Family Alcohol Misuse
Dr Paul Toner
Department of Health Sciences
University of York
Parental Alcohol Misuse
• Parental alcohol misuse is a major societal issue
(Harwin, 2011).
• No accurate prevalence figures in the UK.
• Estimates put this figure at 3.3 to 3.5 million children
living with parents whose alcohol consumption
ranges from increasing risk to dependency (Manning
et al., 2009).
• Parents who misuse alcohol can experience
problems across other areas of their family lives.
Including: external stressors such as housing and
financial strain, mental health problems,
unemployment and lack of social engagement (Kroll,
2004).
• Parental alcohol misuse can also adversely affect
children growing up in this environment, impacting
on attachment (Flores, 2001), family dynamics,
relationships and functioning (Velleman &
Templeton, 2007).
• In the UK newborns and children under three are
known to be at particular risk of neglect and physical
harm (Forrester & Harwin, 2011).
• An additional factor in these children’s vulnerability
lies in the high proportion of women with alcohol
misuse problems who are parenting alone or with
serial partners who also have a substance misuse
problem (Chance & Scannapieco, 2002).
• Parental problem substance use is also one of the
most prominent reasons for children being received
into the care system (Porowski et al., 2004).
• There is also evidence that children with a family
history of problem alcohol use are at increased risk
of developing substance misuse problems
themselves (Osterling & Austin, 2008).
• Given the complexities inherent in families where
there is parental alcohol misuse, it is perhaps
unsurprising that interventions have not been
readily developed and evaluated to address the
needs of this population.
A way forward
• Addiction services and child protection systems have
developed separately, as policy and practice
environments, holding different professional values
and focusing on different issues (Kroll and Taylor,
2003).
• Nonetheless, there is general agreement in the field
that multi-agency, holistic approaches are needed in
terms of meeting the complex and multiple needs of
families with alcohol misusing parents (Barnard,
2007).
• There are a number of holistic services which have
been established in recent years, including the
Family Alcohol Service, Option 2, Families First and
the Family Drug and Alcohol Court.
• The rationale is to provide intensive interventions to
help bridge the gaps between child and adult
services by protecting vulnerable children, while
concurrently improving parenting capacity (Forrester
& Harwin, 2011).
• Evidence of effectiveness is still emerging.
• Research has highlighted the pivotal role that
families play not only as a risk for, but also a
protection against, substance-related problems
(Velleman et al., 2005).
• More evidence is currently available which indicates
that family focused interventions primarily aimed at
the needs of children and adolescents as the focal
clients are promising.
• Including preventative approaches such as The
Strengthening Families Programme (Kumpfer &
Alvarado, 2003).
• And treatment approaches, for example,
multidimensional family therapy (Liddle et al., 2001).
A focus on young people
• Early onset of alcohol use in children and young
people has been associated with later problematic
use (Hingson et al., 2006).
• Also early onset and early hazardous use has been
associated with a range of other problems including
risky sexual behaviour, injury, antisocial behaviour,
violence and changes in brain development (Jones et
al., 2007; Brown et al., 2008).
• Furthermore, when investigating the impact of
substance use on the family, research has shown
that alcohol use among young people can adversely
affect relationships with parents and other family
members (Copello et al., 2005).
• In addition, family involvement in interventions has
been shown to influence the course of the problem
in a positive way (Velleman et al., 2005).
• Among school-age children, while proportions of
those drinking at all have dropped slightly since
1988, the average units consumed increased
markedly between 1990 and 2006 and this has since
stabilised at this higher level (Smith & Foxcroft,
2009).
• Contrary to popular perceptions, average alcohol
consumption among young adults (aged 16 to 24)
has fallen since a peak in 2000-2002.
• Nonetheless, 15 to 16 year olds in the UK have one
of the highest rates of underage drinking and
drunkenness in Western Europe (Hibell et al., 2007).
Rationale for a new approach
• Reviews of evaluation studies have shown familybased approaches to be effective in reducing
drinking among young people (Tripodi et al., 2010).
• However, problems remain with regards to
engagement of family, treatment decay and
translating research into practice.
• A key factor appears to be the resource-intensive
nature of many family interventions, making them
difficult to implement and deliver in many service
settings, especially in the context of substantial cuts
to drug and alcohol services for young people.
SBNT
• Originally developed as part of the United Kingdom
Alcohol Treatment Trial (UKATT).
• Utilising cognitive and behavioural strategies Social
Behaviour and Network Therapy helps clients build
family and social networks supportive of change.
