Path to this page:Home >> Specific Concerns >> Alcohol & Substance Misuse

Implications of Alcohol & Substance Misuse for Child Protection

Although there are some parents who are able to care for and safeguard their child/ren despite their dependence on drugs or alcohol, parental substance misuse can cause significant harm to children at all stages of development.

Where there are concerns or suspicions that the child may be suffering, or at risk of suffering significant harm, a referral must be made to the First Response Service.

All types of abuse have been associated with drug misuse, with neglect being the most common problem, toddlers being especially vulnerable (Alison, 2001 in Harbin and Murphy, 2001).

Ultimately, in any sustained parental addiction pattern, the parent is likely to place their need for their drug of choice over the child's needs.

Hidden Harm – Responding to the Needs of Children of Problem Drug Users (PDF, 703Kb) a report by the advisory council on the misuse of drugs (2003) delivered 6 key messages:

There are an estimated 250,000 to 350,000 children of problem drug users in the UK – about 1 for every problem drug user
Parental drug use can and does cause serious harm to children at every age, from conception to adulthood
Reducing the harm to children from parental drug use should become the main objective of policy and practice
Effective treatment of the parent can have major benefits for the child
By working together, services can make practical steps to improve the health and wellbeing of affected children
The number of affected children is only likely to decrease when the number of problem drug users decreases

Support Services in Haringey

Haringey Advisory Group on Alcohol (HAGA)

Confidential advice for people with alcohol problems and their families.

Tel: 020 8800 6999
Web: Haringey Advisory Group on Alcohol - HAGA (external link)

Drug Advisory Service for Haringey (DASH)

DASH offers a free and confidential service, providing a range of services to drug users, their families, partners and friends in the London Borough of Haringey.

Tel: 020 8826 2400
Web: Drug Advisory Service for Haringey - DASH (external link)

Bringing Unity Back Into The Community (BUBIC)

BUBIC is an award-winning community organisation specialising in crack cocaine usage that provides support for drug users, ex drug users and their family and friends.

Tel: 020 8808 6550
Web: Bringing Unity Back Into The Community - BUBIC (external link)

In-Volve Haringey

Young People's Drug & Alcohol Treatment Service.

Tel: 020 8493 8525

EBAN

Service for crack cocaine and poly-drug users over the age of 18 who are working towards being drug free after drug treatment. Provides referrals to counselling and access to social activities and sports.

Tel: 020 8365 9032
Web: EBAN (external link)

Narcotics Anonymous

Free & non-professional self-help groups using 12 step format of recovery.

Tel: 0300 999 1212
Web: Narcotics Anonymous (external link)

Alcoholics Anonymous

Free & non-professional self-help groups using 12 step format of recovery.

Tel: 0845 769 7555
Web: Alcoholics Anonymous (external link)

Risk Factors

The risk is also greater where there is evidence of mental ill health, domestic violence and when both parents are misusing substances:

Lack of finances to the household to meet basic needs (e.g. inadequate food, heat and clothing, problems with paying rent)
Exposing children to unsuitable friends, customers or dealers
Exposing children to prostitution (for drug acquisition)
Insecure attachment styles or attachment disorders due to emotionally unavailable caregivers
Normalising substance use and offending behaviour, including children being introduced to using substances themselves
Unsafe storage of injecting equipment, drugs and alcohol (e.g. methadone stored in a fridge or in an infant feeding bottle)
Where a child has been exposed to contaminated needles and syringes
Children having caring responsibilities inappropriate to their years placed upon them
Parents becoming involved in criminal activities, and children at possible risk of separation (e.g. parents receiving custodial sentences)
Children experiencing loss and bereavement associated with parental ill health and death, parents attending inpatient hospital treatment and rehab programmes
Children being socially isolated (e.g. impact on friendships), and at risk of increased social exclusion (e.g. living in a drug using community)
Children may be in danger if they are a passenger in a car whilst a drug / alcohol misusing carer is driving

Children whose parent/s are misusing substances may suffer impaired growth and development or problems in terms of behaviour and / or mental / physical health, including alcohol / substance misuse and self-harming behaviour.

