SCIE research briefing 6: Parenting capacity and substance misuse

Published April 2004 (updated August 2005)

The topic of this briefing is how parenting capacity can be affected by parental substance misuse (drugs and/or alcohol) and how this may be managed.

What is the issue?

This section introduces and defines the scope of the briefing and the topic.

A SCIE Research briefing provides up-to-date information on a particular topic. It is a concise document summarising the knowledge base in a particular area and is intended as a 'launch pad’ or signpost to more in-depth investigation or enquiry. It is not a definitive statement of all evidence on a particular issue. The briefing is divided into the different types of knowledge relevant to health and social care research and practice, as defined by the Social Care Institute for Excellence (SCIE).

It is intended to help health and social care practitioners and policy-makers in their decision-making and practice.

The topic of this particular briefing is parenting capacity and substance misuse. Parenting capacity is defined in a recent government framework document as "the ability of parents or caregivers to ensure that the child’s developmental needs are being appropriately and adequately responded to, and to [be able to] adapt to [the child’s] changing needs over time". This includes providing for the child’s basic physical needs, ensuring their safety, "ensuring the child’s emotional needs are met and giving the child a sense of being specially valued", promoting the child’s intellectual development through encouragement and stimulation, demonstrating and modelling appropriate behaviour and control of emotions, and providing a sufficiently stable family environment (1).

The substance misuse covered by this briefing includes both drug and alcohol misuse. This involves drug misuse which is considered by professionals or family members to be having "an adverse impact, not just on the health and behaviour of parents, but on the lives of their children also" (2,3), and a lcohol consumption which "warrants attention because it seriously and repeatedly affects the drinker’s behaviour" (4). There are important differences in the characteristics between drug and alcohol misuse, however. For example, the illegality and stigma of drug use makes concealment of use common (5,6).

Why is it important?

This section summarises research findings relating to the impact or consequences of parental substance misuse on both parenting capacity and childhood development.

This issue is important because the problem is widespread. It is difficult to be precise about the numbers of parents and children affected by substance misuse, but it has been estimated that the number of children who may be exposed to the consequences of problem drug misuse in the UK is between 250,000 and 350,000 (2), while around two million children are affected by parents’ harmful drinking (7). Between 50% and 90% of families on social workers’ child care caseloads have parent(s) with drug, alcohol or mental health problems (8).

The research has indicated a number of ways in which parental substance misuse can have a negative effect on children in both the short and long term. Children of parents who misuse substances make up a substantial proportion of the children coming to the attention of the child protection authorities for abuse or neglect (8,9,10,11), although neglect rather than abuse is the most common reason for intervention by social services (9). However, it is believed that only a minority of such children come to the attention of social workers (12). Children of parents who misuse substances are also likely to enter the care of relatives, who themselves may require help and support in caring for the children (3,13).

Children of parents who misuse substances may also experience behavioural or psychiatric problems (6,9,14,47,48,53) and may themselves engage in substance misuse (15,16). They may also be vulnerable to physical, educational and emotional problems (50). Parents who misuse substances may interact poorly or in an authoritarian manner with their children (5,17,18,19,20,53) and may also be inconsistent and emotionally unresponsive as a result of their substance misuse (21,55). The lifestyle of families with a substance-misusing parent can also be characterised by chaos and a lack of routine (7,10,22,23), as well as social isolation (10,24,25).

What do the different sources of knowledge show?

Organisational Knowledge

This section lists and briefly summarises documents that describe the standards that govern the conduct of statutory services, organisations and individuals working in the field of substance misuse by parents and its impact on their children.

Prime Minister’s Strategy Unit (2004). Alcohol Harm Reduction Strategy.

This report sets out the government's strategy for tackling the harms and costs of alcohol misuse in England. The aim of this strategy is to prevent any further increase in alcohol-related harm.

Scottish Executive (2001). Getting Our Priorities Right. Good Practice Guidance for working with children and families affected by substance misuse. Tackling Drugs in Scotland.

This guidance provides information on substance misuse in Scotland and its effect on parenting, guidelines on inter-agency working, and guidance on confidentiality and the sharing of information between services. This document contains general information, as well as policies specific to Scotland.

Department of Health (1999). Working together to safeguard children: a guide to inter-agency working to safeguard and promote the welfare of children. London, Department of Health.

This document sets out how all agencies and professionals should work together to promote children's welfare and protect them from abuse and neglect. It is addressed to those who work in the health and education services, the police, social services, the probation service, and others whose work brings them into contact with children and families. It is relevant to those working in the statutory, voluntary and independent sectors.

HMSO (1998). Tackling Drugs to Build a Better Britain. The Government's Ten-Year Strategy for Tackling Drugs Misuse. (26)

The updated (2002) strategy is also now available

Children Act 1989 (c.41)

Under the Children Act 1989, local authorities have a duty to provide services to children 'in need'. Joint working arrangements are required to be agreed, implemented and reviewed through the mechanism of the Area Child Protection Committees.

Policy Community Knowledge

This section summarises documents describing proposed structural models for the delivery of policy and improved practice. These documents are published by public policy research bodies, lobby groups, think tanks and related organisations.

