Evidence Base: parental alcohol misuse

Community Care and Community Care Inform examine how children, young people and the entire family environment are affected. By Joy Barlow

Research shows that parental alcohol misuse can have a considerable negative effect on children, young people and the family. Children growing up in households where alcohol use is problematic often do not achieve their full potential in life. They may have low self-esteem, feel unsafe and find it difficult to engage in relationships, illustrating a lack of trust often into adulthood. Such profound effects may impact on the five outcomes of the Every Child Matters framework.

In addition, alcohol misuse is often hidden by parents, by family members and by children themselves. This can have serious consequences for children, including (but not limited to) poor educational attainment, emotional difficulties, neglect, abuse and taking on inappropriate caring responsibilities. Alcohol misuse is also linked with family disharmony and violence.

“Parental alcohol misuse damages and disrupts the lives of children and families in all areas of society, spanning all social classes; it blights the lives of whole families and harms the development of children trapped by the effects of their parents’ problematic drinking” (Turning Point, 2006).

Key research should inform practice and work with children and young people affected by their parents’ misuse of alcohol.

Alcohol is no ordinary commodity. Its impact on our lives and on our families, is habitually underplayed, and the personal, social and health risks involved are ignored or considered an acceptable dimension of alcohol use. This undermines the change in our culture that is required if we are to prevent the harm that blights the lives of whole families and harms the development of children trapped by the effects of their parents’ problematic drinking.

The Policy Gap

Numerous policy documents and inquiries have addressed substance misuse in general, but far less attention has been given to alcohol misuse. There is some evidence of a “siloed” response to alcohol problems at government level that impedes policy.

Cross-government working could lead to a more co-ordinated approach to alcohol policies, in which the needs of children affected by parental alcohol problems are more embedded within the children’s agenda.

A difficulty in the literature is that “parental substance misuse” appears as a generic category, but a focus on parental alcohol misuse rarely exists on its own. Research suggests that assessment of families affected by alcohol misuse needs to be comprehensive in evaluating the complexity of alcohol misuse within the family, and its impact on family members, especially children.

Pre-birth damage

The effects of exposure to alcohol at any point during pregnancy creates a risk of lifelong damage to the brain and nervous system of the unborn child, resulting in impairment of the brain’s ability to plan, learn from experience and control impulses. Research studies show that the degree of pre-birth damage reflects the amount of alcohol a mother consumes. It is now generally accepted that fetal alcohol syndrome is a complex multi-factional disorder in which exposure to heavy alcohol consumption in utero interacts with other environmental factors and genetic predisposition.

Several studies (some in children’s own words) describe the damaging effects of alcohol misuse by parents – on the children’s development, their happiness, their physical and psychological health. Children speak about their parents putting preoccupation with substances before caring for their children; and they learn to explain away or excuse their parents’ lack of care to enable a continual love. If they are parented or protected by older siblings they may not develop the same levels of knowledge or skills to manage their parent’s substance misuse. Alcohol misuse is linked with family disharmony and violence and affects all classes of society.

How common is the problem?

Different methods of collecting data have been used in the jurisdictions of the UK. One report estimates that between 780,500 and 1.3 million children are, or have been, affected by parental alcohol problems.

Another review seeking more accurate statistics concluded that the number of children living with substance misusing parents exceeded earlier estimates, and that over three million children (30%) under 16 years in the UK lived with an adult binge drinker.

Children and young people involved in care proceedings are especially likely to have parents with alcohol problems. An English study found that 60-70% of all care proceedings in three London boroughs involved parental substance misuse. In Scotland, different studies found that nearly half the children referred to the Reporter for child protection had parents who misused alcohol. A study in Glasgow estimated that 3.4% of all children under the age of 16 lived with at least one parent with an alcohol problem.

Interventions

Studies indicate the importance of intensive family-focused interventions that include a strong therapeutic relationship between the practitioner and the parents and child. Strengths-based assessment, recognising the values of the family and its goals are necessary for outcome-focused work centred on the child. There are a number of models of interventions in use that consider both the needs of the child and the family. Examples are the Five-Step Model and the Strengthening Families Programme. While the individual needs of children and adults can be targeted by direct work, reference must be made to the family’s context, circumstances and dynamic.

