Alcohol and Drug problems
Whilst there may be different treatment methodologies for adults with alcohol and drug problems, they are considered together because the consequences for the child are quite similar. Drug problems refers to 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.
Drug and alcohol treatment providers should ask all service users who have a child living with them (or who may live with them in the future) a standard set of questions to ensure an appropriate data set is collected in relation to safeguarding.
This section should be read in conjunction with:
KCS Protocol to Prevent Childhood Exposure to Opioid Substitution Medication to assist professionals to identify which patients are parents or carers, those that have children or children staying with them and the safeguarding arrangements that should be in place when a parent is undertaking Opioid Substitution Treatment;
Harm reduction information to parents
All parents in treatment should receive harm reduction information in relation to their parenting. This should involve a strengths-based discussion as well as written information around a number of risky lifestyle areas, such as the impact of substance misuse on children and the family, protective factors for children, storage of medication, safe storage and disposal of needles, and what to expect from drug and alcohol treatment services working in collaboration with children services.
Although drug and alcohol use in itself does not necessarily affect parenting, the behaviours associated with it may have a detrimental effect on the welfare of children. By reducing the impact of parental substance misuse on children, risks to them can be reduced. Kinship carers (such as an involved grandparent) may be a protective factor, and it is good practice to consider their support needs in any assessment.
If service users do not have children of their own but live with someone else’s children or have contact with, but do not live with, their own children, this information should still be collected in relation to the child(ren) in question and appropriate information and services offered. Whether or not the service user currently has children, they should be asked if they or their partner are pregnant. Women may be unaware of the health risks associated with drinking during pregnancy and this should be discussed along with the possible harmful effects on the foetus. Fetal alcohol spectrum disorders (FASD) is an umbrella term for several diagnoses related to prenatal exposure to alcohol. For substance misusing women in pregnancy and their partners and family alcohol screening in antenatal services maybe considered together with other specialist interventions, such a Bristol Specialist Drugs Project (BSDAS), Specialist Midwives and family nurse partnerships (FNPs).
Pregnancy can provide significant motivation to change, which treatment providers will be in a position to maximise. Early access to antenatal care and joint care planning could reduce the risk to unborn children.
Where there is no current children and families services involvement, treatment provider staff will need to assess the parenting needs of the service user. This is likely to be based on the parent’s view, as the child may not be seen by the drug and alcohol worker. Caution must be taken as there is a tendency for professionals to over-rely on parental information without triangulating against other evidence. As part of the assessment, it is good practice to gather information about other services working with the family and arrange a joint home visit with another professional – a joint approach to visiting is safer for professionals.
There are a number of benefits to this, including:
- a better understanding of the child’s environment;
- the ability to identify and act on high-risk environmental factors, such as fire safety hazards and safer drugs and paraphernalia storage;
- insight into the interaction between parent and child at home;
- the opportunity to identify young carers;
- enabling partner and family members to receive information and support directly, particularly about what to expect from drug and alcohol treatment;
- encouraging the development of a supportive relationship with the family;
- providing an opportunity to listen to and record any comments made by children during the visit
Consideration could also be given to wider factors impacting on the family, for example housing and accommodation, finance, employment, mental health and domestic violence, as there is commonly a relationship between these issues in families with additional support needs.
All drug and alcohol treatment services should ensure that adult assessments consider the need for early intervention and support for parents and children. The majority of substance misusing parents presenting to treatment services are likely to have some form of parenting support needs, so an understanding of the range of services available to this group is essential.
Implication for and effects on Parenting
Excessive drug or alcohol use by parents/carers does not, on its own, automatically mean that children are at risk of abuse or neglect, but children of problematic substance users are a high-risk group. Furthermore, adults who misuse substances may be faced with multiple problems, including homelessness, accommodation or financial difficulties, difficult or damaging relationships, lack of effective social and support systems, issues relating to criminal activities and poor physical/and or mental health.
Parents or carers who experience domestic abuse may use substances as a coping mechanism. Assessment of the impact of these stresses on the child is as important as the substance misuse. It reinforces the need to see substance misuse by parents/carers in the context of family life and functioning and not purely as an indicator or predictor of child abuse and neglect.
The following situations relating to a child or children will need further investigation/referral:
- Abnormal or delusional thinking about a child
- Persistent negative views expressed about a child
- Hostility, irritability and criticism of a child
- Inconsistent and/or inappropriate expectations of a child
- Emotional detachment from child
- Lack of awareness of child’s needs that might require attention e.g. illness
- Keeping a child at home to provide care
- Family income used for drug/alcohol purchase rather than basic essentials
- Child’s safety compromised by drugs, alcohol and paraphernalia not safely stored in the home
- Child exposed to criminal activity connected to substance misuse
- Child exposed to contact with other substance misusing adults who may pose risks either in or outside the home
- Domestic abuse
- Disruption to relationships with the extended family, reducing the protective factor for children
Supporting Parents and Children – Factors to Consider
- Does the parent need childcare support to access treatment?
- What care arrangements need to be in place for the parent to access hospital, a detox/rehab unit or home detox?
- Who is offering the child support?