Advisory Council on the Misuse of Drugs (2003). Hidden Harm.

This is the report of an inquiry into the effect of "parental problem drug use and its actual and potential effects on children". This includes both alcohol and drug misuse. The document also makes practice recommendations.

Hogg C. (1997). Drug using parents: policy guidelines for inter-agency working. Department of Health.

This report seeks to provide guidance and advice to people working with drug using parents. It focuses on policy and covers a range of services including drug services, maternity services and children's services. The importance of both access to services and interagency working is stressed. (Only available in hard copy).

National Children’s Bureau (2003-). Children of Drug-Misusing Parents: Developing Good Practice in Assessment, Decision-making and Placement.

This is an ongoing project that aims to enhance social work decision-making and planning with families where parents/carers are drug misusers, in order to improve outcomes for children. It focuses on all stages of the process from assessment and decision-making to permanency planning. The lessons from the project will be made available to practitioners and social care trainers.

Social Care Institute for Excellence (2003). Families that have alcohol and mental health problems: a template for partnership working. SCIE Resource Guides No.1.

This report describes how to deliver high quality co-ordinated services to families where children live with parents who misuse alcohol or have mental health problems, in accordance with government policy.

The National Treatment Agency for Substance Misuse (2002). Models of care for the treatment of drug misusers.

This document offers information on the epidemiology and treatment of parental substance misuse within the current policy framework. See chapter 3 section 5.

National Society for the Prevention of Cruelty to Children (2003). Evaluation of the Pilot. Family Alcohol Service (FAS).

This is a report evaluating the provision of a pilot family alcohol service in Camden and Islington.

The research literature also suggests services should be coordinated, integrated (27) and interdisciplinary (13,28). Effective risk assessment and screening models (29,30), service evaluation (27) and valid and reliable measures, (12) all need to be developed and applied.

Practitioner Knowledge

This section describes studies carried out by health and social care practitioners, documents relating their experiences regarding the topic, and resources produced by local practitioner bodies to support their work.

Newcastle Area Child Protection Team (2002). Parental substance misuse and the effects on children.

This guidance was developed for practitioners working with children and families and/or adults who have care of children where substance misuse is a factor. The guidance aims to provide practitioners with information about the issue of substance misuse and how this may impact upon an individual’s ability to care for a child. It is intended as a risk management tool for professionals, directing them in their practice when assessing if or how a parent or carer’s substance misuse is affecting a child.

Sheffield Area Child Protection Committee (2001). Child Protection Procedure Manual.

This guidance provides details on how to assess the effect of parental substance misuse on a child.

Option 2. All Wales Unit. Supporting Social Services

Option 2 is an intensive intervention programme aimed at keeping together families in which the parents have a problem with substance misuse and there is a possibility that the children may be taken into care.

Brighton Oasis Project

See also the following article in Community Care, An Oasis for Young People

This project supports young people whose mothers misuse drugs and alcohol.

Research Knowledge

This section summarises the best available research literature. The focus is on studies undertaken in the United Kingdom, so that their findings are as relevant as possible to the intended audience of the briefing.

The scope of the research

Most of the available research was conducted in the United States (9). The research literature focuses principally on mothers (9,16,21,24,31,32,33,34,50,51,54) and, to a lesser extent, parents generally (3,13,35,36,37) ; very little research has been conducted specifically into the parenting capacity of substance-misusing fathers (38,39,47,48). There is no specific research relating to black or minority ethnic communities (4). Two recent research reviews have assessed the available research evidence for both parental drug misuse (3) and parental problem drinking (4). This research has pointed out how studies often fail to evaluate the impact of substance misuse on parenting capacity relative to other aspects of disadvantage, such as poverty, unemployment or depression (3,4). It has also been pointed out that research into interventions in this field tends to be localised, based on small samples, and lacking in rigorous and independent evaluations of its methods and findings (22).

Interventions

The research suggests that potentially successful services to support substance-misusing parents might include education in parenting (34,40,51), specific support for substance-misusing fathers, (3,38,39) and residential programmes for parents and children (7,32). The supporting role of the extended family has also been identified as a vital means of supporting both parents and children (3,20,31,41).

A number of UK and other non-US studies have concluded that it may be appropriate to provide support to parents who have a controlled drug/alcohol habit, but only if their children’s welfare is not adversely affected by their substance misuse. One research study has suggested that treatment offered to mothers to stabilize their habit is a potentially effective means of protecting children from the consequences of parental drug misuse (31). A number of studies have investigated the effectiveness of the provision of training in parenting skills. Residential, family-based parent training and therapy was found by a UK project to be effective for older parents and single-drug users, but ineffective for younger parents and poly-drug users (42). An Australian study found parent-training to be a potentially effective intervention for parents receiving methadone maintenance therapy (35), and a US study of parent-skills training as part of a treatment programme for substance-abusing new mothers found that their knowledge and competence in child care, feeding, and child development was significantly improved (54). A US home-based education and support programme for substance-abusing mothers of newborns and infants to the age of 18 months found that the intervention had no discernible effect; level of maternal drug misuse was found to be the single most significant factor in mother-child interaction (21). Much of the US research has concentrated on women’s substance misuse whilst pregnant and assumes that total abstinence is essential if any treatment programme is to be successful (30,32,41,51). A recent review also recognised that more research is needed on interventions to help parents with substance-misuse issues (51).

