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Juggling Harms: Coping with parental substance misuse

  • University College Copenhagen

Abstract and Figures

Report based on the findings from the Family Life Project - a qualitative longitudinal study of children and young people's experiences of growing up with parental substance misuse (London School of Hygiene and Tropical Medicine). The specific objectives of the study were to explore: young people’s lived experiences (daily life experiences) of family life over time; their relations within the family and extended family; their coping strategies and ways of managing family life; parents’ lived experiences of parenting in a context of substance misuse; and service providers’ perspectives on coping at the level of the individual and the family, and on service access and impact.
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© 2011 London school of hygiene & tropical medicine Keppel Street, London, WC1E7HT
This report was written by:
Kathrin Houmøller, Sarah Bernays, Sarah Wilson and Tim Rhodes
We would like to thank all the young people and parents who shared their
stories with us and gave us an insight into their family lives. Thanks also to
the family members, friends, teachers and service providers who took part
in this research as well as to the following services for their time and effort in
facilitating access to the families involved:
The Children’s Society STARS Project; W.A.M., Nottinghamshire - What About
Me?; The KCA Sunlight Project; The KCA Substance Misusing Parents Project;
Young Carers, South Gloucestershire; Islington Young People’s Drug and
Alcohol Service (IYPDAS); CASA Family Service; Family Action Islington; The
Margarete Centre, Camden and Islington NHS Foundation Trust; The Parental
Substance Misuse Service, Islington; The Alcohol Advisory Service Camden and
Islington (AASCI); and finally, thanks to Greg Holloway for facilitating contact
with substance misusing parents outside of services.
We would like to also thank the co-investigators on this project: Dr Brynna
Kroll, Dr Andy Taylor, Dr Chris Bonell and Dr Nicki Thorogood as well as
members of the advisory committee. A special thanks to The STARS National
Initiative for disseminating it through their website. The coordination of the
study on behalf of the Department of Health was overseen by Dave Seddon at
the Liverpool John Moores University.
The Family Life Project was conducted by the Centre for Research on Drugs
and Health Behaviour at the London School of Hygiene and Tropical Medicine,
University of London and the University of Stirling and was funded by the
Department of Health. The Centre for Research on Drugs and Health Behaviour
receives core funding from the Department of Health’s National Coordinating
Centre for Research Capacity Development, for which we are grateful.
The views expressed in this report are those of the authors and not necessarily
of the Department of Health.
All the images used in this report have been selected from the public image
site, Shutterstock, and are not connected with this study.
Background 7
Objectives 8
Outline of report 8
Study design and methods 9
Young people 9
Significant others 11
Substance misusing parents 11
Service providers 12
Analysis 13
A case-study: Dena 14
Unseen is unknown: parents closing doors 17
Separated time and space 17
That which cannot be seen cannot be known 18
Ambiguity 19
The fragility of damage limitation strategies 20
Key points 21
Becoming aware: young people opening doors 22
Sensory experiences 22
Knowing for certain 24
What is ‘normal’? 26
Reassessing my ‘normal’ 27
Managing hidden and social harms 28
Key points 29
Love, care and family 31
Questioning love 31
Continuing to love 33
The importance of being in a family 33
Accepting parents 34
Caring for family and self 36
Key points 36
Caring for siblings 36
Immediate and long-term protection 37
Skill-building 38
Different paces 39
Blurring of roles 40
Coping together 42
Key points 45
Practices of friendship 47
Disclosing to friends 47
Talk and silence within friendships 50
A ‘space’ for respite 52
Key points 53
Engaging with professionals 54
Teachers becoming aware 54
‘Knowing’ 56
Talking to social workers 57
A space to talk or ‘just be’ 59
The importance of continuity in relationships 61
Key points 63
Multiple and social harms 65
Recommendations 66
Appendix 69
References 72
Notes 73
About the Authors 75
It is estimated that 2 million children and young people in the UK are affected by
parents’ drug or alcohol misuse (Manning et al., 2009). The Hidden Harm report
published by the Advisory Council on the Misuse of Drugs (2003), as well as a recent
growing body of research has sought to map the impact of parental substance
misuse on the lives of children and young people and other family members
(Velleman and Orford, 1999; Velleman and Templeton, 2007; Kroll and Taylor, 2003;
Barnard and McKeganey, 2004; Barnard, 2007; ACMD, 2007). This literature has
linked parents’ problematic substance use with household instability, child neglect,
compromised child care and safety, detached parent-child relationships, and in turn,
‘problem’ behaviours and psychological harm among affected children (Barnard and
McKeganey, 2004; Kroll and Taylor, 2003). Kroll and Taylor, for example, note that
“for most children living with chronic substance-misusing parents, life can be very
painful, difficult, frightening or dangerous” (Kroll and Taylor, 2003: 298).
Whilst mapping the potential harms of parental substance misuse, recent research
has also acknowledged young people’s potential to cope and ‘get by’ (Bancroft
et al. 2004), or even capacity to respond positively and adapt to adversity, often
referred to as ‘resilience’ to harm (Velleman and Orford, 1999). In their study of
young people affected by parental substance misuse in Scotland, Bancroft et
al. (2004) approach ‘resilience’ not as a fixed trait but as a series of choices and
strategies adopted by young people to help them cope on a daily basis or ‘get
by’. They note that, “It is important to recognise their [i.e. young people’s] own
agency and ability to manage adverse life circumstances and, where appropriate,
to enhance the processes they themselves identified as helpful” (Bancroft et al.
2004: x). Research to date, however, has lacked a specific focus on children as
embedded within family relationships (Bancroft et al., 2004; Barnard, 2007), and thus
neglected to focus on the constraints and enabling influences of the family context
on the choices and strategies that young people are able to adopt in their efforts
to cope with, and reduce the harms of, parental substance misuse (ACMD, 2007).
A key recommendation of Hidden Harm and subsequent policy reviews is that the
“voices of children should be heard” (ACMD 2007: 104). The Family Life Project was
therefore funded by the Department of Health of England and Wales specifically
to explore the experiences and understandings, including influence of the family
context, of children and young people affected by parental substance misuse.
The key aim of the study was to create a detailed exploration of young people’s
experiences of family life over time, as changing contexts can have dramatic effects
on young people’s coping capacities. We have focused on trying to understand
the processes of coping for young people affected by parents’ substance misuse
by focusing on the influence of family dynamics on their experiences and coping
strategies. Coping was thus approached not as something inherent to individuals
alone but also as an outcome of social relationships. In contrast to the one-off
studies common in this field, the longitudinal aspect of this study has facilitated the
exploration of coping as a dynamic process influenced by shifting family relations
over time. This report is one of many study outputs. The focus of this report is family
dynamics in particular. Explorations of changes over time will be explored in a
separate paper.
The specific objectives of the study were to explore: young people’s lived
experiences (daily life experiences) of family life over time; their relations within the
family and extended family; their coping strategies and ways of managing family life;
parents’ lived experiences of parenting in a context of substance misuse; and service
providers’ perspectives on coping at the level of the individual and the family, and
on service access and impact.
Outline of report
This report is an exploration of young people’s relationships with parents, siblings
and friends as well as with professionals in a supportive role. Three themes have
emerged as core to young people’s experiences of coping with parental substance
misuse over time: ‘caring for family’, ‘normalcy’ and ‘social harm’. What we mean by
social harms are the harms done to relationships, identity formation and experiences
outside of the family. These three themes, which emerged from the analysis, will
filter through the different chapters of the report.
‘Caring for family’ refers to the importance young people place on family; to have a
family is significant for young people’s sense of self and these ideas may influence
how they manage familial relationships. ‘Normalcy’ highlights young people’s
assessment of what is ‘normal’ and their growing awareness, over time, of how their
home and family life transgress societal expectations around what is considered
‘normal’. And finally, ‘social harm’ refers to young people’s perceptions of the harms
linked to not having a ‘normal’ family and reminds us that parental substance misuse
is about social as well as hidden harms.
Having outlined the study design and participants we explore, in chapter 2, how
parents and young people navigate parental substance misuse within the home.
How are harms perceived by parents and young people and how do they attempt
to manage and reduce these harms? In chapter 3 we consider young people’s
relationships in more detail and discuss the implications that these may have for
their ways of coping. How do young people experience the parent-child relationship
and what happens when siblings are part of the family? How does young people’s
home life influence their relationships with friends and professionals outside the
A core ethos of our work is to enable young people and parents to speak for
themselves. All participants quoted in this report have been given pseudonyms.
Study design and methods
The Family Life Project is a qualitative study and the approach to data collection
has been to capture the participants’ lived experiences as they describe and depict
The study involved interviews with 50 young people aged 10-18 who, at the time of
recruitment, all had experiences of parental substance misuse within the last year.
Parents were defined as any adults with care and parental responsibilities for young
people. To capture experiences of family life over time, 16 of the young people were
followed up, which involved between one and three additional interviews, anything
from three to twelve months apart. Participants were followed up for a maximum of
20 months. Taken together, we undertook 73 in depth interviews with young people.
To capture the dynamics of young people’s family and social relationships, the
study included interviews with 11 of the young people’s significant others such as
grandparents, parents, friends, teachers and key workers, as well as interviews with
29 substance misusing parents unrelated to the young people in the study.
Finally, the study involved interviews with 17 service providers working within the
field of parental substance misuse.
All participants for the study were recruited from five different areas in the UK: Kent,
South Gloucestershire, London, Nottingham and Nottinghamshire. These sites
reflected a range of different support services for young people.
A total of 130 in-depth interviews were carried out as part of the Family Life Project
between May 2008 and May 2010. The interviews lasted between 30-90 minutes
(typically 60 minutes), were audio recorded and transcribed. All interviews were
carried out by the authors and were facilitated by a simple topic guide designed to
explore participants’ narratives of their experiences. The interviews were as non-
directive as possible. Key areas explored during the interviews included: family
life; parenting; awareness of substance misuse; harms related to substance misuse;
coping strategies; help seeking; and recovery.
Young people
The young people sampled were all recruited through specialist services working
with parental substance misuse. The services reflected a range of different
approaches to supporting young people from short-term group work to long-term
one-to-one support. The young people were purposefully sampled to include girls
and boys of different ages and to reflect a range of diverse experiences related to
parents’ substance misuse and living arrangements1.
The young people were introduced to the study by their key worker from the
support service they were involved with. Young people below the age of 16 took
part following parental consent while young people above the age of 16 were
able to consent for themselves. However, all young people irrespective of age
signed a consent form prior to the interview. The young people received a £10 gift
voucher for taking part in a base-line interview and a £15 gift voucher for taking
part in a follow-up interview. With the exception of a few young people who were
interviewed at home or in cafés, the interviews were carried out within school or
at the support services. Their key worker was available post-interview to provide
support and standard child disclosure and protection protocols were used, as
employed by both the services and best research practice.
16 of the 50 young people were included in the follow-up study and were
purposefully sampled to include different ages and to reflect a range of different
life transitions, for example changing school or moving house as well as changes
in parents’ substance misuse related to recovery or relapse. Those whose
circumstances were fluid were most likely to be followed up. The follow-up
interviews illustrated how young people’s experiences of family life may differ
substantially over a relatively short period of time as a result of critical incidents
occurring or shifts in family relations.
The young people sample (further details about each participant is outlined in
the Appendix, which is at the end of the report) comprised 20 boys and 30 girls2.
Just over half of the young people (28) were between the age of 10-13 and the
rest (22) were aged 14-18 at the time of the first interview. The average age was
13. The sample included 5 pairs of siblings. The sample reflected a range of care
arrangements: 24 of the young people were living with the parent(s) who had, or
used to have, a substance misuse problem; 14 were living with a non-using parent;
5 were living with their grandparents; 4 were living on their own or in supported
housing; and 2 were in foster care.
Almost half of the young people (24) were affected by their mother’s substance
misuse, 11 were affected by both their parents’ use and 13 of the young people
were affected by their father’s use only. Two of the young people in the sample
were affected by their grandparents’, who was their primary carer, and siblings’
substance misuse3. The sample included young people whose parents were using
drugs, primarily heroin, crack and cocaine (17), alcohol (25) or both (8), and 34 of
the young people had parents who were still using at the point of the first interview
while the remainder were described as being in recovery, by which we mean seeking
treatment and attempting to reduce use towards eventual abstinence. Two parents
had died.
Carrying out research with children and young people on issues related to parental
substance misuse requires a sensitive approach. In addition, children and young
people in general are seldom asked to critically reflect on their parents’ behaviour
and we therefore anticipated the interviews with young people to be very difficult.
Though considerable effort was put into designing various visual methods and tasks
aimed at facilitating talk we were surprised by how little we came to rely on them
as most young people were comfortable just talking4. While some young people
produced accounts that to some extent sought to minimise or defend parents’
behaviour the majority gave very reflexive accounts and appreciated the autonomy
provided by the interview space. Because parental substance misuse is normally
fraught with secrecy (Kroll and Taylor, 2008; Barnard and Barlow, 2003) it is likely
that the interviews encouraged a verbalisation of what had until then been largely
unspoken or produced an extra degree of reflexivity in the young people. In general,
while many young people found it hard to talk about their parents they nevertheless
seemed to find it liberating to do so and appreciated that they were potentially
helping others affected by parental substance misuse through participating.
Signicant others
The young people’s significant others were either recruited by the young people
themselves as someone who could help them “tell their story” or were recruited
by the researchers with the young person’s permission. A total of 8 of the 50 young
people had their significant others interviewed5. Significant others received a £15
gift voucher for taking part in the study. The young people were not present during
the interviews and their stories were not shared with their significant others and vice
The significant other sample, who were primarily non-users, comprised 6 people
who were the legal guardians of the young people, (grandmothers and parents
(using as well as non-using parents), 4 professionals (key workers and teachers) and 1
The significant other interviews were not carried out to cross-check the accounts of
young people but to capture a more holistic understanding of relationship dynamics.
Substance misusing parents
The substance misusing parents were recruited as a separate sample and had no
connection to the young people involved in the study. This was a decision taken
by the research team informed by the views of young people participating and was
due to the ethical concerns that would be raised around recruitment and write-up if
we recruited the parents of the young people. The majority of substance misusing
parents (n=20) were recruited via snowballing within social networks of problem
drug users, who were largely dependent users of heroin and crack cocaine with little
or no contact with drug-related helping services. Nine substance misusing parents
were recruited through specialist drug services including for dependent users of
alcohol. Parents were purposefully sampled to include parents who had children
of different ages, were living with their children or had had them removed. Parents
received a £20 gift voucher for taking part. The interviews were carried out at home
or at the drug services.
The parent sample (see Table 2 for sample characteristics in the Appendix
comprised people currently using drugs problematically, through being dependent
on them, (n=25) and people having stopped using in the last year (n=4). The
approximate average age of the parents was 41 (range 35-55), and we interviewed
roughly equal numbers of men (n=14) and women (n=15). All but three were primary
users of heroin and/or crack, and most of these had experience of injecting drug
use. Around half (n=12) were currently in contact with methadone substitution
treatment services. Most (14) were at least weekly users of their primary drug.
A minority (6) described themselves as in a process of recovery from their drug
use, and were either conscious to reduce their use, or had recently stopped (4).
