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In focus: AOD and the parent-child relationship

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Australians have a longstanding reputation for heavy drinking – and indeed, a recent report found that on average, Australians drink 10.6L of pure alcohol per year, much higher than the 6.4L global average (World Health Organisation, 2018). Other studies paint a similar picture, showing that around 40% of Australians either drank alcohol at harmful levels, smoked daily, or used an illicit drug in a 12-month period (Australian Institute of Health and Welfare, 2017) – and many of these people are parents.

When service providers engage with parents who are struggling with AOD (alcohol and other drugs) issues, the impact of the parent’s substance use on their children can easily be overlooked. But some simple shifts in practice position can help practitioners ‘bring children into the room’ and improve outcomes for the whole family.

It is the essential parent-child emotional connection that is most readily undermined by parental substance use.

The impact of parental AOD problems on children

Parental substance use often coexists with other complex issues, many of them intergenerational, such as mental health problems, experiences of trauma, insecure housing, family and domestic violence (FDV), financial problems, poverty and disadvantage. These issues can lead to social exclusion and isolation for both children and families.

Against this backdrop, when a parent is also affected by AOD issues, it can have a huge impact on their relationships with their children. Some of the associated risks to children can be:

  • trouble with bonding and attachment due to the parent’s reduced emotional availability (Roche et al., 2014)
  • increased exposure to verbal abuse, inappropriate behaviour, and unsupervised or unsafe situations (Laslett et al., 2015)
  • increased stress and chaos in the family home, putting strain on the parent-child relationship and resulting in behavioural, emotional or cognitive problems (Moore, Noble-Carr, & McArthur, 2010)
  • disruptions to family routines, leading to decreases in school attendance and academic achievement (Moore, Noble-Carr, & McArthur, 2010)
  • children taking on a parenting role for their parents and younger siblings (National Society for the Prevention of Cruelty to Children, 2019)
  • children blaming themselves for family dysfunction; and
  • increased risks of parental separation due to hospitalisation or imprisonment (Moore, Noble-Carr, & McArthur, 2010).

While these risk factors are not always a given – many parents develop strategies to minimise risks for their children (Roche et al., 2014), and not all children will be negatively impacted by their parents’ AOD issues (Dawe et al., 2007) – it is the essential parent-child emotional connection that is most readily undermined by parental substance use.

In the following video (1 minute, 33 seconds), Sally Riley, Child and Adolescent Psychotherapist at Catholic Care Family Recovery Program, talks about the impacts of parental AOD issues on children, and children’s responses to losing connection with their parents.

Engaging parents and the PERCS Conversation Guide

It’s clear that parental AOD issues can affect children negatively from conception right through into adulthood. But many practitioners lack confidence in engaging with parents around the impacts of their substance use.

In response to this skills deficit, Emerging Minds has developed the PERCS Conversation Guide – a short, evidence-informed discussion tool created in consultation with practitioners and parents. The guide supports conversations between practitioners and parents around the impacts of parental substance use on their children, encouraging a preventative, collaborative approach to engagement.

The PERCS Conversation Guide invites practitioners to consider and explore five crucial domains in a child’s life:

  • Parent-child relationship
  • Emotions and behaviours
  • Routines
  • Communication and meaning-making
  • Support networks

Within an AOD context, these domains provide a basis for understanding the key areas that influence a child’s social and emotional wellbeing. Having an awareness of these domains can help practitioners reflect on concerns they may have for a child, and enable these concerns to be more readily brought into conversations with parents about their AOD use.

Many practitioners lack confidence in engaging with parents around the impacts of their substance use.

The importance of routines

Of the five PERCS domains, it is perhaps routines that is most likely to be at risk in families where parental AOD problems are disruptive.

Routines are daily living activities that support areas of children’s wellbeing – from shared activities such as reading or helping with household chores, to expected meal and bedtimes. Research into children’s resilience has shown that establishing or maintaining these family rules, routines and rituals provides a sense of stability and predictability that can help children navigate stressful periods (Goodyear, McDonald, von Doussa, Cuff, & Dunlop, 2018).

Substance use can cause parents to become emotionally unavailable, which can significantly affect their ability to maintain family routines, and to support their children to connect with activities both inside and outside the home. Where there is regular, excessive substance use, children’s lives can be thrust into chaos – which in turn can lead to anxiety and hyper-vigilance around their parent’s wellbeing.

When working with parents, practitioners should strive to identify the routines that are important to their children and themselves, and discuss how these routines have been affected by AOD concerns. The next step is to explore what the parent can do to help reconnect their children and family with these routines.

Where there is regular, excessive substance use, children’s lives can be thrust into chaos.

A parent-sensitive position

Informed by the five domains of a child’s experience, the PERCS Conversation Guide also identifies six practice positions to effectively engage parents in conversations about their children’s social and emotional wellbeing. Within an AOD context, one of these key positions is adopting a parent-sensitive approach to engagement.

When constructing a response to address parental AOD issues, practitioners need to be sensitive to a parent’s experiences of being judged, and adopt a non-judgmental, non-stigmatising stance. It’s also important to take time to build rapport with a parent, rather than rushing towards treatment solutions. Conducting these conversations in a patient, honest, respectful and collaborative manner can help to build a platform of trust, and defuse a parent’s feelings of judgement, blame and shame.

