Children of Parents who Misuse Substances

1. Definition

Substance misuse refers to the abuse of drugs and/or alcohol. Whilst there may be different treatment methodologies for adults with these problems, they are considered together because the consequences for the child are quite similar. Substance misuse refers to both illicit drugs, alcohol, prescription drugs and solvents, the consumption of which is either dependent use [1], or use associated with having harmful effect on the individual or the community.

Many substance misusing adults also suffer from mental health problems, which is described as Dual Diagnosis and there may be several agencies, from both Adult and Children's social care, who are working with the family.

National Serious Case Reviews and Domestic Homicide Reviews have identified domestic abuse, parental mental ill health and drug and alcohol misuse as significant factors in families where children have died or been seriously harmed. Where all three issues are present, they have been described as the ‘trilogy of risk’.

[1] Dependent use would be that in which a parent is physically dependent on a substance and will experience potentially dangerous withdrawals if they suddenly abstain from a substance/alcohol without safe reductions or appropriate medication.

2. Risks

Substance misuse can consume a great deal of time, money, and emotional energy, which will unavoidably impact on the capacity of a person to parent a child. This behaviour also puts the child at an increased risk of neglect and emotional, physical, or sexual abuse, either by the parent or because the child becomes more vulnerable to abuse by others.

Children's physical, emotional, social, intellectual, and developmental needs can be adversely affected by their parent's misuse of substances. These effects may be through acts of omission or commission, which have an impact on the child's welfare and protection.

Parental Substance Use in noted to be an Adverse Childhood Experience (ACEs). Children may be introduced to drug and alcohol misuse at an early age by the behaviour of the parents and the availability of the substances within the home. This increases the risk to the child, as well as making it more likely that they will repeat the cycle and become problematic substance users themselves.

All agencies need to work together in tackling the problems caused by substance misuse in families in order to safeguard children and promote their well-being. This would include having as comprehensive an understanding as possible the extent and range of substances being used by Parents. Professional curiosity around self-reported drug use and sharing this information across agencies is essential to gain as full a picture as possible of substance misuse.

Parents who misuse drugs and/or alcohol may be good enough parents who do not abuse or neglect their children. It is important not to generalise or make assumptions about the impact on a child of parental/carer drug and/or alcohol use. It is, however, important that the implications for the child are properly assessed having full regard to the parents/carers ability to maintain consistent and adequate care. Equal regard should be given to each and every child's level of dependence, vulnerability and any special needs.

Where there is concern that a parent is involved in substance misuse, the impact on the child needs to be considered, including:

• The child's physical safety when the parent is under the influence of drugs and/or alcohol;
• Children can suffer chronic neglect, prebirth and throughout childhood;
• Possible trauma to the child resulting from changes in the parent's mood or behaviour, including exposure to violence and lower tolerance levels in the parent;
• The impact of the parent's behaviour on the child's development including the emotional and psychological well-being, education and friendships;
• The prebirth impacts on the foetus includes low birth weight, premature labour, infections, risk of haemorrhage, and impact on cognitive development;
• The impact on newborn babies who may experience foetal alcohol syndrome or other drug withdrawal symptoms;
• Where a parent might use illicit substances to reduce withdrawal symptoms in their baby;
• The extent to which the parent's substance misuse disrupts the child's normal daily routines and prejudices the child's physical and emotional development;
• The impact on the child of being in a household where illegal activity is taking place particularly if the home is used for drug dealing and the children may come in to contact with risky adults;
• How safely the parent's alcohol and/or drugs and equipment are stored as children can be at risk of ingesting substances or injuring themselves on drug paraphernalia;
• Children are particularly vulnerable when parents are withdrawing from drugs, including street brought prescription drugs and alcohol, which will impact on effective parenting;
• Dangerously inadequate supervision and other inappropriate parenting practices;
• Intermittent and permanent separation;
• Inadequate accommodation and frequent changes in residence;
• Children being forced to take on a caring role for their parent and/or siblings and feeling they have the responsibility to solve their parent's, alcohol, and drug problems.

The circumstances surrounding dependent, heavy, or chaotic substance misuse may inhibit responsible childcare, for example, drug and / or alcohol use may lead to poor physical health or to mental health problems, financial problems, and a breakdown in family support networks.

3. Indicators

There are many reasons why adults take drugs or drink alcohol. If doing so has negative consequences then it may be regarded as misuse. Parents may be aware that their behaviour has a negative impact on their child. There is a risk in focusing on the adult's difficulties and in supporting their attempts to control their behaviours and the impact on the child can be overlooked or seen as a secondary consideration.

