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The aim of this project is to consider literature and research in Northern Ireland, the UK and worldwide surrounding the relationship between alcohol problems and parenting capacity. Alongside this I wish to map existing service provision for children who are parented by a caregiver who has an alcohol problem and draw on recommendations made by the research evidence. I will highlight relevant Policy and Legislation in relation to reducing risk to children via the “Hidden Harm” Government report. The implications of this report will be discussed in relation to service provision and the Northern Ireland response.
“Substance misuse has a clear and direct impact on those connected to the misuse….. the biggest indirect impact is often felt by the children or young people” (HHAP, DHSSPSNI, 2008: 2). Nevertheless Kearney et al (2000) in Hayden (2004) point out that the issue is underestimated and insufficiently recognised in social work caseloads.
Approximately 250,000 – 350,000 UK children have a parent with an alcohol problem (Alcohol Concern, 2000). Parental alcohol misuse is associated with a greater occurrence of emotional and behavioural problems throughout childhood and into adulthood (Kroll and Taylor, 2003). According to evidence from Tunnard (2002) social work caseloads have seen parental alcohol problems feature significantly for some time, with around a quarter to a third of allocated cases being families with parental substance misuse (Forrester and Harwin, 2008). Parental functioning may be affected either whilst the parent is intoxicated, hung over or pre-occupied with sourcing their next drink, making them physically and/or emotionally unavailable to the child (Beckett, 2007). At the acute end of the spectrum, substance misuse is over-represented in cases of severe abuse and child death (Reder and Duncan, 1999, in Forrester & Harwin, 2006).
To analyse the impact parental drinking problems have on children I will explore literature and research from both international and UK perspectives. However it should be noted that methodological weaknesses were evident in some of the studies. For example, there was less focus on women’s drinking patterns and it was difficult to comment on pre-schoolers as children were collectively grouped together. Tunnard (2002) notes how there are more UK studies regarding drug than alcohol problems. Scaife (2008) notes how many studies referred to substance misuse rather than drug or alcohol, making it difficult to separate the two and how research ignored fathers at times, focusing gender specifically on mothers. Many studies were also carried out on small numbers of families who had volunteered to participate, this therefore does not account for involuntary service users or those who have not yet recognised their drinking to be problematic.
A single definition of ‘alcohol problem’ is unclear in many studies making comparison between them problematic. Nevertheless, what is clear from the literature is that parenting coupled with an alcohol problem can result in damaging outcomes for children in terms of emotional development and behaviour (Kroll and Taylor, 2003). “Misuse of alcohol by parents places children at increased risk of serious harm. It does not follow that such harm is inevitable” (Forrester & Harwin, 2008: 1520). What I therefore want to avoid suggesting in this project is that misusing alcohol does not automatically infer poor parenting. To do so would serve to reinforce the oppression faced by those with alcohol problems and further heighten barriers to engagement with addiction services.
Prevalence of the problem
Research by DHSSPS (2008) uncovered that in Northern Ireland 72% of adults drink alcohol, 62% of which drink at least once weekly. 8% of drinkers consume alcohol daily or almost daily, however only 4% identify themselves as ‘heavy drinkers’. Local information is limited but it is estimated that one in eleven children in the UK are living with someone who has an alcohol problem and as the result of parental substance misuse approximately 70% of young people are looked after and 40% are on the child protection register and (HHAP, DHSSPSNI, 2008).
Brisby et al (1997) propose that approximately 35,000 children in Northern Ireland are living with a parent who is a problematic drinker, with 800,000 in Wales and England and 85,000 children in Scotland. Throughout the United Kingdom, alcohol is readily available and is a socially accepted pastime in people’s lives. Alcohol Concern (2009) reports that due to most adult problem drinkers being part of a wider family the likelihood of this negatively impinging on children is excessive as it is estimated that 1.3 million children are affected.
Dore et al (1995) in Hayden (2004) estimate that between fifty to eighty percent of parents known to social services in the USA experience problems with substance misuse. However, it should be noted that differences exist in the treatment of addiction in the UK and USA as the former is focused on Harm reduction social models with the latter being exceptionally disease oriented (Scaife, 2008).
