Being and becoming a father in the context of heavy drinking and other substance use—a qualitative evidence synthesis

Figures & data

Table 1. Search strategy development.

How do fathers experience heavy drinking and other substance use? How does heavy drinking and other substance use by fathers effect their parenting and engagement in family life? What fathers have found helpful in changing their drinking and substance use habits?
Sample	Father* OR paternal OR dad OR men adj3 drinking OR male adj3 substance OR male adj3 drinking OR male adj3 substance
AND
Phenomena of Interest	Alcohol OR heavy drinking OR problem drinking OR alcohol abus* OR alcohol misus* OR substance OR substance misus* OR addiction OR paternal substance OR father* adj3 drinking OR father* adj3 substance OR father* adj3 drug Parenting OR engagement OR relationships OR father-child relations OR parent-child relations OR family Recovery OR change OR coping OR reduction OR health OR help* OR therap* OR change adj3 habit* OR change adj3 behav*
AND
Design	Interview* OR semi-structured interview* OR focus group* OR case stud* OR observ*
OR
Evaluation	View* OR experience* OR perce* OR belie* OR attitude* OR feel* OR think* OR thought* OR understand* OR identif*
OR
Research type	Qualitative OR mixed method*

Table 2. Each study’s contribution to descriptive themes.

Lead author (year)	Young boy and the world as he knew it	Becoming and being a father	Living with addiction
Ahuja et al. (2003)			X
Caponnetto et al. (2020)	X	X	X
Dyba et al. (2019)		X	X
Knis-Matthews (2010)	X	X	X
Lessard et al. (2021)		X	X
Mehus et al. (2021)		X	X
Patel et al. (2020)		X	X
Raynor et al. (2017)	X	X	X
Recto and Lesser (2020)	X	X	X
Schinkel (2019)		X	X
Sieger and Haswell (2020)	X		X
Stover et al. (2018)		X	X
Smith Stover (2017)		X	X
Söderström and Skårderud (2013)	X	X	X

Figure 1. PRISMA flow diagram.

Table 3. Included studies.

