Preventing intergenerational substance misuse should be an urgent priority

Earlier this month, the Inclusion22 service received a referral for an eight-year-old needing urgent support.

The service, working with the children of parents seriously misusing drugs and/or alcohol, is called upon to help end cycles of intergenerational substance misuse. The eight-year-old's parent was a substance misuser, currently receiving support from NHS’ Inclusion service, and the grandparent was also a substance misuser. The eight-year-old is one of thousands of children needing such support.

A costly gap

Recent reports show that drug-related deaths are at the highest level ever. We know that intergenerational misuse of alcohol and drugs is a significant societal issue. And yet, the support and funding to support and intervene for children of substance misusing parents is minimal.

The children in families of a substance misusing parent are often more vulnerable, likely to face future social and health impacts, and are statistically more likely to misuse substances themselves. Approximately a quarter of cases on the child protection register are related to parental substance misuse.

Barriers to support

Children of substance misusing parents face huge barriers to accessing a service due to the stigma surrounding substance misuse - children often fear that revealing information about what is happening at home, whether they are aware of a substance misuse problem or not, will result in their separation through being taken into care. They often face stigma from within the home too, from their parents, carers or wider family support networks who are either ashamed to share such an issue or do not perceive there to be an issue.

A destructive cycle

Children of substance misusing parents are known to be exposed to further harms – a ripple effect of the parent’s lifestyle. Domestic violence in such households is all too common as are serious mental health challenges. And many young people have suffered Adverse Childhood Experiences (ACEs) and could become trapped in a destructive cycle of risk-seeking behaviour, including the use of alcohol and drugs.

Children of substance misusing parents may also feel they have caring responsibilities to the parent. A child Inclusion22 recently supported was struggling to stay awake in classes at school because they set an alarm at various times during the night to check that their substance misusing father was still conscious. Disturbing stories such as these are too common and nationwide support for children involved in such tragic situations is often missing.

Breaking the cycle

Inclusion22 was launched in 2019 to address this gap in support, aiming to break intergenerational substance misuse by supporting and safeguarding these children. It aims to:

• provide children and young people with accurate information and advice regarding drugs and alcohol

• help young people to understand the importance of healthy relationships

• developing a personalised and age-appropriate safety plan, in case of an emergency

Through one-to-one support, Inclusion22 helps children and young people build their confidence, self-belief, and self-esteem, whilst ensuring their basic needs are met. Appointments are held at the child’s school, home or elsewhere to suit each individual case.

“Being able to speak honestly and openly without fear of judgement about my dad and his drug use has allowed me to make sense of his addiction and the impact this had on me over the years. Thank you for staying alongside me after he died and allowing me the time to both grieve and grow. I feel even more determined now to follow my goal of being able to support other young people who have had a similar experience. Thank you!,” said a child accessing the service.

Age-appropriate and flexible interventions

It is essential that support for substance misusing families acknowledges the life-stage and age of those affected. The Inclusion22 model offers both a preventative and educational approach, teaching young people the dangers of substance misuse in a way which is age-appropriate, and then empowering children and young people to make informed, educated choices in their future. This is achieved while giving children and young people a safe space for expressing themselves and processing their own feelings.

Different approaches are used depending on each individual case. During Covid-19 lockdowns, where there was heightened vulnerability, a National Lottery grant enabled children to borrow devices to have their sessions. And when restrictions were lifted, the team introduced ‘walk and talk’ sessions. Staff are qualified drawing and talking therapeutic practitioners too, offering a gentle evidence-based option for children to process emotional pain.

“I’m so grateful and thankful for your help. My daughter has become a confident young lady, she has learnt many skills; eye contact with people, expressing what she really feels and not what she thinks people expect. Inclusion22 has worked brilliantly with my daughter and me. They have made a big difference to our lives; they are very special people,” said the mother of a child accessing the service

Outcomes

The work at Inclusion22 has shown that children and young people will engage with professionals if they feel they are being listened to, genuine trust and rapport are established, and the environment offers somewhere they feel safe. When the going gets tough, it’s often the time to step up, not give up, and as professionals working with young people, we must be their best advocate.

Inclusion22 has supported 81 children in total, including 42 over the past year - all of whom are in the care of a substance misusing parent(s) or carer(s). The outcome measures have been exceeded at every measure, including a consistent trend of significantly reduced risk factors – and 100 per cent of the young people we’ve worked with have shown an increase in self-esteem and wellbeing, and have a robust safety plan in place should a crisis arise.

We must be young people’s strongest advocates, and services supporting and intervening with children and young people facing significant challenges at home. This can prevent the long-term, costly impact of intergenerational substance misuse. If only we could see such future-focussed services nationwide

Emma Norman is director of young people and families at Catch22. Find Emma on Twitter @emmanormanC22