Toolkit for general practice

Summary of the evidence relevant to general practice

Prevalence

Most people drink without negative consequence to themselves or others, including their children. However there is a group of families whose experiences of someone else’s alcohol misuse fall far short of this norm and whose needs are only just starting to be recognised.
Approximately 1 million children live in a household where at least one parent has a significant problem with alcohol.

Research demonstrates that children are affected and do try to ask for help.

In some minority ethnic groups drinking is completely taboo making any problem with alcohol particularly difficult to deal with. Alcohol problems where they occur also transcend social class. So children affected could be children from many different backgrounds.

Effects on children

Studies suggest that it is the family conflict and disharmony associated with problematic alcohol consumption, rather than the drinking per se, that brings adverse consequences. Whether both parents are problem drinkers or just one of them, both can become emotionally unavailable, inconsistent in their parenting and unpredictable. This leads to leads to poor parenting where children are not supervised, nurtured or supported.

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.

The 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 within the school environment (learning difficulties, reading retardation, loss of concentration; generally poor school performance, aggression and truancy)

In addition these children have poor development of trust, fear of neglect and abandonment, fear that the parent will die or otherwise leave, problems in making and sustaining friendships.

Resilience

Research has begun to highlight factors that help minimise the impact of parental alcohol misuse. It seems that some children are more resilient and do not develop problems, either when they are young or when they reach adulthood. Resilience factors include:

The presence of a stable adult figure
Family cohesion and harmony
Deliberate planning by the child that their adult life will be different
A child with good social networks, particularly with adults
High self-esteem and confidence and a sense of self-efficacy,
Ability to deal with change
A good range of problem solving skills
Secure and stable relationships
Experience of success and achievement.

Other factors include being raised in a smaller family, having larger age gaps between siblings, a low level of prolonged separation from the primary carer in the first year of life and children from families that are able to stay together.

There appear to be gender differences in that individual disposition can be more important for females and external support for males. Clearly the age of the child will also be a factor.

Risk of domestic violence and child abuse

There is no evidence that alcohol plays a direct causal role in domestic violence, but evidence suggests a strong association between alcohol misuse and violence in the home. Like parental alcohol misuse, the impact of domestic violence is often manifest in damage to family attachment, aggression or withdrawal, sleep problems, fear and a wish for safety. By implication, the combination of a parent who has alcohol problems and who also suffers or perpetrates violence will exacerbate the harm and risk children face.

Statistics suggest that alcohol plays a part in around a quarter of known cases of child abuse.

Further information on the research and the evidence base can be found in:

Literature review
Signs and symptoms
Effects on children and families
Protecting against long term harm