Problematic substance use: the impact on children

Prevalence• There are no accurate figures of number of children

negatively affected by parental substance problems

• Manning et al. (2009) suggest:– 30% of children under 16 could be living with a “binge drinking”

parent.– 22% of children live with a parent whose drinking is deemed

‘hazardous’.– 8% of children live in a household where a parent has used

illicit drugs in the past year.– 2.8% of children live with a “dependent drug user”.

• NB. Use of a substance does not mean problematic or dependent substance use.

Prevalence (cont.)

Older estimates:• 200,000 - 300,000 children of problem drug users in England and

Wales (ACMD 2003).

• Just under 1 dependent child per every problem drug user accessing treatment (ACMD 2003).

• Estimates: 300,000 to 2.5 million children currently living with an alcohol misusing parent (Cleaver et al. 1999, Tunnard 2002).

• 50-90% of families on children’s social care caseloads have parents with mental health, alcohol or other drug problems (Kearney et al. 2000).

Co-existing domestic abuse• Repeated serious case reviews (SCRs) - where a child has died or

been seriously injured - found substance use and domestic abuse often present in the home. The third factor was parental mental ill health.

• Cleaver et al. (2006) in a study of 357 social work cases found “domestic violence or parental substance misuse rarely exist in isolation” and that the resulting negative effect “on all aspects of children’s lives was more serious”. – They also found 85% of these children had parents who could not

fulfil key parenting tasks.

• Forrester and Harwin (2006) found 34% of cases (n=100) being allocated for longer term social work intervention involved parental substance misuse. Alcohol often co-existed with domestic abuse.

Hidden HarmHidden Harm was a key document from the Advisory Council on Misuse of Drugs (2003). It remains hugely important as one of the first documents to inform Government policy. It highlighted parental substance use and the need for health and social care responses.

Key messages:

1. Parental problem drug use can and does cause serious harm to children at every age from conception to adulthood.

2. Effective treatment of the parent can have major benefits for the child.

3. By working together, services can take many practical steps to protect and improve the health and well-being of affected children.

4. The number of affected children is only likely to decrease when the number of problem drug users decreases.

Policy framework• Children Act 1989

– s.17: children in need – impairment of development without intervention

– s.47: is, or is at risk of, suffering significant harm – s.20: accommodating children due to unsuitable care or

accommodation

• Children Act 2004– reinforced the message that all organisations working with children have a duty in helping to safeguard and promote the welfare of children.

Policy framework (cont.)

• Common Assessment Framework (CAF) – followed Children Act 2004

...common assessment may be appropriate when significant changes have been observed in children who are, have been or are at risk of...• presenting challenging or aggressive behaviours (e.g. bringing a

knife into school), abusing/misusing substances or committing offences;

• experiencing physical or mental ill health or disability (either their own or their parents’);

• exposed to substance abuse/misuse, violence or crime within the family;

(H.M. Government 2006:4)

Exercise: Impact on parenting:

Exercise in pairs or on own

Write down what would you expect to be the possible impact on parenting of someone’s problematic alcohol or drug use?

Impact on parenting

• Not all parents who use alcohol and other drugs (AOD), or have problems with AOD, will place their children at risk

• Some do - impact is twofold:– impact on own parenting– impact on parenting of partner

• Disorganisation within the family - routines disrupted, practical difficulties

• Broken promises – taking them out, visiting someone• Emotionally inconsistent - mood swings, volatile,

edgy, withdrawn• Less emotionally available - less attention

• Watch Vicki Ellis, Manager of the SWIFT family service, talk about the impact of substance use on the family.

Impact on parenting (cont.)• Higher levels of general conflict – problematic substance use often leads to

tensions in family.

• Increased likelihood of domestic violence and abuse– patterns of controlling, coercive or violent abusive behaviour.

• Possible co-existing mental health problems, – e.g. depression, anxiety - co-working with other specialists essential.

• Financial problems– e.g. may lead to or stem from problematic substance use.

• Physical health problems of drinker/user. • ‘One parent family’ syndrome

– drinker/user becomes an extra dependant.

Impact on parenting (cont.)• Watch Richard McVey, Service Manager at substance use service

Aquarius, discuss the impact of substance use on parenting and different parenting styles.

• Increased stress/pressure on partner left to cope.

• Poorer monitoring and supervision of children.

• Greater likelihood of loss, e.g. divorce, death.

• Greater likelihood of statutory agency involvement.

• New babies - more demanding– parent - less able to cope.

• Increased risks of children born with FASD (Foetal Alcohol Spectrum Disorder) or NAS (Neonatal Abstinence Syndrome).

Parents’ views• There is relatively little research in this area.

• Redelinghuys and Dar (2008)– 66 parents in a London-based detoxification unit– 41% were concerned about impact on children now or in future– Most would contact GP or Specialist Substance Use services for

help on behalf of their child.