Sharing of information

The issue of what information is passed on to whom has also been identified as an important issue for in any treatment programme. This is because health and social care staff have child protection responsibilities. Parents therefore fear that they might lose their children, and children fear they may have to leave their parents (4,22,33).

Factors affecting parenting capacity

It has also been pointed out that factors other than substance misuse may affect the ability of a parent to interact with and support their child, for example, poverty (14,21), unemployment and depression (41,43), single parenthood (31,43), and if the parents themselves experienced poor parenting (13), abuse or neglect during their own childhood (10,14,44).

User and carer knowledge

This section summarises the issues raised by service users and carers in relation to this topic, both as described by the literature and as defined through local consultation.

A number of qualitative studies have explored the views of parents and children around parental substance misuse. Mothers have often been found to have low self-esteem (44,45), a lack of self-care (36) and to be in poverty (45). However, being a mother was of vital importance to them (16,44) and led them to try to conceal drug-taking from their children, usually unsuccessfully (5,6,22,31). They were also aware of the safety risks to children (31,36) and the effects on children of any depression, irritability and aggression associated with substance misuse (22,36). Confidentiality in any treatment programme has also been identified as vital because most parents fear that they might lose their children (4,22,33). Children often knew more about their parents’ misuse than parents realised (5,46), felt the stigma and shame of this misuse (5) and feared the possibility of being separated from their parents and taken into care (22). A recent review of the literature on children’s views about parental substance misuse reported the following findings (46). Children worry about their parents much more than may be recognised, particularly if they fear for their parents' safety due to violence, self-harm or difficulty in coping. Children frequently described close relationships with parents. They also often expressed a desire to help their parents overcome problems. However, some children also felt torn between love for parents and a dislike of parents' behaviour and the restrictions this placed on their own lives. Children also said that being involved in finding solutions to problems helped them to cope. Other reviews and research have added to these findings. Children have said that there can be confusion over their role because they sometimes have to look after their parent rather than being looked after by them (52,55). They also say that they can feel secondary to their parents’ addiction, but still feel great loyalty to them and understand that their parents still care (52,55). They also believed that having a strong relationship with a support worker was extremely helpful to them (55).

Recent consultation with parents who are substance misusers, undertaken in the Trent region for this briefing, highlighted a number of additional issues. These parents considered the support provided by both voluntary and mainstream services, such as parent support networks (play groups, family centres) and Surestart, to be extremely valuable. They also acknowledged the effectiveness of residential rehabilitation services, but they wanted to access these services accompanied by their children and believed services felt that this was a problem. By contrast, research from the US found that parents often did not want their children to be involved in their residential treatment (49).

The parents in the consultation exercise also pointed out that they were often reluctant to use social services because they feared losing their children if child protection was considered to be an issue. The support of social services was also often withdrawn or not offered if there were no child protection concerns. The parents in the group were all aware of their parenting responsibilities and responded most favourably to a sensitive approach by services. Finally, they also highlighted the need for support services for the children themselves, and the importance of continuing support after a programme of treatment had been completed.

Useful links

This section lists sources of information relevant to professionals who work within this field:

Adfam (Families, drugs and alcohol)

http://www.adfam.org.uk/html/index.cfm?CFID=1292695&CFTOKEN=11695394

This organisation offers information about substance misuse within families.

Alcohol Misuse

http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/AlcoholMisuse/fs/en

This site is produced by the Department of Health. It contains information on alcohol misuse and links to publications and relevant web sites

Alcohol Concern

http://www.alcoholconcern.org.uk/

This organisation provides information and encourages debate on the wide range of public policy issues concerning alcohol, including its effect on children and families.

Area Child Protection Committees in England & Wales

http://www.dfes.gov.uk/acpc/

This website provides information about Area Child Protection Committees (ACPCs) and the inter-agency work they undertake to safeguard children in their area from abuse and neglect.

Children and Families. Department for Education and Skills

http://www.dfes.gov.uk/childrenandfamilies/

This document provides links to a range of government and non-government bodies and organisations. This was formerly Quality Protects.

DrugScope

http://www.drugscope.org.uk/home.asp

This organisation has a comprehensive information and contact service.

Every Child Matters
Every Child Matters sets out child protection principles and a framework for improving outcomes for all children and their families.

FRANK campaign
The campaign targets 11-21 year olds, and parents of 11-18 year olds and focuses on class A drugs.

Sheffield Drug Action Team
This team has produced a comprehensive list of relevant links under "Related Services" on the left hand side menu.

Substance Misuse
This site is produced by the Department of Health. It contains information on substance misuse and links to guidance, publications and relevant web sites.

Acknowledgements

Thank you to experts and service users for their contributions to this briefing.