Impact of Alcohol Misuse on Parenting Capacity

Introduction:
Alcohol and substance abuse has been found to adversely affect the ability of parents to attend to the emotional, developmental and physical necessities of children. Several governmental and health policies have provisions of services to support parents who engage in substance misuse or neglect children (NHS, 2005). Most research focus on the implications of mothers using drugs and the usual treatment method is counselling or residential programmes. Very few research studies have evaluated the impact of substance misuse on parenting capacity along with other disadvantageous conditions such as poverty and unemployment. For parental support services confidentiality is maintained about the parental condition although children often get to know of their parents’ misuse and may feel a sense of shame at their parents condition and at the same time have a fear of being separated from their parents (Barnard, 1999).

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A recent government framework document has defined parenting capacity as ‘the ability of parents or caregivers to ensure that the child’s developmental needs are being appropriately and adequately responded to, to be able to adapt to the child’s changing needs over time.’ The child’s needs include providing the basic physical needs as well as ‘ensuring the child’s emotional needs are met and giving the child a sense of being specially valued’. According to the Department of Health, ‘Securing the wellbeing of children by protecting them from all forms of harm and ensuring their developmental needs are responded to appropriately are primary aims of Government policy. Local authority social services departments working with other local authority departments and health authorities have a duty to safeguard and promote the welfare of children in their area who are in need and to promote the upbringing of such children, wherever possible by their families, through providing an appropriate range of services’(Department of Health, 2000). Promoting the child’s intellectual development is also an important aspect of parenting as the child can develop only through encouragement and stimulation and through demonstrating and modelling control of inappropriate emotions and showing acceptable social behaviour providing a stable family environment. Thus adequate parenting capacity involves attending to the emotional, intellectual and physical needs of a child and promoting a healthy and supportive family environment (Children Act, 1989)
Substance misuse, as identified by governmental health department covers both drug and alcohol misuse which is considered to have an adverse impact on the health and behaviour of parents and also on the lives and emotions of the children (Sher 1991). Excessive alcohol consumption severely affects the behaviour of the person who engages in drinking although there are differences in social perception of drug and alcohol use. Drug abuse carries with it more social stigma than alcohol misuse and may be consequently concealed from the family.
In this essay we would give a statistical report on the nature and extent of substance misuse especially in Scotland and provide Scottish executive guidelines for child care in cases of parental substance misuse. The impact of parental alcohol misuse has been discussed in detail along with protective measures and social care policies that can provide adequate care to the vulnerable children.
The Problem of Alcohol Misuse
Alcohol misuse however causes substantial deaths, injuries and health problems and rates of drinking are high in the UK, within Wales and Scotland as well (NHS, 2005). In 1996, an estimated 27% male and 14% females drank beyond limits. 6% of men and 2% of women drink at levels which are considered dangerous. The age at which young people begin drinking is also decreasing rapidly (Department of Health, 2000). Alcohol consumption is the major factor in causing injuries and has been associated with most accidents and drowning deaths. Alcohol also causes significant health problems associated with hypertension, haemorrhages, stroke, cardiovascular disease, liver cirrhosis, alcohol dependence as well as social and behavioural problems. Is has been reported that in Accidents and Emergency departments, 80% of people admitted have alcohol related problems (NHS, 2005). Educational messages, informational campaigns and personal behavioural-change interventions are important in raising awareness on the potential dangers of alcohol and the importance of maintaining safe limits in alcohol consumption. Minimal or brief interventions are given at a primary care level and trained nurses provide care and support which are sometimes quite effective in reducing drinking. Family social learning and family social processes are an important influence on adolescent alcohol misuse and more research may be necessary to understand the effectiveness of including family members in group alcohol prevention programmes and the role of parenting skills in prevention of alcohol misuse (Kroll, 2004). The workplace can be another influential factor in reducing or increasing alcohol consumption. Interventions for behavioural modification have to be related to workplace alcohol consumption policy.
The UK home office suggests that Rights and responsibilities in relation to alcohol are important in a Government’s approach to alcohol. Although most people drink responsibly but there is general agreement that the scale of disorder fuelled by alcohol is also quite high. According to the Home Office, in 2002/03, 1.2million violent crimes were alcohol related and 44% of all violent crime was fuelled by alcohol. 35% of all attendances at hospital accident and emergency departments are related to alcohol as are 70% of those which occur between midnight and 5 am (Home Office report, 2005). One in five violent incidents due to over-consumption of alcohol takes place around pubs or clubs. All this involves a high cost with crime and disorder resulting in losses of up to £7.3 billion in a year.
According to the NHS – Alcohol Misuse, Chief Nursing Officer Bulletin, 2005.

more than six million people drink above the Government’s recommended daily alcohol limit of three to four units for men and two to three units for women

• alcohol misuse accounts for up to 150,000 hospital admissions and 22,000 premature deaths each year

• four out of 10 A&E attendances are alcohol-related, rising to seven out of 10 during peak periods – this costs the NHS up to £1.7bn per year

• alcohol misuse is directly associated with issues including relationship breakdowns, domestic violence and aggression, crime, disorder and anti-social behaviour, poor parenting and unsafe or regretted sex.

