Parental Substance Misuse

92 Pages·2011·2.01 MB·English

Parental Substance Misuse:
Addressing its Impact on Children
A Review of the Literature
Parents misusing drugs and alcohol can jeopardise child and family well-being and can undermine the potential
of families to meet children’s developmental, health and welfare needs. Recognising these challenges, the NACD, HSE
and Alcohol Action Ireland come together in this seminar to consider how policy and services can be more effective in
supporting children in families where there are drug and alcohol problems. The seminar aims to:
October 2011
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Addressing its Impact on Children is available for download on www.nacd.ie
© National Advisory Committee on Drugs.
Parental Substance Misuse:
Addressing its Impact on Children
A Review of the Literature
Dr. Justine Horgan, Senior Researcher,
National Advisory Committee on Drugs
Parents misusing drugs and alcohol can jeopardise child and family well-being and can undermine the potential
of families to meet children’s developmental, health and welfare needs. Recognising these challenges, the NACD, HSE
and Alcohol Action Ireland come together in this seminar to consider how policy and services can be more effective in
supporting children in families where there are drug and alcohol problems. The seminar aims to:

Table of Contents
Foreword by Róisín Shortall, TD and Minister of State at the Department of Health
with special responsibility for Primary Care v
Preface by Dr. Des Corrigan, Chairperson, NACD vi
Author’s Acknowledgements vii
Executive Summary viii
1. Introduction, Objectives And Structure Of The Review 13
Introduction and Objectives 13
Structure of the review 14
2. Parental Drug Misuse: Consequences For Child Development 17
2.1 Consequences Of Prenatal Exposure (Pe) 17
Parents misusing drugs and alcohol can jeopardise child and family well-being and can undermine the potential
of families to meet children’s developmental, health and welfare needs. Recognising these challenges, the NACD, HSE
2.2 The Care-Giving Environment 20
and Alcohol Action Ireland come together in this seminar to consider how policy and services can be more effective in
2.2.1 Substance Misuse and Parenting 21 supporting children in families where there are drug and alcohol problems. The seminar aims to:
2.2.2 Evidence Of Parenting Attitudes and Styles Associated With Parental Substance Misuse 21
2.2.3 High-Risk Circumstances 25
2.2.4 Child Maltreatment, Neglect And Abuse 27
3. Child Outcomes 33
3.1 Psycho-Social Outcomes 33
3.1.1 Interaction Between Parental Substance Misuse and Socio-Economic Environment 34
3.1.2 Positive Adjustment 35
3.2 Substance Use Among Children 38
3.3 Next Generation Parenting 41
A Review of the Literature iii
4. Responding To Children Who Live With Parental Substance Misuse 43
4.1 Introduction 43
4.2 Parental Substance Misuse And Strengthening Families 43
4.2.1 Working With Family Members To Promote Substance Misuser
Entry To And Engagement In Treatment 43
4.2.2 Joint Involvement Of Family Members In Treatment Of Misuser 44
4.3 Responding To The Needs Of Family Members In Their Own Right 45
4.3.1 Studies On In-Home Family Support 47
4.3.2 Studies On Family Skills Training 49
4.4 Joined-Up Services For Young People Whose Parents Misuse Substances 55
4.5 Towards A Child-Centred Perspective 57
Parents misusing drugs and alcohol can jeopardise child and family well-being and can undermine the potential
5. Addressing Gaps In The Response To Parental Substance Misuse 59 of families to meet children’s developmental, health and welfare needs. Recognising these challenges, the NACD, HSE
and Alcohol Action Ireland come together in this seminar to consider how policy and services can be more effective in
5.1 Supporting The Parent And Family 59
supporting children in families where there are drug and alcohol problems. The seminar aims to:
5.1.1 Prenatal and Perinatal Stages And Substance-Use Dependency 59
5.1.2 Treatment Service Providers Supporting The Parent and Family 60
5.1.3 Other Service Providers Collaborating To Support The Parent and Family 62
5.2 Child And Youth Development: A Caring Community 64
5.3 Responding To The Needs Of Children And Adolescents 65
5.4 Future Research Needs 66
6. Overview And Summary Of The Report 69
7. Bibliography 77
iv Parental Substance Misuse: Addressing its Impact on Children
Foreword
I welcome the National Advisory Committee on The impact of the report must be that it reinforces
Drug’s Literature Review Report Parental the need to renew all our efforts to break the cycle
Substance Misuse: Addressing its Impact on of substance misuse in families and across
Children. This review draws from the substantial generations. As Minister of State I am determined
body of literature on the effects of parental to tackle the problems highlighted in this report
substance misuse on children and it serves as a and in doing so to impact significantly on the
reminder of the need to renew our efforts to deal overall issue of substance misuse in our country. Parents misusing drugs and alcohol can jeopardise child and family well-being and can undermine the potential
of families to meet children’s developmental, health and welfare needs. Recognising these challenges, the NACD, HSE
with the issues that arise in this context.