Participants had 59 children between them, aged between six months and 36 years
(most were between 5 and 18 years). A minority (2) had had their children removed
into alternative care.
Research on stigmatised behaviours such as parental substance misuse involves the
discussion of socially illicit practices and experiences which are commonly ‘unsaid’ or
‘unsayable’ within wider society. All the interviews with parents were therefore led by
them as much as possible thereby enabling a pace and topic focus appropriate for
discussing sensitive issues. We found that by asking parents to “tell their story”, the
study created a legitimate space for the experiences of parental substance misuse
to be spoken about and for some this was the first time that they had been able to
tell their story within a confidential setting and to someone who was not directly
involved in assessing their family or parenting skills. Especially for parents outside
of all drug service contact, the study presented a rare opportunity to reflect on their
While parents gave very open and honest accounts it is important that we do not
overlook the context in which they were told. Their accounts were not only told to
us, within the framework of a confidential study, but also in relation to dominant
discourses around parental substance misuse. The cultural trope that ‘substance
users make bad parents’ (especially those addicted to illicit drugs) prevails in
discourse framing popular debate. In the UK, it is visible in the light of recent
national television documentaries featuring the damage of problem drug use on
family life (for example, Channel 4’s My Mum Loves Drugs, Not Me), and bubbles
under the surface in the light of heightened concerns surrounding the adequacy of
strategies of child protection. For some parents this context may have produced
accounts aimed at breaking down the trope of ‘junkie parent’. More surprisingly,
however, our interview conversations with parents often seemingly brought about
moments of self-realisation and discovery which hints at the limited opportunities
that substance misusing parents may have for openly reflecting or talking about the
challenges they face.
Service providers
All service providers were recruited in consultation with the young people’s projects
and purposefully sampled to include experts working predominantly with young
people, parents or whole families. The service provider sample of 17 comprised
specialist key workers working directly with young people in either one-to-one
support or through group work (n=9); service providers working with parents both in
relation to treatment and parenting skills (n=4); professionals involved in assessing
families in relation to child protection issues (n=3) and 1 service provider working
predominantly with whole families.
Whilst the service provider interviews took their starting point in the participants’
individual areas of expertise in relation to parental substance misuse key areas of
discussion included: the perceived impact of parental substance misuse on child
welfare; understandings of resilience; trust-building and engagement with young
people; service accessibility and impact; and integration of services.
Service providers are not quoted in this report, but are reflected upon elsewhere.
However their interviews have been used to contextualise and inform our
interpretations as well as the implications and recommendations presented in the
final section of the report.
All interviews were transcribed verbatim, thematically coded and analysed
throughout the study with a particular focus on relational dynamics. The first
transcripts were coded jointly by members of the research team and emerging
themes were discussed and incorporated into the topic guides thus allowing for
further exploration of these issues in subsequent interviews. Although the interviews
were thematically coded, care was taken to maintain the narrative whole of each
interview and when the young people had been followed-up their accounts were
analysed within the context of the previous and/or subsequent interviews. For some
of the young people changes were thus captured over time while others reflected
on changes (over time) within one interview.
The study had MREC ethical approval from the National Health Service Research
Ethics Committee (Oxford) and also from the London School of Hygiene and
Tropical Medicine at the University of London.
A case-study: Dena
This is a description of 17-year old Dena and her family life with substance misusing
parents. Dena has been interviewed three times as part of the Family Life Project
and has also invited her younger brother as well as three of her significant others to
take part in the study. Here we present some of the key elements of her story told
over time as a way of illustrating the types of data we have been able to collect
through the follow up study.
Throughout Dena’s life her Mum has had a problematic use of alcohol, coupled
with periods of powdered cocaine use. Her Dad is a heroin user. Her parents are no
longer together but are both still using and as a result Dena has been, and still is,
the primary carer for her 10-year old brother, David who has a different dad. Dena
has mainly been living with her Mum although over the years she has also stayed
with her Dad as well as with many different members of the family; sometimes
because she herself has decided to move away from her parents and at other
times because her Mum has asked her to move. Social services have been involved
on many occasions. Since the age of 16, and throughout her participation in the
research, Dena has received specialist support related to her parents’ substance
At the time of the first interview Dena was living with her friend’s family together
with David. She had decided to move away from her Mum a few months before
the interview when the situation at home became unbearable due to her Mum’s
problematic use of alcohol. It was Dena’s concerns for David especially which led
her to move once again. Since moving Dena’s Mum had stopped drinking for three
weeks. This was the longest time that Dena remembered her Mum being sober for.
At the time of the second interview, almost eight months later, Dena and David
had moved back in with their Mum, who had relapsed after having been sober for
almost one month. Although she had returned to drinking problematically Dena
felt that her Mum was now able to care more for David compared to before. The
decision to move back had mainly been based on what Dena thought would be best
for David who missed his Mum. Since the first interview Dena had completed her
A-levels and was applying to go to university, which those around her, including her
Dad, strongly supported. Yet, this was not an easy decision to make as moving away
to university would mean leaving David alone with their Mum.
At the time of the third interview, just over 4 months later, Dena had not been
accepted into university but was in the process of applying again. She had, however,
decided to apply to a university closer to home so that she could still look out for
David. Since the second interview, and following an incident of domestic violence,
David had been put on the Child Protection Register as a Child in Need and their
Mum was planning to go into detox again soon. Dena had moved in with her
boyfriend’s family but still visited her Mum and David every day. Dena no longer
received support from the specialist support service.
Dena’s significant others were interviewed in the time between her second and third
interview. She had nominated her Dad, her friend as well as her specialist key worker
to take part. Each of these interviews added to our understanding of the ways in
which these relational connections influence Dena’s ways of coping with her parents’
substance misuse.
Dena’s voice filters through the different sections of this report.
navigating substance misuse
This chapter explores how harms in relation to parental substance misuse are
perceived by parents and young people in this study. Through their stories we look
at how these harms are managed and the strategies that parents and young people
use to attempt to reduce potential harms and maintain normal family life
Unseen is unknown: Parents
closing doors
In our data all parent accounts engaged with the idea that drug use is damaging to
family life in some way and placed strong emphasis on damage limitation regarding
the potential adverse effects of their drug use (Rhodes et al., 2010)7. Keeping drug
use hidden from children, as well as from outside others, was a primary technique
of damage limitation. The object here was to separate out the worlds of drug use/
users8 from that of children/family life, at least as far as children’s knowledge of the
situation was concerned:
We didn’t want him to be brought up in an environment where hard drugs
were, you know, being used... We didn’t want him to be conscious of that,
because it might, you know, it might affect his behaviour at a later date I
suppose. And that’s, that’s the kind of ongoing, kind of theme I suppose,
is trying to keep it a secret you know, from [Simon] primarily, but from
everybody else too.
Separated time and space
Parents’ strategies to separate out the parent’s world of drug use from the child’s
world of family life are mobilised around time and space. Opportunities for drug
use, or heavier use, arose at certain times of the day: “I’d always do it in the night
when my boys were in bed”; “When he’d finally go to sleep that’s when I would start
navigating substance misuse
In the home, all parents we interviewed talked of creating separated spaces in which
to use, away from their children’s view, usually behind closed doors. While children
were said to become accepting of parents having their separate space to “do their
thing”, the following extracts also acknowledge attempts made by children to seek
attention of their parents when behind closed doors:
I used to go to the bathroom. We’d lock ourselves in the bathroom…
Yeah, “Why can’t I come in, Mummy?” “No, I don’t want to see you. I
want to see Daddy.” “But Daddy is on the toilet.” “So why can’t I go in?”
We’d park him in front of the box [television], and go into the bedroom,
close the door, barricade the bloody door, put something in front of it,
and use… He’d call through the door, and we’d go “Yeah, yeah, hold on”.
When separated time or space was not available in the home, the time and space
for drug use would be made: “Try to distract them, so that was the key thing, trying
to distract them”; “I would give them money to get them out the house, to go and
get some takeaway”.
In addition to separated space, homes would be routinely cleaned up of evidence
of drug use, both visual and sensory: “I used to wash the worktop off with bleach”;
“I had to hide my paraphernalia, I had to make sure everything was in order so that
they didn’t see”; “I’d spray the house”; “I’d always put a bucket in the hallway with
bleach in it so it would help take the smell away”.
at which cannot be seen cannot be known
Separating out the worlds of drug use and family life is contingent on keeping drug
use hidden. Such a strategy offers a rationale of that which cannot be seen cannot
do harm for it cannot be known. Our data suggests that being seen to do drugs or
to be a drug user was positioned by parents as a critical threshold to their children
knowing their parents as people who use drugs. Accounts gave repeated emphasis
to the “fact” that children had “never” seen evidence of drug use:
He’s walked into a room a couple of times when there’s quickly been some
shuffling around, and I know he must have thought ‘What the, what’s Dad
doing?’. But he’s never actually, no, I’ve never allowed Jack to actually see
me taking drugs.
substance misuse
I’d hide the stuff, but no, he never saw me taking anything. I can say for
a fact, he never saw me taking it. […] I think he sensed that I was doing
something, but he never saw. He didn’t see me do it.
The only voiced exception to the rule of keeping drug use hidden from view was
when children were judged not old enough to know what they were seeing: “It was
easy to use around him without it affecting him really, that’s how we saw it at the
time”; “He wouldn’t have known what a piece of foil was when he was 3 years old”;
“I think once he got to 6, 6ish, I think we made efforts… you know, he was now
conscious of his environment”.
Maintaining drug use as ‘unseen’ places primary emphasis on drug use being known
through children engaging directly with visible evidence (of activities, substances,
users, paraphernalia). This enables an investment in, and appeal to, ambiguity; that
keeping things visibly concealed maintains sufficient uncertainty to protect a parent’s
hope or belief that their drug use remains undiscovered, or at least unconfirmed.
Mary, a long-term user, emphasised that she was never seen by her son to smoke
crack. She makes an important distinction:
I think he sensed that I was doing something, but he never saw, he didn’t
see me do it.
Knowing is seeing. Even in situations in which parents suspected their children knew
of “something” – which was not unusual – accounts invest heavily in the idea that
drug use is hidden from view. This is even while acknowledging that strategies of
concealment are fragile and open to disruption. Here, Ziggy, a long-term injector
of heroin and crack, characterises his risk management of drug use in the home
as a form of ‘edgework’ in the face of liminal knowledge: his son ‘knows’ a certain
amount, always wants to know more, but never gets to see (and thus, know) enough.
Ziggy’s drug use is sensed but unseen, and thus ambiguous:
You have to be careful. When I’m trying to do my thing, he’s always trying
to get a look at it.
navigating substance misuse
e fragility of damage limitation strategies
The accounts of parents also involved stories of disruption to their strategies of
risk management, such as when their drug use is ‘accidentally’ seen or discovered.
Most parents acknowledged the fragility of their strategies of secrecy in a context of
regular drug use, accepting that these were open to exposure: “He waltzed in, and
we tried to hide it, but he sort of sussed out, ‘What you doing? I know you’re hiding
something” ; “I’d take him to school and I’d be in a real state [withdrawal]... I knew I
was in a real state, and he looked at me like I was a state”.
Every parent we interviewed reflected upon the dilemma that their children may
know more than they have actually seen, or that they have seen enough to know
more than their parents hoped. Yet even in such cases when their child would have
an idea that they were being lied to about the drug use and the other drug users in
their home, the illusion of secrecy appeared important to uphold:
I don’t know if he knew, but, to me, he seemed, it was like he was
confused what was going on. And that’s the way I wanted to keep it. He
didn’t know what was going on... That’s the way I wanted to keep it...
My son would say, “Who was this?” And I’d say it was a friend, like,
everyone was a friend. Maybe, in his head, he might have had an inkling,
I don’t know. But as far as I was concerned, no, they were just friends,
and he didn’t know anything else. He was none the wiser as far as I was
Parents might pursue strategies of ambiguity concerning their drug use even in the
face of their children communicating to them that they know:
We had a special drawer for all the needles and the drugs, and one day
I opened up the draw and there were two plastic skeletons in there, you
know, rubber skeletons.
I didn’t want them to actually catch me doing it. I didn’t want them to see
my paraphernalia. But then, there has been three occasions where I [have]
come home and found my paraphernalia plonked right in the middle of
whatever’s gone on, where they’ve thrown things all over the place with
their anger and frustration.
substance misuse
The dilemma of whether and when parents should ‘come clean’ to their children
illustrates this investment in ambiguity and denial of disclosure. Most parents
repeatedly postponed this conversation, usually to an imagined time when they
were clean of drugs:
Jack and I have actually never talked about it. We have never had a
conversation about my drug addiction. Never. I’ve always kept it quiet
from him.[…] If I am successful in cleaning up, then I’m sure I would, I’m
sure I would have a conversation with Jack, six months, a year down the
I know we’re going to have the conversation, I know we will. But right
now, I mean, I’m not ready for it now. And I think he’s, kind of, like, I think
he’s waiting for me, to me, to actually come to him.
Our data suggests that parents’ disclosure to their children did not relate to age but
instead they only tended to disclose their drug use only once their children indicate
(unambiguously) that they know or when they are about to find out by some other
means. The process of coming to terms with the idea that their children know – or
know enough – is a gradual yet critical one towards accepting the illusionary status
of a narrative of damage limitation.
Key points
Parents’ damage limitation strategies are mobilised around time and •
Many parents engage with the rationale of ‘that which cannot be seen •
cannot do harm for it cannot be known’.
Parents invest in denial of disclosure and strategies of ambiguity •
concerning their drug use.
Parents repeatedly postpone ‘coming clean’ to their children and tend to •
disclose only once their children indicate that they know or when they are
about to find out by some other means.
navigating substance misuse
Becoming aware: young people
opening doors
While parents’ accounts emphasise secrecy and keeping the substance misuse
hidden from view, the accounts of young people emphasise an awareness that
‘something is up’ and that ‘something is not quite right’. The young people might
not know precisely what it is or what to call it, but they know it’s there and that
it affects their family life. This means that while parents attempt to keep their
substance misuse behind closed doors or unsaid, the impacts of their use are not
hidden but may pervade the experience of the home:
He always shut the door if he was using, but it was not something you can
ever, I think, hide 100% when you’re living in the same house as someone
because you just know, you just know.
You know things aren’t right.[…] You might not necessarily know what
she’s using but you know something’s not right.
As a baby I didn’t even notice anything wrong. (...)
Was there anything in particular which made you notice?
Not really, I just, kind of, noticed it in my head. Like, one time when I
were a little baby, she left me at school until, like, nine o’clock at night
and, like, then the next day, ‘cause she was still, kind of, drinking, she
didn’t get me up for school and this were, like, when I was, like, six…five,
she didn’t get me up for school, so – and then, so we’d have a normal –
we had a normal day as if it were weekend, I didn’t know whether it was or
not. Then she ended up taking me to school at about ten o’clock at night.
I were trying to pull her back ‘cause I noticed...‘cause it were dark I knew it
wouldn’t be on if it were dark.