A child may be considered to be at greater risk of harm where substance use is uncontrolled and chaotic.

Research indicates that the risk factors for the safety and welfare of the child may be heightened during periods of withdrawal – with parents/carers exhibiting a reduced responsiveness to the child’s needs and increased levels of anxiety relative to themselves as individuals.

The consequences to the child of a carer experiencing physical or emotional changes due to the misuse of substances require assessment.

Examples may include a parent or carer who may become unconscious or incapable whilst looking after the child, or they may fail to notice or pursue treatment for a child’s illness or accidental injuries or on occasions become violent. Kearney et al (2000) state that the British crime survey in 2000 showed that 44% of domestic violence incidents involved people who had been drinking.

Acquiring Drugs and Alcohol

A parent/carer may take risks with the child's safety when procuring drugs or other substances.

For example, a young child may be left alone whilst the parent/carer goes out to obtain drugs/alcohol, or the child may be taken to procure drugs/alcohol to places where they would be deemed to be at risk. A child may be used by a parent/carer to collect substances and may be tempted to try them, which could be a life-threatening event to that child. Are there inappropriate carers caring for the child?

In some cases, the family's accommodation may be used for selling drugs, prostitution or by other drug/alcohol users to drink and use drugs, to which the child may be exposed. If a parent is sex working where is the child at these times and what risks does this pose?

The issue of the cost of the substances being used, and how the money for them is obtained will need to be addressed. This should include whether appropriate finances are available and utilised for meeting the children’s basic needs and if the child is being involved in shoplifting or other illegal activities to raise money for drugs.

Storage and Disposal

Part of any assessment should include questions about where drugs, alcohol and other substances are stored, and, if parents/carers are injecting drugs, how drug using paraphernalia, needles, syringes, filters, spoons and pipes, are stored and disposed of. Consideration should also be given to the parent/carer's awareness of health risks to themselves of their substance misuse. This could include whether they drive whilst under the influence of drugs, alcohol, or other substances.

Parent/Carer's View

The parent/carer’s perception of the situation is extremely important. If they are aware of the effects their substance misuse may be having on their children they are more likely to try to lessen the impact by stabilising or changing their use.

Child's View

Christensen (1987) states that interviews with children showed that they always knew about their parent’s drinking before their parents thought they did and the majority of the children said that they could remember it from as young as four or five years old. The importance of stability should be stressed rather than insisting parents/carers achieve abstinence.

Key questions to be addressed are whether the child's daily life revolves around the parent’s/carer’s substance misuse and to what extent the child is assuming inappropriate responsibilities.

It should also be established whether the child is being cared for by a large number of people while the parents/carers place their own needs before those of the child.

Home Environment

The expense involved in drug and alcohol misuse can represent a considerable drain on the family's financial resources.

This factor, alongside the chaotic and unstable lifestyle of some substance mis-users, can affect the accommodation and home environment.

It is therefore necessary to assess whether the accommodation is adequate for the child and whether the rent and bills for essential services are being paid.

Stability for the child will be enhanced if the family remains in one locality, while frequent house moves may disrupt service provision of health and education for the child and impact upon their social development.

Child's Developmental Profile

Research shows that the levels of behavioural problems, emotional difficulties and school-related problems are higher in those children who have parents who are problem drinkers, than in other children (Tunnard, 2002).

Some common indicators may be the child who is left alone in the playground, who doesn't know how to play, who is bullied or is the bully. Children may also develop highly sophisticated fantasy worlds as either a way of dealing with living in a non-stimulating home environment where parents are too intoxicated to play, or the isolation they may face as other children are told by parents not to play with children whose parents are substance users.

Some children may be using substances or have a detailed knowledge about them. Some children may adopt a caring role either for younger siblings or their parents and taking responsibility for household tasks. This may lead to higher than average absentee rates from school.

