Parents who Misuse Substances

Substance misuse is the harmful or hazardous use of psychoactive substances, including alcohol, illicit drugs, and prescription medications, regardless of whether they cause dependency. Whilst there may be different treatment methodologies for adults with these concerns, they are considered together because the impacts for children may be quite similar.

Many substance misusing adults often experience mental health problems, which is commonly 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. The factors within the “trio” cover a broad spectrum of concerns that can impact families in different ways. Practitioners should be supported to evaluate the bigger picture and respond to the specific individual needs of families and children. Previously, where all three issues are present, they have been described as the 'toxic trio', however other factors present in a family’s life such as availability of appropriate support and services, parental adverse childhood experiences, cultural or language barriers, disability or poverty may also contribute

Substance misuse can consume a great deal of time, money and emotional energy, which  may impact on the capacity to parent a child. This behaviour may also put a 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.

Parents and carers who have a substance use problem can have chaotic, unpredictable lifestyles and may struggle to recognise and meet their children’s needs. This may result in their children being at risk of harm. Children's physical, emotional, social, intellectual and developmental needs can be adversely affected by their parent's misuse of substances.

Acts of omission or commission, may lead to an impact on the child's well being, welfare and protection.

Early experimentation by children 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 may lead to the child or young person absorbing their parents’ unhealthy coping strategies for stressful situations, addiction being accepted as a normal part of life and potential future intergenerational addiction issues  

All agencies need to work together in  addressing the problems caused by substance misuse in families in order to safeguard children and promote their well-being. 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, from before birth 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 impact on newborn babies who may experience Foetal alcohol syndrome 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 into 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;
• 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 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.

There are many reasons why adults take drugs or drink alcohol, for example, coping with painful feelings, such as anxiety, depression and loneliness, childhood trauma, escaping pain and trauma, neurochemical imbalances, transitions and life changes. Parents may be aware that their behaviour has a negative impact on their child and there is a increased riskof focusing on the adult's difficuties and in supporting their attempts to control any negative behaviour. The impact on the child can be overlooked or seen as a secondary consideration and not as a whole family approach

To be healthy and to develop normally, children must have their basic needs met. If for example a parent is more driven to 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 can be a common, unintentional 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, 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?"

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, must work in collaboration with Children's social care.

Where any agency encounters  someone who is pregnant or the partner of someone who is pregnant and also uses substances, 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.

Pregnant substance misusing women should be identified by maternity services and referred to the Substance Misuse Team. The Care Planning Approach / Care Co-ordination Approach will apply including input from the link midwives and a social worker from Children's social care, who will be invited to any meetings taking place in respect of the child/ren alongside other known professionals.

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

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.

Specialist Substance misuse services 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.

There is a clear need to assess the impact of any addiction issues 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 need to safeguard children must 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, or a child who is living with a parent/carer with substance misuse problems, they must 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.

Parents' own needs will need to be addressed and supported. 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 vital in developing trust between substance misusing 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.

Adfam - support to families affected by drugs and alcohol.

The National Association for Children of Alcoholics

Dual Diagnosis - A Good Practice Handbook

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)

Guidance: Foetal Alcohol Spectrum Disorder: Health Needs Assessment

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

NICE Quality Standard QS 204 Foetal Alcohol Spectrum Disorder