evidence-based criteria, found the parent at issue “to be a current substance abuser” based on the Court’s subjective beliefs concerning the parent’s drug use, and exercised dependency jurisdiction over her children.4 This approach allows judges—who are not addiction medicine professionals—to create their own subjective standard, independent of generally accepted objective diagnostic criteria, for intervening into a family’s privacy and removing a child from his parent’s custody on the basis of substance use or “substance abuse.”

In Christopher R., the Court also adopted a rule that, for children of “tender years . . . ‘the finding of substance abuse is prima facie evidence of the inability of a parent or guardian to provide regular care resulting in a substantial risk of physical harm.’”5 This automatic presumption of harm is unsupported by scientific evidence and stigmatizes parents by equating substance use or a substance use disorder with a lack of parental fitness. This is particularly dangerous in light of courts’ frequent conflation of substance use and “substance abuse,” as occurred in the instant case.

In the current case, the Second District Court of Appeal, Division Five (the “Court of Appeal”) opinion relied on Christopher R. to affirm jurisdiction and a custody removal order based solely on the father’s occasional drug use and other subjective, stigma- based assumptions ungrounded in science or any other objective criteria for diagnosing a SUD or a finding of substantial risk of harm to the child. Specifically, the Lower Courts made numerous assumptions and findings that are contrary to accepted practices in addiction medicine, including: 1) that the use of prohibited substances is tantamount to “substance abuse”; 2) that positive drug tests are evidence of active inebriation at the time of the test; and 3) that parental substance use necessarily poses a substantial risk of harm to a minor child.

Accordingly, Amici contend that the approach adopted by the Lower Courts encourages arbitrary judgments that reflect outdated, stereotypical notions of substance use to the extreme detriment of families, including undermining the recognized priority of parental reunification in dependency proceedings.7 Amici therefore urge the Court to adopt the test for “substance abuse” developed in Drake M., in which “substance abuse” is defined and identified ideally by specialized addiction professionals, but at a minimum according to criteria set out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (the “DSM-5-TR”).8 Amici agree that adopting such an objective, evidence-based test will prevent scientifically unfounded and biased assumptions from needlessly separating and harming families. Amici also encourage the Court to reject the rule, applied by the Lower Courts, that a finding of “substance abuse” is prima facie evidence of a substantial risk of physical harm to minor children. Rather, courts should engage in a fact-specific inquiry to determine whether a parent with a diagnosis of substance use disorder poses a substantial risk of harm to their children that would necessitate jurisdiction.

Introduction

Courts sometimes make diagnoses of "substance use" in parents based on personal views rather than objective, scientific evidence. This subjective approach can cause significant harm, including unwarranted intrusions into family privacy and the separation of parents from their children. While the medical field continuously advances its understanding of substance use and Substance Use Disorders (SUDs), progress is often slowed by outdated cultural attitudes. Harmful assumptions and stigma surrounding substance use and SUDs create major barriers to proper diagnosis and treatment, particularly when used to deny parents their fundamental rights and divide families.

The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) and the California Society of Addiction Medicine (CSAM) are organizations of professionals dedicated to understanding and treating SUDs. These organizations submit this brief to emphasize the importance of using consistent, evidence-based criteria, free from harmful assumptions and stigma, to diagnose SUDs and to determine if a parent’s substance use poses a substantial risk of harm to their minor children.

This brief argues that the lower courts in this case incorrectly treated "substance use" as the same as "substance use." The term "substance use" is outdated and carries a stigma. It should be properly understood as referring to a Substance Use Disorder, which can only be accurately diagnosed by a trained professional. Substance use frequency, duration, or amount alone do not constitute diagnostic criteria for a SUD. Appellate courts have differed on how to define "substance use," and these organizations urge the Court to adopt the standard set in Drake M., where "substance use" can only be determined by a trained professional or based on objective, scientific criteria. It is also important to note that a urine drug test alone cannot diagnose a SUD or indicate if a person was actively under the influence at the time of testing. Scientific evidence does not support the idea that substance use automatically leads to a "substantial risk of harm," nor do parental substance use or Substance Use Disorders inherently create such a risk for children.

California law (Welfare and Institutions Code § 300(b)(1)) allows a juvenile court to assume jurisdiction over a child if there is a substantial risk of harm due to a parent's inability to provide regular care because of "substance use." California Courts of Appeal have adopted different standards for what qualifies as "substance use" under this provision. The Drake M. case established objective, scientifically-based criteria from the American Psychiatric Association’s diagnostic manual for assessing parental substance use. However, in Christopher R., a different court ruled that juvenile courts were not required to use objective, evidence-based criteria. Instead, it allowed judges to make subjective determinations of "substance user" status, based on personal beliefs about drug use, leading to court intervention and child removal without professional diagnosis.

