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Substance misuse refers to the abuse of drugs and/or alcohol. The ‘use’ of drugs or other substances by, parents or carers does not in itself indicate child abuse or neglect and there is no assumption that children living in such circumstances will automatically be considered under the child protection procedures.

The term ‘drug or alcohol misuse’ refers to use of a substance that is associated with problematic or harmful behaviour, i.e. harm is caused to the user or others, such as children, as a result of their use. This term makes a judgement about harm, but does not imply addiction or dependence.


Substance misuse rarely occurs in isolation from other social problems. Lessons from local and national reviews of serious cases and Domestic Homicide Reviews have highlighted the dangers to children from ‘cumulative harm’ which can occur when substance misuse, domestic abuse and parental mental ill health co-exist and increase the risk of harm to children.

Professionals in contact with a child in a drug misusing environment must ask themselves: “What is life like for a child?”

Children of parents or carers who misuse drugs or alcohol are more likely to develop behaviour problems, experience low educational attainment, and are vulnerable to developing substance misuse problems themselves. Some Children's health or development may be impaired to the extent that they are suffering or likely to suffer Significant Harm.

Harm to children from parental substance misuse can be broken down into two types of effects:

  • Direct – as a result of what happens when a parent is intoxicated or recovering.

    Substance misuse may affect a parent or carer’s ability to engage with their child. It may also affect a parent or carer’s ability to control their emotions. Severe mood swings and angry outbursts may confuse and frighten a child, hindering healthy development and control of their own emotions.

    Maternal drug use during pregnancy can seriously affect foetal growth. The use of heroin / other opiates, cocaine and benzodiazepines during pregnancy can all cause severe neo natal withdrawal symptoms. Maternal drug injecting carries the risk of transmission to the baby of HIV and Hepatitis. Maternal nutrition may be poor. (See Substance Misuse in Pregnancy Safeguarding Practice Guidance and Fetal alcohol spectrum disorder: health needs assessment for further information).
  • Indirect – as a result of the prioritisation of drinking or drug taking over a child’s needs.

    A disorganised lifestyle is a frequent consequence of substance misuse. Parents / careers may fail to shop, cook, wash, clean, pay bills, attend appointments etc.

    Indirect harm includes, poverty, physical and emotional abuse or neglect; dangerously inadequate supervision; intermittent or permanent separation; inadequate accommodation and frequent changes of residence; toxic substances in the home; interrupted or otherwise unsatisfactory education and socialisation; exposure to criminal or other inappropriate adult behaviour; and social isolation.

Protective factors and resilience

The risk of harm to the child may be reduced by effective treatment and support of the affected parents / carers and by other factors such as the presence of at least one other consistent caring adult; a stable home with adequate financial resources; maintenance of family routines and activities; and regular attendance at a supportive school.

Protective Factors

  • The presence of a stable adult figure (usually a non-problem drinker);
  • Close positive bond with at least one adult in a caring role;
  • A good support network;
  • Low separation from the primary carer in the first year of life;
  • Characteristics and care style of parents;
  • Being raised in a small family;
  • Larger age gaps between siblings;
  • Engagement in a range of activities;
  • Individual temperament;
  • Positive opportunities at times of life transition;
  • Further, much research shows that, if family cohesion and harmony can be maintained in the face of substance misuse, then there is a high chance that the child will not go on to have any problems (Cleaver et al, 1999; Velleman and Orford 1999).

Resilience factors

  • Deliberate planning by the child that their adult life would be different;.
  • High self esteem and confidence;
  • Self efficacy;
  • An ability to deal with change;
  • Skills and values that lead to efficient use of personal ability;
  • A good range of problem solving skills;
  • The young person feeling that they have had choices;
  • The young person feeling that they were in control of their lives;
  • Previous experience of success and achievement.

Talking to Parents or Carers about their Substance Misuse

It is important to remember that people with alcohol or drug problems will be stigmatised and will often feel ashamed. How you talk to someone about their substance use will vary according to context. Talking to a child who is experimenting with alcohol or drugs is likely to be different to talking to a parent / carer whose substance problems may be seriously affecting their ability to care for their children.

