Family Alcohol Misuse

1. Family Alcohol Misuse Dr Paul Toner Department of Health Sciences University of York

2. Parental Alcohol Misuse • Parental alcohol misuse is a major societal issue (Harwin, 2011). • No accurate prevalence figures in the UK. • Estimates put this figure at 3.3 to 3.5 million children living with parents whose alcohol consumption ranges from increasing risk to dependency (Manning et al., 2009).

3. Parents who misuse alcohol can experience problems across other areas of their family lives. Including:external stressors such as housing and financial strain, mental health problems, unemployment and lack of social engagement (Kroll, 2004). • Parental alcohol misuse can also adversely affect children growing up in this environment, impacting on attachment (Flores, 2001), family dynamics, relationships and functioning (Velleman & Templeton, 2007).

4. In the UK newbornsand children under three are known to be at particular risk of neglect and physical harm (Forrester & Harwin, 2011). • An additional factor in these children’s vulnerability lies in the high proportion of women with alcohol misuse problems who are parenting alone or with serial partners who also have a substance misuse problem (Chance & Scannapieco, 2002). • Parental problem substance use is also one of the most prominent reasons for children being received into the care system (Porowski et al., 2004).

5. There is also evidence that children with a family history of problem alcohol use are at increased risk of developing substance misuse problems themselves (Osterling & Austin, 2008). • Given the complexities inherent in families where there is parental alcohol misuse, it is perhaps unsurprising that interventions have not been readily developed and evaluated to address the needs of this population.

6. A way forward • Addiction services and child protection systems have developed separately, as policy and practice environments, holding different professional values and focusing on different issues (Kroll and Taylor, 2003). • Nonetheless, there is general agreement in the field that multi-agency, holistic approaches are needed in terms of meeting the complex and multiple needs of families with alcohol misusing parents (Barnard, 2007).

7. There are a number of holistic services which have been established in recent years, including the Family Alcohol Service, Option 2, Families First and the Family Drug and Alcohol Court. • The rationale is to provide intensive interventions to help bridge the gaps between child and adult services by protecting vulnerable children, while concurrently improving parenting capacity (Forrester & Harwin, 2011). • Evidence of effectiveness is still emerging.

8. Research has highlighted the pivotal role that families play not only as a risk for, but also a protection against, substance-related problems (Vellemanet al., 2005). • More evidence is currently available which indicates that family focused interventions primarily aimed at the needs of children and adolescents as the focal clients are promising. • Including preventative approaches such as The Strengthening Families Programme (Kumpfer & Alvarado, 2003). • And treatment approaches, for example, multidimensional family therapy (Liddle et al., 2001).

9. A focus on young people • Early onset of alcohol use in children and young people has been associated with later problematic use (Hingson et al., 2006). • Also early onset and early hazardous use has been associated with a range of other problems including risky sexual behaviour, injury, antisocial behaviour, violence and changes in brain development (Jones et al., 2007; Brown et al., 2008).

10. Furthermore, when investigating the impact of substance use on the family, research has shown that alcohol use among young people can adversely affect relationships with parents and other family members (Copello et al., 2005). • In addition, family involvement in interventions has been shown to influence the course of the problem in a positive way (Velleman et al., 2005).

11. Among school-age children, while proportions of those drinking at all have dropped slightly since 1988, the average units consumed increased markedly between 1990 and 2006 and this has since stabilised at this higher level (Smith & Foxcroft, 2009). • Contrary to popular perceptions, average alcohol consumption among young adults (aged 16 to 24) has fallen since a peak in 2000-2002. • Nonetheless, 15 to 16 year olds in the UK have one of the highest rates of underage drinking and drunkenness in Western Europe (Hibell et al., 2007).

12. Rationale for a new approach • Reviews of evaluation studies have shown family-based approaches to be effective in reducing drinking among young people (Tripodi et al., 2010). • However, problems remain with regards to engagement of family, treatment decay and translating research into practice. • A key factor appears to be the resource-intensive nature of many family interventions, making them difficult to implement and deliver in many service settings, especially in the context of substantial cuts to drug and alcohol services for young people.

13. SBNT • Originally developed as part of the United Kingdom Alcohol Treatment Trial (UKATT). • Utilising cognitive and behavioural strategies Social Behaviour and Network Therapy helps clients build family and social networks supportive of change. • A key strength of the approach is the primary focus on addressing alcohol problems by engaging with a network of positive support for lifestyle change (Copello et al., 2009).