According to Scottish executive 2001, there may be certain differences between alcohol misuse, alcohol problems and alcoholism. The term ‘alcohol misuse’ might refer to a less serious or frequent problem than alcoholism as it may not refer to any addiction but on having alcohol for the sake of it. Alcohol misuse has been largely associated with over-consumption or binge drinking which may be different from habitual consumption. Social or medical services related to alcohol consumption are perceived as curative rather than preventative and people generally seek help after becoming dependent on alcohol and not prior to this. Alcohol problems are associated with daily life problems that begin to take over a person’s life and begin to affect personal behaviour. Alcohol dependency is sometimes seen as an alcohol problem although alcohol problem is more defined not by the amount of alcohol being consumed but by the impact it has on the lives of people around a person who engages in such habits. However alcohol physical and emotional dependency is related to alcoholism rather than alcohol misuse or alcohol problems and alcoholics are usually the ones who tend to hide their problems and their dependency which is usually marked by physical helplessness. Extreme misuse of alcohol is again seen as alcoholism although some service providers use the term ‘alcoholic’ with some discretion as some patients may be less comfortable with the term which may even be harmful and detrimental to treatment.
Statistics on Alcohol Misuse –
The following interesting statistics have been provided by Scottish Executive Publications on Alcohol Misuse: Source: Scottish Executive Publications – Statistics on Alcohol Misuse.

1. The UK Government revenue from alcohol was almost £11.5 billion in 1999-00. [Brewer’s Society Statistical Handbook 2000 BBPA]. Cited in Scottish Executive 2001

2. In 1998, the UK population spent £29,805 million on buying alcohol. [Brewer’s Society Statistical Handbook 1999 BBPA]. Cited in Scottish Executive

3. Of the cities in Scotland, Edinburgh had the highest rate (53/10,000 population) and Glasgow the lowest (36/10,000 population) in alcohol consumption. Cited in Scottish Executive

4. Individual consumption of alcohol is usually measured in units. A unit of alcohol = 8 gm alcohol = 10ml of 100% alcohol (roughly equivalent to a half pint of beer, a small glass of wine or a single measure of spirits). In 1995 the Department of Health revised the previous sensible drinking limits (of 21 units for men and 14 units for women per week) to daily benchmarks of 3-4 units for men and 2-3 units for women. [Sensible Drinking: The Report of an Inter-Departmental Working Group Department of Health 1995]. Cited in Scottish Executive 2001

5. In 2000, 80% of respondents in Great Britain had heard of measuring alcohol consumption in units. In a more recent survey of people in Scotland, only 36% of men knew the correct recommended daily levels of alcohol for men whereas 51% of women knew the correct daily levels for women. [Scottish Opinion Faulds Alcohol Study 2001 unpublished] Cited in Scottish Executive

6. UK alcohol consumption has remained steady over the past 20 years. UK population consumption rose during the 1960s (4.7 litres per head of total population of 100% alcohol in 1965) and early 70s but has remained relatively constant since then (7.8 litres per capita in 1998), shown in Graph below Cited in Scottish Executive

7. UK average consumption is less than that of France but more than the United States. In 1997 the UK consumed 7.5 litres per head of 100% alcohol , the USA 6.6 and France 11.5. Cited in Scottish Executive 2001

8. 1 in 4 adults in the UK drink hazardously. In a recent survey of Psychiatric Morbidity, over a quarter (26%) of those interviewed reported hazardous drinking patterns. Men were much more likely to report hazardous drinking behaviour than women. For example, 38% of men reported hazardous drinking compared with only 15% of women. [Survey of Psychiatric Morbidity of Adults in Private Households 2000: First Release of Findings ONS 2001] Cited in Scottish Executive

9. The majority of people in Scotland drink alcohol. In Scotland, 93% of men and 87% of women aged 16-74 drink alcohol, with 74% of men and 53% of women having had a drink in the last week. Cited in Scottish Executive,2001

10. Of people aged 16-74, 15% of men drank more than 35 units per week and 6% of women drank more than 21 units per week. [Scottish Health Survey 1998] Cited in Scottish Executive