• Mahoney and MacKechnie (2001):– Parents blamed selves for negative impact on children but felt

powerless to change their substance using behaviour– Children - important motivation for change– Substance use - took priority over children’s needs for some– Wanted workers who helped with range of needs.

Parents’ views (cont.)

Richter and Bammer (2000) spoke to 22 heroin using mothers re their strategies to protect their children from harm. 7 strategies in order of preference:

1. stop using completely; 2. go into treatment...; 3. maintain a stable small habit; 4. shield children from drug-related activities; 5. keep the home environment stable, safe, and secure; 6. stay out of gaol [jail]; 7. place them with a trusted caregiver and maintain

as active a parental role as possible.

“I remember when I first went to the rehab house, I remember I

could never, now it might sound strange, but I just didn't know

how to even, like, hold her or cuddle her. And you used to find a

lot of parents that come in that didn't know how to give your

child any affection because you had no love or respect or self

esteem or anything for yourself. So it was really hard to give to

someone else.”

(Leor in Richter and Bammer 2000: 405)

Parents’ views (cont.)

Impact on the child (see Galvani 2012 for review)

• Watch Viv Evans, Chief Executive of Adfam, talk about the impact of substance use on children .

• Parental substance use has a potentially negative impact on children of all ages.

• Younger children are more at risk due to their increased vulnerability and inability to make choices to leave/take a break from home.

• The negative impact can start in utero (womb) and continue into that child’s adult years.

• Children are often living in homes where there are anumber of additional needs and challenges, e.g. domestic abuse, poverty, mental ill health.

• They may also be child carers– children looking after intoxicated parents and other siblings.

Impact on child (cont.)• Shame and stigma of parental substance problems

– keeping secrets.• Emotional neglect and abuse

– focus on substance use.• Growing up with parental alcohol problems significantly increases risks

of multiple forms of childhood abuse, neglect. • Developmental delay.• Poor school attendance and achievement.• Disrupted quality time and leisure time.• Social isolation – self-imposed and isolated by others

– fewer friends/isolation from other adults/families.

Impact on child (cont.)• Psychological or psychiatric problems, e.g. low self esteem in

childhood/adolescence.• Behavioural changes, e.g. withdrawn or aggressive.• Disrupted attachment to parents.• Feeling fearful of losing a parent

– e.g. parent dying/overdosing or going to prison.• Feeling responsible for helping the parent and/or for

their substance use.• Increased risk of exposure to domestic abuse.• Increase risk of substance problems in their own adolescence and

adulthood.• Difficulties in their own adult attachments and relationships.

Children’s views“I want to run away from home. Both my parents use

drugs and alcohol and they fight. My mum brings

men home all the time. I really hate their way of

living and would like to get away. I did try to get away

with my sister but my sister is partly disabled so she

couldn’t keep up and we came back home. I am

really unhappy to be left alone in the house all night.”

Sanjay, aged 14

(NSPCC 2010)

Children’s views (cont.)

“My mum and dad don’t feed me. I have to steal money from people so

I can get food. When I cry, Mum and Dad hit me. They are drinking all

the time. I can’t tell anyone because I am scared my mum and dad

might do something and hit me.”

Jonathan, aged 10

(NSPCC 2010)

Protective factors for children (see Galvani 2012 for review)

• Structure and routine to life in spite of parent/s with substance problems.

• Reassurance they are not to blame for it.• Education about parent’s alcohol or drug use.• Good relationship with non-alcohol or drug using parent.• Supportive grandparents and siblings. • Someone to talk to and share problems with.• Peer support and friendship.• External support, e.g. school, faith-based group.• Community resources, e.g. clubs, church.

Protective factors (cont.)

• Being able to get away from home.• Basic needs met: food, clothing, hygiene.• Positive and friendly attitudes from service professionals to both

parents and children• Children view substance use agencies trying to help parents very

positively - does it have family group?• Understanding parent is trying to stop/reduce• Good communication between parents, and between parents and

children.

Resilience factors (Dillon et al. 2007, Newman and Blackburn 2002)

• Strong self-esteem

• High verbal and cognitive skills

• Experience of success and achievement

• Ability to use adults as resources

• Ability to play

• Feeling safe and secure

• Deliberate planning by child for a better future

Pregnancy/FASD• Foetal Alcohol Spectrum Disorder (FASD) affects the unborn child

and is caused by a maternal alcohol consumption during pregnancy.

• Its prevalence is not known.

• It is still minimally understood but evidence suggests the highest risk of FASD is from mothers who regularly consume high levels of alcohol during the first trimester of pregnancy.

• These few slides provide a summary of the impact on substance use on children in utero. For further details go to the resource ‘Specific Issues in pregnancy’.