Think about what you will do with any information before you begin asking questions; if you’re not going to do something with it, or haven't got enough knowledge to interpret it correctly, don't ask. If you remain concerned speak to your designated safeguarding lead or local alcohol or drug agency.

When people have developed problems with their alcohol or drug use this usually happens over a long period of time. Therefore changing that use and maintaining that change can mean a complete, and often sudden, change of lifestyle, socialising, interests. Supporting people at this stage to explore their options and interests is vital in helping them to maintain the change.

See The Cycle of Change and the Child’s Roller Coaster and Parents with alcohol and drug problems: adult treatment and children and family services.

Assessing the Impact

If a drug or alcohol service user is a parent or carer, the outcome of their treatment is likely to be affected (positively or negatively) by the demands being placed on them in caring for their children. Failing to recognise this and seek any necessary support could put both the service user’s treatment outcomes and those of their children at risk.

Where there are concerns that a child is living in the environment of substance misuse, an assessment of the parent or carer’s ability (capacity) to meet the child’s needs should take place to establish the impact on the child of the parent or carer’s lifestyle and capacity to place the child’s needs before those of their own.

Issues which should be covered by an assessment of harm/potential harm to a child living with parents / carers who misuse substances include:

  • The pattern of parental drug use;
  • Accommodation and home environment;
  • Provision of basic necessities;
  • How the drugs are procured;
  • Health risks;
  • Family’s social network and support system;
  • When intervention is necessary;
  • The child’s perception of the situation;
  • The parent / carer’s perception of the situation.

Drug and alcohol services should ask all service users whether they are parents, carers or if they have childcare responsibilities.

Responding to Concerns

The use of drugs or other substances by, parents or carers does not in itself indicate child neglect or abuse and there is no assumption that children living in such circumstances will automatically be considered under the child protection procedures.

In order to establish whether or not a parent or carer’s use of drugs/substances is in itself a source of harm/potential harm to a child, an assessment of the impact of drug use on parenting ability and the life of the family is required. As part of the assessment process, practitioners from adult services, and specialist drug / alcohol agencies, should work in collaboration with Children’s Social Care.

There will be circumstances where there are concerns that a child may be suffering or likely to suffer Significant Harm, and a referral to Children’s Social Care should be in line with the Contacts and Referrals with Children’s Social Care Procedure.

Where any practitioner has contact with a pregnant woman who is using substances, and the degree of substance misuse indicates that parenting capacity is likely to be seriously impaired, they must make a referral to Children’s social care. See Substance Misuse in Pregnancy Safeguarding Practice Guidance.

Where a newly born child is found to need treatment to withdraw from substances at birth, an assessment and a pre-discharge discussion should take place and a referral to Children’s Social Care in line with the Contacts and Referrals with Children’s Social Care Procedure.

Specialist Substance misuse services should be invited to and should attend and provide information to any meeting concerning the implications of the parent/carer’s substance misuse problems for the child, including Child Protection ConferencesChild in Need meetings and Early Help Meetings.

Concerns about a child’s drug or alcohol abuse should be subject of an assessment by an appropriate agency. A child who is using drugs or other substances should not be considered automatically to be suffering or likely to suffer significant harm. See Children and Substance Misuse Safeguarding Practice Guidance for more information.

.When practitioners make a decision to end their involvement with a parent/carer with substance misuse problems, or a child who is living with a parent/carer with substance misuse problems, they should always discuss their plans with the other services who are working with the family, before the case is closed. This is to ensure that any on-going needs can be addressed.

A Whole Family Approach

By taking a whole family approach and by working closely together, drug and alcohol services, dedicated young carer services and children and family services can best meet the needs of parents whose substance misuse is adversely affecting the whole family.

Research has shown that whole family interventions can provide family members themselves with the support that they need as well as lead an improvement in treatment take up, retention and outcomes for those misusing substances.

Amendments to this Chapter

In July 2022, the further information section was added with links to support services and relevant guidance.