This literature review aims to:
Investigate what bearing a parental drink problem has on children.
Consider the effects on children’s overall development, by studying literature from a sociological and psychological perspective.
Examine literature from Northern Ireland, the UK and international sources to establish the influence a parental drink problem can have on a child’s well being.
Analyse the Government response to families of problematic drinkers by inspecting Northern Ireland and UK policy.
Summarise services provided to meet the needs of problem drinkers, identify gaps in current practice and make evidence based proposals for meeting such need.
Tunnard (2002) establishes that throughout research there is a clear message that parental problematic drinking is capable of resulting in behavioural, developmental and emotional effects on children.
Being placed in an addictions team last year ignited my interest in how alcohol impacts on the entire family and during my final placement learning opportunity in family and child care’s Gateway service I found parental problematic drinking to be commonplace amongst new referrals. This, coupled with previous personal experience provided me with a desire to gain a full understanding of the bearing this has on children. I anticipate that this piece of work will enhance my insight in the area and better prepare me for pursuing a Family and Child Care social work role.
‘Alcohol problem’ in context
Various terms are utilised in relation to the concept ‘alcohol problem’ which causes concern due to the creation of overlap. Tunnard (2002) observes that many studies combine alcohol and drug misuse into the broad term ‘substance misuse’. However what does explain the issue well is Tunnard’s, (2002:8) definition: “consumption of alcoholic drink that warrants attention because it seriously and repeatedly affects the drinker’s behaviour”. Recommended daily quantity guidelines have little bearing as it is not quantity which leads to the repeated affect on behaviour. The American Psychiatric Association utilises the definition of: “the maladaptive pattern of use leading to clinically significant impairment or distress characterised by the display at anytime during a one year period of one or more of a specified set of symptoms” (Tunnard, 2002:8). Laybourn (1996) studied parental drinking patterns and assessed the effects on the children, finding opportunistic drinking and binge drinking to be the most challenging to families; these most affect routines and parental ‘availability’ (Tunnard, 2002).
Cultural & Historical perspectives
Bancroft (2007) argues that to address alcohol problems effectively through practice and policy we first need to consider historical and cultural dynamics.
Alcohol, which was referred to in biblical times and before, has undoubtedly been a feature of society since the beginning of time (Room et al, 2005a). It is evident that all societies make use of intoxicating substances, with alcohol being used as a social activity (SIRC, 2000). Norwegian research by Skog, (2006) points to the fact that alcohol has been a feature in most cultures since time began despite its consumption varying over the years due to periods of prohibition through the 19th and early 20th centuries. Indeed, the cornerstone of civilisation- agriculture was thought to be utilised in order to harvest grain for the production of beer as much as for bread (SIRC, 2000).
The pervasiveness of problematic drinking is not thought to be directly related to consumption. One only has to enter a public house in Northern Ireland on a Friday or Saturday night to observe countless people using alcohol to socialise and drink well above the recommended levels when doing so. The difference being that the majority of these people can control over their intake and can choose to stop in the morning. Marmot (2004) points out that there has been a 50% rise in alcohol consumption over the past 50 years, with approximately 25% of the British population drinking more than recommended levels. It is evident that there has been a rise in the trend to consume alcohol, with problems in connection to drinking including self-harm, suicide, early mortality, homelessness, crime and mental health problems. The National Health Service information centre (2009) reported that the complete household spending on alcohol rose by 86% from 1992 to 2007. Following this period alcohol was 75% more affordable than in the eighties, highlighting the trend of it being increasingly affordable and prevalent.
Heath (1998) purports that in countries similar to Ireland where there is a high incidence of people experiencing social and psychiatric problems the intake of alcohol is relatively low. However when compared to Italy or France where alcohol use alcohol is high, social and psychiatric problems are less prevalent. Heath (1998) also points to cross-cultural research which implies that behaviours demonstrated as a consequence of alcohol consumption are shaped by cultural and social aspects rather than the chemical effects of alcohol (SIRC, 2000). Difficulties problem drinkers encounter are therefore not necessarily as a result of the alcohol they consume, but cultural factors relating to societal norms, beliefs, and attitudes towards drinking. In every culture, whilst drinking rules are set in place by Government they remain surrounded by self-imposed norms and regulations regarding who may drink what, when and how (SIRC, 2000). Furthermore alcohol may be used as a sign of status; consider the idea of vineyards, fine wines and champagne for example. Placing some of the blame for alcohol-related behaviours onto society raises questions about how to tackle the issue effectively. This may mean challenging beliefs about the effects of drinking which would not hold favourably with social work values of respect, empowerment or anti-oppressive practice.
