Parental problem drug use

As many as one in three adults have used illcit drugs at least once, problem drug users are less than one percent of the population in England. It is hard to know with any degree of certainty how many children are living with parents who are problem drug users as such behaviour is against the law and characterised by denial and secrecy. In England and Wales  it is estimated that one per cent of babies are born each year to women with drug use, and that two to three percent of children under the age of 16 have parents and only about a third of fathers and two thirds of mothers with problem drug use are still living with their own children. It is not only their parents whose drug misuse may place the child at risk of suffering significant harm, but problem drug use of other family members such as a parent's new partner, siblings, or other individuals within the household.

To understand how problem drug use can affect parents' capacity to meet the developmental needs of their children is far from simple and it is important not to generalise or make assumptions about the impact on children of parental drug misuse. Consideration needs to be given to both the type of drug used and its effects on the individual; the same drug may affect different people in different ways. The situation is further complicated because the same drug may have very different consequences for the individual depending on their current mental state, experience and/ or tolerance of the drug, expectations, personality, the environment in which it is taken, the amount used and the way it is consumed. When parents, or others in the home, stop taking drugs children can be particularly vulnerable. For example, the withdrawal symptoms both physical and psychological may interfere, at least for a while, with parent's capacity to meet the needs of their children. Problematic drug use is likely to continue over time, and although treatment may prolong periods of abstinence or controlled use, for some individuals relapse should be expected. Assumptions about the use or abstinence of drugs should not be based on whether or not parents, or others in the home, are engaged with services for their problem drug use. 

Parental problem drug use is generally associated with some degree of child neglect and emotional abuse. It can result in parents or carers experiencing difficulty in organising their own and their children's lives, being unable to meet children's needs for saftey and basic care, being emotionally unavaliable and having difficulty in controlling and discipling their children. Difficulty in organising day to day living means that important events such as birthdays or holidays are disrupted and family rituals and routines such as meal or bed times, which cement family relationships, are difficult to sustain. Problem drug misuse may cause parents to become detatched from reality or lose consciousness. When there is no other responsible adult in the home, children are left to fend for themselves. Some problem drug using parents may find it difficult to give priority to the needs of their children. Finding money for drugs may reduce what is avaliable to meet basic needs, or may draw families into criminal activities. Poverty and a need to have easy access to drugs may lead families to live in unsafe comminities where children are exposed to harmful anti- social behaviour and environmental dangers such as dirty needles in parks and other public places. At its extreme, parental problem drug misuse can be implicated in the serious injury or death of a child.

Such negative scenarios are not inevitable. A significant proportion of children who live with parents who are problem drug users will show no long term behavioural or emotioanl disturbance. Some problem drug users ensure their children are looked after, clean and fed, have all their needs met and that drugs are stored safely.

A caring partner, spouse or relative who does not use drugs can provide essential support and continuity of care for the child. Other protective factors include drug treatment, wider family and primary health care services providing support the child's attendance at nursery or day care, sufficient income and good physical standards in the home. Many parents, however, who are problem drug users often base their social activities around the procurement and use of the drug and are isolated and rejected by their communities. Drug related debts and angry neighbours may result in unplanned moves which disrupt children's schooling, community links and friendships. The safety, health and development of a considerable number of children are adversely affected by parental problem drug misuse and would benefit from services to meet the needs of both children and parents.

The impact of parental problem drug misuse will depend on the child's age and stage of development as well as this or her personality and ability to cope. Drug use while pregnant may endanger the unborn child depending on the pharmacological make-up of the drug, the gestation of pregnancy and the route/ amount / duration of drug use. Structural damage to the foetus is most likely during 4-12 weeks of gestation; drugs taken later can affect growth or cause intoxication or abstinence syndromes. However, gauging the impact of maternal drug use on the unborn child is complicated when mothers take a combination of substances. Some of the problems associated with maternal problem drug misuse can be ameliorated by good ante-natal care. Unfortunately, some pregnant problem drug users do not seek ante-natal care, either because the drugs affect menstrution and leave women uncertain of dates, or because they fear that revealing their drug use to health professionals will result in judgemental attitudes, the involvement of children's social care services and the possible loss of the baby once it is born. For pregnant drug users in general, irrespective of the substance used, especially where poor social conditions prevail, there is an increased risk of low birth weight, premature delivery, perinatal mortality and cot death. While there is general agreement that problem drug use while pregnant can increase the risk of impairment to the unborn child's development, it is also probable that most women who misuse drugs will give birth to healthy children who suffer from no long term effects.

