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A father coming down from taking crack cocaine cannot stand the crying of his infant son. He shakes him in anger, causing permanent brain damage. A mother out shopping becomes angry with her six-year-old daughter. The mother is drunk and starts hitting her child, nearly killing her. An eight-year-old girl always comes to school late, dirty and dressed in summer clothes in winter. When teachers try to talk to the mother she smells strongly of alcohol.

These are all real children and real events. They all involved parents who misused alcohol or drugs. And all were referred to social services departments.


Social services departments have a responsibility to investigate and prevent abuse of children. They also have a wider remit to provide services for children "in need". While many parents with a drink or drug problem are able to care adequately for their children, substantial numbers have difficulties in doing so.

Social services deal with many of these families yet there has been little research on the incidence of parental substance misuse, its effect on child welfare, and social services departments' handling of cases. The study described here (unpublished), funded by the Nuffield Foundation, tackles these questions. It is the first large-scale British study of social work cases involving parental substance misuse and provides a detailed profile of all parental substance misuse cases dealt with by social services in four London local authorities. It explores the impact on children and interventions by social services.

What did we find? Perhaps the most striking finding was the sheer extent of the drugs and alcohol problem among parents. It affected more than one-third of all cases dealt with by social services over a year. And the more serious the child welfare concerns, the higher the proportion of parental substance misuse: 40 per cent of children on the child protection register and 62 per cent of those subject to care proceedings involved substance misuse. Care orders have a profound impact on children and their families but care proceedings also make major demands on social workers' time and are immensely costly. So parental substance misuse is not only common and damaging - it is also particularly costly in terms of time and money.

Alcohol, crack cocaine and heroin predominated but alcohol misuse was most frequent of all. It accounted for 41 of the 100 families dealt with over the year and was combined with drug misuse in 27 other families. By contrast drug misuse alone was found in 32 families - still of course, a high proportion. But this pattern varied markedly, with alcohol-related misuse predominant in outer London and drugs in the inner city. As the overall proportions were identical, it is clear that substance misuse is a common issue for social workers in areas with contrasting socio-demographic profiles.

Worryingly, cases of crack cocaine appear to have shot up, overtaking heroin misuse. In 1994 our earlier research in similar areas found heroin was 10 times as common as crack cocaine in social work caseloads. Just three years ago the gap had narrowed considerably but heroin rates were still four times higher. By 2000-1 cocaine had overtaken heroin. What is more, this high incidence was found in all four authorities. Our study is London-based but there is evidence that crack misuse is increasing in other areas of the UK. If this trend continues it bodes ill for children's welfare. We found crack cocaine was associated with babies coming into care. The cases were also particularly difficult to work with and social workers frequently faced threats of or actual assault. Yet up to now research findings and practice experience have been primarily based on heroin, and to a lesser extent amphetamine misuse.

The extent of crack cocaine in our sample may overshadow other trends that are every bit as worrying, if less arresting. The substance that caused the most harm to children - and appeared to cause the most professional difficulties - was undoubtedly alcohol. These cases were rarely referred before harm had taken place to the child. Of the 13 children who ended up in hospital with serious injuries, nine involved alcohol misuse and the most behaviourally disturbed children all had parents who misused alcohol.


By contrast, parental drug misuse triggered a very rapid response not only by social services, but by the health sector too. Newborn babies, who predominated in cases of drug misuse, were made the subject of strong protection plans sometimes resulting in the child being removed and placed for adoption. And even when the plan was for children to return to parents, more resources were put in, assessments were inter-disciplinary and planning was more likely to be clear and decisive.

Specialist substance misuse workers were also frequently involved and their input was highly valued by social workers. This was not so with alcohol misuse. The very low levels of identification of problem drinking before birth, and the complete lack of referrals from health visitors, who are ideally placed to identify problems at an early stage, suggested that systems to detect and hopefully prevent harm to children worked poorly in relation to alcohol misuse.

So why should alcohol misuse be so under-recognised? Society's tolerance of alcohol compared with drugs seems an obvious cause. This may explain why the inter-agency framework seemed to work less well in relation to alcohol abuse than to drugs. Other causes were specific to social work.

Our study highlights an urgent need to improve substance misuse training radically. The little training received by most staff focused only on drugs, while basic training was often confined to an isolated lecture. With the introduction of a new social work degree, now would be a good time to give substance misuse a higher profile. In the new social work qualification mental illness and learning difficulties must be covered, but not substance misuse.

However, the messages from our study extend beyond social work. To reach social services, the problem has to be severe. What safety net is there to help the much larger number of children in need because of parental substance misuse?

In July Prime Minister Tony Blair announced a government study into the problems associated with alcohol misuse. Our study suggests that the government needs to launch initiatives at several levels. Public information and education - used so effectively in drink-driving campaigns but never tried for child care - are needed to raise awareness of the risks to children. Improved inter-agency working and training for all professionals would allow better early identification.

Better targeting is an urgent priority. Traditionally, substance misuse services have targeted men but much more needs to be done to help women - a staggering 83 per cent of the families in our study were affected by maternal substance misuse. To increase the participation of mothers, services need to offer outreach home visits and care for children during appointments.

To prevent harm to children from parental substance misuse at a time when drinking and drug taking is increasing is a formidable task. It cannot wait.

Donald Forrester is lecturer in social work, Goldsmiths College, University of London and Judith Harwin is professor of social work, Brunel University.

Background Reading

For further details concerning the study please contact D.Forrester@gold.ac.uk