Author, year	Journal	Geography	Research aim/question	Recruitment	Sample	Methods
Recto & Lesser, 2020	Western Journal of Nursing Research	USA	Explore how Hispanic adolescent fathers view fatherhood; how this is shaped by life events	Community-based fatherhood programme	17 Hispanic adolescent fathers	Semi-structured interviews; qualitative content analysis guided by Life Course Theory
Smith Stover et al., 2017	Journal of Substance Abuse Treatment	USA, large southeastern city	Test the initial feasibility to integrate Fathers for Change Intervention in a new setting	Residential substance use treatment programme	44 fathers 11 participated in focus groups	Mixed methods Focus groups Thematic content analysis
Smith Stover et al., 2018	Child Abuse Review	USA, large southeastern city	Pilot feasibility study of the modified Fathers for Change model	6-month residential substance use programme	10 fathers 3 participated in focus group	Mixed methods Focus groups Thematic content analysis
Knis-Matthews, 2010	Occupational Therapy in Mental Health	USA	Exploring parenting experiences in the context of substance dependence and a year-long drug treatment programme	Year-long substance use treatment programme	5 fathers and 1 mother	Qualitative Observation and in-depth interviewing Constant comparison method and thematic analysis
Mehus et al., 2021	Transcultural Psychiatry	Northern Uganda, in and around Gulu and Pida Loro	‘From the perspective of fathers, in what ways do alcohol misuse impact fathers’ roles and interactions with their children?’	Urban and rural communities	19 fathers	Ethnography Semi-structured interviews Focus groups Additional informants and data sources informed data analysis Spradley’s (1979) ethnographic interviewing and developmental research sequence
Söderström & Skårderud, 2013	Fathering	Norway	‘To describe fathering issues from the perspective of men with problems of addiction’	Residential family substance use treatment	Eight fathers	Interpretative phenomenological analysis
Patel et al., 2020	International Journal of Drug Policy	Kenya, Eldoret Town and Uasin Gishu County	Explore the perceptions of fathers engaged in problem-drinking and their families about previous experiences with seeking or receiving alcohol-related help	Urban and peri-urban areas, recruitment was completed by local pastors and community leaders	31 individuals: 11 fathers, 11 mothers, 9 children	Semi-structured interviews Thematic content analysis
Caponnetto et al., 2020	International Journal of Environmental Research and Public Health	Italy	Explore the lived experience of being a father in drug addiction rehabilitation and how this affects the parent-child relationship	Two therapeutic communities providing rehabilitation for drug addiction	18 fathers	Qualitative, semi-structured interviews
Lessard et al., 2021	Journal of Interpersonal Violence	Province of Quebec, Canada	‘What are the mothers’, fathers’ and adolescents’ qualitative points of view concerning the links between intimate partner violence, parental mental health, and substance use problems, as well as the associated parenting challenges?’	Several organisations, including general public service organisations and IPV community organisations (shelters for female IPV victims and their children, organisations for IPV perpetrators)	43 people; 15 mothers, 16 fathers and 12 adolescents	Semi-structured interviews
Schinkel, 2019	Journal of Developmental and Life-Course Criminology	Scotland	Explore the trajectories of fatherhood and motherhood in the lives of people who have experienced multiple short prison sentences	Scottish Prison Service Third sector organisations	29 men and women with a history of being in prison; 15 fathers, 11 mothers and 3 childless women with a history of ectopic pregnancy or stillbirth	Semi-structured interviews Thematic and narrative analysis
Raynor et al., 2017	Issues in Mental Health Nursing	USA, primarily rural southeastern state	Explore self-care behaviours for mothers and fathers in recovery from SUD, to gain insight into the role of self-care, its definition, and its application to parenting characteristics	Community programs, churches including pre-dominantly African-American, mental health peer support registry	19 parents in recovery from illicit or licit drug use 11 fathers, 8 mothers	Qualitative descriptive approach Semi-structured interviews
Sieger & Haswell, 2020	Journal of Child and Family Studies	USA	‘How do parents view their substance use before and during family treatment court participation?’	Family treatment court, active and closed cases	17 parents with family treatment court involvement seeking to reunite with their child(ren) 11 mothers, 4 fathers	Interviews
Ahuja et al., 2003	Contemporary Drug Problems	England, West Midlands	Investigate the experiences of family member coping with excessive drinking in Sikh or other South Asian British families	Specialist addiction treatment service with an ethnic minorities counselor General practice in two urban areas with high Sikh populations	24 wives, 10 of their husbands and 7 of their daughters	Semi-structured interviews Two questionnaires; Coping Questionnaire and questionnaire on assimilation
Dyba et al., 2019	Substance Use and Misuse	Saxony, Germany	Gaining deep insight into the experiences of parents who have used substances ; parental role and parenting practices	Five outpatient addiction counseling facilities	24 parents, all clients of addiction treatment facilities and currently not using drugs 16 mothers, 8 fathers	Semi-structured interviews

Table 4. Fathers across the included studies.