Maternal problem drug misuse can impact on the attachment relationship between mother and child in a number of ways. Babies who need treatment for withdrawal symptoms may become sleepy and unresponsive. Mothers who undergo rapid drug reduction or abstinence may find it difficult to respond appropriately to their newborn baby. Problem drug misuse may also effect the parent's ability to empathise with the baby. Research has shown that many parents who misuse drugs, particularly heroin, are often emotionally unavaliable to their children. A consistant lack of warmth and negative responses may result in the infant becoming insecurely attached. Babies and young children who are exposed to dramatic and sometimes frightening parental mood swings may become unnaturally vigilant as they try to alter their behaviour according to their parent's state of mind. Serious drug dependancy may result in parents placing their own needs before the saftey and welfare of their children. For example, young children may be left alone at home, or in the care of unsuitable and unsafe people, while the parents prioritises the acquisition of drugs.

 Parental problem drug misuse also affects children during middle childhood. Research suggests that children's education and performance in school may suffer because parental problems dominate the child's thoughts and can affect concentration. Some children feel responsible for their parent's actions, believing they are to blame for their parent's drug taking. This can lead to feelings of inadequacy and guilt when their actions fail to make any impact on their parent's use of drugs. Parental problem drug misuse may have very negative effects on the parent/ child relationship. The need for drugs is paramount and children may believe that they take second place in their parent's lives, leaving them with feelings of anger, betrayal and worthlessness. Children may also have to grow uo too quickly, as parental problem drug use may result in some children having to assume adult responsibilities. Children may be left to take care of themselves for much of the time, which can lead to school work being neglected, erratic school attendance, curtailment of friendships, and a general loss of childhood. Parental problem drug use is associated with higher levels of aggressive, non compliant, disruptive, destructive and antisocial behaviours in children. For some children school and friendships offer respite and a safe haven from a troubled home situation. Other protective factors for this age group include: the presence in the home of an alternative, caring adult who does not misuse drugs, a supportive older sibling and/ or members of the wider family, regular school attendance, vigilant and sympathetic teachers, learning different ways of coping and developing the confidence to know what to do when parents are incapacitated.

 As children grow up parental problem drug use affects them in different ways. Adolescence ushers in great physical changes. Parental problem drug misuse may mean parents are unaware of children's worries over their changing body and fail to provide support and advice. Children's health may be affected because parental problem drug use is associated with an increased risk during adolescence, of children experimenting with drugs. Some young people learn to mirror their parents coping strategies and come to depend on drugs to deal with difficult situations and negative feelings. The relationship, however is complex and most children of parents with drug problems do not themselves become problem drug users. The likelihood that children's education is affected continues into adolescence as young people take on greater responsibility for looking after the home and assuming care of a parent and younger siblings. Nonetheless, the majority of adolescent children whose parents are problem drug users attend school regularly. When parents are unable to look after adolescent children adequately, the normal pace of emotional maturity can be accelerated and for some the relationship between parent and child is reversed. Problem drug use can result in parents continuing to put their own needs above those of their adolescent children, leading to feelings of worthlessness and anger. To deal with these emotions young people may resort to self harm, illicit drug use, spending long periods outside the home, or leaving home altogether.

 Parental problem drug use is a feature in the backgrounds of many young homeless people. Loneliness and isolation are not the experiences of all adolescents whose parents misuse drugs. Friendships are valued highly and many teenagers of parents with drug problems gain solace and support from friends, regardless of whether they are able to discuss family problems. Sadly for some, unplanned moves, often as a result of grug related issues, mean adolescents experience school chamges, lose ties with their community and perhaps most mourned, loss of the support and love of close friends. The key factors that support young people living with parental problem drug use include practicle and domestic help, a trusted mentor with whom the adolescent can discuss sensitive issues, a mutual friend, and the ability to seperate safelt, either psychologically or physically, from stressfull situations.