Furthermore, Christopher R. adopted a rule that for young children, a finding of "substance use" automatically serves as proof that a parent cannot provide regular care, resulting in a substantial risk of physical harm. This automatic presumption of harm lacks scientific support and unfairly labels parents, equating substance use or a Substance Use Disorder with a lack of parental fitness. This is particularly dangerous given how frequently courts confuse general substance use with "substance use," as observed in the present case. The lower courts in this case relied on Christopher R. to affirm jurisdiction and a custody removal order based solely on the father’s occasional drug use and other subjective, stigma-based assumptions, which were not grounded in science or any objective criteria for diagnosing a SUD or finding a substantial risk of harm to the child. Specifically, the lower courts made several assumptions contrary to accepted practices in addiction medicine, including that: any use of prohibited substances equates to "substance use"; positive drug tests indicate active intoxication at the time of testing; and parental substance use necessarily poses a substantial risk of harm to a minor child.

The approach taken by the lower courts encourages arbitrary judgments rooted in outdated, stereotypical ideas about substance use, which severely harms families and undermines the priority of parental reunification in dependency cases. Therefore, these professional organizations urge the Court to adopt the definition of "substance use" established in Drake M., which ideally requires identification by specialized addiction professionals or, at a minimum, adherence to criteria set out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR). Adopting such an objective, evidence-based standard will prevent scientifically unfounded and biased assumptions from needlessly separating and harming families. These organizations also encourage the Court to reject the rule, applied by the lower courts, that a finding of "substance use" automatically proves a substantial risk of physical harm to minor children. Instead, courts should conduct a specific, fact-based inquiry to determine if a parent with a diagnosed Substance Use Disorder poses a substantial risk of harm to their children, which would necessitate court jurisdiction.

Introduction

Courts risk harming families when diagnosing parents with "substance use" problems based on personal opinions rather than objective, scientific evidence. Such subjective judicial decisions can lead to unnecessary court involvement in private family matters and even separate parents from their children unfairly. While the medical field works to advance understanding of substance use and substance use disorders (SUDs), outdated cultural beliefs and stigmas often slow this progress. These biases against substance use and individuals with SUDs create major hurdles to accurate diagnosis and effective treatment, causing significant harm, especially when used to remove children from parents.

The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) and the California Society of Addiction Medicine (CSAM) are groups of professionals dedicated to understanding and treating SUDs. These organizations submit this information to stress the importance of using consistent, evidence-based standards to diagnose SUDs. These standards must be free from harmful assumptions and stigma when determining if a parent's substance use truly endangers their minor children.

A key argument is that lower courts have incorrectly conflated "substance use" with "substance use." The term "substance use" is now considered outdated and stigmatizing; it should properly refer to a substance use disorder, which only a trained professional can accurately diagnose. There are significant differences between simply using a substance and having a substance use disorder. Factors like how often, how long, or how much a substance is used do not, by themselves, meet the diagnostic criteria for a SUD. Also, a urine drug test alone cannot diagnose a SUD or show if a person was impaired when the test was given. Scientific evidence does not support the idea that substance use automatically creates a "substantial risk of harm" to children.

California law (Welfare and Institutions Code § 300(b)(1)) permits a juvenile court to take jurisdiction over a child if there is a substantial risk of serious harm because a parent cannot provide regular care due to "substance use." However, appellate courts in California have disagreed on how to define "substance use" under this law. In Drake M., one court adopted objective, scientific criteria from the American Psychiatric Association's diagnostic manual (DSM-IV-TR). In contrast, Christopher R. allowed courts to use subjective beliefs to find "substance use" and remove children, even without evidence-based criteria. This subjective approach lets judges, who are not addiction experts, create their own standards for intervening in families. The Christopher R. court also established a rule that, for young children, a finding of "substance use" automatically creates a presumption that the parent cannot provide proper care, leading to a substantial risk of harm. This automatic assumption of harm lacks scientific support and unfairly labels parents, equating substance use or a SUD with being an unfit parent.

In the current case, the court's decision to remove a child relied on subjective, stigma-based assumptions rather than scientific criteria. These assumptions included equating any prohibited substance use with "substance use," believing positive drug tests show active impairment, and assuming parental substance use always risks harm to a child. This approach, adopted by the lower courts, leads to arbitrary judgments based on outdated ideas about substance use, which significantly harms families and hinders efforts to reunite parents and children. Therefore, the expert organizations urge the Court to adopt the objective, evidence-based test for "substance use" developed in Drake M., using criteria from the DSM-5-TR, ideally by addiction professionals. They also recommend rejecting the rule that "substance use" automatically means a substantial risk of harm to minor children. Instead, courts should carefully examine the specific facts of each case to determine if a parent with a SUD truly poses a substantial risk requiring court intervention.

INTRODUCTION

This legal case shows the dangers when courts decide if parents have "substance use" problems based on a judge's personal opinion instead of real scientific proof. Such subjective decisions can cause serious harm, including unnecessary legal interference in families' private lives and wrongly separating parents from their children. While medical science continues to improve its understanding of substance use and substance use disorders (SUDs), old cultural beliefs and negative attitudes often slow this progress. Preconceived ideas and the stigma around substance use can block proper diagnosis and treatment. This is especially harmful when these attitudes are used to take away parents' basic rights and split up families.

