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. 1 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 2 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. 3 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. 4 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? 5 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 6 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? 7 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 8 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 9 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 10 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. 11