New ACMD report

1. New ACMD report http://www.drugs.gov.uk/ReportsandPublications/NationalStrategy/1054733801?batch_start=1 http://www.drugs.gov.uk/ReportsandPublications/NationalStrategy

2. Six key messages from the Inquiry • Estimate of between 250,000 and 350,000 children of problem drug users in the UK – about one for every problem drug user. • Parental problem drug use can and does cause serious harm to children at every age from conception to adulthood. • Reducing the harm to children from parental problem drug use should become a main objective of policy and practice. • Effective treatment of the parent can have major benefits for the child. • By working together, services can take many practical steps to protect and improve the health and well-being of affected children. • The number of affected children is only likely to decrease when the number of problem drug users decreases.

3. Child protection and substance use We should particularly be concerned with substance use that is dependant or chaotic. For the practitioner and the client, the ability to distinguish recreational use from problematic misuse is a crucial skill. Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.

4. Links between problematic use and child protection To suggest that all parents who suffer from problem drug use present a danger to their children is misleading. Indeed, much research indicated that in isolation problem drug use of a parent presents little risk of significant harm to children. Cleaver H., Unell, I., and Aldgate, J., (1999) Children’s Needs Parenting Capacity, P.23, London; HMSO.

5. Family alcohol problems • Double the risk of divorce/separation • 40% of domestic violence incidents • 25% of known child abuse cases • 60% of Child Protection Register Robinson (2000)

6. It’s not the drinking, but... • Violence in the home • Marital/relationship conflict • Separation, divorce, loss of parent • Inconsistency and ambivalent parenting • Unpredictability • Drinking/parent centred not child-centred.

7. Effects on Family Life • Inconsistency, changing moods • Role reversal • Communication • Routines and rituals • Social life • Finances.

8. Effects on Family Functioning 1 • Family conflict and disharmony • Cruel, passive or neglectful parental attitude • Inconsistent and unpredictable parenting • Parents do not set clear or safe limits.

9. Effects on Family Functioning 2 • Children take on parental role • Parents are emotionally unavailable and distracted • Outing and social events fraught with uncertainty • Child fears parent might die or otherwise leave them • Deprivation caused by poverty.

10. Effects on Children • Anti-social behaviour - aggressive, delinquency, conduct disorders, hyperactivity • Adolescence – problems associated with using drugs and alcohol • Emotional problems - psycho-social problems, asthma, bedwetting, negative attitudes to self • School environment - academic problems, difficulties learning, loss of confidence, conduct disorders.

11. Problem drinking parents are often: • Unpredictable • Aggressive • Chaotic • Inconsistent • Unreliable.

12. Adverse consequences • Typically multiple and cumulative • Failure to thrive • Blood-borne infections • Incomplete immunisation and inadequate health care • Wide range of emotional, cognitive, behavioural and other psychological problems • Early substance misuse and offending behaviour • Poor educational attainment ACMD (2003)

13. Longer Term Effects • Effects on transition to adulthood • Friendship difficulties • Division between home and peers - home seen as negative • Drinking alcohol/drug-taking at an earlier age • Leaving home early - by comparison with others • Prescribed psycho-active drugs as children and adolescents (27% v 3%) by age 17 • Earlier marriages - seeking social stability.

14. Children of Problem Drinkers • Do not expect adults to provide well for them • Do not anticipate love, warmth or friendship • Are hyper-vigilant towards changing moods • Take too much or too little responsibility • See positive outcomes to problems as exceptions • Do not trust adults to be fair • Find it difficult to relax and enjoy things • Expect and even create conflict in relationships.

15. Protective Factors • A non-drinking parent • Cohesive parental relationship • Cohesive family • Rituals maintained • Influence of important others • Engaged with things outside the home • Deliberate planning.

16. How to Increase Resilience? Help a young person: • See themselves as separate from family problems • Develop belief in own abilities • Understand and express feelings and emotions • Cope with difficulties and problem solve • Engage in activities outside family • Develop their own plans for the future

17. Alcohol, Childcare and Parenting Information from: • Wendy Robinson, NSPCC/ARP Family Alcohol Service • To receive a copy of the NSPCC publication - ‘Alcohol, Childcare and Parenting - A Handbook for Practitioners’ send an A4 SAE with £1.58p in stamps to: Administrator, Family Alcohol Service,  88-91 Troutbeck House,  off Robert Street,  London NW1 4EJ

18. Prevalence of problematic use Research shows that many people experiment with drugs, with most trying them only once in a lifetime. Fewer, but a significant minority, use drugs regularly. Around one-third of people who have ever used drugs become regular drug users, and it has been predicted that roughly ten percent become problem drug users. SCODA. (1997). Drug Using Parents: Policy Guidelines for Interagency Working. p10. London: LGA Publications.

19. Child abuse Child abuse is an interaction that involves the significant mistreatment of the relatively powerless participant (usually the child or young person) by the participant with more power (usually the parent or adult). This interaction will frequently be affected and partly defined by the child’s chronological age, legal status, dependency, and developmental immaturity. The definition of what is child abuse will change over time and is affected by the perspectives and values that are influential in society. Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.