Regardless of the apparent correlation between parental substance misuse and child care anxieties, British research on the issue remains extremely limited (Tunnard 2002). Contrastingly, American research on the same topic has been plentiful and is thought to be explained by the rise in the use of Cocaine in the United States throughout the 80’s. In many states there was a doubling of children being taken into care between ’84 and ’89 as a consequence of parental substance misuse (Freundlich, 2000, in Forrester & Harwin, 2006). However, it is difficult to apply American conclusions to Britain, as families live in different social circumstances and in varying degrees of poverty. As previously alluded to America’s approach to addiction is disease orientated, largely ignoring external causal factors, in contrast to Britain’s social model whereby an individual’s social context is taken into consideration.
Psychological & Sociological viewpoints
Velleman & Templeton (2002) estimate around 8 million families live with the effects of a family drink problem, however Kroll (2004) points out that the needs of children of alcoholics are often invisible. “Alcohol presents two faces to the family. One face that is of a beneficial and healthful beverage that fosters warmth and intimacy. The other face is that of a potentially hazardous potion that jeopardises one’s family through conflict, violence and deprivation” (Leonard & Eiden, 2007: 286).
Moos (2006) purports that strong attachment to a substance misusing parent may increase the possibility of the behaviour being modelled. Kelley et al (2004) studied American college age men and women and found that those who had alcoholic parents were increasingly likely to have an anxious/avoidant or defensive attachment in later life, additionally having an ‘unavailable’ parent was though to create repetition of poor relationships in adulthood.
Bancroft et al (2004) found that children had an awareness of their family’s drinking problem, despite parents believing their children were not aware of their alcohol use. They established that parents felt they were still caring for their children as their material needs such as food and clothing were met, whilst most parents cared about their children they were not caring for them. A Danish study by Christensen (1997) in some ways mirrored Bancroft’s in relation to parents thinking their children did not have knowledge of their problem. The children were aware and at times felt in some way responsible; they were unable to identify a support network for themselves and usually did not ‘tell’ although many wished for a break or some form of respite. Parents went to great lengths to ensure their child’s physical needs were met yet failed to see the emotional neglect caused by their drinking. Moe et al (2007) studied American children aged 7 to 13 who attended a programme for children of problem drinkers. They found that children benefited from knowing the truth about their parent’s problem and addiction in general as this assisted them in feeling less to blame. The young people also related abstinence to being a positive factor in having a good life.
A Scottish study (Laybourn et al, 1996) which looked at the perspectives of 20 children who were parented by a problem drinker further confirmed how aware children are of their parents drinking. Children expressed their general sadness, worry and anxiety about their parent’s alcohol problem and talked of how they witnessed outbursts of drunken violence. “Alcohol is a disinhibitor, which can reduce an individual’s ability to control violent impulses” (Beckett, 2007: 126). Some young people adopted the role of care giver for the parent or for siblings and at times acted as an arbitrator or confidant and they spoke of either being late for school on a regular basis or not attending at all. A number of these children believed they would benefit from meeting other young people in similar circumstances (Laybourn et al, 1996). Velleman (2002) recognises how children may experience psychological and behavioural problems alongside physical effects. Family roles and routines are often disrupted such as school attendance, communication, special occasions and meal times. The young person may become the carer, protector or mediator within the family (Tunnard, 2002) and have difficulties in relation to trust. It is common for children to have to grow up too soon and effectively ‘miss out’ or have unresolved developmental stages due to caring for themselves and siblings whilst parents are unavailable (Kroll & Taylor, 1998).
