Substance Misuse and Families: Social Work Guide

Understanding Parental Substance Misuse

Parental substance misuse is one of the most common factors in child protection cases. It can affect parenting capacity, child safety, and family functioning. However, not all substance use poses the same risks—the key is understanding how substance use affects parenting in each specific case.

Substance misuse often co-exists with mental health difficulties and domestic abuse—sometimes called the "toxic trio"—requiring a comprehensive approach to assessment and support.

Types of Substance Misuse

Alcohol

• Most commonly misused substance
• Effects on supervision and responsiveness
• Withdrawal can be dangerous
• Often normalised and hidden

Opiates (Heroin, Prescription Painkillers)

• Sedating effects on parenting
• Associated lifestyle risks
• Substitute prescribing available

Stimulants (Cocaine, Amphetamines)

• Chaotic patterns of use
• May cause paranoia or aggression
• Financial impact on family

Cannabis

• Often seen as less harmful
• Can affect motivation and attention
• May mask other issues

Impact on Children

Direct Risks

• Neglect of basic needs
• Lack of supervision
• Exposure to drug paraphernalia
• Exposure to substance-using adults
• Witnessing intoxication

Indirect Risks

• Financial pressures
• Criminal involvement
• Inconsistent parenting
• Emotional unavailability
• Children taking on caring roles

Child's Experience

• Unpredictability and chaos
• Fear and worry
• Shame and secrecy
• Taking on inappropriate responsibilities

Assessment

Understanding the Substance Use

• What substances are used?
• Pattern of use (daily, binge, chaotic)
• Amount and frequency
• How is it funded?
• Treatment history

Impact on Parenting

• When does the parent use?
• How does it affect their behaviour?
• Who cares for children during use?
• What do children witness or experience?

Working with Drug and Alcohol Services

Key Partners

• Community drug and alcohol teams
• Prescribing services
• Residential rehabilitation
• Detoxification services
• Recovery support services

Joint Working

• Share safeguarding concerns
• Attend joint appointments
• Coordinate treatment and children's timescales
• Understand treatment options

Stages of Change

Understanding where someone is in their recovery journey:

• Pre-contemplation: Not considering change
• Contemplation: Thinking about change
• Preparation: Getting ready to change
• Action: Making changes
• Maintenance: Sustaining changes
• Relapse: Return to use (common, not failure)

Harm Reduction

Where abstinence isn't achieved, reduce harm to children:

• Safe storage of substances and equipment
• Alternative care when parent is using
• Reduce exposure to substance-related activity
• Support substitute prescribing
• Address chaotic lifestyle factors

Timescales

A key tension in this work:

• Recovery often takes years
• Children's needs are urgent
• Relapse is common and part of recovery
• Court timescales are 26 weeks
• Balance hope with realism

Common Pitfalls

Mistakes to Avoid

• Testing for substances without understanding the context
• Expecting immediate abstinence
• Not liaising with treatment services
• Underestimating the impact on children
• Overestimating capacity for change in children's timescales
• Missing the pattern by focusing on individual incidents

Recording

Documentation should include:

• Specific substances, pattern, and amount
• Treatment and recovery history
• Impact on parenting and child's experience
• Liaison with treatment services
• Progress and any relapses
• Risk assessment and safety planning

Conclusion

Working with families affected by substance misuse requires understanding the nature of addiction, its impact on parenting, and the realities of recovery. Effective practice involves close liaison with treatment services, realistic assessment of capacity for change within children's timescales, and a focus on harm reduction where abstinence is not achieved. The child's experience must remain central throughout.