Domestic Violence, Substance Misuse and Mental Ill-health: The Toxic Trio

Within research examining adverse childhood experiences, the toxic trio describes the risk of child abuse and neglect stemming from a child’s exposure to domestic violence, parental mental health issues and/or learning disability, and  parental substance misuse. 

In this systematic review, researchers examine the evidence underpinning the ‘toxic trio’ in child safeguarding policy and practice.

Despite the 'toxic trio' measure, being regularly used to identify risk in child protection practice, the researchers found evidence that was "weak and lacking in the precision, detail and depth".

There was little research evidencing the causal factors or dynamic interplay between factors, and key concepts, such as mental illness, were rarely defined.

The researchers found little evidence for services offering support or whether the availability of social, economic and environmental resources might influence the impact of the factors on childhood maltreatment.

Overall, these findings suggest the evidence base for the ‘toxic trio’ is not adequate enough to justify its prominance in shaping child protection policy and practice.

The authors urge future research to address the gaps in literature in order to gain a detailed understanding of the interplay between these factors.


Skinner, G. C., Bywaters, P. W., Bilson, A., Duschinsky, R., Clements, K., & Hutchinson, D. (2020). The ‘Toxic Trio’(domestic violence, substance misuse and mental ill-health): how good is the evidence base?. Children and Youth Services Review, 105678.
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