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chapter 4 substance use
The use of tobacco, alcohol and other drugs by parents and children
Awareness has been growing in recent years of the immensely damaging direct and indirect effects of tobacco, alcohol and other psychoactive drugs on very large numbers of children in Scotland. Whilst tobacco use is declining, alcohol consumption has been increasing, particularly among women and young people generally. In the last 30 years, the misuse of a number of other psycho active drugs has become much more widespread. These include cannabis, heroin, cocaine, benzodiazepines, amphetamines and solvents and other volatile substances.
Impact on children
Psychoactive drug use can harm children in a number of different ways. These include: short and long-term effects on development due to maternal use during pregnancy; exposure to second-hand tobacco and other smoke; the consequences for the child's physical, emotional and social development of parental behaviour directly or indirectly influenced by drugs; acute intoxication due to accidental ingestion of drugs; the impact on children of alcohol and other drug use in the wider community; and early tobacco, alcohol and drug use by children themselves.
How many children are involved?
The number of children involved is substantial. Although the proportion has been falling, recent surveys suggest that about 25% of women in Scotland smoke regularly during pregnancy, ranging from 9% of the most affluent to 42% of the least affluent fifth of the population 41. This equates to around 12,500 babies each year. A similar number of women report they drink alcohol during their pregnancy 41. It has been estimated that between 41,000 and 59,000 children have at least one parent who is a problem drug user and around 70,000 with at least one parent who is a problem drinker 42. The most recent survey of 13 and 15 year old children in Scotland found that among 13 year olds, 4% were regular cigarette smokers, 14% had had an alcoholic drink in the last week and 13% had used an illegal drug in the past year ; among 15 year olds, 15% were regular smokers (12% of boys and 18% of girls), 36% had had an alcoholic drink in the past week and 23% had used an illegal drug in the past year (usually cannabis). 43 Regular cigarette smokers were much more likely than non-smokers to have used illegal drugs.
Predisposing factors
Parental psychoactive drug use is much more common among people in more disadvantaged circumstances, but by no means exclusively so 41. Children who start using tobacco, alcohol or other drugs when in their early teens or even younger are more likely than others to have had a disturbed childhood; to live with a single parent or step-parent or parents who themselves use drugs; to be less closely supervised by their parents; and to be involved in truanting or juvenile offending 43. Those who start early are more likely to become involved in multiple drug use and develop drug dependencies which may continue into adulthood, often with serious consequences for their health and well-being. Whilst early drug use occurs across the social spectrum, young people who subsequently develop serious drug problems are much more likely to be from disadvantaged families or live in less affluent areas 44.
"It has been estimated that between 41,000 and 59,000 children have at least one parent who is a problem drug user and around 70,000 with at least one parent who is a problem drinker."
Evidence for harm
There is a growing amount of evidence of the harm to children caused by parental smoking. Smoking during pregnancy can affect the child in a variety of ways 45 (See Box). In addition to the physical effects, a number of studies point to a link between maternal smoking and behavioural problems during childhood and later life 46,47. An important recent study from Denmark found that the more a woman smoked during pregnancy, the lower was her son's IQ at 18, even when the mother's social status and education and other factors were taken into account 48. This suggests that the mental development and life prospects of thousands of children in Scotland are being damaged by maternal smoking during pregnancy.
Health problems of children of smokers
Exposure during pregnancy
Spontaneous abortion
Premature birth
Low birth weight
Still birth
Sudden infant death after birth
Attention deficit disorder and other behavioural disorders after birth
Lower mental ability and academic achievement.
Type 1 diabetes
Exposure during infancy and beyond
Middle ear infections
Lower respiratory tract infections
Asthma and wheezing
Sudden infant death
Heavy drinking during pregnancy can lead to fetal alcohol syndrome - growth retardation, abnormal facial features, intellectual impairment and other abnormalities 49. It is less clear what effect moderate levels of alcohol use during pregnancy may have on the baby but there is sufficient concern for the British Medical Association recently to recommend that women should avoid alcohol altogether 50. Parental problem drinking can cause many difficulties for children, leading for example to violent parental behaviour, financial problems and neglect.
"Parental problem drinking can cause many difficulties for children, leading for example to violent parental behaviour, financial problems and neglect."
Many problem drug users use large quantities of different drugs either simultaneously or consecutively and may also have a poor diet. If pregnancy occurs in these circumstances, it is difficult to determine their combined impact on the fetus but it is unlikely to be anything but harmful 42. Heroin and other opiates, cocaine and benzodiazepines can all cause severe neonatal drug withdrawal symptoms which can take weeks or months to resolve. After birth, the child may be exposed to many sustained or intermittent hazards as a result of parental problem drug use. These include poverty; physical and emotional abuse and neglect; dangerously inadequate supervision; intermittent or permanent separation, inadequate accommodation and frequent changes in residence; toxic substances in the home; interrupted or otherwise unsatisfactory education or socialisation; exposure to criminal adult behaviour and social isolation.
A large proportion of children in Scotland who are in residential care or otherwise looked after are in this position as a result of parental problem drinking or drug use. In 1998/99, parental drug misuse was a major factor in 40% of Child Protection orders in Glasgow and in 2000 parental drug and alcohol misuse was cited in 70% of child protection case conferences in Dundee 51.
"A large proportion of children in Scotland who are in residential care or otherwise looked after are in this position as a result of parental problem drinking or drug use."
Policy and service responses
There is now considerable professional awareness of risks of smoking during pregnancy and in the home 52. Nevertheless, many pregnant women find it difficult to stop smoking and efforts to help them have been disappointing 53. Of crucial importance are measures designed to discourage girls and young women from ever starting to smoke and here there is evidence of recent success. The Scottish schools survey of 2006 found that reported cigarette smoking by 15 year old girls had declined from 24% in 2004 to 18% in 2006 43. On the other hand there is no evidence as yet that the recent increase in alcohol consumption by teenage girls and young women has been reversed. The evidence from other countries suggests that it will require a real increase in the price of alcohol, greater restrictions on its availability, and a real change in our cultural approach to alcohol before consumption will decrease.
In terms of policies, professional awareness and innovative responses, the UK in general, and Scotland in particular, have done much to address the impact of parental drug and alcohol misuse on children 54,55. Within an enlightened and well thought out strategic framework, the NHS, social services and the voluntary sector in Scotland have all contributed to a range of new services and professional training opportunities designed to help this most vulnerable group. Nevertheless, the huge numbers of children involved, the sensitivities around intervening in family life and the limited effectiveness of many interventions mean that services are unable to prevent severe harm to many children. Efforts to discourage women from using tobacco, alcohol and other drugs during pregnancy and the continuing development of services and other measures to minimise the impact of parental drug use on children should thus be given a high priority.
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