To be healthy and to develop normally, children must have their basic needs met. If a parent is more concerned with funding an addiction, or is under the influence of drugs or alcohol, they are unlikely to be able to achieve this consistently. A disorganised lifestyle is a frequent consequence of substance misuse. Parents may fail to shop, cook, wash, clean, pay bills, attend appointments etc.

Substance misuse may affect a parent's ability to engage with their child. It may also affect a parent's ability to control their emotions. Severe mood swings and angry outbursts may confuse and frighten a child, hindering healthy development and control of their own emotions. Such parents may even become dependent on their own child for support. This can put stress on a child and mean they miss out on the experiences of a normal childhood.

Other consequences of substance misuse – lost jobs, unsafe homes (littered with half empty bottles or discarded syringes), broken marriages, severed family ties and friendships, and disruption of efforts made by a local authority to help – are also likely to negatively affect a child.

Any professionals, carers, volunteers, families and friends who are in contact with a child in a drug / alcohol-misusing environment must ask themselves "What is it like for a child in this environment?"

4. Protection and Action to be Taken

Where there are concerns by practitioners involved with a family about a child living in the environment of substance misuse an assessment of the parent's capacity to meet the child's needs should take place to establish the impact on the child of the parent's lifestyle and capacity to place the child's needs before those of their own. A referral to Children's social care in line with the Referrals Procedure should be made and the practitioners from adult services, or other relevant agencies, should work in collaboration with Children's social care.

Where any agency encounters a substance user who is pregnant and whose degree of substance misuse indicates that their parenting capacity is likely to be seriously impaired, they must make a referral to Children's social care with reference to the Thresholds document. Please refer to the pre-birth pathway.

The majority of pregnant substance misusing women will have been identified by maternity services and referred to the Substance Misuse Team. The Care Planning Approach / Care Co-ordination Approach (only applies when there is dual diagnosis) will include input from the link midwives and a social worker (if allocated) from Children's social care, who will be invited to any meetings taking place in respect of the child/ren.

Where a newly born child is found to need treatment to withdraw from substances at birth, an assessment and a pre-discharge discussion should take place and consideration should be given to making a referral to Children's social care in line with the Referrals Procedure before the child is discharged home.

Information should be provided routinely to breastfeeding mothers prior to discharge on the ability to both transmit illegal substances to the baby via breast milk, by accidental contamination and through passive smoking.

Specialist Substance misuse services (Turning Point) should be invited to and should attend and provide information to any meeting concerning the implications of the parent/carer's substance misuse problems for the child, including Child Protection Conferences and Child in Need meetings. Turning Point Chair monthly Multidisciplinary Team meetings which include LLR Children’s Social Care and Midwifery, and the Up-To-Date history of substance misuse is shared.

This helpful guide can assist in assessing safety in the home where parents or carers misuse substances. It also allows practitioners to discuss with parents or carers how best to safeguard their children from accessing harmful substances.

There is a clear need to assess the impact of the behaviour on the child as well as the wider family and community context. Some adult services may be reluctant to share information because of concern about confidentiality. However, the needs to safeguard children should be paramount and agencies with information regarding the parent will have a valuable contribution to make. In these circumstances, practitioners should seek advice from the Safeguarding leads in their organisation, if they are unsure as to what information should be shared, or what action should be taken.

When practitioners make a decision to end their involvement with a parent/carer with substance misuse problems, or a child who is living with a parent/carer with substance misuse problems, they should always discuss their plans with the other services who are working with the family, before the case is closed. This is to ensure that any on-going needs can be addressed.

5. Issues

Parents' own needs will need to be addressed and supported consideration of instigating safeguarding adult processes such as VARM if appropriate. Sometimes access to appropriate treatment resources is limited which may cause delays in providing services however the child's needs must not be put on hold without a contingency plan.

Confidentiality is important in developing trust between drug using parents and staff in agencies working with them in relation to their substance misuse, however, practitioners must always act in the best interests of the child and not prioritise their therapeutic relationship with the adult.

When a woman with a substance misuse and/or problem attends for antenatal care, she should be encouraged to contact the Substance Misuse Team for assessment and advice on the treatment options available to her.

Further Information

Adfam - support to families affected by drugs and alcohol.

Cafcass – SCODA: Risk assessment for Parental drug misuse

Coap - In April 2015, COAP (Children of Addicted Parents) has become part of Action on Addiction.

Dual Diagnosis - A Good Practice Handbook

NHS Choices Care Programme Approach

Hidden Harm - Responding to the Needs of Children of Problem Drug Users

NSPCC Learning from Serious Case Reviews

Think Child, Think Parent, Think Family

Guidance: Parents with Alcohol and Drug Problems: Support Resources (GOV.UK)