Children of Parents who Misuse Drugs or Alcohol

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, or use associated with having harmful effect on the individual or the community.

Misuse of drugs and/or alcohol is strongly associated with significant harm to children of all ages, especially when combined with other features such as domestic abuse, mental illness and personality disorder. The child’s perspective must always be sought and heard and their safety prioritised (NSPCC).

Local Child Safeguarding Practice Reviews (previously 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.

The Advisory Council on the Misuse of Drugs (2018) states that ‘Although many people experiment with substances during adolescence and early adulthood, the duration of use is often time-limited …… it is still acknowledged that initiation of substance use, particularly at a young age, is an important predictor of adult substance-related harm. Any use of substances can be acutely harmful, highlighting the importance of preventive and early intervention’.

When considering concerns about the misuse of drugs, alcohol or any other harmful substances it is usually in the context of concerns about misuse of drugs and alcohol by the parent, any other person living in the same household as the child and any person who has substantial or overnight contact with the child, and where there is an impact on the child. It is important to remember that the parent may also be a child who is under the age of 18 years themselves, and therefore in need of additional services and assessments. Children and Young People under the age of 18 can access services from the Family and Young Persons Team (CGL Spectrum) who give priority to referrals involving pregnancy or where there are safeguarding concerns.

Substance misuse can consume a great deal of time, money and emotional energy, which may unavoidably impact on the capacity 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.

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.

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. 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 parent’s/carer’s 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;
• Chronic neglect, from before birth and throughout childhood including failure to meet the provision for children with additional needs. For further information, please see the Neglect Strategy;
• Possible trauma to the child resulting from changes in the parent’s mood or behaviour, including exposure to violence, lower tolerance levels, withdrawal symptoms including mood disturbances and physical symptoms, and reduced parental vigilance;
• The impact of the parent’s behaviour on the child’s development including the emotional and psychological well-being, education and friendships;
• Exposing children to criminal or other inappropriate adult behaviour;
• Unsuitable care givers or visitors - e.g. customer or dealers;
• Being passengers in a car being driven by a driver who has been drinking or using drugs;
• Effects of alcohol or drugs which may lead to dis-inhibited behaviours e.g. inappropriate display of sexual and/or aggressive behaviour;
• Adverse impact of growth and development of a child including an unborn child;
• Increased risk of the child developing alcohol and drug use problems themselves;
• Taking on a caring role which impacts on their emotional, physical and social wellbeing;
• The impact on new-born babies who may experience Foetal Alcohol Spectrum Disorder or other drug withdrawal symptoms;
• 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, i.e. safe storage;
• Children are particularly vulnerable when parents are withdrawing from drugs;
• Dangerously inadequate supervision and other inappropriate parenting practices;
• Intermittent and permanent separation i.e. custodial sentences;
• Inadequate accommodation and frequent changes in residence;
• Children forced to take on a caring role and feeling they have the responsibility to solve their parent’s, alcohol and drug problems;
• Parents showing an altered state of emotion, including detached emotional thinking with lack of responsiveness to the child's emotional needs;
• Children accepting drug and alcohol use as normal and themselves becoming young people who are taking substances and the associated increased risks of physical and mental illness and criminal and sexual exploitation;
• Co-sleeping and the risk of Sudden Infant Death in pregnancy (see The Lullaby Trust website).

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. The team around the family need to ‘Think Family’.

Parental substance misuse of drugs or alcohol becomes relevant to child protection where there is a risk to the safety of a child, or when substance misuse and personal circumstances indicate that their parenting capacity is likely to be seriously impaired and as such to impact on the child, or that undue caring responsibilities are likely to be falling on a child in the family.

There are many reasons why adults take drugs or drink alcohol and 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 but the impact on the child should always be a primary concern and not be secondary to the difficulties and support needs of the parent.

To be healthy and to develop normally, children must have their basic needs met. If a parent is more concerned with funding or seeking substance use, 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, take children to school 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.

Children who are inadequately cared, and emotional vulnerable for are at higher risk of Child Sexual Exploitation or criminal exploitation (including gangs and county lines).

Other consequences of substance misuse - lost jobs, unsafe homes, failed relationships, severed family ties and friendships, and disruption of efforts made by other professionals 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 this child in this environment?”.

Professionals must also consider that a service user may have a history of misuse of prescribed medication, obtained legitimately or illicitly, where the nature of the medication may lead to dependency, and which can impact on their ability to meet their child’s needs. It is imperative that any legitimate prescriptions are issued following a review of the medication history, and consideration that the request may not be for the reason of the presenting symptom along with accurate recording.

Where any health agency encounters a service user who is pregnant, routine questioning around alcohol and any prescription or illicit drug consumption should be undertaken as part of a holistic health assessment. Should the assessment of the degree of substance misuse indicate that their parenting capacity is likely to be seriously impaired, they must make a referral to Children’s Services.

When a woman, or any partner (father or otherwise) is found in the antenatal period to be misusing substances, he/she should be encouraged to contact the CGL Services for assessment and advice on the treatment options available. If she/he does not agree to a referral, this should be discussed with the organisations safeguarding lead and the Pre-birth Protocol followed.

In the Maternity Services a pathway approach should apply including input from Midwifery and a social worker from Children’s Services and assessments undertaken which should also include any other children in the family unit. Midwives are to refer to Trust Guidelines on Women Who Misuse Substances in Pregnancy.

