Addiction ,Children ,Young People and Families Day I

1. Addiction ,Children ,Young People and FamiliesDay I BA in Applied Addiction Studies Year 3

2. Learning Outcomes • To describe the impact of addiction on child development ,family life and young people • An understanding of factors within this context that leads to drug use and cross generational substance use .An understanding of the co dependency model. • To describe models of intervention to prevent and support families in the context of drug/alcohol use

3. Key Research Questions?-The Research Conundrum • Is it possible to misuse drugs and/or alcohol and be a good enough parent? • What are the factors that make this possible or militate against it? • What is it like to be a child in a family where parents misuse substances?

4. Key Research Questions?-The Research Conundrum • What are the needs of children of substance misusing Parent? • What do substance misusing parents need to support their children to meet their developmental outcomes? • If as a parent your principal attachment is to a substance how does this affect your capacity to form attachments to your children/partner?

5. Methodological Problems Sample type ,bias due to samples being drawn from most socially deprived and problem saturated families Cause and Effect are difficult to study in isolation given multiple difficulties Samples taken in retrospect

6. Methodological Problems Different Concepts of misuse make it difficult to compare

7. Methodological Problems Ethical issues around interviewing children Stigma and secrecy especially around illicit drug use can cause samples not to be representative Medical orientation rather than on children's care giving environment

8. It is very difficult to separate out substance misuse as a risk factor ,independent from all the variables that contribute to the parent-child dynamic that leads to maltreatment……in isolation it presents little risk of significant harm (Cleaver et al 1999,p23)

9. Even when substance misuse occurs within a context of social and economic disadvantage ,children will not automatically be impacted negatively due to parents employing harm reduction strategies ,resilience and protective factors within the child ,the family dynamic and the community (Hogan,1998)

10. Hogan and Higgins,2001 found that some drug using parents in Ireland managed to provide ongoing care basic care in emotionally responsive homes and support their children's education. How? Informal Family Support a key factor Nature ,extent and pattern of drug use also an issue

11. Methodological challenges • Hogan and Higgins,2001 point to the need to understand the processes by which substance misuse, parenting and children's well-being are connected in order to design appropriate policies and services for substance misusing families.

12. Addiction as a Negative Family Process • However research does suggest that both alcohol and drug misuse create the potential for things to go wrong ,adds to the risk from negative family processes ,is strongly associated with neglect and when combined with other parental problems for example mental illness and domestic violence the dangers to children can be significantly increased (Kroll and Taylor2003p32)

13. Children; The Invisible Voices within the Irish Context • Barnardos ,Child links 2000; issue 3 Anecdotal evidence and research suggests that drug misuse has a profound impact on the individual community and family surrounding the individual……the group most affected are the children of drug using parents yet it is surprising how little research has been given to the needs of these children This situation is slow to change!1997 and 2001 only two national studies completed by Children's Research Centre, Trinity College Dublin on the needs of school going children of drug using parents .Drug Treatment Agencies and Voluntary groups are calling for more inclusive Family approaches to Drug and alcohol treatment.

14. Children's Rights-Towards Child Centred Practice UN Convention on the Rights of the Child/National Children's Strategy 2000 • Article 12,states that children have a right to be heard and that their views should be taken seriously. • Issues around balancing the rights of parents and the rights of children ,the rights of children supersede the rights of parents

15. Finding the Invisible Child • International and Irish Policy documents have clearly outlined the need for bridging the gap i.e. greater multi disciplinary working between addiction services, children and family services and other health professionals, with shared goals to reduce the harm of drug/alcohol misuse within families .(Hidden Harm,2003)

16. Professional Boundaries Territorial Anxieties Client Loyalty Legality The Child in the parent Focus Lack of Family Support/Addiction services Fear of losing the service user Fear of children going into care if social services involved What Challenges would you have??? What Causes the Gap?

17. Why we need multi disciplinary working! • Hidden Harm argues that effective treatment for the adult can have major benefits for the child in terms of creating stability, predictability ,routines ,absence of chaos and risks associated with drug use(2003) • However Orford argues that it is an over simplistic assumption that addressing the individuals substance use alone will produce a reduction in harm to children, partners, parents etc.