11. In 2000, there were 1,428 emergency admissions of young people aged 10-19 with a diagnosis of acute intoxication. Admissions were highest (1,036) in the 15-19 year age group (see Graph 4). Cited in Scottish Executive, 2001

12. Alcohol related death rates for women have doubled in the last decade. Death rates have risen from 13.4/100,000 population in 1990 to 31.2/100,000 in 2000, a rise of more than 100%. Although rates for men have increased slightly more than those for women, rates for women have doubled (2.4/100,000 compared with 2.1/100,000). [GRO] Cited in Scottish Executive,2001

13. Men living in the most deprived areas (Deprivation Category 7) are seven times more likely to die an alcohol related death than those in least deprived areas. Cited in Scottish Executive,2001

14. By contrast, people living in more deprived areas were twice as likely to be admitted as a psychiatric inpatient with an alcohol-related diagnosis than those living in least deprived areas. Psychiatric admission rates with an alcohol-related diagnosis were twice as high in Deprivation Category 7 compared with Deprivation Category 1 (151.5/100,000 population compared with 88.7/100,000 population). Cited in Scottish Executive,2001

15. Homeless People – More than half of a sample of homeless people in Greater Glasgow in 1999 were drinking hazardously. This increased with age from 37% of 16-24 year olds to 63% of those aged 55 and over. Men were more likely to report hazardous drinking than women (60% compared with 16%). [Health and Wellbeing of Homeless People in Greater Glasgow ONS 2000] Cited in Scottish Executive,2001

16. 1 in 5 road accident deaths in Scotland is due to drink driving. In 1999 there were 310 road accident fatalities in Scotland. Of these, 60 (19%) were due to drink driving (Table 1).
Cited in Scottish Executive

17. Over the last 10 years, the number of drink drive accidents and casualties has fallen from 1,140 to 750 (accidents) and from 1,600 to 1,110 (casualties) (Table 1). This is against a background rise by almost 30% of the number of registered vehicles (1,657,000 in 1988 to 2,073,000 in 1998). Cited in Scottish Executive,2001

Table 1 Casualties which involved motor vehicle drivers or riders with illegal alcohol levels by severity of accident, Scotland

 

Number of accidents

Number of casualties

Number of fatal casualties

1989

1,190

1,750

80

1990

1,040

1,600

80

1991

990

1,510

80

1992

860

1,230

60

1993

840

1,280

60

1994

790

1,170

80

1995

790

1,210

50

1996

750

1,170

50

1997

790

1,220

40

1998

740

1,090

50

1999

750

1,110

60

*above current drink-drive limit of 80mg alcohol per 100ml of blood
[Road Accidents Scotland 2000 SE 2001]

18. Misuse of alcohol was a contributory factor in over 50% of deaths caused by fire in Scotland. [Fire Safety Scotland Special Guide Scottish Executive 2001]

19. Violent Crime – Of those victims of violent crime who could tell anything about their assailant,72% reported that the assailant was under the influence of alcohol. [Scottish Crime Survey 2000] Cited in Scottish Executive,2001

20. In 1990, alcohol-related deaths accounted for 1 in 100 deaths in Scotland. By 1999, this had risen to one in 40. There were 1,595 alcohol-related deaths in Scotland in 1999, accounting for 2.6% (1,595/60,281) of all deaths in Scotland. This proportion has risen from 1.1% in 1990 (see Graph 7). Cited in Scottish Executive

21. More than two thirds of alcohol-related deaths are of men. 73% of alcohol related deaths were in men. The majority of deaths are in the 45-64 age group. Numbers in older younger men (30-45) have doubled.

22. The majority of alcohol-related deaths have diagnoses of alcoholic liver disease and alcohol dependence. 51% of these deaths had a diagnosis of alcoholic liver disease; 44% alcohol dependence; 13% acute intoxication and 1% alcoholic psychosis. Cited in Scottish Executive

23. 53% of suicides in Scotland who had been in contact with services in the 12 months before death had a history of alcohol misuse. 17% had alcohol dependence. [Department of Health: Safety First: Five Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness 2001]

