Last week (6 April 2021), the Department of Work and Pensions published new research examining the links between parental conflict and substance misuse and the impacts on children’s outcomes. The report, produced by Cordis Bright, is a literature review organised into three main sections which investigate:
- The impact of parental conflict and substance misuse on children
- Interventions for addressing parental substance misuse and conflict and their relative effectiveness
- What characteristics of effective practice can be identified across interventions?
In addition, the review identifies where gaps exist in the evidence base and where these may need to be supplemented for the UK context.
Understanding the impact
The review finds that there is consistent evidence of an association between substance misuse and parental conflict. Some studies point to this association being causal. Most longitudinal studies support the view that substance misuse increases the incidence of parental conflict though there are other studies that highlight how parental conflict can lead to substance misuse. In all cases there is less evidence regarding the mechanism by which one leads to the other and how it interacts with other stressors. The relationship is likely to be complex.
The nature of the negative outcomes for children in families experiencing both substance misuse and parental conflict appears to be the same as for those in families experiencing either substance misuse or parental conflict alone, i.e. mainly externalising or internalising behaviours. There is, however, consistent evidence that children affected by both parental substance misuse and conflict are more at risk of presenting these behaviours. A number of other stressors (including housing, financial instability, crime, schooling or parental mental health) can act cumulatively to increase a child’s risk of negative outcomes.
The review identified few interventions explicitly aimed at tackling both substance misuse and parental conflict.
There is consistent evidence that behavioural couple’s therapy (BCT) results in a greater and longer-lasting reduction in substance use than individual behavioural therapy, and also improves relationship satisfaction and functioning in intact couples. There is also some evidence that BCT can improve outcomes for the couple’s children.
There is some evidence that the involvement of the whole family in substance misuse treatment can increase treatment engagement rates and lead to greater reductions in substance misuse than treatment delivered to the individual alone. There is more mixed evidence for the effectiveness of whole-family interventions on family functioning and there remains a lack of evidence regarding what form of family involvement is most effective.
The review identified that interventions often helped to develop the following set of skills in parents and children:
- helping parents to take responsibility for their actions and to understand the impact of their actions on their families
- improving communication between a couple and within the family as a whole
- skills training focused on emotional coping strategies, both to manage triggers to substance use and to improve parenting practices and conflict management
The development of these skills was shown by studies to help improve outcomes relating to substance use, parental conflict, parenting practices and child development simultaneously.
Characteristics of effective practice
The research found that successful interventions take many forms, and there are no definitive rules for ‘what works’. However, the review still highlighted a number of considerations and common themes relating to design and delivery which influence the effectiveness of interventions.
Principal themes drawn out in this review were:
intervention timing and sequencing
engagement and retention of participants
socio-demographic characteristics of participants
intensity of intervention
format of intervention
technique or therapy deployed – there is some evidence that motivational interviewing can increase retention in substance misuse treatment when combined with behavioural couples therapy.
Gaps in the evidence
The review encountered the following gaps in the evidence base:
Interventions targeting non-dependent substance misuse.
The impact of various sociodemographic characteristics, including socio-economic status, sexuality and whether a couple is intact or separated/divorced, on access, retention and outcomes for participants in substance misuse interventions.
The authors recommend that future research should attempt to isolate the particular element(s) of an intervention’s format or content which make it successful.