• A key strength of the approach is the primary focus
on addressing alcohol problems by engaging with a
network of positive support for lifestyle change
(Copello et al., 2009).
Y-SBNT
• SBNT has additional advantages to help sustain
engagement with vulnerable young people who may
be disconnected from their families by broadening
the reach of the intervention beyond the traditional
family to include supportive peers.
• Core strategies include motivational techniques,
improving communication and coping mechanisms
and crucially given the nature of alcohol misuse
developing a network-based relapse management
plan.
• The therapeutic approach also has scope to address
client focussed elective areas, for example,
educational requirements (Copello et al., 2009).
Y-SBNT Study
• A pilot feasibility study:
• 2 sites Birmingham and Newcastle.
• Random allocation of 30 cases in each site.
• 15 cases receive Y-SBNT.
• 15 cases receive TAU.
• End of treatment and 12 month follow-up.
• Quantitative and qualitative measures.
References
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Harwin, J. (2011). New approaches to parental substance misuse. Public Service Review, 3, 306-307.
Manning, V., et al. (2009). New estimates of the number of children living with substance misusing
parents: results from UK national household surveys. BMC Public Health, 9, 377.
Kroll, B. (2004). Living with an elephant: Growing up with parental substance misuse. Child & Family
Social Work, 9(2), 129-140.
Flores, P. J. (2001). Addiction as an attachment disorder: Implications for group therapy. International
Journal of Group Psychotherapy, 51(1), 63-81.
Velleman, R., Templeton, L. (2007). Understanding and modifying the impact of parents’ substance
misuse on children. Advances in Psychiatric Treatment, 13(2), 79-89.
Forrester, D., Harwin, J. (2011). Parents who misuse drugs and alcohol: Effective interventions in social
work and child protection. Chichester: Wiley-Blackwell.
Chance, T., Scannapieco, M. (2002). Ecological Correlates of Child Maltreatment: Similarities and
Differences Between Child Fatality and Nonfatality Cases. Child and Adolescent Social Work Journal, 19(2),
139-161.
Porowski, A. W., et al. (2004). Effectiveness and sustainability of residential substance abuse treatment
programs for pregnant and parenting women. Evaluation and Program Planning, 27(2), 191-198.
Osterling, K. L., Austin, M.J. (2008). Substance abuse interventions for parents involved in the child
welfare system: evidence and implications. Journal of Evidence-based Social Work, 5(1-2), 157-189.
Kroll, B. , Taylor, A. (2003). Parental substance misuse and child welfare. London: J. Kingsley.
Barnard, M. (2007). Drug addiction and families. London: J. Kingsley.
Velleman, R., et al. (2005). The role of the family in preventing and intervening with substance use and
misuse: a comprehensive review of family interventions with a focus on young people. Drug and Alcohol
Review, 24(2), 93-109.
References
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Kumpfer, K. L., Alvarado, R. (2003). Family strengthening approaches for the prevention of youth problem
behaviors. American Psychologist, 58, 457-465.
Liddle, H.A., et al. (2001). Multidimensional family therapy for adolescent drug abuse: results of a
randomized clinical trial. American Journal of Drug & Alcohol Abuse, 27(4), 651-88.
Hingson, R., et al. (2006). Age of alcohol-dependence onset: associations with severity of dependence
and seeking treatment. Pediatrics, 118, 755-763.
Jones, L., et al. (2007). A Review of the Effectiveness and Cost-Effectiveness of Interventions Delivery in
Primary and Secondary Schools to Prevent and/or Reduce Alcohol Use by Young People under 18 Years
Old: Final Report. London: National Institute for Health and Clinical Excellence.
Brown, S., et al. (2008). A developmental perspective on alcohol and youths 16 to 20 years of age.
Pediatrics, 121, 290–310.
Copello, A., et al. (2005). Family interventions in the treatment of alcohol and drug problems. Drug &
Alcohol Review 24(4), 369-385.
Smith, L., Foxcroft, D. (2009). Drinking in the UK. An exploration of trends. York: Joseph Rowntree
Foundation.
Hibell, B., et al. (2009). The 2007 ESPAD Report: Substance Use Among Students in 35 European Countries.
Stockholm: The Swedish Council for Information on Alcohol and Other Drugs.
Tripodi, S.J., et al. (2010). Interventions for reducing adolescent alcohol abuse. A meta-analytic review.
Archives of Pediatrics & Adolescent Medicine, 164(1), 85-91.
Copello, A., et al. (2009). Social Behaviour and Network Therapy for Alcohol Problems. Brunner Routledge.