Challenges for practice

There is a growing body of evidence for the effectiveness of early interventions with children and families with a view to prevention. Also, it is vital for practice that there is an increased knowledge and awareness by practitioners about the complexity and underlying issues of working with alcohol misuse among parents, for example, child development and the risks to it; the degrees of dependency effected by different substances; gender differences; a child’s resilience factors. One study argues that effective work with parents who misuse drugs and alcohol is synonymous with effective work in general, stressing the importance of supervision and the provision of supportive working environments that give space and time to work effectively. The same study considers the approach of motivational interviewing and its efficacy in working with those affected by substance misuse, seeing it as an exemplar of what can be achieved when there is systematic reflection on practice and outcomes that bring together practitioners and researchers.

About the author: Joy Barlow is head of Scottish Training – Drugs and Alcohol (Strada), a joint initiative between Centre for Drug Misuse Research, Department of Adult and Continuing Education (University of Glasgow) and DrugScope

POINTS FOR PRACTICE

Directors of children’s services

● Interrogate policy and research to apply learning at a local level.

● Promote inter-agency working.

● Identify means by which local prevalence, needs assessment and current service provision may be calculated.

Commissioners of services

● Identify areas of collaboration and integration. Attention should be paid to those services that will support children and families affected by alcohol misuse, domestic violence and mental health issues.

● Commissioned services should reflect a gendered approach.

Service managers

● Ensure that staff are competent and confident in the knowledge and skills required for work in this area.

● Promote an environment where supportive supervision and reflection on learning is encouraged.

● Understand and reflect the necessity of inter-agency working.

● Promote an effective interface between substance misuse services and children’s services.

● Promote early identification and interaction with families.

Frontline practitioners

● Take responsibility for your own knowledge and understanding.

● Understand the impact of alcohol misuse on parenting capacity and child welfare and protection.

● Use the research and evidence base to design and implement interventions to provide support, advice and care for children and families.

KEY TEXTS

Ashenberg Straussner S L, Huff Fewell C (Ed) (2006). Impact of Substance Abuse on Children and Families: Research and Practice Implications Binghamton NY: The Haworth Press

Bancroft A, Wilson S, Cunningham-Burley S, Backett-Milburn K, and Masters H (2004). Risk and Resilience: Older Children of Drug and Alcohol Misusing Parents, Joseph Rowntree Foundation

Barlow J (ed) 2010. Substance Misuse – The Implications of Research Policy and Practice. Research Highlights 53, Jessica Kingsley Publishers

Cuijpers P (2005). Prevention programmes for children of problem drinkers: a review Drugs: education, policy and prevention, 12(6), 465-475

Girling M, Huakau J, Casswell S, and Conway K (2006). Families and Heavy Drinking: Impacts on Children’s Wellbeing. Centre for Social and Health Outcomes Research and Evaluation and Te Ropu Whariki, Massey University

Harwin J, Madge N, and Heath S (2010). Children affected by Parental Alcohol Problems (ChaPAPS): A report on the research, policy. Practice and service development relating to ChaPAPS across Europe. An ENCARE 5 Project funded by the European Union

Mitchell F, Burgess C (2009). Working with families affected by parental substance misuse: a literature review, Scottish Childcare and Protection Network. For the Scottish Government

Turning Point (2006). Bottling it up – The Effects of Alcohol Misuse on Children, Parents and Families

Velleman R (2001). Counselling for Alcohol Problems 2nd edition: London: Sage. (Counselling in Practice Service)

Other relevant guides:

Guide to alcohol and drug use in pregnancy

Helen Stansfield, junior cognitive behavioural therapist / specialist clinical drugs worker for the NHS

Guide to fetal alcohol spectrum disorders

Dr Raja Mukherjee, consultant psychiatrist, Surrey Borders Partnership Trust, Bracketts Resource Centre

Guide to alcohol-related disorders and the impact on parenting and child development

Dr Shazad Amin, consultant in adult psychiatry and foundation programme director, Trafford General Hospital, Manchester BIOG

Guide to the impact of parental substance misuse on child development

Ruth McGovern, senior alcohol health worker, Newcastle University

Guide to the Strengthening Families, Strengthening Communities Parent Programme

Leandra Box, programme manager, Race Equality Foundation and manages the Strengthening Families Strengthening Communities Programmes

Research Review:

Breast feeding and substance misuse

Dr Moira Plant, Professor of Alcohol Studies, Alcohol and Health Research Unit, University of the West of England