Substance Misuse within the household
Introduction
The aim of this practice guidance is to assist practitioners in all agencies
to identify situations where children maybe affected by substance misuse
in their household.
Drug/alcohol use on its own will NOT lead to a child being considered at
risk of abuse or neglect. However practitioners should positively
ascertain why they think a parent’s drug/alcohol use is at a “safe” or
“manageable” level and does not constitute a safeguarding children issue.
The long term effect of substance misuse may not be immediately
apparent but the continued emotional or physical unavailability of a parent
through substance misuse can be very detrimental to children and young
people in different ways and at different times.
Children and young people can be best safeguarded by adults’ and
children’s services working together around the needs of the whole
family. By working together and putting the family at the centre of
shared work, we can reduce the risks to all members of the family, whilst
supporting them in making choices and taking control of their lives
individually and as a family.
Information Sharing
At the beginning of all work with a service user / parent information
sharing should be explained. This should include the kinds of situations
where information will be shared, with whom and why. The service user’s
consent to sharing necessary information should be sought at this stage.
This will save time, misunderstanding and potential conflict later.
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Drug and alcohol information
Drug
Slang
names
How is it used?
Effects on the
user
Withdrawal
symptoms
Possible implication for
parenting
Heroin
Gear,
brown, junk,
smack
Can be smoked,
snorted or
injected;
physically
addictive
Drowsiness, poor
cough reflex,
itchiness; pin prick
pupils; sense of
warmth and
detachment
Flu-like symptoms,
dilated pupils, aching
limbs, restlessness,
sweating, anxiety
Cocaine
Charlie,
white, coke
Snorted or
injected
Anxiety irritability and
restlessness, nausea
Crack Cocaine
Rocks, wash,
chips,
stones
Smoked in a pipe,
or injected
Amphetamine
sulphate
Speed, billy,
whiz
Methamphetamine
Crystal
meth, meth,
ice, tina
Snorted, smoked,
swallowed or
injected; can be in
the form of
powder or tablets
Snorted, injected;
smoked (as ice)
Reduced appetite,
indifference to pain
or fatigue; dilated
pupils; garrulous;
feeling alert and
confident
As above, but
effects are more
intense, happen more
quickly and are of
shorted duration
Reduced appetite;
increase in
confidence and
energy; constant
chewing motion
Euphoria and
exhilaration;
disinhibition
Social, legal and financial
difficulties – neglect of
self and others; physical
and emotional
unavailability; drowsiness;
often used alongside a
combination of other drugs
/alcohol
Disinhibition; acute
irritability and
restlessness; repeated
users can appear nervous,
excitable and paranoid
Benzodiazepines
(tranquilisers)
Temazepam,
Rohypol,
Ativan,
Mogadon,
Librium,
Valium
E, doves,
hug drug
Table form of
various strengths;
2mg, 5mg and
10mg
Users feel relaxed,
calm and disinhibited
Tablets of varying
appearances
Weed, blow,
puff, draw,
ganja,
skunk,
wacky backy
Dark brown
resinous lump, or
leaves, stalks and
seed (skunk is a
hybrid cannabis
which is very
strong)
Hallucinogenic
stimulant; increase
in energy and
euphoria
Relaxation and
feeling of
mellowness; users
can become
talkative;
Ecstasy
Cannabis
Not physically addictive
but very rapid
compulsion to repeat the
experience
Extreme fatigue and
hunger (‘borrowed
energy’); tension,
anxiety, depression and
irritability
Rise in body
temperature and blood
pressure; not physically
addictive but users
develop strong
psychological
dependence
Withdrawal must be
done under medical
supervision; can lead to
panic attacks and
seizures; physically
addictive
Tiredness and
depression; risk of
overheating and
dehydration
Tiredness and lack of
energy
Effects as for cocaine;
users have a tendency to
binge and use large
amounts within a short
space of time
Irritability and
restlessness; tiredness and
difficulty in concentrating
after effects have worn
off
Over use can evoke
paranoia, memory loss,
pronounced mood swings
and unpredictable and
aggressive behaviour
Drowsiness and
forgetfulness and
disinhibited: can be
dangerous if taken with
alcohol
(Inappropriate?) feelings
of warmth towards others;
disinhibition
Links between heavy use of
cannabis by parents and
poor speech development
of children
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Possible indicators of children affected by parental
substance misuse
In considering the impact of parental drug and/or alcohol misuse,
practitioners should ask themselves what it would be like to be a child in
this family.
A common theme for children affected by their parents or carer’s drug
and/or alcohol misuse is the child’s commitment to keeping secret the
family dynamic of drug and/or alcohol misuse and their depth of
understanding of these issues.
Parental drug and/or alcohol misuse can have a range of effects, including
neglect of the child’s emotional and physical needs; exposure to criminal
behaviour and the child’s commitment to keeping secret the family
dynamic of drug and/or alcohol misuse. These can include:
 Developmental delay, including foetal alcohol disorders and neonatal
withdrawal syndrome;