Sensory experiences
The accounts of young people reveal that parents’ use of alcohol may be less
hidden than parents’ use of drugs. Yet, the young people’s experiences appear very
similar, with an emphasis on their parents’ substance misuse being sensed before it
is verbalised and fully understood. Sensory experiences are thus often foregrounded
in the young people’s accounts as ways of building up awareness of their parents’
substance misuse, especially in the absence of visual evidence of substance misuse
(Wilson et al., submitted). As Jackie describes:
substance misuse
(...) I can still smell the smell of her room, of vodka, or... her breath. That
was always the worst one. You know... you come struggling through the
front door and you stink of mints...and your hands are sticky, and your
jacket is sticky...
The appearance of the home space is also frequently used by young people as
an indicator of their parents’ substance misuse and well-being. Aiden for example
recalls contrasting experiences of his domestic space when his mother was drinking
and later, when she had been sober for a short period of time:
When you say it’s good at the moment, is it the best it’s been
for a long, long time, or
On a scale of 10, is it like 10 really good? Or 7?
It’s, it’s not really good, it’s about a 7 or an 8 because like we never used
to have carpets in the house or anything and like over the past 2 weeks
we’ve got nearly all the carpets, a new settee and stuff like that. It’s just
getting herself together now.
Sensory experiences also seem to play an important role for young people in
constructing whether or not a particular environment feels normal, predictable and
secure. Young people describe listening out for certain sounds that communicate
a sense of danger or insecurity which would then prompt them to ‘act’ either by
checking on their parents or leaving the house to stay safe.
Well I didn’t see it, I heard it [Mum’s boyfriend being ‘”raged up”]. (...)I
heard it, but she – I don’t think my Mum thought I heard it, but I heard it.
Do you think you knew more of the situation than your Mum
thought you knew?
Yeah, yeah.
And can you tell me why you think that?
‘Cause, like, my Mum told me to shut my door, but I didn’t shut my door,
I were just lying on my bed, so I heard what’s going on, and if – if I knew
that he had hurt my Mum, I would go straight down there. I’d be straight
down the stairs and hurt him.
navigating substance misuse
Knowing for certain
Young people’s awareness of what is going on is a process, occurring over time.
Whereas parents invest in strategies to conceal the substance misuse, young people
tend to invest in strategies to reveal what is going on. They attempt to make sense
of what they feel through strategies which seek to reveal more about what their
parents are doing. They look for clues and try to interpret what these clues mean.
Nonetheless, young people may never be sure how to interpret what they feel and
see, and this sense of ambiguity can be perpetuated by a lack of trust in what their
parents say:
I’ve got a feeling it might be drugs but I’m not sure.
How come you’ve got this feeling?
I don’t know, it’s just like, ‘cause I keep checking my dad’s arms for marks,
and then I look at his arms and he’s got a cut there, and he says it’s so and
so. I don’t believe him, I think it’s drugs.
Our data suggests that knowing what is going on is very important for young
people. However, this is also very difficult in the face of parental denial about
their substance misuse and, as described above, parents using drugs may invest
considerable energy in preventing young people having any visual evidence of their
drug use:
‘Cause most of the time they’re upstairs – sometimes they’re upstairs
together and I don’t know what they’re doing?
If you want to know what they’re doing do you ever kind of do
anything to have a peek to see what they’re doing? What kind
of things do you do?
Go in there and peek around the corner.
And do they see you? And what do they say?
Get out.
What do you see – what are they doing?
Normally they’re just...sometimes my dad pushes me out of the room but
I don’t know why.
When parents are using drugs we found that young people seek visual evidence to
verify, without doubt or denial, their sense of what is happening. Most pervasive is
seeing parents using which constitutes ‘proof’, and along with this, some relief:
substance misuse
I couldn’t do anything [with the knowledge I had], ‘cause they can lie
through their teeth, I’m telling you that now... There’s no point me going
or saying to her, ‘Oh, are you on it?’, because she’d lie. So I just had to
wait… I had to wait to prove it.(…) …And then 2 months later I found,
that was when I found her, her jacking up.(…) …I felt relieved because I
thought am I going crazy and just imagining all this? When I found out I
was like, no, I’m not going mad, she’s the liar, and she is doing that again.
Because no one really believed me.
(...) My Mum said I should have knocked first, but I knew what was going
on, so I didn’t bother in case they were trying to hide it, and I didn’t want
it going on forever.
In general, the accounts of young people were permeated with comments
suggesting that uncertainty and doubt are integral to the experience of parental
substance misuse. Often the young people are aware that they don’t know the full
story and that their parents are withholding this from them. Even when the young
people feel certain in their knowledge of what is going on, the issue often remains
largely unspoken:
I just knew and they knew I knew.
Yeah. So you just, it was just something that you knew?
Yeah. Did you ever tell your Mum that you knew?
No, but she obviously [pause] knew that I knew (...)
While many young people seemingly accept this assumed unspoken knowledge,
they would prefer for their parents to be honest with them about their use:
Like, I’d rather know than him hiding…with it, and all that.
Was it quite nice when she sat down and explained it to you or?
Yeah, ‘cause then I knew what was going on.
navigating substance misuse
What is ‘normal’?
While young people become aware of parents’ substance misuse this doesn’t
necessarily translate into an understanding of what this involves, either for
themselves or their parents. Understanding comes with experience, and especially
through learning over time, and through comparing and reflecting upon past home-
life experiences in the light of new knowledge. Our data thus suggests that many
young people ‘adapt’, over time, to their parents’ substance misuse and ways of
doing family life and not until later do they understand the seriousness of their
parents’ use or that their family life is not ‘normal’:
I knew she was taking drugs, but I didn’t know how bad the drugs were…
until like I grew up and I realised that they were really bad drugs, like one
of the worst that you can get.
It’s just, I didn’t used to think it [the house being a mess] was that bad but
now I’m thinking about it, it is.
Um. You didn’t think it was that bad at the time though?
Because I just used to see it every day.
Well, I can always remember my Mum drinking, but when my Mum had
my younger brother, I was eight or nine, and he was a baby and she used
to go to the pub and I used to have to babysit…and she used to come
home really late and I used to get really scared, completely drunk, like
not just drunk as in everyday, but just completely out of it and then she’d
come and she’d have, like, a black eye…and she’s had a fight or she’d
come and she’d wake – I would be awake because I wouldn’t be able to
sleep…and then I knew that I didn’t like that. So that’s what made me
notice that she – drinking was bad and she’s been doing too much of it.
Adapting to parents’ substance misuse means that having parents who are affected
by alcohol or drugs becomes part of the young people’s ‘normal’; something that
is not constantly questioned. 17 year old Dena describes this state of normalcy
like, “having milk in the fridge, that’s how normal it is”. Our data suggests that this
may push the threshold for what young people consider normal and acceptable
behaviour, and thus ultimately push the threshold for when they feel the need to
act and ask for help. Here, 12 year old Jacob describes a situation where his Mum
transgresses his ‘normal’, which is for her to have “a fair bit of drink”. This prompts
him to call an ambulance for the first time. Jacob’s comment also illustrates how
young people’s skills for managing parents’ substance misuse develop over time
substance misuse
alongside shifting boundaries for what is considered ‘normal’:
She used to have a fair bit of drink, yeah, but she were never like that
[unable to wake up], never. That’s why I was worried about her [and called
the ambulance], for – ‘cause if that happened regular, I would be, like,
knowing what to do and everything (...).
Reassessing my ‘normal’
Ideas around what is perceived to be normal are not static but subject to ongoing
evaluation and reflection. Young people’s shifting assessments of their parents’
behaviour as abnormal occurs over time. This happens not only during exposure to
a divergence of experiences within the home, and in relation to parents’ changing
substance misuse as described above, but also through experiencing how others ‘do’
family life outside of the home – indirectly through the media and directly through
interacting with their friends and their families. Here, Dena describes how her first
sense of her ‘normal’ being different to other people’s ‘normal’ was when she visited
the homes of her friends:
I didn’t really know that my Mum wasn’t normal until I met other people’s
Mums and they were, like, they had rules and things.
Yeah, so how old were you when you started to meet, like, your
friends’ parents and found out that maybe your family was a bit
Well a lot of my friends at the time were my Mum’s friends’ daughters and
sons, and so obviously my Mum’s friends, they were mainly drunks as well…
so to me, that was normal until I met some – other friends and it was when I
was in year seven, so I was about 12 or 11, when I went round to her house
and her Mum and Dad are together, and I’m not saying that that is normal
because obviously single parents are normal as well, but it was weird how
they had dinner at the same time every day, and they had to have a bath,
‘cause I stayed there, and they woke you up in the morning and it was just
completely different and I really liked it…and I was just – it made me feel
uncomfortable to go back to my Mum’s…knowing what I was missing.
Alongside this growing awareness is a dislocation between the young people’s
experiences at home and what they see at other people’s homes. This dislocation
in experience shows their home to transgress social expectations around what is
considered to be ‘normal’ family life and parental behaviour. The awareness that
their parents’ behaviour feels strange is often accompanied by shame and social
navigating substance misuse
It’s embarrassing because all your friends have got normal parents and you
haven’t...knowing that like, you’re not going to have a birthday party or you
can’t invite your mate around for dinner because it’s just, it’s not appropriate
and their parents won’t let them. It’s horrible, it really is.
Managing hidden and social harms
Realising that family life falls short of expectations leads many young people to invest
considerable effort in concealing their experiences from the world outside their home
to maintain an impression of normalcy. Our data suggests that young people’s reaction
is often to sense that their normal has to be hidden. As a consequence, they invest
considerable energy in presenting their family to others as if it were normal. This is a
way to protect against the threat that their home and parents pose to their everyday
ife and social relationships with friends and at school. Many young people are
concerned about what impression their friends and others may have of their parents,
and also by extension of themselves, and worry that allowing people to know about
their home life may threaten their social position. For some, this means that friends are
rarely, or never, invited to visit, with life at home protected as a separate private world.
In addition to not talking about their parents’ substance misuse young people may try
to avoid being identified as associated with having substance misusing parents:
Even though I was having them problems at home I didn’t let it show in
school. I’d still come in and do my work and act like a normal kid (...). I didn’t
let it show at all and I didn’t say anything.
The motivation for this separation between their home and outside lives is often to
protect against the risk of being bullied or out of fear that if others knew then they
would not want to spend time with them:
No, they [mates] didn’t know ‘cause they were, like, wallies and they’d, like,
wind me up about it…. If I told my mates, my mates could then tell the
bullies, and, like, they would say, like, “Oh, is, like, Mummy not looking after
you properly?”
It’s just that it prevents me from doing stuff because they know what’s going
on in my daily life.
What kind of things does it prevent you from doing?
Like, if I say, “Do you want to come out and hang around?” they say that they
don’t really want to right now.
substance misuse
Others worry that being associated with their parents may spoil their own formation
and maintenance of an identity distinct from their parents:
Is there a reason why you don’t want people to...other people
to know what’s going on?
Because I just think, like, then people would know my life, kind of thing.
I’d rather them see athletics life and my new life.
And I was worried that she’d [boyfriend’s Mum] kind of say, I don’t think
this girl is very good for you. Look at her Mum…you know, she’s probably
going to turn out like that. So I was really worried about telling him…
What these comments show us is that while knowing-for-certain about parents’
substance misuse may reduce a sense of uncertainty and ambiguity about what
is going on in the home, this does not mean that young people can act on this
knowledge outside the home. Knowing does not easily translate into telling. Our
data thus suggest that the majority of young people adopt two types of harm
reduction strategies at the same time: first, they seek to reveal more about what
is going on within the home as a way of creating security about what they know
and to feel more in control; and second, they seek to conceal to others what is
going on within the home by appearing as normal to outsiders as they can, thereby
separating their home-life from their life outside the home. The second of these
strategies is driven by young people’s sense of social harm, such as a fear of bullying
or rejection. This means that young people’s need to manage or reduce social harms
outside the home may inadvertently sustain the harms of parental substance misuse
within it.
Key points
Parents’ substance misuse is often sensed before it is verbalised and fully •
Young people’s shifting assessment of their parents’ behaviour as not •
‘normal’ occurs over time.
Young people’s awareness of parents’ substance misuse is often •
accompanied by a sense of shame and embarrassment that their family
life is not normal.
In response, young people invest considerable effort in concealing their •
family life experiences from the world outside their home, both to protect
themselves as well as their parents.
The need to reduce social harms outside the home may inadvertently •
sustain the harms of parental substance misuse within it.
coPing in tHe conteXt oF reLationsHiPs
This chapter explores young people’s ways of coping with parental substance
misuse in the context of their relationships with parents, siblings, friends, and
professionals. By paying attention to young people’s stories of how these
relationships are experienced and managed in everyday lives, we look at the
influence of these relationships on the choices and strategies that young people
are able to adopt in their efforts to cope with parents’ substance misuse over
Love, care and family
In the previous chapter we have seen how young people reassess their
‘normal’, comparing and evaluating their own experiences through a growing
awareness of others’ family life as well as societal expectations. As part of
this reassessment, young people’s accounts of love and care emerge as key
themes. Experiences of love and care were not something which we asked
about explicitly or envisaged being a central theme but were introduced by the
majority of young people in the study, who questioned the relative absence of
love and care in their relationships with parents (Houmøller et al., submitted).
Our data suggests that young people expect love and care to be implicit to
families, unquestioned and unconditional. Yet, at the same time they are also
aware that their parents’ ability to care for them is affected negatively by their
substance misuse. Managing these contradictions between unconditional
love and sometimes inadequate care is a difficult and confusing process for
young people and one which evolves over time. Learning to manage these
contradictions, however, may be important for young people’s ability to take
care of themselves.
Questioning love
It is striking from the accounts of young people that they have firm ideas about
the kind of love their parents are supposed to give them; often it is taken for
granted that parents love their children and children love their parents. This is
described as a kind of love linked to ties of blood:
coPinG in tHE contEXt
oF rELAtionSHiPS
coPing in tHe conteXt oF reLationsHiPs
Everyone can give you their love but your Dad has a special love
doesn’t he?
This implied linkage between love and ‘being related’ makes it almost impossible
for young people to question the unconditional love between themselves and their
parents, even when the relationship is problematic:
(...) my Dad will always be my dad and I’ll always love matter
what he’s done...and no-one – I’ve had people say, “Yeah, but he’s done
this”. I’ve said, “’Cause I don’t care, he’s my Dad”.
Yet, while believing in unconditional love between parents and children many
young people also feel that their parents do not always care about them when they
are using drugs or alcohol, and parental care is therefore experienced as context-
specific and unpredictable. For some, this absence of constant care feels like having
missed out on having “a proper” Mum or Dad. This is not always experienced like
an absolute state but is changing over time and often seems to follow parents’ cycle
of use:
I feel like I didn’t have a Mum or Dad. Like a proper one where they…
where you just spend time with them and they speak to you… and they
ask you questions about what you’re doing…and things. (…) And then it
was different because he [Dad] would care for me a lot more…when he
wasn’t on drugs.
(...) Sometimes she’s a parent, but then sometimes when she needs to do
what she has to do, she’s not there.
