Dealing with parental substance misuse

Community Care and Community Care Inform are examining how evidence informs important areas of practice. Here, Emilie Smeaton investigates issues relating to substance-misusing parents

Almost one million children in the UK live with drug users (Manning et al, 2009). While not all drug-using parents mistreat their children, parental problematic substance misuse features in 20-70% of social workers’ caseloads (Hayden, 2004).

There are multiple and cumulative adverse consequences of parental substance misuse for children’s development, beginning with foetal growth and including:

● The effects of abuse

● Inappropriate parenting practices

● Exposure to toxic substances and inappropriate adult behaviour

● Attachment problems

● Psychological problems

● Social isolation

● Poor educational attainment

● Offending behaviour

● Early substance misuse

● Separation from parents.

While evidence supports the effectiveness of family focused and social network-focused interventions (Copello et al, 2006), there are several dilemmas when working to address the impacts of problematic parental drug use (Taylor and Kroll, 2004).

Early intervention

Parents with problematic drug use often have concerns about seeking and receiving support to address their drug use (Manning et al, 2009; Rhodes et al, 2010; Taylor and Kroll, 2004).

To alleviate these concerns, practitioners need to develop trust and understanding of parents’ circumstances and ensure parents understand of the child care social work model (Hayden, 2004).

Gaining an accurate understanding of the issues faced by parents who misuse drugs is an important step in overcoming parental denial and resistance and a key step towards meaningful assessment and engagement (Taylor and Kroll, 2004).

Early identification of problematic parental drug use and provision of early interventions is key to minimising the harm to children.

This also helps to prevent escalation of recreational or binge drug use to problematic use that is more likely to cause harm (Manning et al, 2009).

Early intervention can be beneficial in providing drug-using parents with the opportunity to discuss the challenges they face as a parent (Rhodes et al, 2010).

Harm reduction services, such as needle-exchange programmes delivered by statutory and voluntary sector services, play an important role in initiating reflection from parents about their drug use and family life.

Support to protect children

Family therapeutic interventions can reduce risks to child welfare and improve family relationships, particularly when drug treatment is also offered (Copello et al, 2006).

Social workers who provide parenting support and management of drug use in the context of family life are likely to reinforce the effects of drug treatment and vice versa.

However, when addressing the impact of problematic parental substance misuse, ­professionals should bear in mind the ­following:

● Different sets of priorities between child protection and substance misuse systems in both statutory and voluntary sector services leading to barriers to collaboration

● Polarisation between children’s and adults’ services; restrictive procedural arrangements for sharing information

● A lack of shared protocols and inter-agency and inter-professional communication

● Confidentiality issues

● A focus upon children in need rather than children at risk

● Limited attention to overall family welfare (Taylor and Kroll, 2004).

Child protection practitioners have described a sense of feeling ill-equipped to make assessments, support parents with ­substance misuse problems affecting ­children’s welfare and intervene effectively when parental substance misuse impacts upon the well-being of children (Galvani and Forrester, 2008; Hayden, 2004).

However, child welfare practitioners can help families build resilience to protect children from being adversely affected by problematic parental drug use by addressing family disharmony, and neglectful and ambivalent parenting through utilising and adapting skills relating to conflict resolution, anger management, relationship counselling and parenting skills training (Velleman and Templeton, 2007).

Practitioners should work with children to develop protective factors and promote resilience by, for example, adopting therapeutic approaches using play or art therapy to account for the age, gender and developmental age of the child.

Work with children in the assessment process is also important to enable practitioners develop a realistic sense of what children’s lives are like and how they are impacted by problematic parental drug use (Kroll, 2007).

Kinship care

To avoid entry into the looked-after system, formal and informal kinship ­placements can offer an important source of support for children and drug using parents when children are unable to remain living with their parents (Kroll, 2004).

However, because of the links between problematic substance misuse and development of attachment problems, children of drug-using parents may cause challenges to carers, particularly when the child has developed insecure disorganised attachment patterns and has unresolved feelings of grief and loss (Kroll, 2007).

It should not be assumed that kinship care is appropriate for all children and support must be provided to meet the needs of carers and children when kinship care is provided.

Points for practice

● There is a general need to identify gaps in knowledge and share good practice related to early identification of problematic parental drug use, assessment and intervention.

● Managers of child protection practitioners should ensure training is provided that: includes the dynamics of drug use; outlines how it affects users and obstructs and substitutes interpersonal relationships; and informs how to recognise and address problematic parental drug use.

● It is important for child protection practitioners to be aware of how loyalty, secrecy and denial may prevent a child from disclosing the extent of the impact of parental substance misuse at a given time and give consideration to other factors that may reduce the effectiveness of an intervention.

● Because of the links between problematic drug use and socioeconomic disadvantages, it is important for practitioners to be aware of the need to provide parents with support to effectively manage daily stresses associated with socioeconomic disadvantage, and improve parenting practices by providing a supportive and nurturing environment.

● As assessment is a complex process, it should be informed by best practice and consider need as well as risk.

● Joint working between children’s and adults’ services and substance misuse agencies can be improved by clarifying communication systems and joint working procedures to ensure an approach that balances work with the adult, while retaining a focus upon issues for, and risks to, the child.

● Universal and generic services working with parents and children should be aware of the impact of problematic parental drug use and assess for problematic parental drug use.

Emilie Smeaton is research director of Paradigm Research, which carries out social research addressing the lives of children, young people and their families

References and Key Texts

Copello, Templeton and Velleman (2006), “Family interventions for drug and alcohol misuse: is there a best practice?”, Current Opinion in Psychiatry Vol 19 Issue 3 pg 271-276.

Hayden (2004) “Parental Substance Misuse and Child Care Social Work: Research in a City Social Work Department in England” Child Abuse Review Vol 13 pg 18-30.

Galvani and Forrester (2008) “What works in training social workers about drug and alcohol use: A survey of student learning and readiness to practice,” University of Bedfordshire.

Kroll (2007) “A family affair? Kinship care and parental substance misuse: some dilemmas explored” Child and Family Social Work Vol 12 p84-93.

Manning, Best, Faulkner and Titherington (2009) “New estimates of the numbers of children living with substance misusing parents: results from UK national household survey”, BMC Public Health 9, http://www.biomedcentral.com/1471-2458/9/377

Rhodes, Bernays and Houmoller (2010) “Parents who use drugs: Accounting for damage and its limitation” Social Science & Medicine 71 pg 1489 – 1497.

Taylor and Kroll (2004) “Working with parental substance misuse: Dilemmas for practice,” British Journal of Social Work Vol 34 pg 1115-1132.

Velleman and Templeton (2007) “Understanding and modifying the impact of parents’ substance misuse on children,” Advances in Psychiatric Treatment 13 pg 79-89.

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