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New ACMD report. http://www.drugs.gov.uk/ReportsandPublications/NationalStrategy/1054733801?batch_start=1. http://www.drugs.gov.uk/ ReportsandPublications/NationalStrategy. Six key messages from the Inquiry.

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New acmd report l.jpg

New ACMD report

http://www.drugs.gov.uk/ReportsandPublications/NationalStrategy/1054733801?batch_start=1

http://www.drugs.gov.uk/ReportsandPublications/NationalStrategy


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Six key messages from the Inquiry

  • Estimate of between 250,000 and 350,000 children of problem drug users in the UK – about one for every problem drug user.

  • Parental problem drug use can and does cause serious harm to children at every age from conception to adulthood.

  • Reducing the harm to children from parental problem drug use should become a main objective of policy and practice.

  • Effective treatment of the parent can have major benefits for the child.

  • By working together, services can take many practical steps to protect and improve the health and well-being of affected children.

  • The number of affected children is only likely to decrease when the number of problem drug users decreases.


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Child protection and substance use

We should particularly be concerned with substance use that is dependant or chaotic. For the practitioner and the client, the ability to distinguish recreational use from problematic misuse is a crucial skill.

Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.


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Links between problematic use and child protection

To suggest that all parents who suffer from problem drug use present a danger to their children is misleading. Indeed, much research indicated that in isolation problem drug use of a parent presents little risk of significant harm to children.

Cleaver H., Unell, I., and Aldgate, J., (1999) Children’s Needs Parenting Capacity, P.23, London; HMSO.


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Family alcohol problems

  • Double the risk of divorce/separation

  • 40% of domestic violence incidents

  • 25% of known child abuse cases

  • 60% of Child Protection Register

    Robinson (2000)


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It’s not the drinking, but...

  • Violence in the home

  • Marital/relationship conflict

  • Separation, divorce, loss of parent

  • Inconsistency and ambivalent parenting

  • Unpredictability

  • Drinking/parent centred not child-centred.


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Effects on Family Life

  • Inconsistency, changing moods

  • Role reversal

  • Communication

  • Routines and rituals

  • Social life

  • Finances.


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Effects on Family Functioning 1

  • Family conflict and disharmony

  • Cruel, passive or neglectful parental attitude

  • Inconsistent and unpredictable parenting

  • Parents do not set clear or safe limits.


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Effects on Family Functioning 2

  • Children take on parental role

  • Parents are emotionally unavailable and distracted

  • Outing and social events fraught with uncertainty

  • Child fears parent might die or otherwise leave them

  • Deprivation caused by poverty.


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Effects on Children

  • Anti-social behaviour - aggressive, delinquency, conduct disorders, hyperactivity

  • Adolescence – problems associated with using drugs and alcohol

  • Emotional problems - psycho-social problems, asthma, bedwetting, negative attitudes to self

  • School environment - academic problems, difficulties learning, loss of confidence, conduct disorders.


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Problem drinking parents are often:

  • Unpredictable

  • Aggressive

  • Chaotic

  • Inconsistent

  • Unreliable.


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Adverse consequences

  • Typically multiple and cumulative

  • Failure to thrive

  • Blood-borne infections

  • Incomplete immunisation and inadequate health care

  • Wide range of emotional, cognitive, behavioural and other psychological problems

  • Early substance misuse and offending behaviour

  • Poor educational attainment

    ACMD (2003)


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Longer Term Effects

  • Effects on transition to adulthood

  • Friendship difficulties

  • Division between home and peers - home seen as negative

  • Drinking alcohol/drug-taking at an earlier age

  • Leaving home early - by comparison with others

  • Prescribed psycho-active drugs as children and adolescents (27% v 3%) by age 17

  • Earlier marriages - seeking social stability.


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Children of Problem Drinkers

  • Do not expect adults to provide well for them

  • Do not anticipate love, warmth or friendship

  • Are hyper-vigilant towards changing moods

  • Take too much or too little responsibility

  • See positive outcomes to problems as exceptions

  • Do not trust adults to be fair

  • Find it difficult to relax and enjoy things

  • Expect and even create conflict in relationships.


