Working with children whose parents use substances

Smoke and Mirrors: Helping Families Through the Maze of Substance Abuse

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In 2012/13, drug/alcohol use by carer(s) was one of the top four issues in risk of significant harm (ROSH) reports in New South Wales (NSW). Often families affected by drug and or alcohol use face many other problems including housing instability, economic difficulties, mental or physical illness and/or domestic violence. Children in these families are at increased risk of abuse and neglect as well as physical, social and emotional problems (Dawes, Atkinson, Frye, Evans, Best, Lynch et al 2007).

How does parental substance use affect children?

Substance use impacts parent’s judgements and priorities. It influences their choices, their child rearing practices and can negatively affect the consistency and quality of care for their children. Parental drug use can affect a child’s development prior to birth and throughout their child and adolescent development.

Prenatal exposure to substance use

Fetal Alcohol Syndrome (FAS) is the most common birth defect related to prenatal exposure to substance misuse1. Children with FAS may have;

* growth deficiencies, both prenatally and after birth

* problems with central nervous system functioning

* IQs in the mild to severely retarded range

* small eye openings and poor development of the optic nerve

* a small head and brain

* joint, limb, ear, and heart malformations.

Prenatal exposure to cocaine or marijuana can lead to miscarriage, low birth weight babies, decreased head circumference, and impaired brain functioning.

Childhood and adolescence

If parents continue to use drugs after their child’s birth they may have difficulties forming attachments with and responding to the baby’s needs. As children get older, exposure to alcohol and other drugs may create other difficulties for them including;

* depression, anxiety or psychiatric symptoms during childhood or adolescence

* neglect of their material and emotional needs because of the money and time parents spend procuring drugs, being hung over or experiencing withdrawal symptoms

* lack of supervision and consequent exposure to general harms

* being exposed  to criminals and or strangers coming in and out of the house which may increase their risk of being physically or sexually abused

* exposure to family or social violence associated with the  procurement and use of drugs

* poor academic performance and social difficulties at school

* poor engagement with other children, adults or sources of social support

* lack of opportunities for normal play with other children

* taking on the caregiving role for young siblings and subsequent anxiety about their wellbeing

* social stigma about parent’s drug use or the family’s poverty, homelessness or involvement in criminal justice system

Adolescents whose parents use substances are more likely to develop substance use disorders, have poor academic performance and be involved in criminal activity (Jackson 2013). The longer the exposure to substance use, the more serious and negative the consequences are for a child’s development and wellbeing.

What protects children from the negative impacts of parental substance use?

Children with parents who misuse substances are often exposed to compromised parenting, lack of resources and a chaotic lifestyle. They may also be at risk of developing their own drug, alcohol and other problems. Some children demonstrate significant resilience in the face of these challenges. These children share some distinct characteristics including having:

* the support of an extended family

* parents who are well linked to services and resources that protect them from drug use, violence and criminal activities

* parents with adequate parenting and life skills

* have only one parent or carer with problematic drug use,

* are attached to at least one other adult

* have good communication skills and an easy going temperament

* have consistent routines, boundaries & family rituals

* have access to more resources and mental stimulation.

How can we work with children whose parents use substances?

Talking with children about their parents’ substance misuse:

From the age of about seven, children know more about their parents’ substance use than most adults realise. Understanding the patterns of parental substance use from the child’s perspective can help us understand how and when a child is safe within the home.

Talking to children about their parent’s drug use can become the foundation of a relationship based on honesty and trust. Information can help children make sense of the events which have occurred within their family and can prevent them from developing fantasies about their parents’ behaviour. From a safety perspective, being open with children also allows us to discuss safety plans and may result in children feeling less alone and more supported.

However it is important to remember that sharing information with children about their parents’ problems may make them feel different to their peers and this may increase the anxiety and worry they already hold for their parents. Speaking with children about parental substance use may also affect your relationship with their parents who may be anxious that their drug use will be made public if information is openly shared with their children.

When you talk to children about the nature of their parents’ substance use, there are a number of points that can help you to engage with children and not make them feel overwhelmed, fearful and anxious. In particular:

  • ask about and listen to what children say about how their parent’s drug use affects their life
  • match your explanations about their parent’s substance use to the child’s age and developmental stage
  • explain in clear and simple terms that they are not responsible for their parents’ substance misuse
  • communicate that their parents still love them
  • connect them to other people if they wish or ask to speak with them
  • tell them about their parent’s attempts to overcome their problems and change their behaviour as this may alleviate some of their worries and help them believe change is possible
  • develop age and developmentally appropriate safety plans

Building relationships with children

When working with children impacted by parental substance use, there are a number of points that can help support the development of positive relationships. In particular, it is important to:

  • create an environment in which children trust you and feel comfortable and safe. Make sure that children feel that they have their parent’s‘permission’ to engage
  • engage with children in an honest, credible and genuine manner and avoid secrecy
  • ensure you are knowledgeable and communicate in an appropriate age and developmental manner
  • offer children choices about the things that impact them and invite them to tell you how they would like to share their story. Be objective and curious about their experiences
  • try to provide children with hope for the future – do not just focus solely on risk
  • follow up your words with actions – letting children down can be very damaging to your relationship.