Lynskey et al (1994) in a New Zealand study found conclusive evidence suggesting adolescents with problem drinking parents were at increased likelihood of experiencing mental health problems such as depression, anxiety, behaviour problems and are at increased risk of going on to misuse substances themselves. The study pointed to over fifty percent of the participants being affected in one or more of these ways. Further New Zealand research by Connolly et al (1993) found that nine year olds whose parents are problem drinkers displayed greater behavioural problems in school in comparison to their peers and 13 these behaviours manifested themselves at home rather than school.
Taylor et al’s (2008) UK study found that issues of guilt and low self-esteem may result in parents feeling undeserving of treatment as they internalise the negative opinions of others. This in turn has potential to create a negative effect on the welfare of their child(ren) as when parents disengage they may be decreasing the help their child receives. Social learning theory proposes how a parent’s problematic drinking may affect their child: “Substance use originates in the substance-specific attitudes and behaviours of the adults and peers who serve as an individual’s role models” Moos (2006:183). In addition, “Parental alcohol use predicts youngster’s beliefs in the positive effects of alcohol, which is associated with earlier initiation of alcohol use and subsequent alcohol misuse” Moos (2006:185).
Vellemen & Orford (1999) point out that the problems children face at home may be as a result of disharmony and family conflict rather than the parental drinking problem per-se. Children can feel responsible for this discord and powerless in avoiding and controlling the situation (Kroll, 2004). As social workers we need to be aware of how issues such as domestic violence and financial problems may be interconnected with an alcohol problem. Between 2004 and 2005 3,442 children called Childline regarding a family alcohol problem (Childline, 2006), 44% of whom primarily cited physical abuse as a result of their parents drinking. Furthermore, children tended to speak about the effect of the alcohol problem such as domestic violence or physical abuse before mentioning alcohol. Childline also reported that many callers were talking about caring for their younger siblings, often missing school to do so. Finances were regularly an issue for these children, particularly as there was not always enough money left over to buy food. They described feelings of confusion, worry and of embarrassment of their parent, evidently focusing on the adult’s feelings rather than their own. Such feelings have the potential to create social isolation for children as they may fear bringing a friend over to play.
“Alcohol misuse may be coterminous with, or mask, other deficits in parenting, or other relationship problems. Unless tackled, relapse is likely, even if the programme is initially successful” (Sheldon & McDonald, 2009: 220). Forrester & Harwin (2006) noted the strong relationship between substance misuse and domestic violence with 64% of adults who experience such abuse having a family member who has a problem with alcohol. Velleman & Orford (1999) established that children living with parental alcohol misuse are likely to find themselves siding with one parent or another by keeping secrets and are five times more likely than their peers to be pulled into parental disagreements.
Although no systematic database exists evidence suggests that children are more likely to live with mothers who have problems drinking. Children reported that the feelings of fear and embarrassment were more evident when the parent was female in comparison to the parent being male (Scaife, 2008). The traditional role of a mother is perceived by society as a nurturing care-giver. As a result many children find it hard to accept the shame and embarrassment of their mother having an alcohol problem and can feel ‘let down’ as a result (Bancroft et al, 2004). In addition, Bancroft’s Scottish study (2004) concludes that children had mixed feelings of pity and anger in relation to their parents. Their voices indicated elements of abuse and neglect, coupled with violence, school disruption, unpredictability, role reversal and parental absence. Many young people were cooking for themselves and caring for siblings on a regular basis. Bancroft et al (2004) found that this group of children found Young Carers Groups a source of support. Taylor et al (2008) also observed children taking on parenting roles in their UK study.
Forrester & Harwin’s (2008) study drew the conclusion that children who were not removed from the family home had poorer outcomes (39%) compared to those who were removed (56%). They also found that girls tended to be more resilient than boys who had a tendency to internalise problems. Children of alcoholics can develop coping strategies and resiliency (Fraser et al, 2008) and go on to look forward to a bright future: “while parental drug/alcohol use can fracture parent-child relationships, the damage need not be permanent if parents can resolve their substance-use problems” (Fraser et al, 2008: 18). Fraser et al found that many children in their UK study saw Social Workers as important people; keeping their word and believing in the children was highly valued. Parents in this study recognised the damage to their children to include withdrawal, poor school attendance, and behavioural problems; they stated how social services need to provide adequate training for staff in recognising the effects of substance misuse. They cited family upbringing, peer influence and/or specific traumas and tragedies in their lives as triggering their drinking problem. A North American study by Tracy & Martin (2007) conclude that children are a motivating factor in parents seeking help, with many being supported by their children aged 6 to 11.
