The Scottish Government

« Previous | Contents |

Listen

Introduction

Parental substance misuse can result in a considerable number of negative effects on the family. However, it is incredibly hard to calculate how many children and other family members might be affected. There is also growing evidence that some children appear to be more resilient than others to the negative impact of parental substance misuse. There is a need to investigate how these general statements relate to parental substance misuse across Scotland, a topic that has been given priority status by the Scottish Executive, and other key organisations. There is also a need to ensure that recent national and international literature and policy initiatives inform research, practice and policy across Scotland. Thus, the Scottish Executive (Substance Misuse Research Team) commissioned this scoping review, which was undertaken in 2005.

The key aims of this review were:

• to scope how much literature there is on the topic of parental substance misuse;
• to summarise key themes and gaps arising from the literature;
• to collate knowledge and evidence on effective practice; and
• to identify priorities for future work.

Undertaking the review

The international literature, from 1990 to summer 2005, was comprehensively searched for relevant articles (this included published work and 'grey' literature), with the bulk of the searching focused on major electronic databases. We initially found over 4,000 references, but that was reduced to the current total of approximately 2,600 through screening and removal of duplicates. All references accessed were in the English language. The majority were from the USA and were journal articles. Quantitative work, and basic exploratory work ( i.e. impact on or risks for children), dominated the literature. About 40 references related specifically to Scotland, and these were mainly journal articles and reports, including relevant policy documents.

Given the number of references identified, and that this was a scoping review, as opposed to a full literature review, we further examined the literature on two levels. Firstly, we used a checklist to review and count the references across a wide range of topic areas (corresponding to key objectives of the review). Several thousand references were screened in this way; duplicates and irrelevant references were removed from the database. Secondly, we reviewed key areas (corresponding to key objectives of the review and agreed following discussion with the Advisory Group) in more detail, by looking at approximately 40 selected abstracts for each area (or all abstracts if there was a limited number to choose from) and whole articles, chapters and reports in some cases.

The areas thus reviewed were:

• Prevalence;
• Child Protection / Domestic Violence;
• Resilience;
• Pregnancy / Motherhood;
• Fathers;
• Children's views;
• Mental Health; and
• Interventions / Service provision.

Findings

It is clear that there has been a great deal of research into many aspects of the lives of parents who misuse substances and the impact on their families. The impact of, and risks associated with, parental substance misuse appears to have been well mapped. Accumulation of risk associated with certain factors, such as domestic violence, marital break-up, unemployment, deprivation etc., have been highlighted. Particular risks associated with pregnancy, motherhood and parenting have been emphasised. However, it should be highlighted that, despite the dominant focus on negative impact, there are studies that found no evidence of heightened risk for children stemming from parental substance misuse alone.

Following on from this, a philosophical shift in the literature towards resilience is occurring and this has clear potential when applied to children, and other family members, affected by (parental) substance misuse. This shift allows those delivering services to identify and promote resilience factors and processes in families affected by substance misuse. There is growing evidence that a range of services and interventions for children and families is developing, but there is a need for continued expansion of such responses, and for their rigorous evaluation, with both service development and delivery incorporating the views of, and outcomes for, children.

The key gaps in the literature included the following:

• children's views (particularly in relation to impact, resilience factors, service needs, or views on existing service provision)
• fathers
• siblings
• service needs
• service provision
• mental health
• rurality and
• ethnicity.

These are key areas where future attention should be directed. This work must consider the gender and age of children. It is also clear that it is often the problems that are associated with or arise from (parental) substance misuse that can have a greater negative impact on the family than the misuse per se, and hence there is a need to view parental substance misuse as part of a far wider, multi-dimensional, picture. Finally, clear and methodologically sound attempts to measure and validate the numbers of children and families affected by substance misuse are severely lacking.

There are a number of recommendations about priorities for future work and for effective practice resulting from the findings of this review. Whilst many gaps have been identified in our review, it is to Scotland's credit that Scottish research and literature has often been part of a minority literature to address such gaps. We sincerely hope that further work in Scotland can continue to be innovative in this way, using this scoping review as a step in the right direction.

Recommendations

Identification of priorities for future research in this area:

1. Identify the most appropriate methodologies with which to estimate prevalence, and the definitions with which to work.
2. Estimate the prevalence, nationally and locally, of children (and other family members) affected by parental substance misuse, and of associated costs.
3. Future research, evaluation and service development should include, where possible and appropriate, the views and needs of children, both to map their experiences but also to establish their particular service and support needs.
4. Conduct further research on the experiences and needs of particular groups of children. For example, siblings, those living in rural areas, those from black and minority ethnic groups, those who have a parent who has died or is in prison as a result of substance misuse, those living in care, and children living with domestic violence or parental mental health problems, and children who have been exposed to alcohol or drugs in utero.
5. Conduct further research on the views, needs, roles and responsibilities of others central to parental substance misuse, particularly fathers and grandparents.
6. Ensure that the development and introduction of new services and interventions are properly and fully evaluated.
7. Undertake a review of 'what works' in relation to child protection, especially with overlapping issues of substance misuse, and of domestic violence.

Some of the recommendations could be partially met by further, more focused reviews of the evidence. In other cases, further exploratory or evaluative work is needed on a larger scale.

On effective practice:

Commissioners and providers of services in Scotland should:

8. Increase service delivery to the children and families of those affected by (parental) substance misuse, involving a range of service and intervention options. This includes services and teams that respond to the particular needs of pregnant mothers and their neo-nates, as well as services that more holistically meet the needs of children and families together.
9. Commission service provision that takes account of the broader context of substance use and parenting including involvement of the wider family.
10. Recognise and respond to local need where this differs from national need and national priorities.
11. Ensure that services are provided more holistically, focusing on all aspects of parenting, substance misuse and co-existing issues (such as domestic violence, mental health problems, or women who are pregnant and where children might have been exposed to drugs or alcohol in utero).
12. Reflect the equal importance of promoting resilience and reducing risk in the development of interventions and services for children affected by parental substance misuse.
13. Investigate how addiction services, and child and adult services could best be integrated and encouraged to work together.
14. Organisationally, ensure that joint working protocols, and information sharing procedures, are in place.
15. Ensure that professionals in all services are well supported through managers and supervisors who have been trained in working with substance users and their families.
16. Improve qualifying and post qualifying social work training to ensure that it includes training on alcohol and drug use and how this relates to working with children and families. The training of child and family social workers should be a priority; the role of adult social workers was not a focus of this review and would need further investigation.
17. Take steps to develop the means by which data about child-related issues can be collected and collated from clients of services within Scotland whose primary problem is alcohol misuse.
18. Establish a database and directory of services that respond to the needs of children and families.

« Previous | Contents |