14. Y-SBNT • SBNT has additional advantages to help sustain engagement with vulnerable young people who may be disconnected from their families by broadening the reach of the intervention beyond the traditional family to include supportive peers. • Core strategies include motivational techniques, improving communication and coping mechanisms and crucially given the nature of alcohol misuse developing a network-based relapse management plan. • The therapeutic approach also has scope to address client focussed elective areas, for example, educational requirements (Copello et al., 2009).

15. Y-SBNT Study • A pilot feasibility study: • 2 sites Birmingham and Newcastle. • Random allocation of 30 cases in each site. • 15 cases receive Y-SBNT. • 15 cases receive TAU. • End of treatment and 12 month follow-up. • Quantitative and qualitative measures.

16. References • Harwin, J. (2011). New approaches to parental substance misuse. Public Service Review, 3, 306-307. • Manning, V., et al. (2009). New estimates of the number of children living with substance misusing parents: results from UK national household surveys. BMC Public Health, 9, 377. • Kroll, B. (2004). Living with an elephant: Growing up with parental substance misuse. Child & Family Social Work, 9(2), 129-140. • Flores, P. J. (2001). Addiction as an attachment disorder: Implications for group therapy. International Journal of Group Psychotherapy, 51(1), 63-81. • Velleman, R., Templeton, L. (2007). Understanding and modifying the impact of parents’ substance misuse on children. Advances in Psychiatric Treatment, 13(2), 79-89. • Forrester, D., Harwin, J. (2011). Parents who misuse drugs and alcohol: Effective interventions in social work and child protection. Chichester: Wiley-Blackwell. • Chance, T., Scannapieco, M. (2002). Ecological Correlates of Child Maltreatment: Similarities and Differences Between Child Fatality and Nonfatality Cases. Child and Adolescent Social Work Journal, 19(2), 139-161. • Porowski, A. W., et al. (2004). Effectiveness and sustainability of residential substance abuse treatment programs for pregnant and parenting women. Evaluation and Program Planning, 27(2), 191-198. • Osterling, K. L., Austin, M.J. (2008). Substance abuse interventions for parents involved in the child welfare system: evidence and implications. Journal of Evidence-based Social Work, 5(1-2), 157-189. • Kroll, B. , Taylor, A. (2003). Parental substance misuse and child welfare. London: J. Kingsley. • Barnard, M. (2007). Drug addiction and families. London: J. Kingsley. • Velleman, R., et al. (2005). The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions with a focus on young people. Drug and Alcohol Review, 24(2), 93-109.

17. References • Kumpfer, K. L., Alvarado, R. (2003). Family strengthening approaches for the prevention of youth problem behaviors. American Psychologist, 58, 457-465. • Liddle, H.A., et al. (2001). Multidimensional family therapy for adolescent drug abuse: results of a randomized clinical trial. American Journal of Drug &Alcohol Abuse, 27(4), 651-88. • Hingson, R., et al. (2006). Age of alcohol-dependence onset: associations with severity of dependence and seeking treatment. Pediatrics, 118, 755-763. • Jones, L., et al. (2007). A Review of the Effectiveness and Cost-Effectiveness of Interventions Delivery in Primary and Secondary Schools to Prevent and/or Reduce Alcohol Use by Young People under 18 Years Old: Final Report. London: National Institute for Health and Clinical Excellence. • Brown, S., et al. (2008). A developmental perspective on alcohol and youths 16 to 20 years of age. Pediatrics, 121, 290–310. • Copello, A., et al. (2005). Family interventions in the treatment of alcohol and drug problems. Drug & Alcohol Review 24(4), 369-385. • Smith, L., Foxcroft, D. (2009). Drinking in the UK. An exploration of trends. York: Joseph Rowntree Foundation. • Hibell, B., et al. (2009). The 2007 ESPAD Report: Substance Use Among Students in 35 European Countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs. • Tripodi, S.J., et al. (2010). Interventions for reducing adolescent alcohol abuse. A meta-analytic review. Archives of Pediatrics & Adolescent Medicine, 164(1), 85-91. • Copello, A., et al. (2009). Social Behaviour and Network Therapy for Alcohol Problems. Brunner Routledge.