- Does the adult’s crisis or contingency plan include a plan for care of the child?
- Will the parent need support getting the child to and from nursery/school?
- Is there any liaison with school or early years’ service?
- What is the child’s understanding of the parent’s treatment, does the parent need support in explaining what will happen?
- Consider a referral to the Young Carers’ service for the child carer
- Make a referral to Children’s Services (Social Care) if you consider the child may be at risk of harm.
- Make a referral to Children’s Services (Social Care) if a child is likely to be cared for outside their immediate family for more than 28 days (private fostering).
Practitioners should also be aware that successful treatment of parents, allowing them to resume their caring responsibilities might mean a loss for the child of the role they had previously undertaken or a change in the dynamics of the relationship between the child and parent which may have an adverse effect on the child.
Referrals to children and family services
It is good practice for the service manager and/or safeguarding lead to review information gathered during the assessment and throughout treatment, and monitor the need for onward referral either to universal children and family services or to children’s social care. Substance misuse professionals should be clear about the kind of referral they may need to make, with all staff trained around thresholds.
Issues for a practitioner to consider when assessing parental substance use
Do not ignore substance use
As a matter of routine, all child protection assessments should consider whether substance misuse is a contributory factor. Open questions such as “Can you tell me about your use of alcohol and drugs?” are more likely to prompt discussion than closed questions such as “Do you use illegal drugs?”
Use pre-birth assessments
These can provide a valuable opportunity to engage expectant parents, who are often very highly motivated to make changes in their lives. Exposure to drugs during pregnancy may have had an effect on the child’s health before and after birth. Has the mother attended ante-natal appointments and followed the advice to reduce the potential risk to the baby? Bristol Children and Young People’s Services “Expected Baby Protocol” states: “a pre-birth core assessment should always be carried out where there are significant concerns about drug or alcohol misuse and/or a history of previous child protection concerns”. Foetal alcohol syndrome is a concern where expectant mothers drink.
Remember that substance users want to be good parents
Be aware that their aspirations may be too high: that expectant parents may want the child to compensate for past unhappiness or provide an incentive to remain substance free. They may set themselves unrealistic goals. The process is similar to couples in failing relationships having children in the hope that it will bring them together again. Any expectation that a baby will make things better is flawed; the stress of caring for a baby may increase drug/alcohol consumption. It may lead to attempts to become abstinent too rapidly, with considerable risk of relapse. Detoxification whilst pregnant requires specialist interventions.
Consider the importance of substance use in the parent’s life
If a parent’s primary relationship is with a drug or alcohol, then it will adversely affect their relationship with others including children. If household resources - financial, practical and emotional - are diverted to substance use, there will be deficits for the children.
Ask for details of the drug and alcohol use and their effects
“Drug use” or “Drinking” are not single phenomena but include a wide range of behaviours. The parent, who consistently drives under the influence with their child in the car, may be seen very differently to a parent leaving a ten year old in charge of the home whilst going out to buy drugs. This in turn could be viewed differently to being physically present but incapable through intoxication. There is no easy scale. Specific information about the nature of substances used, and the lifestyle implications of such use, is needed in order to assess the impact on parenting. Note that use of one substance does not preclude others: a range of illicit drugs, prescribed medication and alcohol. Also being in receipt of a prescription (e.g. methadone etc.) does not always lead to stability or exclude use of other substances. Substance users are experts in their own substance use: if in doubt ask them to explain. Risk assessment tools specific to alcohol misuse and drug misuse are provided in the appendices to aid practitioners in determining the impact of a parents drug and/or alcohol use.
Do not assume that abstinence will always improve parenting skills
Substance use may serve a function as an emotional or psychological support. There may be risks of relapse, or parents may struggle to adjust to a substance free lifestyle or relationship. Where applicable, stability in treatment might be a more realistic option.
Find out whether substance use is the “only” parental problem
If so, then prospects for success are higher. Substance users face the same challenges as the rest of the population. Substance misuse makes all other problems worse. Where there are multiple parental problems (e.g. mental health difficulties, domestic violence), then prospects of being able to offer safe and long-term care to children are significantly reduced.
Consider age related risks
A child born to a drug or alcohol dependent mother may need to be followed up to monitor any special health/developmental needs. It is important to consider these needs and the parent’s ability to meet them. Substances and drug-using paraphernalia are a potentially serious hazard to young children. A number of very young children are admitted to hospital and sometimes die each year from ingesting their parent’s methadone, 'Children of substance misusers are in more danger of inadvertently ingesting drugs because these
substances are present in the home; methadone and cocaine are extremely dangerous to children. It is therefore important to establish the following information:
- what substances are being taken?
- are needles used?
- where everything is stored and are they locked away securely?
- are the children aware of where the substances are kept?
At the older end of the age spectrum:
- are any of the child’s siblings using substances? (This may also increase the likelihood that the child will themselves become involved in substance use);
- what is the Child’s role?
- are they being cared for or have they become carers for siblings and/or parents?
- what are their hopes and fears?
- who can they turn to?
- how does the child relate to other children?
- do they have friends outside a drinking/drug using subculture?
