Family members and addiction, risk and protective factors from birth to adulthood

Many parents who use drugs do so in moderation and don’t present an increased risk of harm to their children. However, it is recognised that there can be an increased risk for child maltreatment and welfare involvement compared with other children. Children may often be cared for by a relative who may or may not have legal custody. Most children remain in the care of their parents and can be unknown or hidden from child welfare services throughout their childhood. This challenge of silenced children is known as ‘Hidden Harm’.

In the words of two mothers:

“I feel my children definitely feel like they are the only ones that had this addictive embarrassing mother and they can’t speak openly to me about it…. Those little fears that kids shouldn’t have. I know because my own dad was an alcoholic.’ ‘I absolutely loved being a mum, its probably the best gift,I ever could have been given. And like my kids are gone, its only coming up to a year, they are not gone that long, and they’ve both been separated from each other now as well, so that kills me, you know…’

Risk factors during pregnancy

It is recognised that women who use drugs, alcohol and tobacco often already face many other challenges. These are compounded during pregnancy when the non-medical use of substances places a mother at an increased risk of a number of obstetric risks and consequences. These can be summarised in order of the stage of pregnancy and can include all obstetric complications from early pregnancy loss to postpartum haemorrhage. The effects of opioids, cocaine and cannabis use on newborn infants can include neonatal abstinence syndrome, low birth weight and premature birth.

Protective treatments and services for expectant mothers

A summary of factors that protect mothers who use substances during pregnancy and their babies, include:

1. Multidisciplinary, comprehensive treatment services. Such services have shown to improve outcomes for mothers and babies in terms of risk for premature birth, nutrition, decreased morbidity and mortality
2. Multidisciplinary, comprehensive treatment approaches. These combine a variety of additional services including medical and prenatal care, addiction counselling, psychosocial support, child care services and transportation assistance.
3. Stigma reducing services. As stigma is associated with substance use among pregnant women, this presents a significant barrier to accessing treatment. See CityWide report in the download section on stigma.
4. Medication-assisted treatment. This is an effective component of a comprehensive treatment plan for pregnant women who use drugs. Potential impacts on the child For some children, the effect of their parents’ use continues from their infancy into their adult lives. A summary of potential impacts by age is provided below. A text-based version of this image is available in the Downloads section.

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Image caption: Summary of potential impacts on a child across their developmental stages, as a result of parental substance use}

Programs to support children into adulthood

Appropriate support systems can protect children as they enter adulthood. These can be the support within the extended family or the community and it can have a positive influence on the child’s ability to cope with trauma experienced within the family.

Programs that provide protective factors include interventions that involve children as well as parents, and family skills training components and programs whose duration is longer than ten weeks. Outcomes that feature interventions such as program-related knowledge, coping-skills, and family relations, provide better results than more distant outcomes such as self-worth and substance use initiation.

Building resilience among young people has also been found to be important. Doing well in adolescence is not seen as the absence of problems; instead it is seen as the development in various life skills that promotes thriving. Social competence and self-regulation have been found to be important for young people.

In summary, it is essential that adult and child services work together to build strong links and forge a multiagency based on a non-stigmatising strengths approach. This is particularly important to minimise the effects of adverse childhood experiences (ACEs) that can have a significant impact on the likelihood of a child who has grown up around substance use from using themselves. The next step looks at ACEs in more detail.