I would like to express my appreciation to all and Alcohol Action Ireland come together in this seminar to consider how policy and services can be more effective in
The information outlined is not surprising but it those involved in compiling this report. These supporting children in families where there are drug and alcohol problems. The seminar aims to:
brings much evidence together in a coherent way include in particular Dr. Justine Horgan, Senior
that informs policy makers and those involved in Researcher in the NACD who carried out the
dealing with the problems that arise in a very literature review, the members of the Research
effective way. The report outlines the impact of Advisory Group for the project and Dr. Des Corrigan
parental substance misuse on children, from the and Joan O’Flynn, Chair and Director of the NACD
unborn, through early years and on to respectively.
adolescents, with differing responses needed
across the age brackets.
Róisín Shortall, T.D.
The report also documents consequences of drug
Minister of State at the Department of Health
use for parenting and overall family life. Many
with special responsibility for Primary Care
issues arise in this regard and these can result in
children being at high risk of encountering
emotional and social problems.
A Review of the Literature v
Preface
Among the tasks assigned by the Government to the n Health promotion and public information
NACD is that of advising it about the consequences messages that target parents and the impact
of problem drug taking in Ireland. As part of that of their drug and alcohol use on their children
remit the NACD has published studies on the effects need to also promote support services and
of the drugs phenomenon on communities, interventions.
Travellers, the homeless and on families.
The report also sets out a range of measures
Parents misusing drugs and alcohol can jeopardise child and family well-being and can undermine the potential
This new report focuses on the needs of children which need to be taken on board in order to
of families to meet children’s developmental, health and welfare needs. Recognising these challenges, the NACD, HSE
whose parents are problematic substance redress the gaps in our knowledge of what is
and Alcohol Action Ireland come together in this seminar to consider how policy and services can be more effective in
misusers. It was prepared at the request of the happening to the children of drug users in Ireland supporting children in families where there are drug and alcohol problems. The seminar aims to:
NACD by our Senior Researcher Dr Justine Horgan at this time, emphasising five essential research
who is to be congratulated on the quality of her activities.
review and analysis of the Irish and international
The NACD endorses the detailed recommendations
literature on what is known about the impact of
contained in the report and commends the
parental use of a range of drugs on their children.
individual actions to those State agencies with
The report looks, not only at the biological impact
responsibilities in the substance misuse and child
of drug use during pregnancy and breast feeding,
welfare arenas.
but even more importantly highlighting the
psychosocial impact on children when their
On behalf of my colleagues on the NACD I would
parents misuse drugs including alcohol.
like to thank Dr. Horgan and all those on the
Research Advisory Group (RAG) who so ably
The report draws attention to gaps in our
assisted her in the work leading up to the report.
knowledge of the true extent and impact of that
drug misuse in Ireland. A number of key messages
I would also like to express my personal
are identified in this study:
appreciation to our former Director Susan Scally
and to her successor Joan O’Flynn and to the
n International evidence underlines that
hardworking staff of the NACD for their inputs into
parental drug and alcohol misuse has negative
the successful production and launch of this
consequences for child development,
landmark report. The NACD also acknowledges the
parenting and family life
on-going support for its work from the Minister of
n Common principles and standards to support State Róisín Shortall and her officials in the Drugs
work with parental substance and alcohol
Policy Unit of the Department of Health.
misusers should underpin services working to
safeguard the development of their children
Dr Des Corrigan FPSI
n The national Children First guidelines should
Chairperson
be used by organizations working regularly
with children who experience parental
substance misuse and with their parents
vi Parental Substance Misuse: Addressing its Impact on Children
Author’s Acknowledgements
This report has been prepared as part of the I would also like to thank members of the NACD
2010/11 Work Programme of the National Prevention Sub-Committee and members of the
Advisory Committee on Drugs. Many people have NACD Committee who provided support and
been involved in the preparation, consultation advice for the research and for this report.
and review of the report. I would particularly like
Other people have generously participated in
to thank the members of the Research Advisory
reading earlier versions of the report. In this
Group for their support and advice throughout the
regard I am very grateful to Brigid Pike, Health
duration of the study.