Neglect and other forms of abuse; high levels of accidents in the
home, possibly due to poor parental supervision; missed healthrelated appointments
Attachment issues and behavioural difficulties
Being left at home alone or with inappropriate carers;

Emotional difficulties e.g., crying for no apparent reason,
inexplicable feelings of anger;

School problems e.g., poor attendance, non-attendance, levels of
attainment dropping, poor concentration;

Unwillingness to expose family life to outside scrutiny, social
isolation, not taking friends home;

Role reversal and confusion e.g., protecting others, acting as a
mediator and/or confident, taking on an adult role; being a young
carer;

Extreme anxiety and fear, fear of hostility, violence;

Offending behaviour;

Early use of drug and/or alcohol and minimisation of the risks
associated with, or conversely a very strong dislike of drug and/or
alcohol;

Self-harming/suicidal behaviour;

Feelings of gloom, worthlessness, isolation, shame and
hopelessness, poor self-esteem, disempowerment;

Family dislocation e.g., moving schools, relationship conflict,
domestic abuse.
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Issues to assess when considering how substance misuse
in household impacts on children
The short and long term impact on children will depend on a multitude of
factors including their age, level of understanding, personality,
circumstances, coping strategies and degree of external support.
Additionally, children’s responses can alter over time as circumstances
change and children adopt alternative coping strategies.
Practitioners working primarily with children and families must adopt a
proactive approach to routinely enquire about drug and/or alcohol misuse.
Open questions such as “Can you tell me about your use of alcohol and
drugs?” are more likely to prompt discussion than a closed question such
as ‘Do you use illegal drugs’?
Practitioners should be mindful that parents will minimise drug and
alcohol use and its impact on their lifestyle. Judgements should be based
on evidence not optimism and practitioners must be prepared to challenge
an individual’s account of their drug and/or alcohol use as necessary.
They should always try to imagine the impact of parental drug and/or
alcohol misuse from the child’s perspective,
Things to consider from the child’s point of view:
What is day-to-day life like? The good bits? The bad bits? What is it like
to wake up in their house every morning? If they are at home when their
parent is misusing substances what changes do they see in their parents’
character? How do they feel about this? (What does drug or alcohol
misuse mean to them?) What would they like to see change and why? Is
there anyone they like to talk to? Do they like having friends come and
play?
Practitioners must also be mindful of the relationship between drug
and/or alcohol misuse, mental ill-health and domestic abuse.
Some useful questions
A. A measure of the parent’s substance use/misuse. This should
include:

What substances are being used? E.g. heroin, crack cocaine, alcohol,
prescribed medication, combination of drugs, prescribed medication
and alcohol.
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
Is the use considered to be occasional, recreational, bingeing (large
amounts in any one session, especially alcohol use), dependent (daily
use), chaotic (concoction of different drugs being used? Amounts
increasing), prescribed (is it being used as prescribed by doctor?)?

How are the substances being taken? E.g. IV, smoking, oral

Cost? E.g. how much a day/week (compare with amount parent earns)

How funded? E.g. how does the parent explain how they can afford
the substance and day to day living for themselves and their child?

When being used? E.g. time of day (child present, at school, prior to
child returning home)

Where? E.g. In the home or elsewhere

With whom? E.g. if using in the home are other users coming around?
Is partner user or non user?

Lifestyle implications including risks associated with procurement of
substance? (Does the parent recognise risks to child in association
with dealing, prostitution, shoplifting, enforced separation from child
due to arrest?)

The parent’s commitment to change? E.g. Does the parent see their
substance misuse as a problem?
Discover the place of the substance in the life of the parent
B. The effect of the substance use on the user as a parent. (Parenting
Capacity) This needs to take into account:

Their parenting pattern when using, withdrawing or reducing use?

The parent’s perception of how they feel their use/misuse affects their
child (If they are unwilling to accept there is any affect, they need to be
able to say what safe guards are in place i.e. family members on hand to
look after children when parent using, non-using partner/friends,
adequate financial resources to fund use, pattern of use to fit around
child so no use whilst child is in the house).

the parent’s capacity to change (parental insight into their own
use/misuse, evidence of warmth in relationships towards children,
adequate support systems)

Whether there is/was a history of substance misuse within their own
family?
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Parenting capacity
Prompts:

Does the parent’s drug/alcohol use disrupt daily routines? In what way?

Is child left alone while parent procuring drugs/alcohol?

Does the parent use appropriate baby sitters?