18. Mind The Gap !Practice Point • More Child Centred Approaches are dependent as much on ways in which organisations respond and collaborate as on the development of particular models or techniques (Kroll and Taylor,2003p292)

19. Attachment Theory • Secure Attachment between parent and child is arguably the cornerstone of healthy development across the life cycle (Howe et al 1999) • What is attachment? “a child having the need to seek proximity to and contact with a specific care giver in times of distress ,illness and tiredness”(Bowlby,1984)

20. Attachment Theory Continued • Babies and children are not passive in the attachment process-cues 1.Signalling Behaviour e.g. smiling 2.Aversive Behaviour e.g. crying 3.Active Behaviour e.g. Following

21. Attachment Theory Continued • An attachment relationship develops ,within this a child develops an internal working model of all relationships i.e. mental representations of worthiness based on other peoples availability and their ability to provide care and protection

22. Attachment Theory continued • Internal working models influence emotional ,social and cognitive regulation across the lifespan • If children and adults internal working models are secure they are able to reflect on the self ,others and relationships in a relatively non defended way .This allows people to think about their own and others feelings ,actions ,beliefs and behaviours

23. Attachment Theory Continued • Secure Working models=Concepts of Self such as a child believing they can control their social context ,meet goals, stable self efficacy , solid self esteem.

24. Attachment Theory continued • “A Behavioural Control System” • The core conditions for a healthy attachment process are emotional and physical presence and parental sensitivity to a Childs cues/needs .Belsky also argues that the psychological attributes of the attachment figure ,her relations with her partner, access to support services all impact on attachment relationships.(1999)Ecological perspective. • Outcome=Child feels worthy of love, has self respect ,sees others as same ,world is predictable ,safe and you can influence it

25. Attachment Styles Secure Attachment-explore Anxious/resistant attachment-cling or attack Anxious/avoidant-Withdrawal and Self sufficiency Disorganized/disoriented-Inconsistent ,behaviour, Confusion and Indecision (see handout ,Attachment and Bonding in Cases of Emotional Abuse 2006p99)

26. Attachment Theory Continued • Insecure Attachment Styles are seen as a strategy developed to cope with parental lack of availability or sensitivity which is required to meet a child's emotional ,cognitive and social needs(Iwanweic,2006p99)

27. Parenting Style • Authoritarian and Unavailable=Insecure Avoidant Style • Role Reversal/inconsistent Responses=Resistant Attachment Styles • Fear and Terrorising=Disorganized Attachment Styles

28. Substance Misuse affects parenting capacity directly through its effects on mental state and judgement ability or indirectly through the parents lifestyle or the adverse social environment in which such parents live.(Swadi,1994p237)

29. Parenting Styles of some drug misusing Parents • Rejecting/low warmth • Avoiding • Threats • Harshness • Control • Disapproval • Laxivity i.e. Permissive (Kroll and Taylor,2003)

30. International Research has found a link between substance misuse and insecure attachment styles The combination of mental health issues ,substance misuse and domestic violence has been to seen to lead to children with disorganized attachment styles.

31. Some Parents also report improvements in their parenting style as the substance helps them psychologically cope with the demands of parenting (Kroll and Taylor, 2003)

32. Attachment ,Separation and Loss • Adult Children of alcohol misusers discuss the pervasive losses and often unresolved grief of their Childhood • Invisible “Losses” ,Friendships ,Sense of Belonging etc • Implications For a sense of being emotionally held through the difficult developmental tasks of the child's lifespan • Loss of secure attachment, self esteem ,Self efficacy • Actual abandonment by co dependent parent and substance misusing parent, through death

33. According to Hogan, research suggests that children with opiate using parents are at increased risk because these mothers were observed to rely on harsh Verbal responses when communicating with their children.(1995)

