Harms to children; manifold, serious and long-lasting

There has been an increase in the awareness of harmful effects of parents’ problematic substance use to their children for the past 10 years. Previously, most researchers looked at the risks of intergenerational inheritance of problem substance use or mental health problems, often using clinical data. These studies show that there is a risk of social inheritance of problematic substance use, but they also show that the connection is complicated and many factors protect the child from repeating parental behaviour (Jacob & Windle, 2000; Harter, 2000; Lieb et al, 2002; Yu, 2003). In spite of this knowledge, public discussion has not always been very useful. Blaming the parent, moral condemnation or simply closing one’s eyes to the problem may lead to increased stigma. Families have often tried to keep their problems secret, perhaps even being afraid to look for help. Child custody officials have a duty to protect children’s rights when parents neglect or abuse their children, but in conflicting situations and due to the typically long duration of substance use problems, their task is difficult.

Recently, researchers have increasingly paid attention to alcohol-related harm to others. Many of the studies on harm caused by someone else’s drinking focus on close relationships, looking at harm to partners, other family members and children (Laslett, Ferris, Dietze, & Room, 2012). This discussion has widened the research perspective into recognising children as citizens with rights and needs of their own. This tradition has the advantage of focussing on the factors that could make the children’s and the whole family’s situation better in the present circumstances, rather than only predicting the risks of future health or how the children might manage in adulthood.

This special issue includes six articles focussing on harm to children and young adults. The articles were initially presented at an international symposium on “Harm to Others”, arranged by Kettil Bruun Society in Helsinki on September 2015. Sixty participants from all over the world attended the meeting.

Jim Orford’s paper provides a framework through which such harm could be examined. He takes an international perspective on the harm to close family members caused by problem substance use. Orford writes that although there is a common core to the harm experienced by all affected family members, the family harm is variable, dependent on important ways on relationship, and social and cultural factors. Family members experience greater coping difficulty and higher levels of strains under condition of greater accumulated burden, a family position of structural subordination and dependence, and lack of good quality social support. Coping with a close relative’s problem substance use is “variform universal”. The study calls for services where these other factors can be taken into account.

Two studies published here present results from register-based epidemiological research on harm to young and adult children. Kirsimarja Raitasalo el al. show that young Finnish children’s (0–6 years) hospitalisations for injury, somatic illness or psychiatric disorders were more prevalent if the mother or the father had a substance abuse problem, compared to other children born in the same year. The study also showed that among these small children, the mother’s problem caused more harms than the father’s. Thomas Hemmingson’s study is based on Swedish register data and shows an association between father’s alcohol consumption level and their sons’ alcohol-related hospitalisation in adulthood. Interestingly, the study shows an association between not only problematic alcohol use among the fathers, but also lower levels of alcohol consumption in fathers and offspring alcohol-related problems in adulthood.

Enser et al. interviewed university and college students in England about their experiences of alcohol-related collateral harms. Risk factors for these experiences included gender and family members who drink every day. In particular, it is worth noting that when a more homogenous group is sampled, such as university students in Enser et al’s paper, the role of the harmed party’s own consumption is no longer important. This suggests that own consumption as a predictor of being harmed by others may, at least in part, reflect membership in a heavy drinking network. As such an overarching theme in these papers is that harms were not associated with the harmed person’s lifestyle, rather their exposure to those who drink heavily.

Two studies point out challenges and possibilities for practical work and support among families, who are struggling to look after their children and to overcome their substance use problems. Pirskanen et al. ask in their study how previously substance abusing but presently recovered parents in Finland describe their re-discovered parenthood. The parents who had undergone successful treatment identified in various ways their role as a parent. The study contributes to understanding how parenthood was regained following recovery, and shows that a responsible life and regaining parenthood are possibilities and realistic expectations. On the other hand, the study shows that there is a strong tension between abusing substances and parenting, and that the parents are aware of this. Näsman and Abrahamson report the results of a Swedish study looking at the role of the other parent, who does not have addiction problems. They were interested in finding out to what extent the children, who have experienced serious harm caused by the substance misusing parent, can find support and help from their other parent. The children described how the other parent, for many reasons, may have restricted ability to give the child the needed help and support. The authors argue for a family perspective, taking all parties into account, and not neglecting the child’s experience.

The harmful experiences that children go through due to their parents’ problem drinking or drug use are severe, sometimes life-threatening. Long-lasting health risks are also possible. There clearly is a common core to the experience of being an affected family member, an experience which small children also encounter. The studies published here make this very clear, but they also highlight the need and possibilities of looking for solutions. Protective factors and the points of entry available for supportive and curative interventions differ. Many factors need to be considered and understanding the variability is important. On the other hand, some similarities are clear. The experience of being a child in a family where an adult’s substance use causes problems has many similarities despite individual differences, and support and help should be developed based on understanding this experience and on listening to the children themselves. Any health or social work professional, whose client has substance use problems, should discuss the children’s situation as well. Any adult working with children and noticing that the child’s parents have substance use problems, should listen to the child and help him/her. One of the most obvious, but for some reason almost totally neglected resource here is the non-drinking parent. More support for them would be important, independently of whether they are living with the problem drinking or drug using parent or not.

Ignoring the problems that children face is a serious neglect of the basic norms of any civilised society. These norms have also been stated and signed by most countries in the UN Convention on the Rights of the Child (United Nations, 1989). We need open social discussion, disappearance of the stigma attached to families suffering from problematic substance use, and we need to develop adequate help and support. Stigma attached to this very common situation is unnecessary and harmful and leads to a waste of human potential among the young citizens. It is important to focus on the family’s strengths, and involve all family members.

Studies show the great variability of harms and family situations, and thus the variance of recommendable interventions. But the main result is that any person’s problematic substance use has serious and manifold impact on other people, especially those close to him/her. Harm to children from parents’ substance use is in accordance with the relevance that parents have in their children’s lives – harm can thus be life-threatening and life-lasting.

Declaration of interest

The authors report no conflicts of interest.