More than 200,00 children affected
Parental Alcohol Misuse (PAM) can negatively affect children’s physical and mental health, and other outcomes including educational attainment and behaviour. Effects can be acute when experienced in conjunction with other adverse experiences such as domestic abuse, marital conflict, and deprivation. PAM is a common feature in child protection and care proceedings, and places a considerable burden on social services.
That’s the summary of a new (9 February 2018) report from the Parliamentary Office of Science and Technology.
The scale of Parental Alcohol Misuse
Parental alcohol misuse (PAM) refers to a spectrum of problem drinking by those with parental responsibility for children.
Estimates of the total number of children affected by PAM vary widely according to sources and definitions used. These figures are likely to be underestimates as they are
taken from survey data and respondents generally underreport alcohol consumption.
Uncertainty about what constitutes ‘problematic drinking’, associated stigma, and fear of having children removed by social services may delay drinkers and their families in seeking help.
In addition, most figures are based on either the number of adults with children who are seeking treatment for alcohol dependence or the number of children known to social services due to problems that may include PAM. There may be more children whose parents are not in treatment or who are not known to social services, and who do not receive support themselves.
Public Health England are producing new estimates of the number of children affected by PAM. This will update statistics from a 2009 report, which were based on 2004 data and is expected in April 2018.
Analysis of data from two large surveys from 2014 estimated between 189,000 and 208,000 children live with an alcohol-dependent adult, of which 14,000 live with two alcohol-dependent adults.
Data from Public Health England and the Office for National Statistics suggest that in 2016, 15,500 children in England lived with an adult receiving treatment for alcohol dependence
Services for children affected by PAM
The services that are available vary throughout the country as each local authority has different needs. A freedom of information request by the All-Party Parliamentary Group (APPG) for the Children of Alcoholics (COA) to local authorities in England found that none of the 138 respondents had a specific strategy to support children affected by PAM.12 Services for children may also be commissioned as part of adult alcohol treatment services.
A report by the charity Adfam suggested that dedicated family services are rare and often provided by grassroots organisations with local expertise and support networks, rather than local authorities. These organisations may not have the capacity to meet modern commissioning requirements and secure funding. Charities providing services for children affected by PAM include the National Association for the Children of Alcoholics (Nacoa), the NSPCC, and Addaction.
Effective interventions
There have been few high-quality evaluations of services specifically targeting children affected by PAM in the UK but research suggests three effective aspects.
1: Protective factors and resilience
Many children experiencing PAM go on to become well-adjusted adults despite stressful childhood experiences. Research has identified a number of protective factors that help children to be resilient and have positive outcomes. These include individual characteristics such as having high self-esteem and being optimistic, as well as other factors, such as maintaining normal routines like family meals.
2: Family-focused services
Family-focused services have been shown to improve outcomes for the alcohol misuser as well as children, and to be cost effective. Data from a cohort study and interviews with children found that services focusing on the whole family, rather than just the child or parent, were effective in achieving long-lasting change.
Research with children themselves has found that children want services that focus on them as individuals, rather than defining them by their parents’ problems. Group support is beneficial in reducing feelings of isolation and blame. Young people appear to favour services that combine space for them to engage in ‘normal’ activities alongside more therapeutic services such as counselling.
Up to half of children cared for by a family member, usually a grandparent (commonly referred to as kinship care), have experienced PAM. This group faces challenges including social isolation and stigma, and may require specialist services. A pilot programme run by Mentor UK in Scotland helped kinship care families to form peer support groups. Initial evaluation has shown that the groups foster family cohesion and self-esteem among children.
3: Parenting skills
Interventions which target both parenting practices and substance misuse aim to improve family functioning and reduce family conflict in order to protect children. There have been few well-evaluated studies in the UK, but initial findings suggest this approach improves family communication, cohesion, and child well-being.
Conclusions
- The majority of evidence on the effects of parental drinking on children focuses on parents drinking at or above harmful or dependent levels. However, it is unclear at what level of drinking parenting capacity is impaired.
- The effects of parental alcohol misuse (PAM) can start before birth and continue into adult life. Heavy drinking during pregnancy may lead to Foetal Alcohol Spectrum Disorder (FASD), an under-diagnosed condition that is associated with behavioural and learning difficulties, and increased risk of mental health issues and involvement in crime.
- Parental alcohol misuse disrupts everyday routines and leads to inconsistent and unpredictable parenting. Children may feel isolated, stigmatised, and guilty, and may have to take on caring responsibilities. Experiencing PAM is associated with a greater risk of mental and physical health problems, including eating disorders and depression. PAM is also associated with neglect and domestic abuse, and child protection cases involving PAM have poorer welfare outcomes for children.
- A number of protective factors, including self-esteem and having a trusted adult role model, help children to be resilient and to have positive outcomes despite experiencing PAM. Family-focused services improve outcomes for alcohol misusers as well as children, and are cost effective.
- The All Party Parliamentary Group for Children of Alcoholics and the Office of the Children’s Commissioner have called for greater awareness around the effects of PAM among practitioners and those working with children. Recommendations include producing a national strategy, increasing the availability of support for families affected, and improving data collection on families accessing support.
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