Impact of FASD on children• Signs and symptoms of babies and young children with FASD can

vary enormously.

• They may include:

– Pre and post-natal growth deficiencies, e.g. shorter body length, small head, failure to thrive.

– Physical anomalies, e.g. small upturned nose, heart and kidney problems.

– CNS dysfunction, e.g. severe learning difficulties, heightened sensitivity to touch.

Impact of FASD on children (cont.)• One to one attention best for FASD affected children – concentration

can be difficult for them.

• Clear instructions are needed - often repeated continually.

• They may have no sense of time.

• They may have no understanding of risk or danger.

• In youth/adolescence , they can have very low self-esteem.

• They need to learn practical skills, e.g. decision-making.

Supporting parents of FASD affected children• Key to supporting parents, and therefore the children, is early

identification.

• This needs to be followed with clear communication to teachers, carers etc so that FASD affected children aren’t labelled ‘bad’ or ‘naughty’ when they don’t remember or don’t concentrate well.

• In this film clip, watch Liz talk about the response to her own drinking from pregnancy services and her lack of awareness of FASD as a result of her own drinking.

• One of the ways health and social care staff can help support parents of FASD affected children is by arranging respite care to give them a break.

Pregnancy (cont.)• For drug using pregnant women, the child could experience neonatal

abstinence syndrome (primarily heroin, benzodiazepines).

• First trimester again is considered to be the most risky.

• Similar effects on foetus as with alcohol.

• Risks of baby being still born or dying from SIDS (Sudden Infant Death Syndrome).

• Difficult to determine effects of single drug due to poly-substance use and environmental risk factors.

• Baby will go through withdrawal process – up to several weeks and may need medicating.

Self-directed study• Explore the website for the National Organisation of Foetal Alcohol

Syndrome - UK - http://www.nofas-uk.org/

• Download the factsheets:

Foetal alcohol spectrum disorder (FASD)

Living with FASD

References• Advisory Council on the Misuse of Drugs (2003) Hidden Harm: Responding to the needs of

children of problem drug users. London: HMSO• Cleaver, H., Unell, I. and Aldgate, J. (1999) Children's needs: parenting capacity: the impact

of parental mental illness, problem alcohol and drug use, and domestic violence on children's development. London: The Stationery Office

• Cleaver, H., Nicholson, D., Tarr, S. and Cleaver, D. (2006) The response of child protection practices and procedures to children exposed to domestic violence or parental substance misuse. Executive summary. London: University of London/DfES

• Dillon, L., Chivite-Matthews, N., Grewal, I., Brown, R., Webster, S., Weddell, E., Brown, G. and Smith, N. (2007) Risk, protective factors and resilience to drug use: identifying resilient young people and learning from their experiences. Home Office Online Report 04/07. Available online at: http://dera.ioe.ac.uk/8471/1/rdsolr0407.pdf

• Forrester, D. and Harwin, J. (2006) 'Parental substance misuse and child care social work: findings from the first stage of a study of 100 families.' Child and Family Social Work, 11, 325–335

• H. M. Government (2006a) The Common Assessment Framework for children & young people: Supporting tools. Integrated working to improve outcomes for children and young people. London: HMSO. Available online at: https://www.education.gov.uk/publications/standard/publicationDetail/Page1/CAF-SUPPORT-TOOLS

• Kearney, K., Levin, E. and Rosen, G. (2000) Alcohol, drug and mental health problems: working with families. London: National Institute for Social Work

• Mahoney, C. and MacKechnie, S. (eds) (2001) In a different world. Parental drug and alcohol use: a consultation into its effects on children and families in Liverpool. Liverpool: Liverpool Health Authority.

• Manning, V., Best, D.W., Faulkner, N. and Titherington, E. (2009) New estimates of the number of children living with substance misusing parents: results from UK national household surveys. Available at: http://www.biomedcentral.com/content/pdf/1471-2458-9-377.pdf

• NSPCC (2010) Children talking to ChildLine about parental alcohol and drug misuse. Available at: http://www.drugsandalcohol.ie/13691/1/NSPCC_clcasenoteparentalalcoholdrugabuse.pdf

• Newman, T. and Blackburn, S. (2002) Transitions in the Lives of Children and Young People: Resilience Factors. Edinburgh: Scottish Executive

• Redelinghuys, J. and Dar, K. (2008) A survey of parents receiving treatment for substance dependence: The impact on their children. Journal of Substance Use, 13 (1), 37–48

• Richter, K.P. and Bammer, G. (2000) A hierarchy of strategies heroin-using mothers employ to reduce harm to their children. Journal of Substance Abuse Treatment, 19, 403-413

• Tunnard, J. (2002) Parental drug misuse – a review of impact and intervention studies. Available online at:http://lx.iriss.org.uk/sites/default/files/resources/parental%20drug%20misuse.pdf

References (cont.)