Study (author, year)	N, %sample	Age	Culture and nationality	Residence	Education and work	Children	Parental and family relationships	Substance use
Recto & Lesser, 2020	17, 100%	16–23	Hispanic, born in the US	12 living with own parents 5 with the mother of the baby	4 at school 7 working full-time 5 working part-time 5 unemployed	Infants on first year of life	10 in a relationship with the mother of the baby	Marijuana (Michael) Unspecified (David, Mario, Robert)
Smith Stover et al., 2017	44, 100% initially, 37 completed the whole programme,only fathers recruited In focus groups subsample of 11 fathers	21–39	79.5% Caucasian 6.8% Hispanic 6.8% African American	Not specified how many fathers were cohabiting	Not specified	50% had one biological child 38.6% had two children Mean age of youngest child 4.6 (2.92)	34.1% had seen children monthly in the last 12 months 31.8% had seen children daily 75% never married 4.5% married 20.4% separated or divorced	22 reported opiates as primary choice 6 polydrug users 4 cocaine Rest chose alcohol, amphetamines, barbiturates, cannabis and hallucinogens
Smith Stover et al., 2018	10, only fathers recruited Three fathers in focus groups	21–44	9 Caucasian 1 African American	Not specified	Not specified	6 had two biological children 2 had one biological child 1 had three biological children	6 had seen children daily prior to treatment 5 never married 3 separated 2 married	Opiates
Knis-Matthews, 2010	4, 80%	32–48	Not specified	Not specified	Not specified	3–22 (most children under-18 at the time of interview) 1–4 children	Three fathers had frequent contact with children One had contact with youngest but not with the two oldest One had contact rarely with his only child	Not specified
Mehus et al., 2021	19, 100%	29–63	Northern Ugandan, Acholi	Not specified	Diverse range socio-economic positions	Average 5.4 children Mean age of youngest child 6.6 years Mean age of oldest child 17.6 years	Not specified; appears fathers lived with their children and partners in rural and urban locations—none mentioned to be separated from family	Alcohol
Söderström & Skårderud, 2013	8, 100%	30–49	Norwegian	All married or cohabiting	2 vocational education 3 secondary 2 upper secondary 1 higher education	2 with one child 2 with 2 children 3 with 3 children 1 with 5 children Inclusion criteria: child age 0–6	All had female partners with addiction Married 1 Cohabiting 7	Cannabis 1 Amphetamine 2 Benzodiazepine 1 Polysubstance 4 Age at first use ranged from 9 to 25 years 5 injecting
Patel et al., 2020	11, 35.4%	Average age 38	Kenyan, majority belonged to the Kalenjin tribe	Inclusion criteria: fathers sleeping most nights in a shared home with family (cohabiting and not working far away)	Majority were casual workers Average household income 1905 Kenyan shillings / week	Average age 12 10/11 children enrolled in primary school	Majority were married	Locally brewed alcohol with most fathers
Caponnetto et al., 2020	18, 100%	21–56 (median 38.5)	Italian nationality	Not specified	Middle school—high school diploma, one participant had completed the fifth grade	Not described	Two divorced Two separated 14 single with different relationships to family	In rehabilitation for heroin and cocaine addiction
Lessard et al., 2021	16, 37%	Average age 39, age of two fathers unknown	87.5% identified as Quebeckers or Canadians 12.5% identified as other	Not specified	Not specified	Inclusion criteria: At least one child under 18 years old, regular contact with parents	Not specified	Alcohol 16 Drug abuse 12 Prescribed medication abuse 4
Ahuja et al., 2003	10, 24%	34–64, median 45/46	21 were first generation immigrants to the UK	Appears all residing with wives and families	One fluent in spoken English All preferred speaking Punjabi at home	Not fully specified	All married	Only alcohol explored in the study
Schinkel, 2019	15, 52%	26–60	White British	Prison / community, not specified for community-residing	Not specified Almost all in the whole sample ‘from disadvantaged backgrounds’	8 fathers with 1 child 5 fathers with two children 2 fathers with 3 children	Not specified	Not specified
Raynor et al., 2017	11, 57.9%	No breakdown to data about fathers and mothers separately. Whole sample: 29–60 years of age 73.7% white 57.9% married 65% college-educated 57.9% in paid employment
Sieger & Haswell, 2020	4, 24%	No breakdown between fathers and mothers. Whole sample: 22–47 years of age, average age 34 11 white, 4 black, 2 Hispanic, 1 biracial Between 1 and 6 children, average 4 children Children’s age range 1–28 12 participants had previous Child Welfare Services involvement prior to their family treatment court case Drug of choice: 9 metamphetamine; 1 metamphetamine and marijuana; 3 PCP; 1 PCP, alcohol and cocaine; 2 alcohol; 1 alcohol and cocaine
Dyba et al., 2019	8, 33%	No breakdown between fathers and mothers. Whole sample: 17/24 currently in a relationship One married couple among participants Mean age 31.33 years 1–4 children Children’s mean age 7.87 years; majority pre- and elementary school age 8 parents not living with any of their children 2 parents with at least one child living outside the parent’s home 13 parents living with all of their children Only fathers reported lack of contact or irregular visits with some or all of their children

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