In the following video (1 minute, 33 seconds), Suzie Hudson, Clinical Director of the Network of Alcohol and Other Drugs Agencies (NADA), talks about suspending judgement and building trust with parents who are dealing with AOD issues.

Conducting these conversations in a patient, honest, respectful and collaborative manner can help to build a platform of trust, and defuse a parent’s feelings of judgement, blame and shame.

Taking a child-aware approach

Working from a safe, parent-sensitive platform, practitioners are more able to not only engage with the parent’s AOD struggles, but begin to bring their children into the dialogue. Taking a child-aware position within this context, practitioners can help make children visible within the engagement – looking for entry points to bring them into the conversation and shining a light on how the parent’s substance use may be affecting their dependents.

Adopting this child-aware position is an important step towards improving children’s social, emotional and physical outcomes within AOD-affected families – giving children a voice in services, helping to build better parent-child relationships, and empowering parents to look after their children to the best of their abilities.

In the following podcast excerpt (58 seconds), Melissa Shee, Senior Practitioner of New Roads Drug and Alcohol Rehabilitation Service in South Australia, talks about child-aware practice and giving children a voice within AOD engagement.

Identifying strengths and staying hopeful

Another key practice position in engaging with parents with AOD issues is to focus on strengths and hope – identifying, highlighting, encouraging and building upon the parent’s capabilities and positive qualities, rather than their shortfalls and limitations.

Practitioners should demonstrate a belief that a parent wants the best for their child. From this position, practitioners can help to identify the values that underpin a parent’s hopes for their child, and the things that are important to them in their parent-child relationship (Fowler, Reid, Minnis, & Day, 2014; Parenting Research Centre, 2010; Rosengren, 2009; Emerging Minds, 2019; Price-Robertson, Olsen, Francis, Obradovic, & Morgan, 2016).

Parents who use substances are often their own harshest critics, leaving them without hope and unable to see the positives. But empowering parents with the hope that things can improve builds their self-efficacy, and helps them to see opportunities for strengthening the essential emotional connections they have with their children.

In the following video (1 minute, 11 seconds), Phoebe, an Emerging Minds child and family partner, describes how identifying a parent’s strengths and staying hopeful within AOD engagement can be a positive support.

Empowering parents with the hope that things can improve builds their self-efficacy, and helps them to see opportunities for strengthening the essential emotional connections they have with their children.

Resources

Online course: The impact of parental substance use on the child Online course: Parental substance use and child-aware practice Conversation guide: PERCS Conversation Guide Practice paper: Piloting PERCS: An early intervention and prevention strategy for children living with violence and parental substance use Podcast: Substance use and child-aware practice – part 1 Podcast: Substance use and child-aware practice – part 2 Practice paper: Working with mothers affected by substance use: Keeping children in mind Short article: Talking to parents about substance use issues

References

Australian Institute of Health and Welfare. (2017). National Drug Strategy Household Survey 2016: Detailed findings. (Drug Statistics 31 Cat. No. PHE 214). Canberra: AIHW.

Dawe, S., Frye, S., Best, D., Moss, D., Atkinson, J., Evans, C. … Harnett, P. H. (2007). Drug use in the family: Impacts and implications for children. Canberra: Australian National Council on Drugs.

Emerging Minds. (2019). Keeping child mental health in mind: A workforce development framework for supporting infants, children and parents. Adelaide: Emerging Minds.

Fowler, C., Reid, S., Minnis, J., & Day, C. (2014). Experiences of mothers with substance dependence: Informing the development of parenting support. Journal of Clinical Nursing, 23(19–20), 2835–2843.

Goodyear, M., McDonald, M., von Doussa, H., Cuff, R., & Dunlop, B. (2018). Meeting the intergenerational needs of families where a parent has a mental illness. Journal of Parent and Family Mental Health, 3(2).

Laslett, A. M., Mugavin, J., Jiang, H., Manton, E., Callinan, S., MacLean, S., & Room, R. (2015). The hidden harm: Alcohol’s impact on children and families. Canberra: Foundation for Alcohol Research and Education.

Moore, T., Noble-Carr, D., & McArthur, M. (2010). Who cares? Young people with parents who use alcohol or other drugs talk about their experiences with services. Family Matters, 85, 18–27.

National Society for the Prevention of Cruelty to Children. (2019). Parental substance misuse: How to support children living with parents who misuse alcohol and drugs. London: NSPCC.

Parenting Research Centre. (2010). Smalltalk manual. Melbourne: PRC.

Price-Robertson, R., Olsen, G., Francis, H., Obradovic, A., & Morgan, B. (2016). Supporting recovery in families affected by parental mental illness. Melbourne: Australian Institute of Family Studies.

Roche, A., Trifonoff, A., White, M., Evans, K., Battams, S., Adams, V., & Scarfe, A. (2014). From policy to implementation: Child and family sensitive practice in the alcohol and other drugs sector. Canberra: Australian National Council on Drugs.

Rosengren, D. B. (2009). Building motivational interviewing skills: A practitioner workbook. New York: Guilford Press.

World Health Organisation. (2018). Global status report on alcohol and health. Geneva: WHO.

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