The severity of the problem of alcohol consumption could be seen from the report presented which indicates that alcohol related deaths, violence, mental illness, emergency admissions and road accidents have all gone up in the last few years with the UK alcohol consumption also showing a steep rise in the late 90s and early 2000. These problems are especially reflected in parental alcohol consumption cases which have severe adverse impacts on children.
Promoting Child Welfare – The Perspective from Scottish Executive
The Scottish Executive documents provide the following vision for the welfare of Scottish children: ‘A Scotland in which every child matters, where every child, regardless of his or her family background, has the best possible start in life’. Two important documents have been released for these purposes. ‘For Scotland’s Children’, which was published in 2001, gave advice on how better to integrate children’s services and the ‘Report of the Child Protection Audit and Review 2002’, aimed to improve services for children who experience abuse or neglect at home or elsewhere.
The Child Protection Review (2002) states:
“The problems of neglect and problem drug or alcohol use are often related, particularly where household finances are spent on drink or drugs, or the behaviour of the parents or their associates impact on the child’s welfare. Some problems are intergenerational, particularly neglect. We have concerns about the future well being of a large number of children who are now being born into drug misusing families, and ensuring their better protection must be a priority.”
Child Protection Committees, Drug/Alcohol Action Teams, and agencies involved in preparing Children’s Service Plans should ensure that all agencies agree on how they will work together to protect children, support families and provide appropriate services (Daniel, 2004). Tackling all kinds of substance misuse is a high priority for the people of Scotland and the Scottish Executive and all methods need to be developed according to Scottish National strategies. One such strategy is – Tackling Drugs in Scotland: Action in Partnership and the Plan for Action on Alcohol Problems.
Scottish Executive Committee recognises that although not every family with substance misuse experience difficulties, parental substance misuse can have significant and damaging consequences for children at home. The Committee proposes that such children are entitled to help, support and protection even within their own families although sometimes help from agencies are necessary for their safety and security. Parents are also required to support their children and help children to overcome their problems by promoting children’s full potential. The national drugs strategy calls for agencies to assess the needs of children who are neglected by parents on drug misuse and help provide services to these children for their safety and welfare. The Scottish executive has provided guidance to all Drug Action Teams and Child Protection Committees and encouraged these organisations to have local policies on support to help children of drug misusing parents. Within the specified Alcohol Plan for action, children of problem drinkers are also identified as a group with specific needs. Drug and Alcohol Action Teams look at the needs of children whose parents misuse alcohol.
The main tenets of the Scottish Executive are given as follows:
1. Children’s welfare is the most important consideration;
2. It is everyone’s responsibility to ensure that children are protected from harm;
3. We should help children early and not wait for crises – or tragedies – to occur; and
4. We must work together, in planning and delivering services, in assessment and care
planning with families, and in multi-disciplinary training.
According to the Scottish executive, as there is currently, no national database of problem alcohol users in Scotland, data on alcohol use come from a number of sources:
• in 2000, 26% of all women and 44% of all men drank more than twice the daily
benchmark on their heaviest drinking day
• the proportion of women aged 16-64 drinking more than the weekly recommended
limits increased from 13% to 15% from 1995 to 1998
• young people, aged 16-24, in Scotland are drinking more; average weekly
consumption in young people aged 16-24 has risen from 1995-1998 for both sexes
• men living in the most deprived areas of Scotland are seven times more likely to die
an alcohol-related death than those in the least deprived areas
• 72% of victims of violent crime reported that their assailant was under the influence
of alcohol
Recent estimates has also suggested that 40,000-60,000 children in Scotland are affected by their parents’ drug use and 80,000-100,000 are affected by parental alcohol misuse.
The following examples give data from two urban areas – Glasgow and Dundee –
I – A local study of children’s cases, in which Glasgow City Council had sought
Child Protection Orders between 1998 and 1999, found that of 111 Orders made on
children in 62 families, 44 (40%) cited drug-related risk. 47 of the children were
named on the local child protection register, 27 because of concerns about neglect
and 16 for physical injury (Quinlan, 2000 cited in Scottish Executive 2002). Source: Scottish Executive
II- In Dundee the proportion of children subject to child protection case conferences
whose parents were recorded as having problems with alcohol and/or drug misuse,
rose from 37% in 1998/1999 to 70% in 2000. Of the 30 children on the child
protection register in October 2000, 53% had parents with problems associated with
drug and/or alcohol misuse. Source: Scottish Executive
The Impact of Parent’s Substance Misuse on Children
According to Mountenay (1998) parental substance misuse is neither a necessary nor a sufficient cause of problems in children. However, alcohol and substance misuse greatly increases the risks of family problems and substance misuse in parents can become a focal issue of life and social behaviour of children at home. Mountenay (1998) has further claimed that long term drug or alcohol misuse in parents lead to deteriorating mental health and permanent mental problems for children. Alcohol dependence causes severe problems in households and the fact that drug use is illegal can cause similar problems among children who perceive the problems of their parents with considerable shame and disgust. The problem of children is however mainly ill-researched and less known and they are seen as hidden tragedies or unseen casualties (Wilson, 1982)