 Parental problem alcohol use

The government's strategy on alcohol reduction defines harmful drinking as:

Findings from the General Lifestyle Survey 2008 suggest that 7% of men and 4% of women regularly drink at higher- risk levels: rates which have fallen slightly over the past few years. In addition to regular higher risk drinking, problems can also result from binge drinking or, for example, drinking before driving. Nearly a fifth of men and 14% of women are drinking more than twice the lower risk limit at least one day per week, a figure that is used as a proxy for "binge drinking" at a population level. It is estimated that up to 1.3 million children are affected by parental alcohol problems in England. An analysis of call recieved by Childline shows that the majority (57%) of callers identified their father or father figure as the problem drinker, a third of their mother or mother figure and 7% indicated both parents had a drink problem.

 The impact of excessive alcohol consumption on parents' capacity to look after their children will depend on their current mental state and personality, their experience and tolerance of alcohol and the amount of alcohol consumed. For example, parenting may be affected because excessive drinking can affect concentration, induce sleep or coma, or reduce psychomotor co-ordination. In addition inhibitions may be lost, which can result in diminished self control and violence.

Parental problem drinking can be associated with violence within the family and the physical abuse of children, but who has the alcohol problem is relevant. Alcohol misuse by a father or father figure can be related to violence and the physical abuse of children, while mothers with an alcohol problem are more likely to neglect their children. Children are most at risk of suffering significant harm when alcohol misuse is associated with violence. If parents with a chronic drink problem stop drinking, the physical reactions they experience may also affect their capacity to meet the children's needs. As noted in relation to chronic drug misuse, severe and chronic alcohol problems are likely to continue over time and, although treatment may result in abstinence, relapse is possible. The adverse effects of parental alcohol misuse on children are less likely when not associated with violence, family discord, or the disorganisation of the family's day to day living. Particular ly important is the presence of a parent or family member who does not have an alcohol problem and is able to respond to the child's developmental needs.

 Many of the problems associated with problem alcohol use during pregnancy could be ameliorated to some extent by good ante- natal care. However, pregnant women with alcohol problems may not attend ante- natal care until late in pregnancy because they fear professionals will judge them. The effect of drinking on the developing foetus is related to the amount and pattern of alcohol consumed by the mother, and the stages of gestation. The foetus is most vulnerable to damage during the first three months but is at risk throughout the pregnancy. Drinking during pregnancy, particularly in the first three months, is associated with an increased rate of miscarriage. Heavy drinking can cause Fetal Alcohol Syndrome (FAS), whose features include growth deficiency for height and weight, a distinct pattern of facial features and physical characteristics and central nervous system dysfunction. A syndrome that does not show the full characteristic features of FAS, Fetal Alcohol Spectrum Disorder, has been reported, and may develop at lower levels of drinking than is reported for FAS. The Chief Medical Officer and NICE both advise pregnant women or women trying to concieve to avoid drinking alcohol. If they choose to drink, to minimise the risk to the baby, they should not drink more than onr to two units of alcohol once or twice a week and should not get drunk. The NICE guidelines emphasise the importance of avoiding alcohol especially during the first three months of pregnancy as this is the key time for organ and nervous system development. It is generally accepted that heavy alcohol consumption during pregnancy increases the risk of damage to the foetus. Most mothers with alcohol problems, however do give birth to healthy babies. Only approximately 4% of pregnant women who drink heavily give birth to a baby with Fetal Alcohol Spectrum Disorder.