Children may be inhibited from developing relationships with other children or embarrassed by their parent’s behaviour. Friendships can provide vital support and a source of sanctuary from problems at home.
Base your judgements on evidence not optimism
If substance use is enduring and chaotic and there is no evidence of improvement, this will undermine other interventions or support offered. It is better to be realistic from the onset. Creating plans and agreements that are unrealistic promotes a sense of failure in the parent and may put the child at risk. Setting new contracts in the hope of improvement is not appropriate.
Be aware of your own views and feelings about substance use
Consider how these might affect your judgements. If you are unfamiliar with drug use and users, it may help to think how you would respond to an alcohol user or a smoker trying to change their behaviour. Assessments must be based on evidence.
Recognise that parents are likely to be anxious
Drug users in particular will worry about losing their children. This “fear factor” is likely to lead to reluctance to seek help or a denial or minimisation of problems. Children may share this fear of being separated from their parents.
Include family members
Include fathers, partners and relevant members of the extended family (for example grandparents). Assessment can sometimes focus on mothers, but others may have an equal impact on the children. Where extended family members are described as significant support by parents ensure that you are aware of what that support is and whether there are any difficulties (e.g. substance misuse, mental health issues etc.) that may affect the support they can provide. Family group conferences may make a real contribution to decision making.
Explore the child’s point of view
What is the reality of home life? i.e. What is a day in the life of the child like? Do the parents thoughts about this match or vary those of the child?).
Bristol Recovery Orientated Alcohol and Drugs Service (ROADS)
This is part of the Bristol wide service to support anyone directly or indirectly affected by the problems associated with drug and alcohol misuse.
Support will include the following:
Extra and more flexible treatment to support people to focus on recovering from their dependency on drugs or alcohol.
- A programme of support to stop people from relapsing including group work and access to an online support programme called Breaking Free Online.
- A range of housing support will be provided for different stages of their recovery.
- Opportunities for people to get work experience, including volunteering opportunities and access to training and education.
- A range of support for families of people with drug and alcohol problems.
- Access to a range of mutual aid options/self-help groups, including SMART and 12 Step Fellowships.
- The service will be committed to meeting the needs of a diverse community.
Email: firstname.lastname@example.org Telephone: 0117 440 0540 (DHI) Open Monday to Friday: 9am to 8pm
There are drop in sessions for service users at the local Community Recovery Hub
Community Recovery Hub times and locations
Drop in Monday to Friday: 1pm to 3pm (closed bank holidays)
- Central: E5, 16-18 King Square, BS2 8AZ
- North: Greenrooms, Greenway Centre, Doncaster Road, Southmead, Bristol, BS10 5PY
- South: @Symes Community Centre, Peterson Avenue, Hartcliffe, Bristol, BS13 0BE
Alternatively, professional looking to support someone to access ROADS services, you can fill in the ROADS Engagement Referral Form (pdf, 104k) (opens new window) and email it to DHI.
If you are a GP, please access the online REMEDY Referral Support Tool for clinical pathways and guidelines.
Email: email@example.com Telephone: 0117 440 0540 (DHI) Open: Monday to Friday: 9am to 8pm Saturday: 9am to 1pm
Bristol Drugs Project (BDP)
For treatment and engagement service.
Call 0117 987 6000 Email firstname.lastname@example.org
Visit http://www.bdp.org.uk Available Monday to Friday 9.00 am to 8.00 pm and Saturday 10.00 am to 5.00 pm. 11 Brunswick Square, BS2 8PE
Addiction Recovery Agency - Kings Court, King Street, Bristol, BS1 4EF
Housing services for people at all stages of recovery.
Call 0117 930 0282
Avon and Wiltshire (NHS) Mental Health Partnership Trust (AWP)
For specialist community and inpatient treatment for drugs and alcohol, including stabilisation and detoxification. Referrals through ROADS Engagement Service. Priority appointments for the most complex clients.
Call 0117 9232077
Email – Visit - http://www.awp.nhs.uk/services/sdas
Detox in a GP Practice
Support in alcohol detox or an opioid substitute prescription and detox. BDP’s Shared Care team work in GP Practices across Bristol.
GP can make a referral or contact ROADS for more information.
Homelessness and Housing
A range of supported housing opportunities are available to match stages in the recovery journey.
Housing support for alcohol and drugs is led by ARA (Addiction Recovery Agency). Professionals can refer via the Housing Support Register.
Email: email@example.com Telephone: 0117 930 0282 (ARA)
St Mungos’s Housing
Housing, Health and skills support across Bristol. Call 0117 9440581 Email firstname.lastname@example.org
Alcoholics Anonymous Call 0845 769 7555 Email email@example.com
Cocaine Anonymous is a fellowship of men and women who share their experience, strength and hope with each other so that they may solve their common problem and help others to recover from their addiction.
Call 0800 612 0225 Email firstname.lastname@example.org
Call 0300 123 6600 Email email@example.com
For people needing support and advice about the nature of drug addiction. Anyone from the using addict, their friends and family members through to drug workers and the press are welcome to call.
Call 08457 90 90 90
Call 0808 800 4444 Email firstname.lastname@example.org.