Support Systems

Most adults who abuse drugs/alcohol are often in contact with their wider family network. It is important not to overlook the positive aspects of this when considering what childcare interventions are necessary. The relatives' awareness of the substance misuse - although probable - must not be assumed. Support when offered by relatives is not always without its own difficulties and therefore whether the parents are accepting of help from relatives needs to be explored. Often family members are not aware of the substance use.

The adult’s social network may primarily involve other substance users who due to their own circumstances may have limited capacity to provide support. The family's responses to the involvement of professional or voluntary agencies will also need to be considered.

Relapse Prevention and Recovery

If a parent has ceased using, or claims to have ceased using drugs or alcohol, there are a number of factors which should be explored.

It should not be assumed that abstinence will automatically improve parenting capacity. Abstinence can be a ‘risky’ time for children who begin to experience the parent putting in boundaries and routines.

The psychological and emotional recovery from drug or alcohol addiction can often take longer than the time it takes to get over the physical addiction. Without the psychological and emotional recovery, the relapse rate will be significantly higher.

Detoxing can be difficult, and a drug/alcohol using parent may require additional childcare support during this process. Children can experience post-detoxification confusion as there is a change in the parental behaviour towards them, including change of boundaries and routines and discipline. The child should receive support in their own right to help them deal with their feelings, if available.

A key factor is whether the parent has the sustained support to stay stopped. Self-help communities like Narcotics Anonymous (external link) and Alcoholics Anonymous (external link) have the highest success rates for sustained abstinence and behaviour rehabilitation. Professionals can attend 'open' meetings of Narcotics Anonymous and Alcoholics Anonymous to gain a better understanding of the workings of 12-step programmes.

Pregnancy

Maternal substance misuse in pregnancy can have serious effects on the health and development of the child before and after birth. Many factors affect pregnancy outcomes, including poverty, poor housing, poor maternal health and nutrition, domestic violence and mental health. Assessing the impact of parental substance misuse must take account of such factors. Pregnant women (and their partners) must be encouraged to seek early antenatal care and treatment to minimise the risks to themselves and their unborn child. See section 6.8 of the London Child Protection Procedures 2007 (PDF, 7.7Mb) for details of the pre-birth referral and assessment.

Most women with substance using problems are of childbearing age.

Pregnant substance users have an increased risk of:

Having a premature baby
Having a low birth-weight baby
Death of the baby before birth, or shortly after birth sudden infant death syndrome or ‘cot death’
Babies may experience withdrawal symptoms or exhibit signs of maternal drug use after birth.

However, it is worth noting that not all substance-using pregnant women disclose their substance use, and not all babies will show signs of withdrawal from substances.

Dual Diagnosis

Dual Diagnosis is where a parent presents with two conditions such as mental illness and substance misuse. See the parental mental illness page to find out more.

Sometimes, substance misuse can cause the onset of mental illness. Pre-existing psychiatric conditions or pre-dispositions can be adversely affected by substances (e.g. psychosis following LSD or heavy amphetamine, cocaine, crack and cannabis use).

In some cases, parents self-medicate with substances in order to cope with a mental illness.

In child protection cases it is important that the relationship between a parent’s/carer’s substance use, any mental health problems and actual impact upon the child’s development is thoroughly assessed.

Both local substance misuse services and mental health services are available to assist in Children's Social Care assessments.

Newborn babies and children

Newborn babies may experience withdrawal symptoms (e.g. high pitched crying and difficulties feeding), which may interfere with the parent / child bonding process. Babies may also experience a lack of basic health care, poor stimulation and be at risk of accidental injury.

Working Together

Substance misuse professionals must identify those adults who are parents, or who have regular care giving access to children, and share the information with LA children’s social care as early as possible.

Professionals in all agencies must recognise that their primary duty is to safeguard and promote the welfare of the child/ren.

All care programme meetings for adults who are a parent must include ongoing assessment of the needs or risk factors for the child/ren concerned. LA children’s social care should be invited to such meetings if appropriate and contribute.

Strategy meetings / discussions, child protection conferences and core group meetings, must include professionals from any drug and alcohol service involved with the subject child and their family.