Is the child taken to areas of risk? Dealers house, shoplifting,

Is parent allowing home to be used to sell drugs? Is the parent allowing
the home to be used by other users? Does this happen while child is
present?

Is the parent aware of the dangers of the child accessing any illicit
drugs, prescribed medication, alcohol etc? Are they stored safely?

Does the family associate primarily with other users?
C. Effects on the child of the style of parenting outlined above.
This part looks at what the child needs from their parent and measures how
well the child’s basic needs, need for protection, need for stimulation, need
for love and affection and need for control are being met
Prompts:

Is child missing appointments i.e. health / school? Are they arriving late
at school?

Are substances safely stored in the house? (If the bleach isn’t stored
safely what is the likelihood of other substances being safe?)

Where is the child when parent is procuring substances? (school, with
relatives, looked after by other users, taken with parent)

Does the child witness substance taking? (by parents or other users using
house)

Is the child assuming responsibility beyond their years? (looking after
siblings, caring for parents)

Is the child witnessing violence between parents, or between parents and
dealer/other users etc.?
This needs to be considered in conjunction with:
C. Assessment of the level of childcare demand on the parent. The level
of demand will go up and down dependent on the number (more children
greater demand), developmental stages and personalities of children
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concerned (sickness or disability impacts significantly on this demand). This
part also includes a consideration of who is available to share responsibility
for the childcare, including other parents, grandparents, other relatives or
significant family friends. (Are they users or non users?)(Are family
members aware of substance misuse?)
D. Family and Environmental factors

Is the parent spending more on substances than they earn? Is money put
aside to ensure the provision of basic needs?

Is the accommodation adequate?

Who lives in the house (are they users?)

Is the family isolated in the community due to the parent’s substance
misuse?

Are family members in contact with the family? Will parents accept their
support?
E. Analysis.

Is the substance use significantly affecting the parenting capacity? If so
how?

Is the substance use and associated behaviour significantly impacting on
the child’s health and safety, education, emotional and social
development? If so how

What are the resources and strengths in this family? How might they
impact on the care of the child?

What is the parents understanding of and attitude to the need for
change? What change might be acceptable and attainable?
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Risk Factors Associated with Substance Misuse
Research shows that there are some factors associated with a parent’s or
carer’s substance misuse which have the potential to increase the risk to
children living in these households. (Hidden Harm, 2003 and 2007).
Both parents being multiple drug and alcohol misusers, who are
misusing substances together at the same time.
 Parents using illicit drugs or drinking alcohol in addition to their
prescribed medication.
 Drug and alcohol misuse taking place in the home, and the house being
used by other drug and alcohol misusers.
 The family not engaging with services and an emerging pattern of not
attending appointments.
 Parent believing that their drug / alcohol misuse doesn’t affect their
children.
 The absence of extended family support.
 Child care arrangements being ad hoc with children being cared for by
other substance misusers.
 The child being exposed to and being made aware of criminal activity.
 The presence of the child (though not necessarily in the same room)
when substances are being used and the dangers associated with drug
using paraphernalia.
 Domestic abuse and/or mental health issues in the household.
 What does the child do, and who cares for them during school
holidays? Are they additionally at risk, whilst in the care of their
parent / carer for longer periods?
There is a cumulative effect of these risk factors i.e. the more that are
present, the higher the risk of negative outcomes.

Reducing risk
However, all the major risk factors are amenable to intervention, even if
the parental alcohol/drug misuse is not at this time. This means that
practitioners engaged with families where parents have drug and/or
alcohol misuse problems can focus on: Family violence; parental conflict;
parental separation and loss; inconsistent and ambivalent parenting; daily
supervised consumption of prescribed medication and safer storage;
safer drug and alcohol use; parents using separately and not to the point
of intoxication; planning substance misuse around reducing and stopping
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illicit drug use / alcohol misuse; the child’s routine; making safe child care
arrangements.
Strengths / Protective factors
At the same time as recognising the potential risk factors, it is important
to identify what protective factors are present in the home environment
and how to build on these strengths.