Forrester & Harwin (2008) noted that in studying 100 families, where minor or decreasing levels of alcohol misuse was evident, children remained in the family home and care proceedings began much sooner with drug misuse compared to alcohol misuse. This highlights the somewhat lenient view society and in turn, social services have on alcohol. It is perceived as ‘normal’ to utilise alcohol for social purposes, indeed Room (2005b) argues that alcohol holds a high status, for example in the UK or USA speaking of a champagne reception elicits thoughts of pro-social behaviour.
Policy & Legislation
The Children Act (2004) and The Children (NI) Order (1995) established concepts of ‘Child in Need’ and ‘Significant Harm’, highlighting a Trust’s legal obligation to identify such notions and safeguard a child’s welfare through the provision of services to families. However the pertinent deliberation in all family alcohol misuse cases is not to lose sight of the fact that the welfare of the child is paramount. The UN Convention on the Rights of the Child (1989) ensures that the paramountcy principle is upheld and affords children the opportunity for their voice to be heard. Since the Children Act was implemented the UK has focused social services input on supporting families. The implications of which are apparent in “Supporting the Families” (1998), “Every Child Matters” (DfES, 2003), “Every Child Matters: Next Steps” (DfES, 2004) and “Every Child Matters: Change for Children” (DfES, 2004). These Green papers set out a National framework for meeting the needs of children, supporting families, focusing on prevention and minimising risk. Murray & Shenker (2009) argue that despite these Every Child Matters papers endeavouring to protect and sustain child welfare, policy still fails to acknowledge the distressing influence on family members. In addition, Murray & Shenker further argue that England’s Harm reduction strategy overlooks the need to respond to families affected by problem drinking; instead focusing individually on the drinker.
Although being criticised for over-focusing on dugs rather than alcohol, the Advisory Council on the Misuse of Drugs Hidden Harm report (2003) recognises how “Children deserve to be helped as individuals in their own right” (Hidden Harm, 2003:18). It’s key messages include acknowledging that services need to work together, treating the parent will benefit the child and that substance misuse affects children of all ages. It recommends that decreasing harm should be the objective of policy and practice and that prompt identification of affected children should be a priority. In addition it stresses the importance of multi-agency collaboration and joint training and resources.
Local government have begun to recognise the need to tackle alcohol problems and have generated a Regional action plan: The New Strategic Direction (NSD, 2006-2011) for alcohol and drugs, the overall aim being to reduce drug and alcohol related harm in Northern Ireland. “A particular feature of the New Strategic Direction (NSD) is the identification of two themes. These are: children, young people and families and adults, carers and the general public.” DHSSPS (2006, NSD: 1.6.1). A further important objective is to ensure that adult addiction services work in collaboration with children’s services to provide a shared policy agenda to improve the lives of young people living with substance misusing parents or carers.
The Northern Ireland report- our children and Young people, our shared responsibilities (2006) saw the inspection and consequent reform of child protection services and implementation of Regional Safeguarding boards. Relevant recommendations further highlighted a need for increased inter-agency strategies responding to alcohol and drug misuse and its impact on children. It points to the need for increased inter-agency training and the importance of engaging and consulting with children and families. The 10year Northern Ireland strategy- Our children and Young People, our pledge (2006) identified 6 outcomes expected for all children, including safety and stability which are important factors to be considered when working with young people affected by alcohol in the family.
Service User Perspectives
Throughout the research, there were various harrowing quotes from children demonstrating their feelings towards their parents which go some way in summarising what they are going through.