Due to parental substance misuse, children may be at high risks of maltreatment, emotional and physical neglect, family conflict and inappropriate parental behaviour (Barlow, 1996). Children may be exposed to or get associated with drug or alcohol related crimes and as a consequence they are more likely to show behavioural problems and experience social stigma and isolation and may also themselves become substance mis-users as adults. Since parents on drugs and alcohol spend a lot of time on buying, assessing or obtaining these substances, their emotional or social relationships with their children are hampered as they do not have much time or availability for their children. This problem is especially acute in single parent household and in economically deprived areas, especially when there is no support from relatives or family members.
Households in which drug or alcohol abuse is common is characterised by violence, criminal activity and poor or unstable environments. Drug or alcohol dependent parents ultimately make poor relationships and have strained and conflictual relationships with their children. Parents may fail to keep up or perform their parental duties and provide ineffective supervision, inconsistent care or overly punitive or strict discipline which may strain their relations with the children. There may be deficiencies in parenting skills of parents which may in turn have been imbibed from the parents of the drug users who served as poor role models. Barlow (1996) claimed that children of drug using parents may in the long term show serve social and motional difficulties, and may show strong reactions against change, isolation, with difficulty in learning, problems with social humour and estrangement and isolation from family and peers.
However the impact of parental alcohol or drug misuse varies according to the age of children and according to which developmental stage they are in. The impact also depends on abilities of children. Children with physical or learning disabilities or with some health problems may be more vulnerable to emotional difficulties due to their parents’ conditions and parents involved in substance misuse may have difficulties in understanding these especially sensitive children or meeting their needs. Thus assessment of care quality and parental support should always consider each child individually.
Infants in their pre-school years and babies in general are particularly vulnerable to effects of physical and emotional injury and neglect and this can have damaging effects on their long term development and social adjustment. Neglect can happen when the parent in care is in an alcoholic or drugged condition and unaware of the child’s needs or reactions. Parental commitment to care for children is severely affected when in drugged or alcoholic condition and can lead to inappropriate responses to the questions or concerns of the child. The parents in drugged or alcoholic state may be unhappy, tensed or irritated and can even injure or harm the child under the influence of such conditions (Forrester, 2000). Poor and inconsistent parenting damages the attachment process and unpredictable parental behaviour hinders the child’s cognitive and emotional development. Substance misuse is usually an expensive vice and there may be financial demands on the parents which mean money would be wasted and not used appropriately to improve a child’s material environment. Physical or emotional rejection in such household can prevent children from developing a positive sense of self esteem or even a sense of identity and children may have their physical needs neglected and tend to remain unwashed, uncared and unfed (Sher, 1991). Children may be beaten up and be subjected to direct physical violence and by witnessing direct domestic abuse, they may themselves learn inappropriate behaviour which may take the form of post traumatic stress disorder in which they display emotional symptoms if parental behaviour becomes unpredictable and frightening.
Older or primary school children are at increased risks of injury and they may show symptoms of fear of hostility with parents and also anxiety. The gender of the children play an important role and girls may show different reactions to such parental behaviour than boys. Although boys tend to show behavioural problems like aggressiveness, girls can be equally affected. At this stage, poor parental supervision and parental neglect or disinterest can lead to failure in academic attainment and children’s attendance to school can become irregular or erratic. Separation from parents can also cause distress and disrupt social behaviour and academic achievement (Kroll, 2004). Parental behaviour can lead to feelings of embarrassment and shame in these individuals and may be responsible for making children socially isolated for fear of humiliation by friends. Children can also start taking responsibilities for themselves and their younger siblings and may become too independent trying to move away from home and family life. Children and adolescent with drug or alcohol problems at home may not attend school and become delinquent. They may become isolated with no friends, may reject family altogether and experience significant disruption in their education (McKeganey et al, 2002). Without parental support children at adolescence and puberty may have to face increased problems although they may become increasingly beyond parental control. Sexual aggression, bullying tendencies and emotional disturbances may accompany concerns of shame and embarrassment in children to compensate physical neglect by parents. Children with parental substance misuse might develop an early problem of drug and alcohol abuse themselves.
Chandy et al (1993) discuss that children of alcoholics constitute an at-risk population and their study attempted to understand the impact of parental alcohol misuse on school performance of children. They used a sample of 838 teenagers from alcohol misusing parents and found that these teenagers performed significantly poorer in all the six measurements of school performance. The study identified that the teenagers who did perform well in school said that their parents have high expectations of them and these teenagers rated themselves highly in terms of health and also claimed to be religious and thus religiousness and parental expectations could be considered as protective factors as identified in this study.
In another study by CoSandra et al. (2000) the effects of parental alcohol use on African American and White adults were studied. The study results indic