Substance misuse

A number of recent serious case reviews have identified parental substance misuse as a cause of a child's death or a factor that played a significant role. Research by the NSPCC into serious case reviews since 2010 identifies that:

The biggest risk posed to children is that parents, when under the influence of drugs or alcohol, are unable to keep their child safe (i.e. overlay and accidents caused through lack of supervision).

NSPCC (2013)

Some key areas of risk are identified as being:

• sudden infant death syndrome associated with co-sleeping
• accidental ingestion of drugs
• accidents (fire, drowning) due to inadequate adult supervision
• parents deliberately giving the children drugs.

What do we need to consider? Assessments must remain child focused, considering what the impact of the parental substance misuse may be on any children living in the home or being cared for by the adult. Some key questions of parents are:

• what substances are they using?
• when do they use (i.e. are there specific times of the day when they use)?
• how do they use (i.e. do they binge once a week or is it a regular event)?
• what is their method of use (e.g. smoking, injecting)?
• where are the drugs and any associated paraphernalia, such as needles, stored?
• where are the children when they are using and who is providing care for them?
• what do they perceive to be the come down time after using, and what is their understanding about their ability to parent effectively during this time?

Rule of optimism The NSPCC research of recent serious case reviews also identified that professionals were too trusting of parent's self reporting, with substance misuse not being seen as excessive or too problematic. It is important to ensure that you maintain a healthy scepticism about what you are being told. as with domestic abuse, the reported levels are likely to be lower than the actual amount used. Research conducted in 2013 into people's self reporting of alcohol use confirms that there is significant under reporting, with the lead research author stating:

Currently we don't know who consumes almost half of all the alcohol sold in England.

When this is coupled with statistics from a 2011 Community Care article that states almost 1,000,000 children in the UK live with drug users, this gives some insight into the scale of the problem that we face when assessing parental substance misuse.We must also remember that current compliance does not necessarily mean that there will be or has been ongoing compliance, and therefore the risks need to be regularly reviewed and the challenge to the substance misusers sustained.

Working with the family The NSPCC make the following recommendations for working with the family:

• Drugs and alcohol in the home must be stored securely at all times, out of the reach of children.
• The risks of children ingesting drugs or alcohol must be explained to all substance misusers, in a way they understand and are able to take on board.
• Children must be unable to get close to potential hazards in the home (eg. ponds or heating appliances).
• The risks of co-sleeping must be explained to all adults who look after the children, in a way that they understand and act upon.
• Professionals working with substance misusing families should check compliance with the issues listed above on every visit/meeting.
They also identify that new and increased risks include:

• new partner (or previous partner coming back)
• involvement of extended family members in family life
• non-family visitors to the home
• missed appointments with any agency
• dropping out of treatment programme
• domestic abuse or mental ill health problems
• criminal activity or anti-social behaviour incidents
• stress (which may impact upon substance misuse habits)
• moving home.

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^{References:NSPCC (2013) - Learning from case reviews involving parental substance misuse}

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