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Protective Factors

  • A non-drinking parent

  • Cohesive parental relationship

  • Cohesive family

  • Rituals maintained

  • Influence of important others

  • Engaged with things outside the home

  • Deliberate planning.


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How to Increase Resilience?

Help a young person:

  • See themselves as separate from family problems

  • Develop belief in own abilities

  • Understand and express feelings and emotions

  • Cope with difficulties and problem solve

  • Engage in activities outside family

  • Develop their own plans for the future


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Alcohol, Childcare and Parenting

Information from:

  • Wendy Robinson, NSPCC/ARP Family Alcohol Service

  • To receive a copy of the NSPCC publication - ‘Alcohol, Childcare and Parenting - A Handbook for Practitioners’ send an A4 SAE with £1.58p in stamps to:

    Administrator, Family Alcohol Service, 

    88-91 Troutbeck House, 

    off Robert Street, 

    London NW1 4EJ


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Prevalence of problematic use

Research shows that many people experiment with drugs, with most trying them only once in a lifetime. Fewer, but a significant minority, use drugs regularly. Around one-third of people who have ever used drugs become regular drug users, and it has been predicted that roughly ten percent become problem drug users.

SCODA. (1997). Drug Using Parents: Policy Guidelines for Interagency Working. p10. London: LGA Publications.


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Child abuse

Child abuse is an interaction that involves

the significant mistreatment of the relatively

powerless participant (usually the child or young

person) by the participant with more power

(usually the parent or adult). This interaction will frequently be affected and partly defined by the

child’s chronological age, legal status, dependency, and developmental immaturity.

The definition of what is child abuse will change over time and is affected by the perspectives and values that are influential in society.

Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.


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Substance misuse

Substance misuse is a compulsion or desire to continue taking a drug, or drugs in order to feel good or avoid feeling bad. The compulsion or desire is usually initiated following previously repeated use of the drug and is difficult to control. When the compulsion is to avoid physical discomfort, it is physical dependence; when it is to avoid anxiety or mental distress, or to promote stimulation or pleasure it is known as psychological dependence.

SCODA. (1997). Drug Using Parents: Policy Guidelines for Interagency Working. London: LGA Publications.


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Child protection and substance use

We should particularly be concerned with substance use that is dependant or chaotic. For the practitioner and the client, the ability to distinguish recreational use from problematic misuse is a crucial skill.

Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.


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Links between problematic use and child protection

To suggest that all parents who suffer from problem drug use present a danger to their children is misleading. Indeed, much research indicated that in isolation problem drug use of a parent presents little risk of significant harm to children.

Cleaver H., Unell, I., and Aldgate, J., (1999) Children’s Needs Parenting Capacity, P.23, London; HMSO.


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Treatment and care for adult substance users

Community Based Services might include

  • Counselling / support

  • Drop-in support

  • Needle exchange

  • Complementary therapies – acupuncture

    Medical based services might include

  • Methadone prescriptions

  • Community detox

  • Access to inpatient detox


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Treatment and care for adult substance users

Social Services might include

  • Counselling / support

  • Access to funding for rehabilitation services

    Rehabilitation Services

  • (a) Day centres and (b) residential services

    The services offered by rehabilitation services vary:

  • Therapeutic input

  • Vocational training

  • Relapse prevention

  • Support in gaining housing, employment, access to health services, access to children


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Screening & Assessment

Screening

  • Refers to any process (reactive or proactive) used to identify whether someone is using drugs

    Assessment

  • Occurs after drug use has been identified. Its meaning is a process that informs intervention planning by ascertaining the severity and pattern of drug use, and how the drug use affects the young person concerned.