Research Board and to Aidan McGivern, the Drugs
n Mary Ellen McCann, UCD School of Applied Treatment Centre Board for their time and
Social Science valuable comments on earlier versions of the
report.
n Marion Rackard, HSE Social Inclusion
n Bobby Smyth, HSE Addiction Services I with to express sincere thanks to Dr. Peter
Mühlau, Department of Sociology, Trinity College
n Claire Deane, Barnardos
Dublin for his tireless support in accessing
n Gavin Mulhall, HSE
research literature. I would also like to
n Liam O’Brien, Community Addiction Response acknowledge his helpful input in structuring
Parents misusing drugs and alcohol can jeopardise child and family well-being and can undermine the potential
Programme, Killinarden the report.
of families to meet children’s developmental, health and welfare needs. Recognising these challenges, the NACD, HSE
n Máirín O’Sullivan, Department of Education and Alcohol Action Ireland come together in this seminar to consider how policy and services can be more effective in
Gratitude also to Peigín Doyle who contributed
and Skills supporting children in families where there are drug and alcohol problems. The seminar aims to:
to the finalisation of the report.
n Siobhán Maher, Family Support Network
Finally, I would like to thank Dr. Des Corrigan,
n Martin Keane, Health Research Board
Chairperson NACD, the former NACD Director
n Pauline McKeown, Coolmine Therapeutic Susan Scally, the present NACD Director Joan
Community O’Flynn, Mary Jane Trimble, NACD, Seán
McNamara, NACD and Alan Gaffney (fomerly
n Gabriel Staunton, Office of the Minister
NACD), for their support and assistance in carrying
for Drugs.
out the work and in the production of this report.
Justine Horgan
October 2011
A Review of the Literature vii
Executive Summary
Children depend on their family to meet their The review of the research literature was guided
physical, psychological and social needs and their by two main objectives. First, to identify the needs
economic security and well-being. All of these can of children of substance misusers, the review
be jeopardised by parents misusing substances. should describe the impact that parental
Recognising the problems that parental substance substance misuse has on the lives of children
misuse poses to the functioning of the child’s involved. The second objective is to report the
family, The National Drugs Strategy (Interim) 2009- main findings on the provision of services that
2016 underlines the need to target the child’s respond to the children’s needs. While work to
needs in relation to parental substance misuse. support drug and alcohol-dependent adults is
ongoing, little is known about the extent to which
While not all substance use by parents disrupts
the services involved assess the needs of their
family relationships, it is clear from the
children. The main sources of this information on
international literature that problem substance
these issues hail from the UK and the US.
use undermines the potential of families. For a
substantial minority of the affected children, the The issues covered in this report reflect the remit
effect of their parents’ substance misuse of the NACD. Accordingly the review of the
continues into their adult lives. For some, the literature focused on studies of parents’ use of
impact can be multifaceted and persist not only illegal or illicit substances. Some of these studies Parents misusing drugs and alcohol can jeopardise child and family well-being and can undermine the potential
into adult life but even into the lives of the next included parents in treatment for substance use. of families to meet children’s developmental, health and welfare needs. Recognising these challenges, the NACD, HSE
generation. In recognising this problem, the Others have selected parents according to criteria and Alcohol Action Ireland come together in this seminar to consider how policy and services can be more effective in
National Advisory Committee on Drugs undertook for substance use disorder (e.g. DSM-IV1) or supporting children in families where there are drug and alcohol problems. The seminar aims to:
to develop a review of the main findings reported according to their pattern of use e.g. frequent or
in recent national and international literature. high levels of substance use. For ease of reporting,
the term ‘parental substance misuse’ has been
Over the last two to three decades, a substantial
applied throughout the report. Where single
body of literature on parental substance misuse
studies are discussed in this report and it has been
on children has developed. Several reviews have
feasible to do so, the specific substances involved
been published addressing specific aspects such
are mentioned. It was not the purpose of this
as the consequences for parenting of substance
review to highlight issues that are specific to
misuse (Hogan, 1998), the implications of parental
certain types of substances and consequently this
substance misuse for child outcomes (Tunnard,
is infrequently done in the report.
2002; Barnard and McKeganey, 2004), and others
have addressed responding to parental substance
misuse (e.g. Velleman and Orford, 1999; Velleman Structure of executive summary
and Templeton, 2007; Tunnard, 2002). Despite the
The structure of the report is set out in four parts.
inter-related nature of these issues, there is
The first part relates to the consequences that
currently no up-to-date work published providing
substance misuse has for the care-giving
an overview of the three areas. Considering the
environment. One of the most striking
significant improvements in methodology and
developments in the literature in recent years has
research design that have been made in recent
been the increased prominence of the child
years, as well as the increased prominence of the
developmental framework in the discussion of
child developmental framework in this discussion,
parental substance misuse. This is reflected in the
an up-date synthesis of the research literature is
first part of the review, which begins by discussing
necessary. In order to give the reader the
the implications of drug misuse during pregnancy
opportunity to assess the quality of the research
evidence, this review also reports the key aspects
of study design. 1 Diagnostic and Statistics Manual, 4th edition. Also
known as DSM-IV-TR, a manual published by the
American Psychiatric Association (APA) that includes all
currently recognized mental health disorder.
viii Parental Substance Misuse: Addressing its Impact on Children