A review of the Literature
Alcohol and family problems
The impact of alcohol problems on children and families can reach into every area of life – physical and psychological health, finances, employment, social life and relationships. Problematic alcohol use can have a particular impact on the family, its structures and functions. Velleman (1993) suggested that there were seven key aspects of family life that could be adversely affected – roles, rituals, routines, social life, finances, communication and conflict. Domestic violence and child abuse are two particular areas that will be discussed in more detail below.The particular impact of parental alcohol misuse on children
The impact of parental alcohol misuse on children was identified as long ago as the late 1960s with Cork’s inaugural study. The foreword to her book began, “In their concern for the alcoholic (sic), researchers have often overlooked his (sic) family. We therefore have little understanding of the sufferings of thousands of children in our communities” (Cork, 1969).
Children suffer a range of problems as a result of being in a childhood environment where a parent has an alcohol problem – physical, psychological, and behavioural (Velleman, 2002). Children can be affected, albeit differently, regardless of whether it is the mother or father who is the problem drinker. They often take on responsibilities that are beyond their years, thus affecting their education and peer relationships. The child can be deprived of their childhood as they are too ashamed to bring friends home, or are not able to go out with friends because they have to care for a sibling or drunk parent.
Experiencing or witnessing physical, verbal and sexual abuse are realities, with the drinking affecting family holidays and celebrations such as Christmas and birthdays (Velleman, 2002). The child will commonly blame themselves for the problems that the family is experiencing in a vain attempt to make their environment better able to support them. Children exposed to alcohol because their mother drank problematically whilst pregnant are at risk from a particular range of physical and psychological problems.
Studies suggest that problematic alcohol use by a parent most significantly affects the quality of their parenting. Problem-drinking can result in a parent being emotionally unavailable, inconsistent and unpredictable (Cleaver et al., 1999). This can lead to parenting that is passive, cruel or neglectful; where children are not supervised, nurtured or supported.
How children are affected by parental problem drinking can vary, with gender and being particular areas of difference. Increasingly, research provides evidence of the impact of parental substance misuse on child welfare at both an emotional and physical level and of the effects on child-parent attachment across the life-cycle (Kroll and Taylor, 2003).
In almost every study reviewed children of problem drinking parents have higher levels of a range of problems than children of non-problem drinkers, even when compared with children of parents with other problems. Factors that can increase the likelihood of children being adversely affected include parental disharmony, violence, both parents drinking problematically, and the drinking taking place within the family home.
Risk factors in terms of resulting problems for the child can be grouped under three main headings - anti-social behaviour (increased risk of aggressive behaviour towards others, hyperactivity and other forms of conduct disorder), emotional problems (a wider range of psychosomatic problems from asthma to bedwetting, negative attitudes to their parents and themselves, high levels of self-blame, withdrawal and depression) and the school environment (learning difficulties, reading retardation, loss of concentration, generally poor school performance, aggression and truancy) (Velleman, 1993). In addition children can have problems that include poor development of trust, fear of neglect and abandonment, fear that the parent will die or otherwise leave, problems in making and sustaining friendships, verbal or physical aggression and witnessing or being a victim of conflict or violence.
Thus, it is more likely to be the conflict and disharmony associated with problematic alcohol consumption, rather than the drinking per se, that brings adverse consequences (Velleman and Orford, 1999). It seems that not much has changed in the worries that children have - 85% of children interviewed in Cork’s study (1969) said that fighting and arguments were their primary concern.
A related key area of concern is the impact of domestic violence on children particularly given the increasingly clear links between domestic violence and alcohol consumption. However, it seems that “the scale of the problem is often underestimated” (WHO, 2001) as domestic violence and its impact on children have been notoriously difficult to research. Most commonly, such violence is perpetrated by men towards women (Simmons et al., 2002) with children the innocent, but harmed, bystanders. With one in four women suffering violence from their partner at some point in their lives (Mirrlees-Black, 1999) and 54% of women repeat victims of domestic violence (Kershaw et al., 2001), there is no doubt that children are at risk from such violent behaviour in the home. Harwin and Forrester’s (2002) study of social work with families in which parents misuse drugs or alcohol found that “alcohol misuse was strongly associated with violence in the home” (p5).
There is no evidence that alcohol plays a direct causal role in domestic violence, but evidence suggests that injury severity and the risks of violence increase with the perpetrator’s consumption of alcohol (Berk et al., 1983; Brecklin, 2002; Eberle, 1982; Pernanen, 1991). Victims of domestic violence estimate that 45% of perpetrators had been drinking at the time of the assault (Flood-Page and Taylor, 2003) with other studies suggesting figures considerably higher than this (Brookoff et al., 1997; Scully, 1990).
The impact of witnessing parental violence and the impact of parental problematic drinking on children is alarmingly similar (Galvani, 2003). While the impact of problem drinking on children has been addressed above, the impact of domestic violence is often manifest in damage to family attachment, aggression or withdrawal, sleep problems, fear and a wish for safety (Mullender et al., 2002). By implication, a combination of a parent who has a problem with alcohol and who also suffers or perpetrates violence will exacerbate the harm and risk children face.