Our data suggests that love and care is not something which the young people can
take for granted but is instead questioned when parents do not consistently express
love and care in ways that they are expected to as parents. This is often linked to the
feeling that alcohol or drugs come first:
I feel like if you love someone and you’re putting them…if you’ve got
children then they should be first. They’re not first if you take drugs or
drink. They’re always second after that and for me, I don’t know, it really
makes me angry because it’s like if you love me you’d buy milk rather than
that bottle of wine. Do you know what I mean?
coPing in tHe conteXt
oF reLationsHiPs
Continuing to love
It was rare, however, for a young person to unwaveringly conclude that their parents
did not love them, even when care was missing, and often their talk about this issue
remained ambiguous or doubting. Almost all of the young people interviewed
continued to believe in their parents love for them and many managed to make a
distinction between expressions of care and their parents’ feelings of love:
And I know my Dad loves me, he’s just not – he just don’t care.
While almost all of the young people expressed an enduring love for their parents,
their accounts also revealed that over time many of them had actively withdrawn this
love and care temporarily in an attempt to deal with, and protect themselves from,
what felt like their parents lack of care. However, withdrawing love was usually a
short-term strategy and not one that could be maintained over time. Instead, young
people felt that it was necessary to continue to love and not to give up on love for
their parents, even when the relationship was problematic. Here, Anna reflects on
the pain and potential damage involved in maintaining a relationship with her Mum
and yet she feels that she still has to keep on loving her:
I don’t particularly like her very much but I have to love her. (...) the best
thing in an ideal world would be to turn away from her and say, “You’re
causing me too much hassle, too much pressure, too much hurt. I don’t
want anything to do with you”. But at the end of the day, I only have one
Mum and even if I don’t like her very much, I have to love her. I have to
numb my feelings over it, cause I know she’s drinking now…I mean, I
wouldn’t be surprised if she’s smoking now. But I just have to say, “Good
morning” to her, “Have you eaten? Do you want me to make you a
cup of tea?”.
e importance of being in a family
Our data suggests that young people’s felt necessity to continue to love their
parents is linked to the importance they place on being in a family and having
parents, even if their parents do not really act like parents at all. Being in a family is
important for young people’s assessment of themselves as ‘normal’ and because it
provides a sense of belonging as well as a sense of security:
(...) it is very important to have your Mum and Dad because there’s going
to be times in your life when you’re going to just feel so lonely and you’re
going to want your family round you. The most important people in your
family are your Mum and Dad really.
coPing in tHe conteXt oF reLationsHiPs
Continuing to love is also important because turning away from parents involves
breaking the moral expectations inherent to the parent-child relationship. Young
people’s continued investment in love is thus also about social obligations and
norms; doing what is perceived to be ‘right’ according to expectations about love
and care within families:
(...) it would be terrible if my Mum died tomorrow and, and I thought
well my last, Mum’s last memory of me would be me turning around and
saying I don’t want anything more to do with you.
Accepting parents
Not only did the young people need to still love their parents but our data suggests
that they also needed to find ways to excuse their parents’ sometimes lack of care
to enable this continued love. Our data suggests that young people’s acceptance of
their parents played a key role in enabling love and that this could help minimize the
emotional pain involved in maintaining the relationship. This is how Anna and Dena
explained their relationships with their parents:
We don’t get on very well...but the way I see it is, my Mum’s not very
well...she’s not going to live forever...I’ve just got to really try and ...even if
it’s just sitting together watching TV.
(...) Now I understand why they are how they are. And before I didn’t, I
just thought that they chose to [use drugs and alcohol] and that’s it. They
chose it over me...and I want David [younger brother] to understand that
before he gets too old enough to just go. “Well, I don’t want nothing to
do with you” ‘cause I think it’s important that he has a Mum.
To fully accept their parents also meant learning to live with the chronic nature of the
situation as described by Leslie:
(...) The relationship we have now it’s the best it could be. It’s the best it’s
ever going to be. It’s never going to get any better.
For the young people this also involved coming to terms with their own inability to
stop their parents’ substance misuse:
coPing in tHe conteXt
oF reLationsHiPs
(...) before I’d be right on it. I’d want to stop it. I’d want to try and do
everything in my power to try and stop it but now I can’t. I’ve realised I
can’t (...). She will find a way to do it if she wants to do it.
Caring for family and self
Young people’s acceptance of their own inability to change their parents is often
linked to an increasing realisation, especially amongst older young people, that they
have to also take care of themselves and to overcome a felt conflict between caring
about their parents and caring for self. From a young age many of the young people
had taken on a caring role in relation to their parents, however, as they grew older
and more aware of their own future adult lives this became increasingly difficult.
Here, Kerry reflects on her acceptance of her Mum’s constant risk of relapse as well
as her concomitant acceptance that she cannot always be around to keep her Mum
It’s like every day that she’s not drinking is an achievement but we all know
that there’s gonna be a day when she’s gonna wake up and she is gonna
go on the drink. (...) it scares me but then it’s like we, we always can’t be
here for her to say to her, “Mum, you can’t do this. You can’t do that”, and
we’re all not gonna, we all want to live our lives and we can’t be there all
the time to say to her, “Now Mum don’t have a drink, come home and
have a cup of tea or some juice or something”.
By accepting their parents’ substance misuse and thus not investing any hope in
their long-term recovery our data suggests that young people find a way to care
about ‘now’ which minimises their sense of responsibility for their parents’ recovery.
This allows them to still love and care about parents without taking on the caring
responsibilities that familial love normally entails and which could potentially
compromise their ability to take care of themselves.
coPing in tHe conteXt oF reLationsHiPs
Key points
Young people anticipate a norm of unconditional love between parents •
and children but feel that their parents do not always care about them
when they are preoccupied with drugs or alcohol.
The felt linkage between love and ‘being related’ makes it difficult, if •
not impossible, for young people to question the unconditional love
between themselves and their parents, even when the relationship is
Young people’s felt necessity to continue to love their parents and care •
for family is linked to the importance they place on ‘being in a family’,
and acting according to their expectations about familial love and care.
Young people learn to explain away or excuse their parents’ sometimes •
lack of care to enable a continued love.
Overcoming a felt conflict between caring for family and caring for self is •
important for young people’s sense of coping.
Caring for siblings
We have seen how caring for family is central to young people’s experiences of
parental substance misuse. Sibling relationships are an important aspect of this
and our data suggests that siblings may accentuate a felt conflict between caring
for family and caring for self. Relationships don’t happen in isolation and alongside
learning to manage their own relationship with their parents and get by, young
people are also often dealing with their sibling relationships, and how their siblings
are affected by parents’ substance misuse. Through the accounts of young people
it becomes clear that older siblings, especially girls, often take on a caring role
for their younger siblings. Our data suggests that sibling order may thus be very
important, with siblings going through different exposures and experiences and
therefore potentially developing different competencies and skills for coping.
Immediate and long-term protection
When older siblings take on a protective role for their younger siblings this involves
protecting them from the immediate risks of being around the substance misuse,
such as potential violence or avoiding witnessing the direct results of their parents
being intoxicated. This sometimes involves taking younger siblings out of the house
or removing them to their bedroom when a situation becomes unsafe within the
home. These strategies appear to reproduce parents’ damage limitation strategies
(chapter 2) – separating out the worlds of substance misuse from that of family life.
However, caring for younger siblings also involves attempting to protect them in the
immediate or long-term by avoiding social harms associated with having parents
misusing drugs or alcohol, such as bullying, or by making the younger sibling aware
that what their parents are doing is not ‘normal’:
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(...) I do it [pay for brothers’ haircuts] because, I, I hate to say it, my
brother get bullied, they do, because of their appearance (...). (Sally is 18
and her brother is 11)
Like I didn’t think it was wrong [Mum’s drinking] which was really scary
because I hope my brother knows that it’s wrong…because I wouldn’t
want him to think that drinking excessively is okay…or taking drugs is
okay because your Mum does it. (Dena is 17 and her brother is 10)
The strategies that young people use to protect their younger siblings illustrate the
skills and knowledge that they have built through having to deal with their parents’
substance misuse; they have had to become equipped to identify potentially risky
situations and learn how to mediate and avoid them.
Young people’s immediate and long-term protection strategies towards younger
siblings imply that they protect their siblings from being exposed in the same way
that they themselves were and our data thus suggests that sibling order is very
important. This may mean that when younger siblings are parented or protected by
older siblings they do not develop the same levels of knowledge or skills to identify
what constitutes a risky situation or how to manage the potential dangers associated
with parental substance misuse:
“I’m used to it. I had to put up with my Dad hitting my Mum. But he don’t
no more, but my [younger] sister ain’t had to put up with that, and she’s
not really old enough to know what it’s like.” ((Emily is 13 and her sister
Abigail is 10)
Well, I can tell when she’s [Mum] had something because her face looks
a bit dozy, sleepy and she normally falls asleep quite a bit ‘cause she
used to do it. My [younger] sister [she don’t know what’s right and what’s
wrong. She don’t know whether she’s took drugs or she don’ she
don’t know whether she’s safe, so my sister gets a bit confused with it all,
Yeah. How do you know that your sister doesn’t know like when
it’s right and wrong?
Because when I, I go Gemma, does it look like Mum’s had something?
And she goes, no. When I know that she has. (Meg is 11 and her younger
sister is 10)
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Although protected by their older siblings, the accounts of younger siblings often
reveal that they are aware of what is going on and of how much their older siblings
are doing to look out for them. Still, our data suggests that younger siblings, to
some degree, may become dependent on older siblings in dealing with their
How did you manage, like when this [Mum being drunk] used to
happen every day?
It was um, my [older] sister – she’s moved out now – she was quite young.
She was about 15, 16…So she had to deal, handle it mostly. (...)Yeah, and
my sister moved out...when my Mum came out of [hospital]…that was the
end of my sister. She was 16 and she moved out.
Okay then. So that was it?
Yeah, so there was no sister anymore.
No. Did that change things for you? It must have?
Yeah, cause we had to do it on our own. It was never as bad as what it was
before. But it was still – yeah sometimes my sister would actually have to
come all the way down back home to look after my Mum. But most of the
time we dealed with it ourselves. My older brother, he was mainly dealing
with it then. (Julia is 12 and her brother is 20)
What other stuff would, would you used to do, when things, you
know, when it was a bad day or things were getting bad?
Go up my [older] brother or my sister and tell them what’s
happened and see if they could come round and sort it out and stuff.
(Aiden is 13 and his sisters are 16 and 22 and his brother is 25)
While caring for younger siblings is described as a strenuous task, having younger
siblings who thus need you is nevertheless sometimes mentioned by older siblings
as a motivation to do well and as an important element in their own sense of getting
by. This is Leslie’s reflections on what helps her get through her Dad’s drug use:
(…) it’s Ethan, my brother.
I’ve always known that sooner or later, it’s going to be me that’s left
looking after him. I’m going to be the one that he’s looking to. He ain’t
got no-one else really. (...) And I know he needs me, otherwise I probably
wouldn’t be here. (Leslie is 16 and Ethan is 6)
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Dierent paces
Not only may siblings experience parental substance misuse differently due to their
place in the sibling order but our data also suggests that siblings often move at
different paces in how they feel about their parents’ use and in their attempts to
deal with it. As described above, some young people learn, over time, to accept
their parents, however, our data also suggests that siblings often find themselves at
different stages in this process towards acceptance. This is sometimes the cause of
conflicts between siblings when they do not agree on how to love and care about
(...) She [sister] was like, she would text me stuff and be saying, oh she’s
[Mum] not her Mum and all this.
She says she’s not her Mum?
Yeah. Which got me like mad about her text.
What do you think?
Well she still is my Mum really, isn’t she. (...) At the end of the day she is
her Mum really. She can’t just switch her off. (Kathy is 16 and her sister is
(...) Everybody [her siblings] has seen me as letting my guard go right
down and saying, “hello you should help Mum. She’s got nothing”.
Whereas Aiden [younger brother] was turning round and saying, “Kerry
she’s old enough, do you know what I mean, you can’t always, you’re not
always gonna be here” (...).
So he changed. He sort of had quite a different perspective
didn’t he?
Yeah. (...) it used to be the way that nobody could say a bad word about
my Mum. And now it’s like, well, he’s the way I was. (Kerry is 16 and Aiden
is 13)
Moreover, while older siblings have sometimes learnt to accept their parents’ risk
of relapse, often through experiencing parents’ repeated relapses in the past, they
are aware that their younger siblings are sometimes still full of hope in their parents’
recovery. Therefore, whilst older siblings may have moved away from investing hope
in their parents getting better, as a way of coping, this is complicated by being
linked back in to the experience of disappointment through younger siblings:
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I’ve got no hope for her [Mum] at all anymore and I really didn’t think that
was going to happen but it has (...)
So you, you used to have hope and you used to kind of want to
believe when she said, “I’m going to be straight, I’m not going
to use”?
Yeah I really, really did. And I can see that in my little brother. (...) she
didn’t even give me a [birthday] card. I don’t, that, I don’t care like, it
doesn’t bother me but for a young child [younger brother] when his
Mum doesn’t get him a card or a present like, I can see that being quite
upsetting. (Sally is 18 and her younger brother is 11)
Blurring of roles
Older siblings often take on the role of a quasi-parental sibling, hereby blurring the
roles between being a sister or brother and being a parent. Our data suggests that
older siblings may attempt to give their younger siblings the parenting that they
themselves never had for example discipline or emotional warmth:
I’ve always tried to protect his head, keep him a child as long as –
childhood’s too short anyway…but that’s never really going to be, but I
tried to, you know. (...) And, you know, I’ve always complimented him on
everything. (...) and, you know, I want him to feel wanted. (Leslie is 16 and
Ethan is 6)
However, parenting younger siblings is often complicated by parents’ shifting
substance misuse; sometimes they are parents, sometimes they are not. Our data
suggests that young people’s parenting role is sometimes a cause of tension and
arguments, especially during periods of recovery when parents come back on to the
parenting scene and issues around authority in relation to younger siblings have to
be negotiated between young people and parents. Through the accounts of young
people it is clear that they are aware of the blurring of roles and that it is potentially
problematic. As Dena recognises:
I do need to start seeing him as my little brother… rather than like, my
baby. (Dena is 17 and her younger brother is 10)
This is often linked to the realisation that caring for younger siblings involves down-
prioritizing their own needs and that this is potentially detrimental to their ability to
also take care of themselves. Moreover, young people also reflect on the fact that
their parenting role in relation to younger siblings may prevent parents from working
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towards recovery; that having to care for their children can be a motivation for
parents to get better:
I thought that maybe...that with Noah [younger brother] going with his
dad [removed by social services] that she [Mum] would wake up and see
that she needs to make a change… (Lauren is 17 and Noah is 12)
Me taking Ryan [younger brother] would be a bonus for her [Mum]
because then she hasn’t got that responsibility you know.
That’s right.
She’d be living the life that she wants to live. All the time she’s got Ryan
she’s got, she has got that little bit of responsibility.(Sally is 18 and Ryan is
And then things turned around [Mum getting better]. I can’t put my finger
on what it was.
But things that...I think actually it was as soon as we had the child
protection conference. I think that scared her. (...) they’re [social services]
threatening my Mum that they will [remove younger brother]. Which I
think is good. Like I like that. (Dena is 17 and her younger brother is 10)
However, despite feeling that the blurring of roles may, to some degree, work
against parents’ recovery young people struggle to give up their role as primary
carers as they also believe that while their younger siblings need their parents,
they also need to be cared for properly. Sometimes this can only be facilitated by
maintaining their role as carer:
(...) my little brother really wanted to move back [with Mum]. Like he really
misses his Mum. And I didn’t want him to move back on his own because I
know that like, um, he wouldn’t have been looked after properly, so I kind
of had to go with him. (...)But, yeah I knew that if I wasn’t there – I don’t
really know what would of – I don’t think that he, that he would’ve been
allowed to stay there [by social services] and stuff like that.
