5.1 Children living in households where there is substance misuse
See the Family Approach Protocol and Toolkit for more information.
- How substance misuse affects children
- A Family Approach
- What action can be taken
- Substance misuse in pregnancy
- Further information
Substance misuse is the problematic use of drugs and/or alcohol.
Substance misuse usually refers to someone who inappropriately uses or is dependent on illicit drugs, alcohol, prescription drugs or solvents; and their use of these is associated with having a harmful effect on the individual, their family or the community. However, professionals should be mindful that a single use of alcohol and/or drugs can have consequences which are equally as devastating as long-term use.
Parents’ dependent alcohol and drug use can negatively impact on children’s physical and emotional wellbeing, their development and their safety. The impacts on children include:
- physical maltreatment and neglect
- poor physical and mental health
- development of health harming behaviours in later life, for example using alcohol and drugs and at an early age, which predicts more entrenched future use
- poor school attendance due to inappropriate caring responsibilities
- low educational attainment
- involvement in anti-social or criminal behaviour
How substance misuse affects children
Parental problem alcohol and drug use affects children and their experiences of family life in a number of ways. And it’s not just parent’s dependent alcohol and drug use which is a problem. Parents who are using alcohol and drugs at higher risk levels can also have an impact on children.
Substance misuse can consume a great deal of time, money and emotional energy, which will 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.
The circumstances surrounding dependent, heavy or chaotic substance misuse may inhibit responsible childcare. For example, substance misuse may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks. Substance misuse may also impact on the ability of a parent or carer to assess and manage risks to their children, including the risk of harm.
The impacts on children can include:
- physical and emotional abuse or neglect as a result of inadequate supervision, poor role models and inappropriate parenting
- behavioural, emotional or cognitive problems and relationship difficulties
- taking on the role of carer for parents and siblings
- preoccupation with, or blaming themselves for, their parents’ substance misuse
- infrequent attendance at school and poor educational attainment
- experiencing poverty and inadequate and unsafe accommodation
- exposure to toxic substances and criminal activities
- separation from parents due to intervention from children’s services, imprisonment or hospitalisation
- increased risk of developing drug or alcohol problems or offending behaviour themselves.
A Family Approach
Research and data show that many families face multiple, entrenched and serious problems that will have a serious impact on the children and adults within the family. Research suggests that a multi-agency, ‘family approach’ can be effective in helping families, even for those who have not benefited from traditional service approaches.
A Family Approach is one that secures better outcomes for children (including unborn babies), adults with care and support needs, children and their families by co-ordinating the support they receive from Adult and Children and Family Services. The support provided by these services should be focused on problems affecting the family as this is the only effective way of working with families experiencing the most significant problems.
See the HIPS Family Approach Protocol.
What action can be taken
A referral to Children's social care in line with the Referrals Procedure should be made if there are concerns about a child living with parents with 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.
Children’s social care should be the main contact point for child safeguarding concerns. All alcohol and drug treatment services should have a documented referral process into social care for where there are safeguarding concerns. All children and young people’s alcohol and drugs services should have a ‘designated practitioner’ or ‘dedicated and named practitioner’.
Substance misuse in pregnancy
Substance misuse in pregnancy can have serious effects on the health and development of the child before and after birth. Not every woman who uses substances will need additional support or a referral to specialist services. Many other factors affect pregnancy outcomes, including poverty, poor housing, poor maternal health and nutrition, domestic abuse and mental health. Assessment must be used to understand the impact of, and risks associated with, parental substance misuse and this must take account of other factors such as these.
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 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.
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.
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. See Sharing information procedure for more information.
- Adfam- support to families affected by drugs and alcohol.
- Nacoa - National Association for Children of Alcoholics
- 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