In addition, there is evidence that some women use alcohol to cope with the impact of domestic violence (Cantrell, 1986; Corbin et al., 2001; Downs et al., 1993; Downs and Miller, 1994) and that some men use alcohol as an excuse for its perpetration (Scully, 1990; Hearn, 1998). Therefore, any attempts to minimise harm to children from parental drinking has to address the presence of domestic violence and recognise the increased risk this may pose to children and family life.
The link between alcohol misuse and child abuse is also clear. Statistics suggest that alcohol plays a part in around a quarter of known cases of child abuse (Robinson and Hassell, 2000). In a study of fatal child abuse in the UK, a history of ‘substance abuse’ was recorded in 60% of cases (Wilczynski, 1995). Although concern about substance misuse often arose in these cases, this concern had rarely been included in a full assessment of the child’s needs. A study by the NSPCC between 1977 and 1982 suggested that heavy drinking was a factor in 25% of known child abuse cases, and that 20-30% of parents who physically abuse their children were heavy drinkers. Further, some research suggests that children are more likely to suffer physical abuse if the father is the drinker, and are more likely to suffer neglect if the mother is the drinker (Cleaver et al., 1999).
Further data can be presented. In 1995 a Welsh study of 31 child protection case conferences found heavy drinking a factor in nearly 60% of cases (Social Service Insight, 1987). In the London Borough of Camden, a Child Protection Statistical Report for 1998-99 showed that domestic violence, drug misuse and alcohol misuse continue to be the highest contributory factors within the family unit that affected the welfare of the child (Robinson and Hassell, 2000).
More recent data indicates that around a third of cases held by a long-term child care social services team involved parental alcohol misuse, with just under half of those negatively influenced by alcohol misuse and a further third by combined alcohol and drug misuse – “… [alcohol] caused the most harm to children – and appeared to cause the most professional difficulties” (Harwin and Forrester, 2002). Of additional concern was the finding that these cases tended to be ‘heavy end’ scale – most involved care proceedings and 40% of those concerning registration on the child protection register featured alcohol or drugs.
In the main, these children tended to be younger and either to be part of a family where both parents were substance misusers, or to come from single parent families where the lone parent was a substance misuser. Harwin and Forrester describe families characterised by chaos, violence, relationship breakdowns, housing difficulties and unemployment. This is in addition to clear concerns regarding the children’s welfare, usually characterised as neglect. Furthermore, their data suggests that social workers struggle to work with these cases as a result of a lack of preparation and training in substance use and its impact on the family, difficulty with families who deny that their substance misuse is causing problems, the threat of violence and threatening behaviour from clients and the lack of involvement of substance misuse professionals in care plans.
Given the amount of time that this work takes, and the training that staff need, studies like this have implications for social services resources. In addition, Harwin and Forrester (2002) discuss the implications for other professionals, such as specialist substance misuse workers and health visitors, if social workers were to become more involved in working with families where substance use is a problem. Alcohol’s legal status and prominent role within society is seen as partial explanation for the challenges that arise when working in this area and they conclude that, “this may explain why the inter-agency framework seemed to work less well in relation to alcohol abuse than to drugs”. There is a need for equal vigilance regardless of the primary substance of misuse.
Clearly child abuse results from a complex constellation of factors. The relationship between alcohol and child abuse adds to this complexity and has proved difficult for professionals to work with. However, it appears that a significant proportion of child abuse may involve parental alcohol misuse. The evidence suggests that these are children in need as identified under the Children Act (1989). In this respect at least, problem drinking by parents is not a problem that children or families should be left to cope with alone.
There is increasing evidence of the impact on children of growing up with a problem drinking parent. Far less is known about the continued impact of parental drinking when these children are adults, when many will have families and children of their own. A 1994 study in New Zealand (Lynksey et al., 1994) found that young people reared in a family in which a parent was described as having ‘alcoholism’ (sic) had rates of psychiatric disorder at the age of 15 years that were 2.2 - 3.9 times higher than other young people. Other studies have shown that young people with problem drinking parents are more likely to be using alcohol at an earlier age and in a risky fashion (22.4% vs. 12.5%), and are more likely to be using other substances (i.e. illicit drugs) in a risky fashion (21.8% vs. 10%).
Preliminary results from a UK study (Callingham, 1999) of several thousand adults found that over 16% had experienced trauma in the home where they grew up, including having at least one problem drinking parent. These adults were likely to continue suffering distress as a result of their childhood experiences, and were more likely to drink problematically, be unemployed or divorced. Thirty per cent of this group of respondents said that the problem had affected them ‘very badly’ as children; 10% said that it continued to affect them very badly. Respondents did not describe their relationships with their parents as positively as children who had not grown up in these environments; they also used more negative terminology to describe some aspects of themselves (Callingham, 1999).