Parents’ recognising the possible affect of their substance misuse on their
family life and wanting to make changes
Parents’ engaged with services and complying with treatment
Honesty from both the parent and practitioner and an understanding that
risks that develop will be discussed
Extended family to be fully aware of the substance misuse problem and to
offer support to the children
For the child to develop a close positive bond with at least one adult in a
caring role (including parents, siblings and grandparents) who can provide
them with consistent attention and support and ensure that family activities
are maintained.
The family to nurture a good support network outside of the nuclear family
The family to maintain contact with the universal services that can provide
support.
For the child to be engaged in a wide range of activities, within which they
can recognise that they are separate from their parents’ problems and
therefore develop their own sense of self and self-esteem
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Pathway for referral into Sheffield Substance Misuse
Services for parents disclosing drug and / or alcohol misuse
Has the parent / carer disclosed issues with
drugs and / or alcohol?
No
Continue to monitor in
response to changes in
circumstances
Yes
Is the client pregnant?
Yes
No
Is the parent / carer in
contact with drug /
alcohol services for a
prescription or
counselling?
No
Is the parent / carer
requesting support /
help for their alcohol
use?
No
Is the parent / carer
requesting support /
help for their drug
use?
Yes
Yes
Talk with client’s drug / alcohol service
or allocated drug / alcohol worker.
Ask how they think the drug / alcohol use
impacts on their parenting capacity.
a) For harm reduction advice for alcohol
misuse signpost to SEAP
Tel: 0845 3451549 (clients can also
self refer)
b) For treatment for alcohol misuse refer
to SEAP (Single Entry Assessment
Point) Tel: 0845 3451549 (clients can
also self refer)
Yes
No
If any concerns regarding a child are
identified follow the child protection
procedures.
If a child is identified as having additional
needs, complete a CAF and refer to MAST
If no issues are identified, ensure the parent
is aware of possible impact their substance
misuse may have on their child.
Advice can be sought from Safeguarding
Children Substance Misuse Service. Tel: 0114
2735490
Does the child want support
regarding their parent / carer’s
substance misuse?
Refer to Specialist Midwifery Service
for drugs and alcohol
Tel: (0114 2268000 bleep 903)
Yes
a) For harm reduction advice for drug
use signpost to The Arundel Project
drop–in.
Tel: 0114 2721481
(Clients can also self –refer)
b) If in or at risk of being in the Criminal
Justice System; signpost to
Addaction DIP Tel 0114 2536830
b) For treatment for drug misuse refer to
SPAR (Single Point of Assessment
and Referral)
Tel: 0114 3050500
(referral only from professionals)
WAM (What about me?) project
supports children whose parents
misuse drugs and/or alcohol Tel:
Imogen Powell 0114 2755973
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CONTACT DETAILS FOR SUBSTANCE MISUSE SERVICES IN SHEFFIELD
Addaction Drug Interventions Programme (DIP)
42 Sydney Street, Sheffield S1 4RH Tel: 0114 2536830
Service Provided: The DIP operates within all parts of the Criminal Justice System. (Harm
reduction advice, support and referral for drug treatment)
The Arundel Project, CRI
92a Arundel Street. Sheffield S1 4RE Tel: 0114 2721481
Service provided: Drop in, harm reduction advice, Specialist needle
complementary therapies, and assertive outreach for hard to reach groups.
exchange,
Fitzwilliam Centre (Sheffield Health and Social Care)
Specialist Substance Misuse Service, 143 – 145 Fitzwilliam Street, Sheffield
Tel: 0114 3050500 (drugs) / 0845 3451549 (alcohol)
Service provided: All clients requiring specialist treatment, assessment or support for a drug
problem or alcohol problem need to be referred to Fitzwilliam Centre for an assessment.
Following this assessment, complex cases, including those involving mental health issues
receive their drug/alcohol treatment and key working in Fitzwilliam.
SEAP (alcohol) 08453451549
SPAR (Drugs) 08452450370
Phoenix-Futures Community Services
Storth Oaks / Priory Road, Sheffield, S10 . Tel: 0114 2582310
Service Provided: Phoenix Futures provide a structured counselling outreach service for drug
misuse. (DRR, Families in interim accommodation)
Primary Care Addiction Service Sheffield (PCASS)
Guernsey House, 84 Guernsey Road, Sheffield. S2 4HG Tel: 0114 3054401
Service provided: PCASS provides drug treatment and key-working for clients (GP deputising
service). Includes the specialist substance misuse pregnancy clinic.
Sheffield Alcohol Service Sheffield (SASS)
646 Abbeydale Road, Sheffield, S7 2BB Tel: 0114 2587553
Service Provided. SASS provide information, peer support for people at all stages of recovery
(ARC – alcohol recovery community), training and the Families Together project (working with
families in crisis).
The Corner, CRI (Young people’s drug and alcohol project)
91 Division Street, Sheffield S1 4GE Tel: 0114 2752051
Service Provided: The Corner offers advice, information and support around drugs and
alcohol use for people under 18 years old.
Turning Point Adult Treatment Service
44 Sydney Street, Sheffield S1 4RH Tel: 0114 2755973
Service Provided: TPATS provides psychosocial interventions supporting both drug and
alcohol clients with their recovery. Includes substance misuse pregnancy clinic.
WAM (What About Me?) project Tel: 0114 2755973
Service Provided: WAM provides support for children affected by a parent’s drug and / or
alcohol misuse either one-to-one or group work.
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