 Once born, babies may be likely to suffer significant harm. When alcohol problems result in parents being pre-occupied with their own feelings and emotions they may fail to notice or respond appropriately to their baby. Chronic alcohol problems may limit the mother's capacity to engage with a stimulate her baby. A consistant lack of warmth can result in the infant becoming insecurely attached. Supervision is essential to keep the more mobile infant safe from harm, but harmful drinking can affect parent's concentration and lead to a lack of oversight. Chronic drinking may also mean parents fail to recognise when their baby or infant is unwell, or delay seeking medical help for minor injuries if these have resulted from a lack of supervision. The infant's health may also be affected because high levels of alcohol consumption can depress appetite, and parents may fail to respond to their child's need for food. Research suggests parental problem drinking may also impact on the young child's cognitive development. Babies and infants are more likely to be protected from significant harm when one parent does not have an alcohol problem and is able to respond to the emotional and cognitive needs of the child, there is significant income and good physical standards in the home and the parent who is drinking at harmful levels acknowledges their problem and recieves treatment.

Parental alcohol problems continue to affect the health and development of children during middle childhood. For example, children's health may be endangered because, although alcohol consumption is not common during this period of childhood, maternal drinking increases the likelihood that children aged 10 years will start drinking. Learning may also be affected. Children of parents with chronic alcohol problems are more likely to experience reading problems, poor concentration and low academic performance. When parents are intoxicated they may not be capable of encouraging the child to learn, or of providing sufficient support with schooling. Alcohol can make parents behave in inconsistant and unexpected ways, loving and caring at one moment and rejecting and cold at another. This can leave children feeling betrayed, let down, angry, and uncertain that they are loved. Middle year children tend to feel guilty and blame themselvesfor their parents' drinking; emotions which are compounded when parents deny the problem. A further possible consequence of parental problem drinking is that children may grow up too quickly, having to look after themselves, younger siblings and thier alcoholic parent. It should not be assumed that all children in middle childhood who live with a parent with alcohol problems experience emotional and behavioural difficulties. Older siblings and close relatives can provide children with much needed emotional and practical support. Unfortunately, wider family and friends are often unaware of the family difficulties as a fear of stigma and ridicule may keep all family members silent. There is considerable evidence to suggest that the combination of parental chronic drinking with domestic violence causes a more detrimental impact on children than parental alcohol misuse in isolation.

 To ensure children understand the physical changes that result from puberty and how to cope safely with new relationships, they need the support of their parents or carers. When alcohol problems dominate parents' lives children may be left to deal with these issues alone. Chronic alcohol problems may also result in parents failing to provide adolescents with adequate supervision. Research suggests youngsters aged 11-12 years are more likely to use alcohol, cannabis and tobacco if their parents have an alcohol problem. Young people who start drinking at an early age are at greater risk of poor health and being involved in accidents and accidental injury. The relationship between parental problem drinking and young people's drinking patterns is complex, because observing the devastating effect alcohol has on their parents' lives may act as a strong deterrent. Young people's education may continue to be affected by their parents' alcohol problems and they may find themselves facing the stress of examinations with little or no support. Education may also be interupted because teenagers feel compelled to stay at home to look after their parents or younger sibblings. Alack of educational attainment has long term effects on young people's life chances. However, generalisations should not be made. For some young people school offers an escape from the problems at home and an oppertunity to build a different life from that of their parents. Relationships between teenagers and their parents can also be affected. Chronic alcohol problems may result in parents putting their own needs above those of their children, leaving teenagers feeling let down, angry and worthless. Teenagers may experience physical neglect when drinking takes precedence and there is not sufficient money for household essentials and clothes. Such neglect may jeopardise friendships or lead to bullying. To keep up appearances some young people may resort to stealing or other illegitimate ways of obtaining money to keep up appearances. Others may seek to escape the difficulties within the home by withdrawing into themselves, using drugs or alcohol, or leaving home altogether. Many young people who leave home will experience homelessness which is associated with poorer mental and physical health and an increased likelihood of substance misuse.

 It is important not to assume that all young people will have problems just because they grow up living with a parent who has alcohol problems. The majority outgrow their childhood problems. Research suggests that the following factors can support young people: sufficient income and good physical standard in the home, regular medical and dental checks, a trusted adult, a mutual friend, supportive and harmonius family environment, and regular attendance at school, work-based training or a job.

 This information has been taken from Working Together to Safeguard Children 2010.