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The screening and assessment process

1

Screening

2

Parental

substance

use

what substance

how much / how obtained / how taken

when (pattern of use)

who with

cost

lifestyle implications

3

Effect on

parenting

capacity

history of own parents

expectation of self as parent

basic care

ensuring safety

stability

4

Effect on

child's needs

development

basic needs

protection

self esteem

relationships

love and affection

control

child care demands

stages of development

personality

special circumstances

availability of other adults

Adapted from Murphy and Harbin (2000)


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Stage 3 Assessing ability to parent

  • Ensuring safety

  • Stability

  • Income


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Stage 4 - Assessing the needs of the child

  • Basic Care

  • Emotional and behavioural development

  • Stimulation

  • Family and social relationships


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why drugs?

“That humanity at large will ever be able to dispense with Artificial Paradises seems very unlikely. Most men and women lead lives at the worst so painful, at the best so monotonous, poor and limited, that the urge to escape, the longing to transcend themselves if only for a few moments, is and always has been one of the principal appetites of the soul.”

Huxley, A. (1951). The Doors of Perception. London: Penguin.


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DATs are responsible for:

  • assessing the need for services to tackle drug use/misuse locally and co-ordinating a response;

  • providing information about local patterns of drug misuse;

  • agreeing a local drug misuse strategy and planning/purchasing appropriate services;

  • setting local targets;

  • encouraging joint commissioning between member agencies;

  • developing links with all relevant agencies;

  • signing off local spending plans;

  • reporting on progress towards objectives and targets;

  • allocation of pooled treatment funding.


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Young Person’s Holistic Needs Assessment

Full assessment of substance related needs if required

Identifying substance related needs

DrugScope / Home Office (2003: 9)


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Purpose of identifying substance related needs

To identify:

  • the young persons knowledge of drugs, alcohol and solvents

  • if the young person uses drugs, alcohol or solvents

  • if the young person misuses drugs, alcohol ir solvents

  • if the young person is in immediate danger

  • if substance use is part of complex, or troubling behaviour

  • unusual behaviour for that age group in relation to their substance use.


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Assessment Process Flowchart

Assessment Process

(Including identification of substance related needs

No Further Action

Review of young person’s needs

Advice and Information

Immediate Action needed

Tier 2 Intervention

Referral to tiers 3/4

Other interventions to meet non-substance needs

Plan to meet young person’s needs

DrugScope / Home Office (2003: 26)


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Process for identifying young people’s substance related needs

e.g.

Young:

Homeless

Looked After

Carers

Offenders

Excluded

Step 1

When you should screen for substance use

When a young person seeks advice/information about drugs, alcohol or solvents

Following identification or suspicion or drug taking

When a drug related incident occurs

When a vulnerable young person comes into contact with your service

Step 2

Confidentiality

Practitioners are advised to explain their service’s confidentiality policy. Explain the consequences of identifying substance related needs, including information about what you as a practitioner can provide and information on any agency you refer them to.

Step 3

What should the process establish?

Knowledge of drugs, alcohol and solvents

If they take drugs, alcohol or solvents

If they misuse drugs, alcohol or solvents

If the young person is in immediate danger

If substance use is part of troubling behaviour

Unusual behaviour for that age group in relation to their substance use

Step 4

Outcomes of identifying substance related needs

No further action

Provision of drug and alcohol education in a universal setting

Targeted information and advice

Referral to meet a tier 2 need

- ‘counselling’ or a drug related prevention programme

Referral to meet a tier 3 need

- complex treatment, e.g. prescribing and/or complimentary therapy

If there is a child protection concern, refer to social services


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CAGE Test to screen for potential alcohol problem

Have you ever:

  • Cut back or Changed your drinking pattern?

  • felt Annoyed of people criticised your drinking?

  • felt Guilty about drinking?

  • Needed a drink Early in the day to steady yourself (Eye opener)?

    2 out of 4 yes answers is a positive screen

    Mayfield et al. (1974). The CAGE questionnaire: validation of a new alcoholism screening instrument. American Journal of Psychiatry. 131: 1121 - 1123.


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