Where a newly born child is found to need treatment to assist with withdrawal from substances or other drug/alcohol related medical conditions at birth, a referral to Children’s Services in line with the Referrals Procedure should be completed or if already open to Children’s Services the social worker must be informed, followed by the arrangement for a multi-agency discharge planning meeting before the child is discharged home the discharge planning meeting will refer to the birth and discharge plan if the baby is subject to a Child in Need Plan or a Child Protection Plan Specialist Substance Misuse Services should be invited to attend along with Universal Services (Health Visitor) to provide information to any meeting concerning the implications of the parent/carer’s substance misuse problems and agree a plan for follow up. The GP should also be contacted to discuss onward care.

There is a clear need to assess the impact of the behaviour on the baby/infants 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 must be paramount and agencies with information regarding the parent will have a valuable contribution to make. In these circumstances, professionals 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.

Following outcomes of the pre-birth assessment, if a decision to close the case and move to universal services, an agreed plan must be discussed to support the family. This is to ensure that any on-going needs can be addressed and is to ensure that professionals working with the family have a clear guide to thresholds and step up and step down, are supported in their work and so that we can work pro-actively with children and their families to prevent escalation and statutory intervention where this may not be necessary.

A child’s parents/carers own needs will need to be addressed and supported. Sometimes access to appropriate treatment resources is limited which may cause delays in providing service. However, the child’s needs must not be put on hold without a safe contingency plan. Should there be safeguarding concerns for an adult, advice should be sought from the organisation safeguarding adult lead and consideration for a referral to Adult Care Services.

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

If a parent/carer disengages from substance misuse services or does not attend for review appointments, or is non-compliant with treatment, the impact of this on the child must be assessed and professional judgment used as to the level of risk to the child. Where there is on-going risk to the child, this should always be referred to Children’s Services. See: See the Adult, See the Child.

Professionals need to be mindful of disguised compliance, self-reported information and avoid over optimism about the progress as this removes the focus from the child.

Confidentiality is important in developing trust between parents who use substances and staff in agencies working with them in relation to their substance misuse. However, professionals must always act in the best interests of the child and not prioritise their therapeutic relationship with the adult.

Where there are concerns by professionals 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 must take place.

Agencies should refer to the Hertfordshire Continuum of Need document to identify the level of intervention required, and to ensure that professionals have a clear guide to thresholds and step up and step down in order to support work to safeguard children, and to work pro-actively with children and their families to prevent escalation and statutory intervention where this may not be necessary. Where escalation is not preventable these systems allow rapid escalation of cases through clear information gathering and analysis to ensure decision making is evidence based.

Professionals must 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 Hertfordshire Children’s Services in line with the Contacts and Referrals Procedure should be made and the professionals from adult services, or other relevant agencies, should work in collaboration with Children’s Services.

The Families First (Early Help) pathway encourages the assessment by multi-agency professionals of children and families where worries may be raised but there is no substantiated evidence or risk of significant harm. This will ensure that children and families will receive the right support at the right time to attempt to prevent escalation to statutory social care.

Young people themselves can need support for substance misuse and cases should be referred at the earliest opportunity to the Family and Young Persons Team at CGL Spectrum who will support each case based on the individual needs of the young person. If it is identified that additional support is required for other family members, a referral can be sent to Families First.

Partnership working across agencies is vital for effective assessments of risk and to ensure child(ren)'s safety and involves all services must collaborate using a ‘Think Family’ approach and share information regardless of the ages of the parents and carers.

To benefit treatment parents/carers should be asked to agree to their information on substance use and treatment being shared with relevant agencies however, in accordance with the Data Protection Act (2018), consent is not needed where there is a significant impact on the child, or where informing the adult will place the child at further risk.

Care programme meetings regarding parental drug or alcohol use must include consideration of any needs or risk factors for the children concerned. Children's Services should be given the opportunity to contribute to such discussions. A representative from substance misuse services should attend Child Protection Conferences if a child of a parental drug or alcohol user is the subject and should provide written reports where necessary.

Strategy Discussion and Meetings and Child Protection Conferences may include workers from any drug and alcohol services involved with the family in accordance with the key presenting needs.

Young People Resources

• The Loop;
• In the mix.

Professionals, Carers and Parents

• ADFAM;
• Talk to Frank;
• NSPCC;
• Drink Aware.

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

Asking curious questions about drugs and alcohol

Examples of how to talk with an adult about drugs and alcohol?

Opening Questions
Being a parent can be really stressful/tiring tell me how you relax?
It is not unusual for people to try or use alcohol or drugs. Is this something you have tried or use?
As part of my role I ask all parents about alcohol or drugs they may be using.

Further Information

When was the last time you used alcohol or drugs?
Do you take any prescribed medication?
How would you know if your alcohol use or drug use was a problem? Asking for help can be difficult. Would you like some support around your drinking or drug use? What kind of support might you like?

Drug Seeking Behaviour

“Drug-seeking behaviour” is a widely used, although poorly defined term that refers to a patient's manipulative, demanding behaviour to obtain medication. The patient may imply that the only possible solution to a medical problem is a prescription of a controlled (addictive) medication. 15 Apr 2000

Resources

• Dealing with drug seeking behaviour webinar (Ruth Bastable) (vimeo.com);
• NHS England and NHS Improvement South West, Useful links;
• A Systematic Approach to Identifying Drug-Seeking Patients - FPM (aafp.org).

With thanks to North East Lincolnshire Safeguarding Children’s Partnership.

Guidance: Foetal Alcohol Spectrum Disorder: Health Needs Assessment

Guidance: Parents with Alcohol and Drug Problems – Adult Treatment and Children and Family Services