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Deciding whether or not to take on the role of primary carer for younger siblings
is difficult, especially when young people are about to move away from home or
are no longer living with their parents and siblings. As Sally describes, choosing
between herself and her younger brother is associated with feelings of selfishness:
gradually I realised that it comes to the point now where I’ve got my
own life to think about. My own worries. It’s not selfish, whereas before I
thought it was but it’s not.
Cause it’s not my… as much as I love my brother, and I can still love him
and look out for him… but he’s not my responsibility.
Coping together
Even though siblings are positioned differently in terms of exposure and knowledge
about their parents’ substance misuse, young people often find solace in having a
sibling to share their experiences with, especially if they are close to each other in
Were there any things that really helped you kind of get
through it?
Um, my little sister. She was there for me and I was there for her. (Macy is
13 and her sister is 8)
So we’ve just got through it, like, between us. I mean, me and my sister
was, like, we was like a couple, we was always doing things together.
We’d get through it together. (Nick and his sister are both 18)
(...) but me and my brother got quite close ‘cause…we were going
through the same things, so – we didn’t talk about it, but we knew what
each other was thinking (...). (...) me and Sam would always, like, we’d be
sitting there, and Mum would come downstairs, and we’d look at each
other be like, “Yeah, she’s pissed.” And we always knew. And I think – I
don’t know if it’s from his point of view, too, but from my point of view, if I
hadn’t have had my brother, it would have been a lot more harder. (Jackie
is 15 and her brother is 17)
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Jackie’s comment illustrates that while having each other is a mutual support this,
however, does not necessarily translate into siblings talking about their feelings
openly with each other. Our data suggests that siblings’ silent sharing of experiences
may be linked to growing up with their parents’ substance misuse together as their
sensed ‘normal’ and thus not as something which is easily verbalised. Sometimes
the accounts of young people reveal that this shared awareness makes talking seem
unnecessary or even unnatural:
They [older siblings] know what it’s been like and they don’t like him [Step-
Yeah. Were they quite shocked when you told them?
Told them what?
That, for example, that he was sort of using drugs quite a lot?
They already knew.
They did know, yeah.
I didn’t obviously tell them. They just knew. (Daniel is 12 and his older
brothers are 19 and 20)
Is there a particular reason why, why you think you don’t talk
about it – you and your brother?
Um, I suppose it’s cause we’ve never been really brought up to really
express how we, like, feel. Just kind of accept it and that’s it. Deal with
it kind of thing. (...) It would be really, really weird [to sit down and talk
about it]. It would be like sitting down and, yeah. I couldn’t picture it…
For other young people, not being able to talk openly with siblings is related to
ideas around protection. Kerry, for example, knows that her older sister has given up
a lot to care for her and her younger brother because of their Mum’s drinking and
that this responsibility is stressful. In talking about what this awareness means for
their ability to voice their feelings Kerry says:
I think she [older sister] don’t like to say anything [about being stressed
out from caring for them] because of it hurting our feelings. (…) I won’t
talk to her if she’s stressed out. (Kerry is 16 and her older sister is 22)
Similarly, Sarah is afraid that she will upset her younger sister Bianca if they start
talking about their Mum and her drug use:
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I like prefer to talk to my friends than Bianca about it.
Why’s that?
I don’t know, I just don’t like talking to Bianca about it in case I say
something wrong and upset her. So like, I leave Bianca to talk to her
mates about it so then, but like if she does want to talk about it she can
always like come and ask me or something. But I’ll wait till she comes to
me, instead of me going up to her. (Sarah is 13 and her sister Bianca is 12)
The majority of young people in the study had older or younger siblings and felt
that by sharing the experience they were coping with their parents’ substance
misuse together. However, a few young people felt that they were left to cope on
their own as siblings’ sometimes different prioritizations or feelings towards parents
meant that one sibling was left with the primary responsibility of dealing with
their parents’ substance misuse. Anna, for example, resents that her older brother
prioritized taking care of himself and left her alone with their mother:
I remember thinking, “well there’s not much good you being here now
Mark [older brother] because you walked out and I was 5 years old
and I had to look after this woman then who was like dribbling and not
washing” and, yeah, it was really hard. So I had all that resentment against
him. (Anna is 15 and her brother is 27).
Importantly, Anna feels that because she is the only child left it is even harder for
her to turn away from their mother, even if she wants to, because her mother would
then have nobody left to care for her. In this way, ‘coping together’ may not only
refer to the mutual support within sibling relationships but also to the fact that the
strategies for coping available to young people may be dependent on their siblings’
availability, feelings, and prioritisations.
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Key points
Sibling order matters; when younger siblings are parented or protected •
by older siblings they may not develop the same levels of knowledge or
skills to manage parents’ substance misuse.
Siblings often move at different paces in how they feel about their •
parents’ substance misuse and in their attempts to cope.
Older siblings often struggle to give up their role as primary carers and in •
consequence, often down-prioritize their own needs.
Siblings often share their parents’ substance misuse in silence. This may •
be linked to growing up with their parents’ substance misuse together as
their ‘normal’.
getting suPPort From Friends and ProFessionaLs
GEttinG SuPPort FroM
FriEndS And ProFESSionALS
Practices of friendship
Young people invest considerable effort in concealing their experiences from the
world outside their home as a way to protect against the threat their parents pose
to their everyday life with friends and at school. However, our data suggests that
trusted friends are sometimes allowed to transgress the boundary between home-
life and life outside the home and are thus a significant source of support for young
people (Bernays et al., forthcoming).
Disclosing to friends
The accounts of young people reveal that many of them do not talk to friends about
their parents’ substance misuse9. Some young people mentioned that they could
not see the point of friends knowing or just assumed that their friends already knew,
even if they had not talked about it directly. Many young people, however, feel that
their parents’ substance misuse is a private family matter, and not a subject which is
easily talked about:
You don’t have any mates that you, kind of, talk to about...?
No, ‘cause it ain’t really none of their business is it? I don’t care how
much mates they are.
No. So they don’t know about – like, about any of all this?
Yeah, they don’t (...)
(...) I don’t like talking about it. I’d prefer to keep it inside.
(...)What about your good friends and stuff, do they, do they
They know some parts of it, but no of course I won’t tell them. No, so
they don’t really know much.
No. You haven’t told them?
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So you don’t have that need to share it with them?
No, they don’t care anyway. I don’t have really close friends…
I have friends.
But not ones that I’d want to talk to about this with.
Young people’s anxieties about disclosing to friends need to also be understood
within the context of fragile friendships. Our data suggests that many young people
have been hurt by falling out with trusted friends who then told others about their
family life:
“Cause like Claire [younger sister], she told someone about everything
The drugs?
Yeah, and then they fell out and her friend was like, “well if you don’t do
this, or you don’t be friends with me again, I’m telling everyone that your
Mum used to do this”.
Others, like Julia, choose to build up a ‘public story’ about their family life which
discloses parts of what is going on – just enough to keep further inquisitive
questions, and thus a full disclosure, at bay.
So what do you – how do you explain it to your close friends?
Well, I just say, like, “My Mum and Dad’s been arguing, and they’ve been
having fights, and I have a Social Worker, somebody I can talk to,” (...).
They don’t, they – like they say, “You don’t have to tell me about all the
story, like, you can say what you want to say.”
Yeah, and you don’t want to tell them the whole story?
Well, I’ve only told one of my friends, Tina, obviously.
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(...) what my story is at the moment is that I say, “oh my Mum had this
accident a few years ago (...)”…and I just say, “yeah and I live with foster
carer and go stay with my Mum on the weekends so she has time to
recharge her batteries”…and that’s normally enough. I don’t need to go
into details about stuff. But yeah, it was really
hard to tell people like, the full story about it.
Okay. So you don’t, you have got people who know – friends –
who know the full story…
They know… they know, they know that my Mum’s an alcoholic…
When young people mentioned friends as sources of support the key priority in
forming and maintaining these supportive friendships was being confident that
they were able to trust their friends. To negotiate the uncertainty of how much you
can trust someone, our data also suggests that young people sometimes adopt a
strategy of selective disclosure; testing their friends’ trust by disclosing information
over time. Trust and loyalty in friendship is thus often demonstrated by being silent:
I told Rose and Jack something once and I’ve trusted them ever since
cause they never said nothing.
(...) that’s how close a friend he is, he wouldn’t say anything to anybody.
However, rather than disclosure necessarily being facilitated through talking,
our data suggests that friends often come to ‘just know’ by witnessing parents’
substance misuse or an episode of violence within the home. While this can
sometimes be through a dramatic one-off event, friends often come to know in
the same way that young people learn about their parents’ substance misuse;
incrementally through environmental exposure. This may make the need for explicit
disclosure unnecessary:
He knows because he actually always used to come and sleep over at my
Mum’s when I lived there...well he just knows it all.
Even after disclosure has happened through witnessing parents’ substance misuse
some young people prefer to still not talk about it with their friends:
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How come he [friend] knows?
Because he was there when it happened.
(...) Okay, have you talked – have you spoken about it?
No, not since it’s happened.
You’ve never chatted about it with him?
No, we’ve both just forgot about it, carried on.
Would you have liked to have spoken to him about it?
What do you mean?
Would you have liked to talk about it with him?
How come?
Just forget about it.
Yet, our data suggests that this silent indirect disclosure in time may lead to trusted
talk, and through the accounts of young people, friends’ awareness of parents’
substance misuse is described as a great source of support.
Talk and silence within friendships
The kinds of support that friends give are varied. Yet, the young people’s accounts
of friendship seem to orientate around their friends’ awareness of parents substance
misuse and of their ability to give the young people space and choice about when
and how they want to talk. Importantly, a friend’s awareness facilitates a more
nuanced understanding of young people’s home life which in turn makes it possible
for young people to talk more freely and critically about their family life without
feeling that they are disloyal to their parents:
She knows everything I’ve been through and she’s met my Mum and she
knows that my Mum’s not a bad person. Whereas with a proper outsider
you think well, maybe, perhaps she thinks my Mum’s really bad, and she’s
Moreover, a friend’s awareness of what is going on also enables young people to not
have to explain or talk about their family life all the time; friends learn to interpret
what kind of support is needed at particular moments:
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Friends and ProFessionaLs
What was it about her that made it okay to talk to her, do you
Well, I think she, kind of, knew what I was going through. And she, like,
when she could see that, like, I was having a bad day, she came up to me
and started talking to me and stuff.
We were with each other that much that we pretty much knew what each
other needed without having to be told. It’s like if I wanted a hug and a
shoulder to cry on, she’d know...but if I wanted my space, she’d know.
The importance of silent communication between friends was also emphasized by
Nathalie who was interviewed as Dena’s friend. Throughout her account she talks
about learning to read the situation and intervene to provide Dena an alternative
space to hang out when things get too tense at home and emphasises how she
makes sure to offer her support without explicitly talking about what is going on
with Dena’s Mum. This is not to suggest that Dena is not aware of this but rather that
support can be done in silence:
(...) like if I um, went over there and um, one night she like, I was seeing
that Lorna [Dena’s Mum] was getting really agitated or Dena was upset,
I’d be like, come stay at mine just watch a film or something. Not like
make it aware that she’s having a rough night, just be like, just come and
stay at mine kind of thing.
So it wasn’t something that you’d say directly you know…
No. (...) Yeah I’d just be like, just come and stay.
Yeah. Would Dena know…?
She’d know deep down what I was saying, but she would, like, we know
what we’re talking about without saying it…
-Nathalie (significant other)
Our data suggests that young people’s appreciation of silent support is linked
to their felt need to be in control of when and how to talk about their parents’
substance misuse. In particular, young people appreciate the conversational space
that their friends give them to talk or not talk about their experiences at home;
trusted, good friends tend ‘not to pry’ and ‘don’t ask direct questions all the time’.
This is not necessarily about avoiding talk, but just allowing the young person to be
in control of how talking is done:
getting suPPort From Friends and ProFessionaLs
when I want to talk about it I’ll bring it up and she [friend] will listen and
then tell me something so we’re kind of confiding together. She won’t ask
questions but wait for me to tell her.
Importantly, Sarah talks about the even power balance in this conversation; once she
says something, her friend may also tell her something. The support of friends may
thus seem to be effective in part because it can be reciprocal and therefore young
people do not feel that they are a burden. Talking with friends, however, is not only
about how they ask questions but also about how they listen. Nathalie for example
described having developed conscious practices of listening, such as avoiding direct
eye contact, as she figured out how Dena likes to talk:
I think Dena finds it easier if we’re doing something to talk, like if we’re
sitting in my room I just kind of look down or fiddle with something so
that she can talk to me.
-Nathalie (significant other)
A ‘space’ for respite
While silent support and friends’ ability to know when and how to talk and listen is
described by young people as a key element within their friendships, friends also
offered a space for fun and distraction from parents’ substance misuse. The accounts
of young people emphasise that friends can provide a space for respite. Not only
did young people spend time at their friends’ houses when their own home felt
unsafe but it was also in the company of their friends that they could laugh and be
cheered up. While this space can provide a distraction from what is going on our
data suggests that this space may also be used as a form of coping. Nathalie thus
describes how joking and laughing is an important part of her friendship with Dena
and how they find a way to communicate about serious issues through joking:
(...) the issues on there [tv-show] do relate to Dena…and we know that,
but we laugh about it and we make jokes like, “oh my god. He’s so
-Nathalie (significant other)
We came back and we were making like farm yard noises in Lorna’s
[Dena’s Mum] room. But obviously Lorna was knocked out like, asleep, she
didn’t realise. But it is really fun.
-Nathalie (significant other)
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Friends and ProFessionaLs
In this way, friends who are aware of what is going on and have a nuanced
understanding of parents’ substance misuse may be allowed to talk and joke about
parents in a way in which others are not.
Key points
Many young people do not talk to their friends about parents’ substance •
misuse. This needs to be understood within a context of fragile
friendships and uncertainty around ongoing trust.
Friends often become aware of parents’ substance misuse in the same •
way as young people themselves – through environmental exposure. This
often makes explicit disclosure unnecessary.
Young people appreciate the conversational space that their friends give •
them to talk or not talk about their experiences at home: trusted friends
don’t ask direct questions all the time.
Friends who are aware of parents’ substance misuse and have a nuanced •
understanding of what is going on may be allowed to talk about parents
in a way which others are not.
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Engaging with professionals
When asked what advice young people would give to others affected by parental
substance misuse, the majority mention ‘telling someone’ as an important way
to access support. Yet, our data suggests that there is a contradiction between
advice and practice. Talking to professionals such as teachers, social workers or
specialist parental substance misuse workers is often accompanied by feelings of
transgressing expected family loyalties by disclosing what is going on. Many young
people also fear that they will be removed from their parents as a consequence of
talking. Through the accounts of young people, issues around ‘trust’ and ‘knowing’
(similar to what young people value in friendships) emerge as key factors in their
willingness to engage with professionals and establish supportive relationships.
