This report has focused on the impact of parental substance misuse, specifically alcohol and illicit drug use, in children aged between 2 and 12 years. The report builds on two prior important documents. The first of these is The Role of Families in the Development, Identification, Prevention and Treatment of Illicit Drug Problems (Mitchell et al., 2001) commissioned by the National Health and Medical Research Council. The second key document is Hidden Harm: responding to the needs of children of problem drug users, commissioned by the Advisory Council on the Misuse of Drugs (UK). Hidden Harm arrived at 48 key recommendations, of which 42 were endorsed by a later government response (Great Britain Department for Education and Skills, Government Response to Hidden Harm). The current report begins with a review of the literature on prevalence of substance misuse in families. Additional original analyses were then conducted by the consortium on the National Drug Strategy Household Survey and National Health Survey. Professor Christina Lee, University of Queensland, provided the analysis of the Longitudinal Study on Women’s Health and Dr Tanya Caldwell and Professor Bryan Rodgers, ANU, provided the analyses on the Longitudinal Study of Australian Children. Finally, analyses of specialist population databases were conducted (Life experiences of people serving community corrections orders (Qld); Patterns of amphetamine use: Qld).
It is clear that the use of alcohol and other drugs in households with dependent children is high. The national databases all point to high rates of binge drinking in particular. While rates vary across each of the studies, there is a clear pattern showing that the highest rates of binge drinking amongst those with children are single mothers and the lowest rates are amongst women in couple households. Analyses from the Longitudinal Study on Women’s Health also found high rates of illicit drug use amongst women with children. Evidence for a ‘cumulative parenting disadvantage’ is clear from the specialist data sets. Elevated levels of substance use are linked to other significant lifestyle and functioning deficits including exposure to violence, mental health problems and elevated levels of criminality. These occur in adults living with children and in those with children who are financially dependent upon them. Key points 1. International household surveys and other population estimates suggest that approximately 10 per cent of children live in households where there is parental alcohol abuse or dependence and/or substance dependence. 2. International research indicates that parental substance misuse is a key feature of families identified by child and protective services. Although figures vary considerably, it is notable that most studies suggest that at least half of families identified by child and protective services have a profile that includes parental substance misuse. 3. Based on the number of children aged 12 years or less living in Australia (1 755 343 males and 1 666 031 females in this age group, totalling 3 421 374 children; Australian Bureau of Statistics, 2004), we estimate that 13.2 per cent or 451 621 children are at risk of exposure to binge drinking in the household by at least one adult; 2.3 per cent or 78 691 live in a household containing at least one daily cannabis user. Finally, 0.8 per cent or 27 370 live in a household with an adult who uses methamphetamine at least monthly and reports doing so in their home. Drug use in the family: impacts and implications for children viii While parental substance misuse can affect many aspects of a child’s life, it is gener – ally difficult to disentangle the effects of parental substance use from broader social and economic factors that contribute to and maintain the misuse of either drugs or alcohol. In Chapters 2 and 3, the research literature is reviewed to ascertain the con – tribution of other factors, in addition to parental substance misuse, that influence child outcome. The key points arising from this review are as follows: Key points 4. While there is a good literature doc – umenting the negative impact of parental substance misuse, combined with other life problems, on child out – come, there is no specific comparison between substance classes. For exam – ple, it is not possible to determine whether parental amphetamine abuse poses a greater risk to adverse child outcome compared to a substance such as heroin. Australian research into this area needs to be encouraged. 5. Parental substance misuse might be seen as a possible marker of co-morbid parental psychopathology, which may in itself contribute to greater impairments to child outcomes than substance use alone. To improve child outcomes in substance-abusing families, treatment programs need to attend to the man – agement of parental mental health issues and their corresponding impact on the parenting role. 6. To improve child outcome in substanceabusing families, treatment programs need to attend to the management of parental mental health issues and their corresponding impact on the parenting role. In practice, this might translate into both improved training oppor – tunities for alcohol and other drug (AOD) workers to help better address mental health issues, and improved liaison with mental health services. It appears likely that employing experi – enced mental health workers in AOD services will increase the use of such treatment options within substanceusing families. 7. Treatment services need to help fami – lies with parental substance abuse to better manage the daily stresses associ – ated with socioeconomic disadvantage in order to reduce the impact of this risk factor on child outcomes. Tackling drug use in isolation is unlikely to be effective without addressing the key context issues of unemployment and poor housing that in many cases sus – tain drug lifestyles. 8. Effective interventions for substanceabusing families need to target the parent’s capacity to seek and sustain support systems in their family and social networks. Therapeutic interven – tions that directly address the parent’s access to social services and commu – nity supports can effectively reduce child maltreatment risks and also fos – ter adaptive parenting behaviour. 9. Substance abuse problems and part – ner violence often co-occur for women. Treatment services need to routinely screen for the occurrence of family violence and provide services for these problems. Likewise, services to help address alcohol and other drug prob – lems need to be provided in women’s shelters and ‘safe houses’. Executive summary and conclusions ix 10. Women with substance abuse problems are also at high risk of being assaulted. This in turn increases the risk of subsequent substance dependence and heavy use. These women need to be targeted to receive self-protection or crime protection training in an attempt to break the vicious cycle that links victimisation, post-traumatic stress disorder and substance abuse in women. 11. The inclusion of couples-based interventions that assist parents to manage their anger and levels of verbal/violent behaviours more effectively within drug and alcohol treatment services is recommended. This can improve psychosocial outcomes in children by reducing family hostility, tension and exposure to conflict. 12. A significant protective factor in a child’s life is the experience of a secure relationship with his/her parents through the provision of sensitive and responsive care and appropriate limits. All attempts should be made to enhance this relationship through support of the parent(s) while engaged in treatment. 13. Women drug users who are also mothers typically experience marginalisation and discrimination due to their parenting status. This dynamic needs to be acknowledged. Attention should be directed to the development of realistic methods to appraise and support both the parenting strengths and the difficulties experienced by these women, in particular the internalised view of self as a ‘hopeless’ parent. 14. Many men who have childcare responsibilities are accessing treatment services, yet the experience of substance-misusing fathers has been largely ignored in the research literature and treatment setting. The alcohol and other drug sector has a unique opportunity to work with fathers on parenting issues, particularly as more men than women access treatment services. 15. Grandparents are increasingly taking on full-time caring responsibilities in response to concerns for the welfare of their grandchildren due to their own children’s substance misuse. The support needs of these grandparent carers are many and at present are only erratically addressed. Australian research is urgently needed to determine bestpractice models for supporting grandparent carers. 16. The perspective of the child living in a substance-abusing family is important. Giving children an opportunity to express their views and to help them understand the nature of their parents’ substance misuse needs to be facilitated. This needs to take into consideration a child’s developmental level. 17. To accurately describe how substance misuse affects parenting capacity, further research is required, especially
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