34. How can Parental substance misuse impact on parent –child attachments? Kelley,2002- Parental Sensitivity can be impacted upon i.e. irritability, inconsistent moods, impulsiveness ,low frustration tolerance ,impaired judgement ,lack of ability to monitor behaviour ,ignoring, rejecting, verbal assaults ,inappropriate expectations ,long absences, stranger care

35. How can Parental substance misuse impact on parent –child attachments? Contd.. • Environmental Issues- Non stimulating ,access to dangerous substances ,social isolation ,Lack of social support ,lifestyle and chaos ,frequent moves • Secondary Issues- Increased likelihood of violence and physical/mental illness

36. What risks does this pose to children's needs?? • Educational and Cognitive Development • Emotional and Behavioural Development • Identity and Social Development • Family and Social relationships • Self-Care

37. A Developmental approach to the impact of parental substance misuse 0-2;mothers with substance misuse problems have been shown to respond less frequently to their babies cues, when did respond controlling instead of facilitative (Juliana and Goodman,1997).Infants who are regularly rejected come to see themselves as unloved and unlovable.(Fahlberg,1991) .Impact on identity, self esteem,concentration,expressive and receptive language, ability to complete a task.

38. Developmental focus • The primary developmental task for a baby is to develop trust in others(Fahlberg,1991) • They lack an independent view of the themselves hence they may mirror caregivers affect, responses etc.

39. A Developmental Focus • 3-4;Physical danger, need to be provided with feelings of Safety, At risk of Parental aggression ,Cognitive Deficits, lack of Inquisitiveness, Social and emotional development-They are good people who sometimes do not good things-Impact on this if parenting style is hostile or critical.

40. A developmental Focus • Beginning to internalise their parents problems-Blame themselves, attempt to put things right(Rutter,1985)-can put themselves in danger. • A Fearful Age-The greatest Fear is that parents will abandon them(Fahlberg,1991)

41. A Developmental focus • Children can become fearful and unnaturally vigilant(Davenport,1985) • Regression and emotional or Behavioural disturbances (Glaser et al,1997)

42. A Developmental focus • 5-9 Years-Academic Performance, Being as the same gender as the substance Misuser can be more traumatising for the child of the same gender as the substance misusing parent, Negative Self Image, Finding Magical ways to prevent parent substance misuse

43. A Developmental focus • Seeing Alcohol or Drug Misuse as an illness is a protective factor for children from self blame.(Rutter,1995)Retrospect discussion of Feelings, Shame etc,Desire for normality

44. A Developmental focus • Regression,Behavioural,Cruelty to animals, Seek Escape, length of difficulties impact on girls, boys more vulnerable to immediate responses(Rutter,1985),Self Esteem,Fear,Curtail friendships, Too much Responsibility

45. Developmental focus • 10-14 Years; Denial of own needs and feelings, reject Family, substance exploration,education,premature responsibilty,perfectionism • What Else?

46. Developmental Focus • 15 and over- • Inappropriate role models, greater risk of accidents, problematic sexual relationships, school exclusion/early school leaving, Low Self Esteem/Self Efficacy, increased Isolation, Poor Problem solving Skills, Own Needs Secondary to adults

47. Anxious Overburdened Lonely Scared Missing Something ,Searching Fear Shame Insecurity Anger and Hate Guilt and blame Depressed Can we add? Emotional Checklist of children of substance misusers

48. Ecological Approach • Whether Parents can perform effectively in childrearing roles within the family depends on the role demands ,stresses and supports emanating from other settings….parents view of the child, as well as their view and feelings of their own parenting abilities and is related to such external factors such as adequacy of childcare arrangements ,presence of friends ,extended family and neighbours who can help out in emergencies ,the quality of health and social services and neighbourhood safety (Bronfenbrenner 1979p7)

49. Ecological Approach • The Ecological perspective underpins a case management process. • Case Management is a client centred Strategy that involves Assessment/Planning/Linking to Relevant Services/Community Resources and Advocacy (Hesse et al,2008)

50. Ecological Perspective • Considers the role of Substance Misuse in the family • Structural Inequality and Social integration • Support Networks (Jack 1997)