Teachers becoming aware
While young people invest in keeping their parents’ substance misuse hidden, some
do disclose to their teachers. Our data suggests that disclosure tends to happen at
crisis points when it becomes difficult for young people to maintain a separation of
life at home and life at school:
I used to talk to my teachers and everything…about that [Mum’s drug
use] cause they used to look after me as well while I’m at school because
I used to start crying…I used…I used to cry at school a lot and everyone
used to take the mickey out of me and they thought I was a wining baby
and I actually wasn’t…
Did you talk to any of the teachers, like, directly? Did they give
you any help with your problems at home?
My Head of Year, when I said – I remember I didn’t do my coursework and
he said, “Why not?” and I said, “Well my Mum’s been in – is in hospital
and I’m living here and I just I can’t do it” and he was, like, really shocked,
but he was really nice…to me about it.
First thing (...) when they split up, I went straight to my teacher, said,
“Miss, could I talk to you?” And then she said, “What’s up, Ben?” And I
says, “My Mum and Dad have split up.”
getting suPPort From
Friends and ProFessionaLs
However, many young people choose not to disclose to their teachers and instead
the school often becomes aware of the family situation through young people’s
low attendance or through their involvement with social services. The accounts of
young people reveal that without any direct communication with their teachers they
are sometimes uncertain about whether teachers know what is going on with their
parents, but often they assume that they must do. This assumption may be brought
about by experiences of being treated differently to their peers.
(...) I don’t know, I know it’s meant to all be confidential, but I don’t know
how, but I would just remember all the teachers were, like, they knew…
and they’d ask questions and they’d be, like, “Haven’t you done your
homework?” I’d be, like, “No, sorry.” They’d be, like, “Oh, don’t worry.”
And I just – I don’t know why, but I just knew that they knew (...).
The uncertainty around how much teachers know seems to link to a more general
lack of transparency and communication with young people about their parents’
substance misuse and who this information is passed on to. This may add to young
people’s anxieties about talking. As Dena’s comment above also shows, many young
people have experienced how information about their families is shared with others
and is thus experienced as being out of their control:
Did they [teachers] know what was going on at home?
Um, only cause of social services.
And how did social services find out?
Um, I can’t remember. Um, I can’t remember now.
Were you ever tempted to tell anybody what was going on
when it was bad?
Um, I didn’t really want to tell anyone…
Why not?
…it would make the situation worse.
Um, my head [of] house knows.
A teacher?
(...) How did they know?
Um, through social services I think.
getting suPPort From Friends and ProFessionaLs
That teachers and other professionals are aware of parents’ substance misuse,
however, does not necessarily, from a young person’s perspective, translate into
‘knowing’ what this involves or how this is experienced. The accounts of young
people show how they sometimes question professionals’ ability to fully understand
what they are going through and that this may be a barrier to also appreciate the
support that is offered:
Did the teachers understand the situation your Mum was in or
did they not know?
They, they thought they did but they didn’t really know what was going
on. Like they just knew that she was drinking but they never knew
anything else so they thought they knew what was going on but really
they were saying to me “I know what’s going on at home” but I was
thinking, “But you don’t know nothing”. And trying to be all nice to me
‘cause they think they know but really they don’t know nothing. That used
to wind me up as well.
‘Cause my year six teacher knew my Mum, so it was easier to talk to him.
It sounds to me, from what you’ve said, is that both with
Michael [friend] and him, it was easier in a sense to talk to
people who knew your Mum?
Why is that?
‘Cause, like, for people who don’t know my Mum, they don’t know what
you’re going through.
The same ideas around ‘knowing’ are also expressed by young people in relation
to their experiences with social services. Some feel that even though social workers
visit them at home they do not necessarily walk away with a realistic picture of
what their family life is like. This is linked to the idea that knowing can best happen
through experience (similar to young people’s appreciation of shared experiences in
friendships) and that the experience which social workers get during an announced
visit cannot capture their everyday lives:
(...) she [social worker] come around, which wasn’t a sort of unexpected
visit and so my Mum had time to…tidy up, and put food in and do you
know what I mean. It’s so unrealistic how they do it. It’s just, just ridiculous.
getting suPPort From
Friends and ProFessionaLs
And can, do you notice that your Mum prepares for it? Is it
Definitely. Like she’ll wake up, she won’t drink so much, she’ll clean up,
she’ll put food in the cupboard and milk. She might make a cake. You
know what I mean.
I phoned the social services on my Mum. Nothing seems to get done
about it. They ring up and they say yeah we’re going to be round on such
and such date at such and such time, that’s no good in my eyes. Cos then
she can be straight on that day and she can sort the house out a bit and you know what I mean (...).
Armed only with the information gleaned from such announced visits, it may be
difficult for young people to accept that social workers know what is best for them
and their families. Here, Dena describes how she decided to move away from her
Mum together with her younger brother, against the advice of social service:
(...) they [social services] told me not to go [and live elsewhere], and
literally the conditions that and my brother were in were just like
disgusting and their telling us like, you can’t go. So I, I’m pleased I made
the decision to take my little brother out of that, that environment. And
their decision, their decision was, I think, totally wrong.
Talking to social workers
When young people talk about their experiences with social services they often
mention social workers’ ways of accessing knowledge about their family as invasive.
This needs to be understood within a context of families’ concerns that their
involvement with social services may lead to removal, and for these reasons parents
sometimes tell their children not to say anything about what is going on:
(...) my Mum said that I shouldn’t tell them [social services] if my Mum was
drinking and all that but sometimes I actually told them.. ‘Cause she told
me that they’d actually take me away (...).
(...) so did it help in any way, that social services got involved?
Just thought they was a bunch of um... nosy gits.
getting suPPort From Friends and ProFessionaLs
As Paul’s comment also illustrates, our data suggests that young people tend
to interpret direct questioning, in the absence of trust, as interrogatory and
confrontational. While the perceived tone of questioning from social workers needs
to be understood within the context of child protection issues in which accessing
information is crucial, from a young person’s perspective this way of talking becomes
indicative of the imposition of external mechanisms of control. This is sometimes
experienced as undermining their capacity to explain or influence their own
They would just ask me all the questions all the time and I used to just
didn’t like it....’cause they was so direct. They wasn’t nice, it wasn’t as if
they’d come and say, “How are you?” It was coming in “Okay, so you’re
living with your Mum and your Mum’s blah, blah, blah and you…” and
they were so direct…and aggressive and straight to the point, boom, you
answer it this way or that way, like you can’t go, “Well.” It was horrible… I
kind of felt like I didn’t have a choice but to answer questions…and I felt
like I was constantly being analysed”.
There were, however, a few exceptions to this. Gemma, for example, liked how her
social worker “talked about things with us” and David appreciated his social worker’
(...) so if a social worker asks you a question about your Mum…
…do you want to tell them or not?
Yeah, yeah. Cause I know that they’re from the council and they won’t tell
...only their boss…which their boss won’t tell anyone…I hope. Cause if
they do they’re in trouble.
Also Lauren had a good experience with social services. Her comment demonstrates
the importance young people place on ways of talking and being in control:
(...) their [social services] interactions with me were good, but some
children just hate social workers and think they’re all evil. And the...the
social worker that I had, she was really nice, so. (...)
What do you think makes a good social worker?
getting suPPort From
Friends and ProFessionaLs
Um, when, they don’t tell you what to do. Like they listen to you. That
they take things slowly and don’t rush you into doing stuff.
A space to talk or ‘just be’
The majority of young people’s accounts engage with silence and talk as valuable
enabling elements in establishing supportive relationships over time, similar to
Lauren’s comment above. In examining the data for instances in which young
people feel confident talking to professionals these revolve around a relationship
with a teacher or specialist support worker who gives them a space for silence or
alternative talk. Allowing the young person to not talk about their experiences at
home appears to elicit trust and therefore enable a safe space to talk. The young
people in our study who mentioned their teachers as sources of support thus
especially valued the space that they had been given within school to ‘just be’:
If I was having an off day, she’d [Head Teacher] let me sit in a corner
on a beanbag and work in her office (...). She did it because she was
generally a caring person who recognised a child needed help…and
helped in the best way she thought was possible…which was giving her
a safe environment to work in where she could just be on her own, just
work…have a cup of tea and a biscuit and have someone to talk to that
she trusts…and that’s all anyone needs. That’s all people who are going
through the situation right now needs. That’s all I still need.
A similar viewpoint is expressed by Emily’s teacher, John, who was interviewed as
her significant other. John is only aware of few details in relation to Emily’s family
situation and while he doesn’t try to talk to her about it, and she never brings it up
when she sees him, she knows that he knows about her parents. John describes
supporting Emily by giving her the space that she sometimes needs within school
and by making sure that this space is available without her having to ask. Here, John
describes how Emily sometimes looks sad or withdrawn and how he then gives her
the opportunity to just be:
“Emily are you going to be finding it rough this morning? Yes sir. Well, just
go and sit in the corner”. (…) at times she just needed to be there and
be, and not talk about anything that was troubling her. Just to chat…and
I, that, that sense of normality and that sense of alternative parenting. (...)
Leave her be. “You alright Emily? Yep. When you’re ready. Take your time”
You nurse it.
-John (significant other)
getting suPPort From Friends and ProFessionaLs
Also Emily’s school therapist, Susan, acknowledges the supportive potential of a
space to just be:
(...) she didn’t have to talk. She just would sit. She would play with the
equipment, the play therapy activities, clay…things like that. (...) um, and
I would never ask Emily. If Emily wanted to tell me about it I knew Emily
would. But equally I think that Emily knew that I knew that if she came to
me she needed to…just sit…really.
-Susan (significant other)
Giving the young people the choice to talk, what to tell and at what pace seems to
be a key element also of the specialist support workers’ relationships with the young
people in our study. Here, Jamie talks about how his project worker allows for a
space for non-talk which establishes trust and respect:
She [key worker] knows if I say I don’t know then I don’t want to talk about
it yet, and that’s OK.
Lauren has a similar experience with her key worker:
He [key worker] changed that I could talk – when I first met him, I didn’t
want to talk to him. I was just, like, “Yeah, no,” I didn’t want to talk really
but now we talk about everything now. With him he didn’t just ask me
questions directly like, “Oh, what..?” We’ve met about 100 times and
not all of the time we’ve spoke about my Mum…and what’s going on.
So it’s, like, I can talk to him about other stuff and talk about that so it’s
not I’m just being nagged at answering questions…and I find that I’m
comfortable talking to him.”
Similarly Alex and Leslie value being able to talk with their key worker, often on their
own terms, about ‘everyday stuff’:
(…) we talk about sport, homework and all that. Like, you know, we don’t
have to talk about stuff… Like we can talk about school or people in my
class and all that.
getting suPPort From
Friends and ProFessionaLs
I don’t know, she [key worker] was almost that person that, you know,
if I didn’t want to talk, I’ll talk about general conversation. Ain’t like
somebody being nosey, you know, or… I mean, if we’d go somewhere if I
didn’t want to leave the car, we could stay in the car.
However, young people’s appreciation of being in control over when and how to talk
is not only about talking in itself. Our data suggests that this is as much about the
availability and accessibility of a space which is ‘theirs’ and which they can use how
they want to, as well as having a trusted adult available to support them on a regular
e importance of continuity in relationships
The majority of young people value spending time with the same adult over longer
periods of time, in order to allow space to develop the trust and rapport which
underpins effective communication. The key workers in our study who were involved
in short-term intervention work were therefore conscious that this may not be an
ideal form of support. Moreover, while short-term interventions equip young people
with important coping-skills some of the key workers interviewed wondered whether
short-term intervention left them potentially more vulnerable. This view-point is also
expressed by Emily’s therapist:
I think the [support work] that she was referred to enabled her to realise
what was going on. Um, which was a good thing in a way but also it
opened her eyes to the seriousness of Mum and Dad’s drug problem…
um, and the seriousness of her situation at home… living with these
parents. (...) of course the knowledge is a good thing, but again it opened
her eyes to the, to how bad her family situation really, really was. (...) Um, I
think sometimes then you’re left, or these children are left with a, “Oh my
God. This is it ‘cause who’s going to help me” (...).
-Susan (significant other)
However, young people do not only experience lack of continuity in relation to
support within specialist support services. The accounts of young people who had
built supportive relationships with their teachers illustrate that these relationships
are sometimes experienced as fragile over time, especially as young people change
schools. Many young people also felt that the involvement of social services might
not be sustained over time. After repeated experiences of having being ‘left’ by
professionals some young people may develop feelings of resignation, which in turn
may negatively affect their willingness to engage with professionals at a later stage:
getting suPPort From Friends and ProFessionaLs
I don’t see the point of having Social Workers. No? ‘Cause they don’t
really help and they just leave you after a while.
Establishing trust and moving beyond silences and non-talk takes time. Having
the same support person enables this process to take place and young people
appreciate the opportunity for a continuous relationship. Here, Ben and Sarah
describe the frustration of talking with different people and inevitably repeating
themselves and how the consistency of having one individual to talk to has been a
particularly helpful aspect of the specialist support service:
(…) it’s never a different person, ‘cause whenever I go to see somebody,
Paul in my school…there’s, like, six different people I have to go to...and I
don’t like it. No. And I just want one person to talk to...that I don’t have to
keep going there, and back there, and back to tell everybody, and I just
want one person.
And I didn’t want to have to keep repeating myself…and it were getting
on my nerves. But then like, with [support service] it’s like the same person
every time I come and see her. So, I don’t have to keep like, repeating
stuff all the time.
Some of the young people in our study were involved with the same key worker over
long periods of time and our data suggests that this creates a sense of availability
beyond the scheduled meetings. While some called their key worker or sent a text
message if something happened in between their meetings others just found solace
in knowing that their key worker was there and could be contacted.
getting suPPort From
Friends and ProFessionaLs
Key points
In the absence of early identification young people’s disclosure tends to •
happen at crisis points.
Professionals’ awareness of parents’ substance misuse does not •
necessarily, from a young person’s perspective, translate into ‘knowing’
what this involves or how it is experienced.
Young people appreciate professionals who give them the space to build •
trust as well as the choice to talk, what to tell and at what pace.
Young people’s repeated experiences of disrupted relationships with •
professionals may result in resignation and lack of engagement.
concLusion: imPLications For coPing and suPPort
Multiple and social harms
The findings from the Family Life Project support the current policy shift towards
‘whole family support’ (Social Exclusion Task Force, 2008), recognising the need for
family focused approaches that engage with family dynamics. The complex interplay
of actions and relationships within the family in the context of parental substance
use, mean that the strategies adopted by one individual are likely to affect and may
disrupt the coping strategies of others. Individuals within families may experience
multiple forms of hidden and social harms, and our findings have suggested
that parents’ and young people’s coping strategies over time may inadvertently
reproduce these. They may thus be both protective in the short term and a barrier
to further support. For example a young person may decide to deliberately conceal
their problems at school to protect themselves and their younger sibling from
being bullied, but this may perpetuate the harm at home. Minimizing the harms of
parental substance misuse requires sensitive understanding of the obstacles which
parents and young people face in disclosure and the need to tackle hidden and
social harms at the same time. Our findings illustrate that parents and young people
are concerned about protecting themselves, and each other, from a range of harms
(including social harms) and their prioritisation of risks and harms are likely to be
experienced differently.
concLuSion: iMPLicAtionS
For coPinG And SuPPort
concLusion: imPLications For coPing and suPPort
Enabling environments for help seeking and talking
Talking about the challenges of parenting in the face of drug use is not an A.
easy thing to do, and needs to be made much easier. Our data suggests that
some parents engage in a process of postponement, deferring the opportunity
to ‘face up’ to their situation. This suggests the need for earlier intervention
opportunities. Low threshold interventions, including harm reduction and drug
treatment services, might give greater emphasis to creating the opportunity
and space for parents who use drugs to talk about the challenges they face
as parents. However, in a climate in which the trope of ‘junkie parent’ prevails
in public debate there is a fine line between service efforts being feared as
unwanted surveillance or as harmful and services being perceived as helpful.