Techniques to connect with children

A number of techniques are useful when working with children whose parents use substances. Some effective techniques include:

  • providing opportunities to draw

Getting children to draw a family tree is a good way for children to talk about their family and can be a springboard to discuss their relationship with other family members. Completing a support star where children write down at each point of a star the people or organisations that support them and then write down their unmet needs in the middle of the star helps us learn about a child’s met and unmet needs. The three houses tool2 is also a good way to get children to talk about what makes them feel safe or unsafe and about their dreams and hopes for the future. Getting a child’s permission to share this with their parents can act as a motivator for change.

  • developing family life books

Children whose parents have substance use problems often experience very disrupted lives. Family life books in which mementos such as notes, photos, letters and drawings can be an important repository for children’s memories.

  • facilitated discussions

These are discussion in which children write down their stories and then communicate them back to their parents. Many children feel unable to express their thoughts and feelings directly to their parents and this process enables them to put their experience, fears, hopes and dreams into writing and to communicate them to their parents. The result can be confronting, yet a potentially transformative experience for the parent to hear directly from their child.

  • peer support groups

Children often feel excluded, ashamed and stigmatised as a result of their parents’ substance misuse. For these children, opportunities to meet and share their stories with other children who have had similar experiences can be very therapeutic. These groups require skilful facilitation.mirror families

In this model of support, individuals with a connection to the child are identified and supported to contribute to creating an extended network of support. The group can include extended family members, friends and other adults such as teachers who show a connection with the child. Support is offered to develop these networks and to ensure that the network has the skills to maintain the connection without organisational support.

  • family activities camps, school holiday programs

Families in which parental substance use is an issue may not have the financial resources to participate in family activities. Where possible, referrals to these sorts of programs can be a way of encouraging positive engagement between children and their parents and can contribute to the vital strengthening of the parent-child relationship.

How can we help parents who use drugs help their children?

Because children often know that their parents use drugs, it is important to encourage parents to talk to their children about their drug habit. These things may be helpful depending on the child’s age and developmental stage:

  • encourage them to be honest with their children about their drug use
  • encourage parents to ask their children about their worries and fears associated with their parent’s drug use
  • encourage parents to help children understand what is happening and let them know that their drug use is not the children’s fault. Remind them to let their children know that they love them
  • help parent’s identify a safe person such as a neighbour or relative whom the children can call upon if in trouble. Get parents to teach their children how to contact support people
  • help parent’s program an emergency number into the phone and show their children where it is and how to use the phone and what information they should provide in an emergency (i.e street number and address)
  • encourage parents to tell children to ring an emergency number or get help if they think there is a problem, especially of they think they are in danger or if their parents may have had an overdose

How can we work with parents who use substances?

The most important work we can do with parents is to strengthen the parent- child relationship. Parents with substance use problems are often motivated most strongly by the potential impact and possibility of change for their children. Parents are more likely to engage in services if the intervention is likely to result in a direct tangible benefit to their child.

Parents have substance use problems often experience a range of other problems in their lives including mental health, family violence, housing, incarceration, financial troubles and trauma. Each issue presents its own set of challenges to effective parenting. Supporting parents to engage in the recovery process while also addressing the other issues impacting on family functioning is vital.

The best way to support parents is to:

  • provide holistic support to strengthen the parent-child relationship
  • address parents’ basic material needs
  • provide parenting and life skills
  • provide access to services focused on all of the other issues evident in parents’ lives such as drug treatment, mental health and family violence.
  • form a trusting relationship so a parent can talk about and flag stressors and the possible triggers to relapse

To learn more about working with children watch Stefan Greunert’s presentation at the Research to Practice seminar.


Dawe, S., Atkinson, J., Frye, S., Evans, C., Best, D., Lynch, M., et al. (2007). Drug use in the family: Impacts and implications for children. Canberra, ACT: Australian National Council on Drugs.

Jackson, A. (2013). Assessing the Impact of Parental Drug Use, Family Structure, and Environmental Conditions on Adolescents Self-Reported Drug Use, Serious Delinquency, and Deviant Behaviors. International Journal of Criminology and Sociological Theory, Vol. 6, No.2, March 2013, 1103-1124

For more information please refer to Fetal Alcohol Syndrome practice note on located at,-evaluation-and-data/research-to- practice/past-seminars/fetal-alcohol-spectrum-disorders

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