20. Substance misuse Substance misuse is a compulsion or desire to continue taking a drug, or drugs in order to feel good or avoid feeling bad. The compulsion or desire is usually initiated following previously repeated use of the drug and is difficult to control. When the compulsion is to avoid physical discomfort, it is physical dependence; when it is to avoid anxiety or mental distress, or to promote stimulation or pleasure it is known as psychological dependence. SCODA. (1997). Drug Using Parents: Policy Guidelines for Interagency Working. London: LGA Publications.

21. Child protection and substance use We should particularly be concerned with substance use that is dependant or chaotic. For the practitioner and the client, the ability to distinguish recreational use from problematic misuse is a crucial skill. Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.

22. Links between problematic use and child protection To suggest that all parents who suffer from problem drug use present a danger to their children is misleading. Indeed, much research indicated that in isolation problem drug use of a parent presents little risk of significant harm to children. Cleaver H., Unell, I., and Aldgate, J., (1999) Children’s Needs Parenting Capacity, P.23, London; HMSO.

23. Treatment and care for adult substance users Community Based Services might include • Counselling / support • Drop-in support • Needle exchange • Complementary therapies – acupuncture Medical based services might include • Methadone prescriptions • Community detox • Access to inpatient detox

24. Treatment and care for adult substance users Social Services might include • Counselling / support • Access to funding for rehabilitation services Rehabilitation Services • (a) Day centres and (b) residential services The services offered by rehabilitation services vary: • Therapeutic input • Vocational training • Relapse prevention • Support in gaining housing, employment, access to health services, access to children

25. Screening & Assessment Screening • Refers to any process (reactive or proactive) used to identify whether someone is using drugs Assessment • Occurs after drug use has been identified. Its meaning is a process that informs intervention planning by ascertaining the severity and pattern of drug use, and how the drug use affects the young person concerned.

26. The screening and assessment process 1 Screening 2 Parental substance use what substance how much / how obtained / how taken when (pattern of use) who with cost lifestyle implications 3 Effect on parenting capacity history of own parents expectation of self as parent basic care ensuring safety stability 4 Effect on child's needs development basic needs protection self esteem relationships love and affection control child care demands stages of development personality special circumstances availability of other adults Adapted from Murphy and Harbin (2000)

27. Stage 3 Assessing ability to parent • Ensuring safety • Stability • Income

28. Stage 4 - Assessing the needs of the child • Basic Care • Emotional and behavioural development • Stimulation • Family and social relationships

29. why drugs? “That humanity at large will ever be able to dispense with Artificial Paradises seems very unlikely. Most men and women lead lives at the worst so painful, at the best so monotonous, poor and limited, that the urge to escape, the longing to transcend themselves if only for a few moments, is and always has been one of the principal appetites of the soul.” Huxley, A. (1951). The Doors of Perception. London: Penguin.

30. DATs are responsible for: • assessing the need for services to tackle drug use/misuse locally and co-ordinating a response; • providing information about local patterns of drug misuse; • agreeing a local drug misuse strategy and planning/purchasing appropriate services; • setting local targets; • encouraging joint commissioning between member agencies; • developing links with all relevant agencies; • signing off local spending plans; • reporting on progress towards objectives and targets; • allocation of pooled treatment funding.

31. Young Person’s Holistic Needs Assessment Full assessment of substance related needs if required Identifying substance related needs DrugScope / Home Office (2003: 9)

32. Purpose of identifying substance related needs To identify: • the young persons knowledge of drugs, alcohol and solvents • if the young person uses drugs, alcohol or solvents • if the young person misuses drugs, alcohol ir solvents • if the young person is in immediate danger • if substance use is part of complex, or troubling behaviour • unusual behaviour for that age group in relation to their substance use.

33. Assessment Process Flowchart Assessment Process (Including identification of substance related needs No Further Action Review of young person’s needs Advice and Information Immediate Action needed Tier 2 Intervention Referral to tiers 3/4 Other interventions to meet non-substance needs Plan to meet young person’s needs DrugScope / Home Office (2003: 26)

34. Process for identifying young people’s substance related needs e.g. Young: Homeless Looked After Carers Offenders Excluded Step 1 When you should screen for substance use When a young person seeks advice/information about drugs, alcohol or solvents Following identification or suspicion or drug taking When a drug related incident occurs When a vulnerable young person comes into contact with your service Step 2 Confidentiality Practitioners are advised to explain their service’s confidentiality policy. Explain the consequences of identifying substance related needs, including information about what you as a practitioner can provide and information on any agency you refer them to. Step 3 What should the process establish? Knowledge of drugs, alcohol and solvents If they take drugs, alcohol or solvents If they misuse drugs, alcohol or solvents If the young person is in immediate danger If substance use is part of troubling behaviour Unusual behaviour for that age group in relation to their substance use Step 4 Outcomes of identifying substance related needs No further action Provision of drug and alcohol education in a universal setting Targeted information and advice Referral to meet a tier 2 need - ‘counselling’ or a drug related prevention programme Referral to meet a tier 3 need - complex treatment, e.g. prescribing and/or complimentary therapy If there is a child protection concern, refer to social services

35. CAGE Test to screen for potential alcohol problem Have you ever: • Cut back or Changed your drinking pattern? • felt Annoyed of people criticised your drinking? • felt Guilty about drinking? • Needed a drink Early in the day to steady yourself (Eye opener)? 2 out of 4 yes answers is a positive screen Mayfield et al. (1974). The CAGE questionnaire: validation of a new alcoholism screening instrument. American Journal of Psychiatry. 131: 1121 - 1123.