Parent-driven and peer-based interventions may thus create relatively ‘safe
spaces’ for help and talk.
The assumption amongst parents and young people that accessing help will lead B.
to children’s removal is dominant and often prevents parents and young people
from disclosing. There is a need for social services to transparently engage with
this fear: explaining to parents and young people the steps and procedures
involved in their engagement with the family and possibly working with other
parents who have successfully been through the process to provide support and
encouragement to parents coming into contact with social services. This supports
the holistic focus adopted in the Families First social work model in supporting
families affected by parental substance misuse (Woolfall, 2008).
School environments provide an important resource to support early disclosure. C.
For many young people their first point of adult support was a teacher at school.
Ensuring that links between the home and school are developed will help
teachers more fully ‘know’ and understand about a young person’s situation and
would help young people to more readily open up within school when something
happens at home. Our data showed that families particularly appreciated it when
pro-active family liaison officers or teachers successfully attempted to establish
a communication link with parents, as it made it easier for parents to feel ‘safe’
when their children are talking to professionals within school about the effects of
their parents’ substance misuse. In turn young people may feel more comfortable
opening up to professionals within the school knowing that their parents are
‘on board’ and have given their permission. A central concern of interventions
must be how they engage with the social harms of being identified with parental
substance misuse.
concLusion: imPLications
For coPing and suPPort
Understanding the inuence of family dynamics
Parental substance misuse may involve a blurring of roles which is further D.
complicated when parents are in a process of recovery. We understand recovery
as a process not as the end point. Family support is crucial even when the family
is no longer identified as ‘in crisis’, to help families rebuilding their relationships.
This is a crucial element in supporting a family and parent’s recovery, as the strain
on relationships can increase the pressure on relapsing.
When older siblings invest in protecting their younger siblings and in keeping E.
the family together as a way to reduce the harms of parental substance use this
may inadvertently keep the harms hidden as well as compromise young people’s
ability to prioritise their own self-care. There is a need for interventions which
implement support opportunities for younger siblings to mediate the weight of
the young people’s responsibilities to parent.
Young people affected by parental substance misuse are often the more ‘hidden’ F.
young carers and need to be recognised for a range of caring roles. Whilst
older siblings ‘grow out’ of support their sense of coping is often linked to the
wellbeing of their younger siblings which suggests a need for support services
to engage with their role as primary carers and keep older siblings informed
about their younger siblings. This may assist older siblings in moving on and in
considering their own needs.
Facilitated work with families
Parents and young people often struggle to communicate effectively about G.
parents’ substance misuse with parents’ postponing disclosure even in the face
of their children communicating to them that they know. There is a need for
support which focuses on communication between parents and children and on
developing the skills and language to talk about parental substance misuse. This
may be in the form of facilitated talking whereby parents and young people are
supported in discussing parents’ substance misuse within a safe space.
Whilst support for young people as individuals equips them with key skills for H.
coping with parental substance misuse this form of support essentially returns
them to an unchanged environment where the relationship dynamics remain the
same. Because young people’s coping is interwoven with other family members
there is a need for facilitated talk which engages with these relationships or, at
the minimum, takes these relationships, their influence and effect into account.
Ideally if support cannot involve the whole household, work with individuals
needs to be connected by an individual or joint working.
Although siblings grow up together with their parents’ substance misuse this I.
does not necessarily translate into direct talk, and siblings often worry about each
other’s feelings. Working more directly with sibling dynamics through facilitated
talking may prevent some of these anxieties as well as develop the opportunities
for support created by sibling relationships.
concLusion: imPLications For coPing and suPPort
Support should be easily available and continuous
There is a need for long-term support for young people, ideally where they J.
are involved with the same key worker over time to facilitate trust. In order to
improve their accessibility, young people should be able to contact services,
ideally their own key worker, out of hours. Whilst our data suggest that facilitating
long term retention of staff is preferable in supporting young people, this may
not be feasible within some service settings. In such cases effort should be made
to make the service accessible to young people by encouraging young people to
feel a connection with and establish trust in the service organisation, rather than
with just one individual. This would help young people manage staff turnover
without feeling let down. Services which ran an out-of-hours telephone service,
shared by project workers, seemed particularly effective at being accessible and
Friends occupy a unique role in helping young people navigate their way through K.
the experience of parental substance misuse, being able to offer support on
multiple levels. This suggests that the supportive role of friendships needs
to be taken seriously by services, especially during transition periods such as
changing school or moving house when the potential loss of friendships may be
experienced as significant by young people. Whilst this relates to young people
aged 12 and over, this is not a fixed category as there were some participants
who were 10 and 11 who also talked about the importance of their friendships.
There remains a strong need for greater cooperation between services, not only L.
between adult and children services but within children’s services, in particular
between young people’s key workers and social workers. This would facilitate
arrangements for additional support during transitional periods, for example
when young people are moving between schools, to ensure that there is
continuous support available to minimise the risks when a young person loses the
support of a trusted teacher.
Overall the study findings suggest that the absence of social
interventions that tackle the social harms associated with parental
substance use may limit the impact of current interventions as well as
reinforce hidden personal harms.
concLusion: imPLications
For coPing and suPPort
Table 1: Sample characteristics, young people
Pseudonym Age Drugs/alcohol Using parent
Abigail 10 drugs both
Adam 16 drugs Siblings
Aiden 14 alcohol Mum
Alex 11 drugs Dad
Andrew 15 alcohol Dad
Anna 15 alcohol Mum
Amy 10 alcohol Dad
Ben 12 alcohol Dad
Beth 14 alcohol Dad
Candice 11 drugs and alcohol Mum
Carla 16 alcohol Mum
Daniel 12 drugs and alcohol both
David 10 drugs and alcohol Mum
Dena 17 drugs and alcohol both
Emily 13 drugs both
Gemma 10 drugs both
Hannah 16 alcohol Grandparents
Helen 17 drugs Mum
Jackie 15 alcohol Mum
Jacob 12 alcohol Mum
Jamie 17 alcohol Dad
Jasmine 15 alcohol Mum
Jason 10 drugs and alcohol both
Jenny 11 alcohol Mum
Jessie 16 drugs Dad
Joe 13 drugs both
Julia 12 alcohol Mum
Kathy 15 drugs Mum
Kelly 10 drugs Dad
Kerry 16 alcohol Mum
Lauren 17 drugs Mum
Leslie 16 drugs Dad
Liam 13 alcohol Mum
concLusion: imPLications For coPing and suPPort
Maria 16 alcohol Mum
Macy 13 alcohol Mum
Meg 11 drugs both
Mike 12 drugs and alcohol both
Nick 18 drugs and alcohol both
Paul 12 alcohol Mum
Pete 12 alcohol Dad
Phil 15 drugs Mum
Rachel 10 alcohol Dad
Ruth 11 alcohol Mum
Sally 18 drugs Mum
Sam 11 drugs Dad
Sarah 13 drugs Mum
Simon 12 alcohol Dad
Tom 13 alcohol Mum
Zach 10 drugs and alcohol Mum
Zoe 17 alcohol Mum
Table 2: Sample characteristics, parents
Pseudonum Age Drug use Children Gender
Adio 49 former crack 3 boys, 3 girls Female
Ali 36 crack, heroin, alcohol 1 boy Female
Barbara 42 former alcohol, crack 1 boy Female
Carlo 38 former heroin injector 1 boy Male
Carmen 36 heroin, crack,
methadone (former injector) 1 boy, 1 girl Female
Dan 47 heroin injector,
bupremorphine 1 girl Male
David 42 alcohol 2 girls Male
Ebbe 50 heroin, methadone 1 boy, 2 girls Male
Erico 37 subutex (former heroin, crack) 1 boy Male
Ingrid 39 heroin, crack, methadone 2 girls Female
Jack 36 heroin chaser (former injector) 2 boys, 1 girl Male
concLusion: imPLications
For coPing and suPPort
Jan 48 methadone 1 girl Female
Jenni 31 heroin, crack, injector,
methadone 1 boy Female
Jon 50 methadone 2 girls Male
Kate 36 cocaine 5 boys, 2 girls Female
Kirsty 36 crack, heroin
(former injector) 5 boys, 2 girls Female
Larry 49 methadone, heroin
(former injector) 1 boy Male
Lou 51 heroin chaser, methadone
(former injector) 2 boys Male
Mary 43 crack (former injector) 1 boy Female
Mwansa 49 crack, cocaine 2 boys Female
Nadine 41 heroin chaser
(former injector) 1 girl Female
Nanu 35 methadone
(former injector) 1 boy, 1 girl Female
Pete 35 heroin chaser
(former injector) 1 girl Male
Rich 47 heroin injector, methadone 1 boy Male
Rob 41 heroin chaser 1 boy Male
Stef 31 former heroin and crack 2 girls Female
Sue 43 alcohol 1 boy Female
Zed 41 heroin chaser 1 boy Male
Ziggy 54 heroin and crack injector 1 boy Male
concLusion: imPLications For coPing and suPPort
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concLusion: imPLications
For coPing and suPPort
The study only included young people who were in contact with services offering specialist 1.
support in relation to parental substance misuse. Whilst young people outside of services may
be a particular vulnerable group whose voices need to be heard, we did not feel that it was
appropriate to invite them to take part in the research without having a specialist key worker
available post- interview to offer them support if necessary.
This gender ratio, with girls over represented, reflected the client profile of the services 2.
through whom we were recruiting participants.
These represent an under-researched area which requires investigation. The young people 3.
were included to highlight these relationships and because they were keen to be involved in
the study.
Information concerning disclosure of child protection issues was explained to the young 4.
people before carrying out the interviews. All the young people taking part in the research
were familiar with issues around child protection through their involvement with the specialist
support service and were comfortable talking about these.
We were aware that by introducing significant others into the research this could potentially 5.
introduce an increased risk of disclosure as there may be circumstances in which there is a
disparity between young people’s perceptions of significant others’ awareness concerning a
parent’s substance misuse and what significant others may actually know. To avoid any risks of
disclosure, we took care to assess how certain the young people were about their significant
others’ knowledge and took care not to include some of those nominated if we envisage this
introducing any risk. We emphasised to the young people that they should only nominate
significant others who were already aware of the young person’s involvement with the specialist
support services or in the research. Involving young people’s friends as significant others were
sometimes impossible as this required parental consent from their friend’s parents who were
not necessarily aware of what was going on.
All substance misusing parents taking part in the research were given information concerning 6.
disclosure of child protection issues as part of the informed consent process.
The majority of parent accounts relate to drug use. However, we found that although drug use 7.
might be more hidden than parents’ use of alcohol young people’s experiences of each appear
very similar.
Parents’ comments about separating drugs from family life refer to a separation of hard drug 8.
use rather than all drug use.
Our findings do not highlight significant gender differences in how young people approached 9.
and experienced talking with friends about parental substance use. We found that there were
slightly fewer boys who spoke openly about it with their friends. Amongst the young people
who did speak with their friends, their experiences appeared to be influenced by their ages
and particular circumstances rather than gendered patterns.
About the authors
Kathrin Houmøller graduated from the Department of Anthropology and
Ethnography, University of Aarhus with a specialism in medical anthropology. Since
January 2008 she has been working at the Centre for Research on Drugs and Health
Behaviour on the Family Life project, a qualitative longitudinal study of children and
young people’s experiences of family life affected by parental drug use. Her research
interests include the social impact of substance use, young people and families and
their process of caring and coping.
Sarah Bernays is a research fellow in the Centre for Research on Drugs and Health
Behaviour, which is based at the London School of Hygiene and Tropical Medicine,
University of London. She is trained as a social anthropologist and conducts research
with young people and families. Her research areas include substance use, HIV/
AIDS and the role hope may play in influencing risk. She is particularly interested
in conducting qualitative research with marginalised and/ or vulnerable groups and
how to best include them in participatory research and dissemination.
Dr. Sarah Wilson is a Lecturer in Sociology at the University of Stirling (Department
of Applied Social Science). She has been involved in several projects on parental
substance misuse in Scotland. Her PhD focused on HIV-positive mothers’ use
of statutory and voluntary social services. She is also a qualified solicitor, with
experience of practice in the areas of childcare and criminal law.
Prof Tim Rhodes is the Principal Investigator on this study. He is Director of the
Centre for Research on Drugs and Health Behaviour at the London School of
Hygiene and Tropical Medicine and leads a programme of research focused on
the social aspects of drug use and drug-related health harm. His work focuses
on the social science of HIV and hepatitis C risk and treatment, including in Russia,
South Eastern Europe and the UK, with a primary emphasis on qualitative studies.
© 2011 London school of hygiene & tropical medicine
Keppel Street, London, WC1E7HT
... A parent's capacity to meet their child(ren)'s needs in relation to basic care, safety and stability may be negatively impacted due to the physiological, financial, social and lifestyle implications of substance use (Staton-Tindall, Sprang, Clark, Walker, & Craig, 2013). Substance misuse can also lead to inconsistency and instability in household routines as well as in caregiver behaviour and emotional responses (Horgan, 2011;Houmoller, Bernays, Wilson, & Rhodes, 2011). ...
... Qualitative studies have found that children report feeling anxious, angry, fearful, depressed and isolated as a result of their parent's substance misuse (Templeton, Velleman, Hardy, & Boon, 2009;Turning Point, 2006). These feelings conflict with, and are exacerbated by, the deep sense of love and loyalty that children may feel towards their parents (Houmoller et al., 2011). PSM also affects children's health and development with studies showing that exposure to substances in utero can lead to cognitive and developmental delay across childhood and into adulthood (Irner, 2011). ...
... Likewise, the parenting needs reported are those that have been found to impact significantly on children living with PSM, such as safety (Sprang, Staton-Tindall, & Clark, 2008), stability (Velleman & Orford, 1999) and family functioning (Houmoller et al., 2011). However, what this study does distinctively show is the frequency of these issues at the point of referral to CSC. ...
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Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.
... S. Lester, et al. Children and Youth Services Review 118 (2020) 105429 supportive, trusting relationships (Barn, 2010;Chouliara et al., 2011;Collins & Barker, 2009;Driscoll, 2013;Fraser, McIntyre, & Manby, 2009;Gaskell, 2010;Grant, Repper, & Nolan, 2008;Griffiths, Norris, Stallard, & Matthews, 2012;Houmoller, Bernays, Wilson, & Rhodes, 2011;Jobe & Gorin, 2012;Luke & Coyne, 2008;Madigan, Quayle, & Cossa, 2013;Matthews & Sykes, 2012;McMurray, Connolly, Preston-Shoot, & Wigley, 2011;Montgomery, Pope, & Rogers, 2015;Munro, Lushey, & Ward, 2012;Winter, 2010). Supportive relationships with professionals were described as 'the cornerstone' (Grant et al., 2008) of effective engagement and service delivery Relationships with peers -'you were with so many people in the same situation ' Relationships with peers, whilst an invaluable source of support for some, were challenging for others due to stigma, shame and practical issues. ...