For example: “My mom always told me, You don’t tell anyone about what goes on at home, if you tell anybody you won’t be living with me anymore … so I never told. My life seems like one big secret. It’s hard to trust people now” (Murray, 1998: 526). A young girl aged 8 goes on to state: “I would love my mum to stop drinking but I know she won’t” (HHAP, DHSSPSNI, 2008: 4)
A mother agrees: “There should be more family type services – addiction affects everyone in the family and this needs addressing” (HHAP, DHSSPSNI 2008: 4)
“I grew up feeling ashamed, frightened, lost, guilty and lonely; feeling unconfident, unsafe, unlistened to, unprotected, unloved, unlovable; feeling there was no-one there, inside or out.” (The words of actress Geraldine James: Guardian extract, McVeigh (2010)
Through my placement in Family and Childcare’s Gateway Service it was evident that alcohol was a feature of many referrals. Two service users I worked with spoke of how they had been affected by a family drinking problem.
Ms A was removed from the care of her parents in her early teens as they both had problems with alcohol, resulting in Ms A experiencing neglect. She told me of how poor her home circumstances were and how, looking back, she could not believe how long social services permitted her and her siblings to live there. Nevertheless she spoke very warmly of her mother and how of much of an effect her death had on her.
Ms M’s husband had a severe alcohol problem and still does; she divorced him when her youngest children were born but recognises the impact his behaviour had on her older children. Ms M experienced domestic violence when he was drunk which was witnessed by the older children. She states how clearly she can see the difference in her older and younger children due to them not having had their father present in their lives. She talked to me about how he would disappear for days, sometimes weeks, leaving her and the children worrying about his whereabouts.
Local and Regional Resources
There are a number of services and resources operating throughout the voluntary and statutory sectors in Northern Ireland and the UK which aim to support problem drinkers and their families. In order to better prepare workers, Eastern Board training “Taking the Lid off” supplies staff with training on examining the effects of addiction on the entire family. Trust Community Addictions Teams also utilise “Taking the Lid off” booklets to assist problem drinking parents in seeing the problem from the perspective of other family members. Service users may be referred to in-patient treatment at Downshire hospital or Carlisle House, for example. Whilst the focus of these resources is on getting specialised help for the parents, as pointed out in the regional HHAP (DHSSPSNI, 2008), assisting them will in turn help the children. AA meetings and Trust addiction team group work programmes afford parents the opportunity to meet with others in the same circumstances and provide a mechanism for working through their issues.
The Dunlewey centre offers some support and counselling for children, alongside working with their parents on the “Key to Change Programme”. A book called ‘Rory’ has been launched by ASCERT, Barnardos, SE Trust and Public Health agencies (BBC News, 2010). This aims to raise awareness of the issues of drinking in the family home and demonstrates to children that it is all right to talk about it. The Barnardos PHAROS service operates in The Eastern Board area, working on supporting and treating families affected by substance misuse, whilst the Dove House Hidden harm project supports children by offering respite and resilience work. The Ego project in the Western Board supports young people at risk of hidden harm via one to one counselling. Within the Eastern board, EDACT operates sub group meetings to allow representatives from voluntary and statutory addiction services to discuss concerning issues and prevent overlap of services. Alateen operates in the UK and Ireland for young people aged 12-17, allowing them to share their familiarity of living with a family member or friend who has an alcohol problem. The regional headquarters is based in Lisburn, with services including a helpline and meetings, sponsored by AA members.
Despite these services showing signs of beginning to understand the needs of children it is evident that the focus remains on the adult receiving help. For the majority of services the parents need to be identified and engage with services themselves in order for the children to avail of any assistance. In addition it was clear whilst talking to Social Workers in Gateway that awareness levels need to be raised regarding the type of services available to children and the importance of recognising the effects on them. Whilst the provision of services is essential, Zohhadi et al (2004) point out a number of potential barriers to family engagement with treatment including a lack of parental recognition of their problem and insufficient knowledge of available services. Social stigma creates an added element of secrecy resulting in families feeling marginalised. Society negatively stigmatises ‘alcoholics’ therefore entering treatment may mean further marginalisation (Room, 2005b). Children risk ‘normalising’ their parent(s) behaviour and as consent is required to work with them parents may not permit this for fear their child disclosing the full extent problem and being removed by social services. Taylor et al (2008) noted difficulties in engaging children if parents do not consent and how engagement can lead to the parent feeling labelled.
Recommendations and Conclusions
It is apparent from the reviewed literature that being parented by a problem drinker has a variety of psycho-social effects on children. A more holistic, systems approach needs to be employed whilst supporting families as other issues tend to take preference ov
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