Organizations like the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) and the California Society of Addiction Medicine (CSAM) are made up of professionals who study and treat SUDs. These groups have submitted a brief to highlight the need for consistent, evidence-based standards, free from harmful assumptions and stigma, to diagnose SUDs. They also stress the importance of using these standards to decide if a parent's substance use truly puts their minor children at serious risk.

The brief explains that the lower courts in this case mistakenly mixed up "substance use" with "substance use." The term "substance use" is outdated and carries a negative stigma; it should properly refer to a Substance Use Disorder (SUD), which only a trained professional can accurately diagnose. The brief clarifies that how often, how long, or how much a substance is used does not, by itself, meet the criteria for diagnosing a SUD. It also notes that a urine drug test alone cannot diagnose a SUD or show if someone was actively under the influence when tested. Furthermore, scientific evidence does not support the idea that any parental substance use automatically creates a "substantial risk of harm" to children.

Under Welfare and Institutions Code § 300(b)(1), a juvenile court can take legal control over a child if there is a significant risk of the child suffering serious physical harm because a parent cannot provide proper care due to mental illness, developmental disability, or "substance use." California's appellate courts have used different definitions for "substance use" under this law. One court case, Drake M., adopted objective, science-based criteria from a medical manual to determine "substance use." However, another case, Christopher R., allowed juvenile courts to use subjective beliefs, rather than objective evidence, to label a parent a "substance user" and remove their children. This approach lets judges, who are not addiction experts, create their own standards for stepping into family matters and taking children away based on substance use.

In the current case, the Court of Appeal's decision to affirm jurisdiction and a custody removal order relied on the Christopher R. approach. This decision was based solely on the father's occasional drug use and other subjective assumptions that lacked scientific or objective proof for diagnosing a SUD or finding a serious risk of harm to the child. Specifically, the lower courts assumed that any use of prohibited substances equals "substance use," that positive drug tests prove a person was actively high at the time of the test, and that a parent's substance use always poses a serious risk of harm to a minor child.

Therefore, AMERSA and CSAM argue that the approach taken by the lower courts promotes arbitrary judgments based on old, stereotypical ideas about substance use. This seriously harms families and goes against the goal of reuniting parents with their children in dependency cases. The organizations urge the Court to adopt the objective standard for "substance use" established in Drake M., where a diagnosis is made by addiction professionals or based on specific criteria from a recognized medical manual. This evidence-based test would prevent unscientific and biased assumptions from needlessly separating and harming families. They also ask the Court to reject the rule from Christopher R. that automatically assumes a substantial risk of harm to children if "substance use" is found. Instead, courts should look at the specific facts of each case to determine if a parent with a SUD truly poses a serious risk that requires legal intervention.

INTRODUCTION

This case shows how harmful it can be when courts decide a parent has a serious substance problem based only on their own feelings, instead of using real facts and medical rules. This kind of judgment can cause big problems for families, leading to courts stepping in where they shouldn't and even separating parents from their children. Often, old ideas and unfair judgments about substance use make it harder to understand and treat these problems correctly. Groups of experts, like AMERSA and CSAM, have spent their lives studying and helping with substance use disorders. They are sharing their knowledge to help courts make fair decisions based on facts, not old beliefs, when looking at a parent's substance use and whether it truly puts children at risk.

There is a big difference between simply using a substance and having a serious substance use disorder. Only a trained health professional can accurately say if someone has a substance use disorder. Just because someone uses a substance often or in large amounts does not automatically mean they have a disorder. Also, a drug test only shows if a substance was used; it does not tell if someone was high at the time of the test or if they have a disorder. Experts say that a parent's substance use, or even a substance use disorder, does not always mean they are a danger to their children.

A state law allows courts to take children from a parent if the parent cannot care for them due to a serious substance problem. However, courts have disagreed on what "serious substance problem" means. In one case, called Drake M., the court said to use clear, medical rules from experts to decide. But in another case, Christopher R., the court let judges use their own ideas about a parent's drug use. This means judges, who are not doctors, could decide to take children away based on their own opinions, which may not be fair or based on facts. The Christopher R. case even said that if parents of very young children use substances, it automatically means the children are in danger, an idea not supported by science.

In the current case, the courts made similar mistakes. They said that simply using a drug meant the father had a serious substance problem. They also believed that a positive drug test meant he was high at that moment, and that his substance use automatically put his child at great risk. These ideas go against what medical experts know about substance use.

The expert groups believe that using these old, incorrect ideas about substance use hurts families and makes it harder for parents and children to be reunited. They are asking the court to use the clear, expert rules from the Drake M. case to define a "substance use disorder." They also want courts to stop automatically assuming that a parent's substance use disorder means their children are in danger. Instead, courts should carefully look at each family's situation to see if a parent's serious substance problem truly puts their children at risk and if court action is truly needed.