... (Brewer & Sparkes, 2011, young person) This element of peer support was also valued by a young person who had experience of being in a care home: "In a children's home everyone has something in common and it's like 'oh why are you here then, what's your story' you know." (Gaskell, 2010, p. 141) A sense of 'shared experience' (Griffiths et al., 2012;Houmoller et al., 2011), 'solidarity' (Saha et al., 2011) or common identity (Grant et al., 2008) with peers was considered important in helping people to overcome the emotional impact of ACEs. In one study on victims of sexual abuse sharing experiences in a group setting an author noted that participants "changed their negative self-attributions, minimised their selfblame and unburdened themselves from feelings of guilt and responsibility for abuse" (Saha et al., 2011, author description). ...
... The majority of studies (n = 13) noted the ability of formal services to provide support, either through foster carers (Barn, 2010;Driscoll, 2013;Madigan et al., 2013;Matthews & Sykes, 2012) or a range of other types of professionals including social workers (Fraser et al., 2009;Houmoller et al., 2011;Jobe & Gorin, 2012), project workers (Grant et al., 2008), support workers (Houmoller et al., 2011), outreach workers (McMurray et al., 2011, leaving care personal advisers (Munro et al., 2012), therapists (Chouliara et al., 2011), healthcare professionals (Griffiths et al., 2012;Montgomery et al., 2015), and teachers (Driscoll, 2013;Fraser et al., 2009;Houmoller et al., 2011). ...
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Background: Adverse Childhood Experiences (ACEs) such as, physical and sexual abuse, neglect, or living in a household with domestic violence or substance misuse, can have negative impacts on mental and physical health across the lifecourse. A deeper understanding of the kinds of services that people affected by ACEs feel they need to overcome these negative impacts is required. Review question: How do people affected by ACEs between the ages of 3 to 18 experience support and services in the UK? What are their needs relating to services and support? Methods: Systematic review of qualitative evidence. We harvested relevant studies from existing systematic reviews of qualitative evidence located through a search of 18 databases. Included studies needed to be published in or after 2008, conducted in the UK, and report the views of people exposed to ACEs relating to their service needs. We included studies with participants who were affected by ACEs between 3 -18 years old with no restriction on the age at which they accessed services. Results: We identified 71 reviews from which we harvested 238 references on title and abstract screening. Following full text screening and quality and relevance appraisal we included 20 studies. Each of the included studies focussed on a specific ACE population. Almost half focused on young people who were fostered, looked-after or leaving care. No studies focussed on parental incarceration or divorce. Young people value emotional and practical support. Service providers were most valued for displaying empathy, being non-judgemental, and being active listeners. Supportive relationships, especially with adults, are a key factor in feeling understood. Conclusions: People affected by ACEs describe the importance of stability and continuity in the support they receive. These factors are important for allowing necessary time to overcome obstacles and build up trust. Research often frames response to ACE in terms of short term individual psychological outcomes but these findings highlight the importance of focussing on wider social factors to encourage meaningful engagement with services.
... Children living with parents with drug and alcohol problems often seek help from friends and family (Bancroft 2004;Houmøller et al. 2011), and most remain living with friends and family (Rees 2011;Rees and Lee 2005;Wade and Rees 1999). However, there may still be significant risks to this group; one-sixth of youth have been physically or sexually assaulted when staying with friends and one in twenty have been assaulted when staying with relatives (Wade and Rees 1999). ...
Full-text available
The disappearance of children has become a public social issue that has captured the attention of many in the last two decades, especially because there is not a worldwide consensus on the definition of “missing child”. This research analyzed events of missing children from 2000 to 2020 in Italy; data were collected from the main national sources of information: the websites of two Italian press agencies (ANSA and Adnkronos) and the four main Italian newspapers (Il Messaggero, La Repubblica, Il Corriere Della Sera, La Stampa) with a double-blind procedure. Our data show that male minors disappear to a greater extent than female minors and the disappearance of Italian minors is more represented than that of foreign minors. The majority of minors are found and when they are found they are still alive often within the first week after the disappearance. Our data shows that children disappear between the ages of 0–5 more than the cases involving adolescents. Also, of 182 missing and found children, information regarding the presence of abuse was reported in only 18 cases. The data of the present study were discussed in comparison with those of the Italian Government’s Extraordinary Commissioner for Missing Persons highlighting differences between the official data on missing children and those reported by newspapers; this study is intended to highlight a growing focus on the phenomenon, not only from a media perspective but also from an institutional one.
... They may spend periods of time away from their parent with other family members, or in the care of the local authority. At the same time, children can remain optimistic about the future and express love and concern for their parent (Houmoller et al., 2011;Adamson and Templeton, 2012). ...
Full-text available
Purpose The purpose of this paper is to present the findings from an evaluation of an intervention (Moving Parents and Children Together (M-PACT+)) aiming to address the effects of parental substance misuse (PSM) in school settings. The paper considers the evidence of effectiveness, and goes on to explore how schools were involved with the intervention. Design/methodology/approach A theory of change was developed for the intervention, which identified key steps of change that were expected for the beneficiaries (family members and children). Mixed methods were then used to form a portfolio of data to support or refute the theory. The data included quantitative validated scale data and questionnaires at various points in time with staff, and participants (including children), and qualitative data obtained from school staff, intervention staff, families and children. Findings This paper concludes that the evidence supports the theory that providing M-PACT+ in school settings can begin to address the effects of PSM for the families that engage with it. Further, the paper shows that the ethos of the schools involved influences how families are identified and referred, and that interventions of this kind are most likely to succeed where they are integrated into an ethos where there is a shared responsibility for a broad child well-being agenda between schools and other community agencies. Originality/value This paper explores the evaluation of a unique family intervention. The findings will be of value to those seeking to implement such interventions in partnership with schools and/or community agencies.
A child goes missing every five minutes in the UK, exposing them to dangerous circumstances and severe consequences. This study aims to discover what variables might predict the transition from one-time (low risk) to repeat (high risk) runaway episodes in Sussex and West Mercia. A large anonymised dataset was provided by the Sussex and West Mercia police forces, consisting of 1,188 missing child cases, of which 1,158 had run away from home in these regions between 1st November 2016 and 28th February 2017. Using an exploratory approach, Chi squared analyses and a binary logistic regression were carried out in order to determine what factors were most significantly associated with runaway risk. These analyses resulted in a final 7-factor model: being in social services care, being known to the Youth Offending Services, being above the age of 12 years, having a criminal record, substance abuse, child sexual exploitation and family discord. This 7-factor model resulted in an accurate classification of 70% of cases. In order to better protect children by preventing repeat runaway episodes, this model should be applied in addition to current methods to better classify children as low risk or high risk. These suggestions are discussed further.
This paper details a study that listened and empowered an adult (Beth, a pseudonym), through the use of a life story methodology, to reflect on her childhood experiences of parental drug misuse. Voice Relational Analysis was applied to Beth's life story to assist the researcher to unravel and cipher, through the complexities and nuances of her voice, Beth's familial relational experiences and the lengthy lineage these have had on her ability to relate with others. This paper highlights the somewhat complex composition of her interpersonal relationships and reveals how she related both positively and negatively within them.
Influenced by legal conceptions and institutional approaches, much literature on difficult family circumstances has focused on identifying the abuse and neglect suffered, and potential ‘outcomes’ for children and young people, including the risks that such experiences may pose for their future lives. This chapter, in contrast, highlights the importance of examining children’s and young people’s understandings and lived experience of such phenomena. As Newman (2002) argues, the meanings that children themselves attach to adversity are important, and these understandings may vary between children and adults. Work in geography, sociology and other disciplines associated with childhood studies, and the innovative methods they employ, may help to develop such understandings. Such work includes explorations of children’s autonomy in different spaces, and the importance of the everyday sensory, embodied and affective dimensions of children’s and young people’s spatial experience and place-making. This work also rejoins recent considerations of children’s emotional geographies (Blazek and Windram-Geddes, 2013).
This chapter critically explores the development of services for children and young people affected by parental drug and alcohol use. How children and young people are conceptualized, whether as ‘helpless victims’ or as ‘problem solvers and inter-dependent contributors’, ultimately affects how services are designed and developed. The chapter is divided into three sections. The first section, Being Counted, considers the prevalence of children and young people currently living with parental drug and alcohol use, as well as the sources relied upon to identify this often hidden group. The second section, Being Heard, explores common themes emerging from listening to these children and young people, and the effects parental substance misuse has on family and school life, creating multiple problems. The third section, Being Included, considers the development of direct services for children and young people affected by parental drug and alcohol use, and the principles that should underpin their engagement.
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We review how research over the past decade both supports existing knowledge about the risk factors that children in the UK affected by parental substance misuse face, and adds to our knowledge about the protective factors, protective processes and evidence of resilience which can reduce the likelihood that children will experience poor outcomes. Further research is needed to understand what areas of resilience are most important to target and how other variables, such as gender or age, may influence how protective factors affect the development of resilience. Longitudinal research is also needed to better understand how an individual's resilience may change over time. Finally, there remain many considerable challenges which practitioners, service providers, commissioners and policy makers face in better meeting the needs of this population of children.
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Concern is increasing about children growing up in families where there are substance use problems but relatively little is known about the perspectives of the children themselves. We report on a qualitative study with young people who grew up in such families, exploring their accounts of their daily lives at home, school and leisure. We focus on the everyday interactions, practices and processes they felt helped them to ‘get by’ in their challenging childhoods, showing how the protective factors thought to promote ‘resilience’ were seldom in place for them unconditionally and without associated costs.
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The existing estimates of there being 250,000 - 350,000 children of problem drug users in the UK (ACMD, 2003) and 780,000 - 1.3 million children of adults with an alcohol problem (AHRSE, 2004) are extrapolations of treatment data alone or estimates from other countries, hence updated, local and broader estimates are needed. The current work identifies profiles where the risk of harm to children could be increased by patterns of parental substance use and generates new estimates following secondary analysis of five UK national household surveys. The Health Survey for England (HSfE) and General Household Survey (GHS) (both 2004) generated consistent estimates - around 30% of children under-16 years (3.3 - 3.5 million) in the UK lived with at least one binge drinking parent, 8% with at least two binge drinkers and 4% with a lone (binge drinking) parent. The National Psychiatric Morbidity Survey (NPMS) indicated that in 2000, 22% (2.6 million) lived with a hazardous drinker and 6% (705,000) with a dependent drinker. The British Crime Survey (2004) and NPMS (2000) indicated that 8% (up to 978,000) of children lived with an adult who had used illicit drugs within that year, 2% (up to 256,000) with a class A drug user and 7% (up to 873,000) with a class C drug user. Around 335,000 children lived with a drug dependent user, 72,000 with an injecting drug user, 72,000 with a drug user in treatment and 108,000 with an adult who had overdosed. Elevated or cumulative risk of harm may have existed for the 3.6% (around 430,000) children in the UK who lived with a problem drinker who also used drugs and 4% (half a million) where problem drinking co-existed with mental health problems. Stronger indicators of harm emerged from the Scottish Crime Survey (2000), according to which 1% of children (around 12,000 children) had witnessed force being used against an adult in the household by their partner whilst drinking alcohol and 0.6% (almost 6000 children) whilst using drugs. Whilst harm from parental substance use is not inevitable, the number of children living with substance misusing parents exceeds earlier estimates. Widespread patterns of binge drinking and recreational drug use may expose children to sub-optimal care and substance-using role models. Implications for policy, practice and research are discussed.
We outline the huge literature on the potentially negative impact on children of growing up with a parent who has an alcohol or drug problem, the risk factors that can exacerbate this effect, and resilience and the protective factors that can reduce it. Clear ways that practitioners can intervene to reduce risk and to increase resilience are discussed. All practitioners have a responsibility to work in holistic ways if damage to children and families is to be avoided, and we summarise the key common skills needed to work with individuals (children as well as adults) and families. The differences between a resilience and a deficit approach are outlined.
Children of drug dependent parents form a large and growing population at elevated risk of adverse developmental and social outcomes. In this study 36 children and young people described growing up in such families. Parents tried to shield children from exposure, however the majority of young people demonstrated a detailed awareness of their parents' problem with drugs whilst living with the parentally imposed fiction that drugs were not at the heart of their family dynamic. Children and young people are locked into a silence they find difficult to unburden to anyone. The policy imperative is recognition of the impact on children of living daily with parental drug dependence and means of ameliorating their living circumstances in ways that do not label them further.
Parents who use drugs parent in a context of heightened concern regarding the damaging effects of parental drug use on child welfare and family life. Yet there is little research exploring how parents who use drugs account for such damage and its limitation. We draw here upon analyses of audio-recorded depth qualitative interviews, conducted in south-east England between 2008 and 2009, with 29 parents who use drugs. Our approach to thematic analysis treated accounts as co-produced and socially situated. An over-arching theme of accounts was 'damage limitation'. Most damage limitation work centred on efforts to create a sense of normalcy of family life, involving keeping drug use secret from children, and investing heavily in strategies to maintain ambiguity regarding children's awareness. Our analysis highlights that damage limitation strategies double-up in accounts as resources of child protection as well as self protection. This illuminates tensions in the multiple functions that accounts of damage limitation can serve. We draw a distinction between accounts in which damage is qualified and those in which damage is accepted. Accounts of damage qualification highlight a theme of 'good enough' parenting. Accounts of damage acceptance highlight a theme of 'recovery'. We find that the interview accounts operate in response to a regulative norm of 'good parenting' in which one strives to deflect damaged identity through narratives of damage qualification and to seek understanding and acceptance through narratives of recovery. Noting the absence of space for parents who use drugs to openly reflect or talk about the challenges they face, we identify the need for social change interventions to create enabling environments for earlier help seeking and talking.
To review the literature on the impact of parental problem drug use on children, and indicate the efficacy of key evaluated interventions to reduce the impact of parental drug use on children. Comprehensive narrative review of English language published research and intervention spanning the last three decades identified through searching library databases and citation. Problem drug use can impede parenting and the provision of a nurturing environment. Although small-scale, localized and resource-intensive these key evaluated interventions show cautious optimism that problem drug-using parents can reduce drug use and achieve better family management. Children have rarely been directly the focus of intervention. Wider application and more rigorous evaluation of interventions in this area are needed. Given the scale of the problem it is important to establish how statutory services can apply the lessons of these more localized interventions.
Hidden Harm: Responding to the needs of children of problem drug users. Advisory Council on the Misuse of Drugs
ACMD (2003) Hidden Harm: Responding to the needs of children of problem drug users. Advisory Council on the Misuse of Drugs.
Hidden Harm Three Years On: Realities, Challenges and Opportunities. Advisory Council on the Misuse of Drugs
ACMD (2007) Hidden Harm Three Years On: Realities, Challenges and Opportunities. Advisory Council on the Misuse of Drugs.
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