How well do frontline workers think the sector is responding to parental substance use? Oliver French shares Adfam’s findings.

Since the publication of Hidden harm back in 2003, we’ve seen a great spike in the attention given to parental substance use in official strategies, guidance and protocols. What’s been lacking, however, is information on the views and experiences of the frontline practitioners who deal with these issues day in, day out. Adfam’s report, Parental substance use: through the eyes of the worker, aims to redress this balance. 

A big positive from the research was that practitioners in drug and alcohol services were adamant that the sector has improved in relation to parental substance use, backed up by other recent research like the NTA’s Parents with drug problems: how treatment helps families and Ofsted’s What about the children? 

However, there was a feeling among the treatment staff we interviewed that the issues raised by Hidden harm had been embraced more by the drug and alcohol workforce than by social workers. Some of those working in substance use still felt isolated from their partners in children and family services, and when partnership did flourish it tended to be based on individual professional relationships built up over time through work with mutual clients. Many were worried that, as well as losing experienced staff members, cuts could also mean the loss of the productive partnerships they’d built up. 

A local parental substance use coordinator argued that not looking at parenting meant ‘missing a huge part of the picture’. This doesn’t mean that everyone in the treatment workforce has to become a family expert overnight. As one drug worker told us, ‘looking at the family doesn’t double your workload or mean workers are meant to become “family therapists” – it makes your work more effective.’

Treatment workers need to foster therapeutic relationships that are honest, supportive and challenging, and help parents to understand the impact of their addiction. As the coordinator stated, ‘parental substance users want the best for their children just as much as any parent does, and understanding the impact they’re having can help them make changes that wouldn’t be seen otherwise.’ 

A good relationship with a drug worker can give parents a new perspective on how their behaviour and lifestyle impacts on their children, even if they – as is common – underplay their children’s knowledge of their drug taking. It’s important to look at strengths rather than just risks – ‘treatment workers need to feel comfortable talking about parenting, not just safeguarding.’

We shouldn’t forget that ‘the capacity to be an effective and caring parent’ is named in the drug strategy as a key outcome in a recovery-focused system, but we can’t simply assume that this box is ticked if a parent enters treatment, their drug use declines, or they show progress in other areas of their own recovery. We have to keep a true focus on the welfare of the child, ensure they are listened to, and address their needs – as well as bearing in mind that parenting can improve even if substance-using behaviour does not. 

As the treatment system adapts and changes, there are questions to be asked about the child’s conception of recovery – how do they understand lapse and relapse, for example, and how are they affected by this journey? If their parent is disengaged from treatment – either in a ‘planned exit’ or through dropping out – what does this mean to the child? 

Of course we have to build and celebrate recovery, but this can be a long and difficult process and we have to confront the fact that lasting damage can be done to children’s lives. We need to minimise the impact on children, not only through identifying parenting issues at the first opportunity, but also through providing them with support in their own right.

Treatment agencies also need effective referral chains with local family support services, especially those supporting kinship carers. Grandparents in particular may take care of children when things are at their most chaotic, when the user goes into rehab, or when they need the space to pursue the early stages of their recovery without the pressing responsibilities of childcare.

The practitioners we spoke to were full of praise for low-threshold support services for parents, drugs, including mutual aid groups. The feeling was that such fellowships – operating a little under the radar, without statutory backing – play a key role in parenting, even if they don’t explicitly intend to. 

Mutual aid could be there for parents if they were vulnerable to trigger events, were struggling to readjust to family life, or needed help in maintaining changes. Parents need support on an ongoing basis, not just when things go wrong. As one practitioner said, ‘addiction is like a slippery slope – if the right support isn’t provided on the way up, you can end up right at the bottom again.’ 

The main concern of many of the workers we spoke to, however, was leadership. The plea was: don’t just make parental substance use a ‘tickbox issue’, and don’t skim over it in supervisions. One drug worker put it succinctly: ‘the confidence of the workforce is directly related to the level of support they feel from above’, and it’s up to our managers in treatment, and leaders in the whole sector, to provide this.

Oliver French is policy and communications coordinator at Adfam.

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