Introduction

This paper, from Muir and colleagues (2023), details a systematic review exploring the lived experiences of children and young people whose parents use substances. We know from a wide range of research and policy, that parental drug and alcohol use has wide ranging impacts on young people throughout their lives, and this study, which includes the experience of 737 children & young people, considers the issue from the perspective of the lived experience and narrative experience of individuals.

The paper opens with a reminder that parental substance use is highly prevalent worldwide, and there are a wide range of health, social care, and safeguarding concerns that can accompany problematic and/or habitual use of drugs or alcohol in the family setting (Canfield, 2017). The urgency of the issue is captured in the background of the paper, which sets out the estimated scale of impact, with around 4% (or 478,000) children in the UK living with a parent who uses drugs or alcohol (Children’s Commissioners Office,2020) and correlations with poor school attendance and concentration (Diaz et al 2008), low academic performance (Hogan & Higgins, 2001), antisocial problems (Molina et al, 2010), anxiety and depression (Gorin, 2004) and their own substance use problems (Velleman & Templeton, 2016).

For me this study is an opportunity to reflect on the scope and potential impacts of parental substance use, considering the strategies and behaviours that a child or young person adopts to cope with, and make sense of their experiences, rather than focusing on the factors of vulnerability which have been revisited a number of times over the last two decades (see for example Barnard & Barlow, 2003; Ronel & Levy-Cahana,2011; Park & Schepp, 2018 etc)

Method

The review was registered with PROSPERO and papers were identified by searching the key electronic databases using key word searching. The authors set out their search strategy within the paper. International peer reviewed papers were included, with papers, in languages other than English, translated for inclusion, and grey literature searched, with authors contacted directly where papers were not accessible. Inclusion criteria included – focus on lived experience or perceived impact on children on young people under the age of 25 whose parents used one or more substances. Several studies were included that extended beyond this age criteria, with data for under 25’s extracted where this was possible. Studies were excluded where they mainly reported on looked after children, those in the criminal justice system, and those that reported the views of others rather than the child or young person themselves. In total 35 studies, over 49 papers, including over 700 children, were included in the thematic synthesis within the paper.

Results

What is clear across the studies, and within the analysis that is presented by Muir and colleagues in this paper, is that children and young people will often attempt to mitigate and manage the difficulties associated with unstable parenting and home environments. This includes coping with stigma and young carer responsibilities and has the potential to impact in a way which continues beyond childhood and into adulthood, with links to problems with mental ill health, substance use and poor emotional and social wellbeing in adulthood.

The authors identify five overarching themes in their synthesis of the literature, these include:

1. Living with insecurity and unpredictability.
2. Social and emotional impacts
3. Controlling the uncontrollable – creating safety within the family
4. Coping with social and emotional impact
5. Formal and informal support available to both the child and young person or the parent.

The paper includes useful tables, breaking down the data and how it was filtered before getting into the detail of the findings. It breaks experiences down into key areas that influenced the lived experience of the child or young person, and the areas where coping and resilience were particularly relevant in terms of mitigating the ongoing impact of the parents’ substance use and associated behaviours. Some of the key factors to bear in mind when thinking about the impact of parental substance use in practice are identified as the child’s relationship with parent, the cycle of use, roles and responsibilities within the family home and the stability of the family living arrangements.

The findings also go on to discuss something which I have been interested in my whole career – hypervigilance and how lived experience of parental substance use allowed children and young people to spot signs and clues that better prepared them for periods of substance use, and violence, paying particular attention to the emotional and social strategies and skill sets that the children had acquired to manage the impacts. For example, the study notes that in many cases the children reported that they tried to hide their parents’ substance use issues, in order to avoid social impacts such as stigma, embarrassment and fear of ruining social relationships. Children and young people reported that their emotional and social support is often being provided by their siblings, stable parents of other children, as well as a friend or neighbour, however support wasn’t always immediately available, and there is a risk for exploitation and negative coping strategies introduced by friends.

Strengths & Limitations

The review navigates through various qualitative studies, exposing the nuanced narratives of children and young people grappling with the consequences of their parents’ substance abuse. One of the paper’s strengths lies in its exploration of the perceived impact on the targeted demographic, Muir et al. meticulously examine the psychological, social, and developmental repercussions.

While Muir et al.’s systematic review contributes significantly to our understanding of the topic, a critical lens prompts reflection on potential gaps. The geographic and cultural diversity of the studies reviewed could be explored further, offering a more comprehensive understanding of how these experiences vary across contexts.

Additionally, a deeper exploration of the effectiveness of existing support systems could enhance the practical implications of the paper. In addition to examining the lived experiences as told by participants of multiple studies, it also delves into the perceived impacts of parental substance abuse and the strategies adopted as a response to the many challenges that this complex issue creates. The paper provides a comprehensive synthesis of existing research into a complex issue that remains a significant concern across health and social care with children and young people.

Implications for Practice

Although the links between problematic substance use and poor parenting are often made in both practice and in the literature, the focus on the child’s perspective is the contribution that this paper makes, identifying that the impact on a child’s development can be complex and often misunderstood or misinterpreted.  Whilst the strategies and coping mechanisms that children and young people develop, in response to parental behaviours can be strengths, the ability to adapt and survive through understanding people is no mean feat, and sadly, current resources and interventions are not sufficient to put a dent into how many profoundly affected children transition into adulthood without ever being heard.

Muir and colleague’s systematic review could ‘be an invaluable resource for practitioners, clinicians, and policymakers seeking to address the profound impact of parental substance abuse on children and young people. Through the exploration of the lived experiences, perceived impact, and coping strategies, the paper not only sheds light on a critical societal issue, but also lays the groundwork for informed interventions and support systems. The paper highlights that risks and protective factors can be individual, (e.g. high or low self-esteem), parental (e.g. positive and consistent parenting or negative and inconsistent parenting), familial (e.g. no other comorbid psychopathology in parents or additional comorbidities) as well as social (e.g. positive or no social support) (Park & Schepp, 2015).  As the paper states, good qualitative research seeking to gain more understanding from the child or young person’s experience is a valuable addition, and one which we should keep at the forefront of our minds when considering policy, practice approaches and child focussed interventions.

Statement of Interests

None

Links

Primary Paper

Muir, C., Adams, E. A., Evans, V., Geijer-Simpson, E., Kaner, E., Phillips, S. M., Salonen, D., Smart, D., Winstone, L., & McGovern, R. (2023). A Systematic Review of Qualitative Studies Exploring Lived Experiences, Perceived Impact, and Coping Strategies of Children and Young People Whose Parents Use Substances. Trauma, violence & abuse, 24(5), 3629–3646. https://doi.org/10.1177/15248380221134297

Other References

Barnard, M., & Barlow, J. (2003). Discovering parental drug dependence:  Silence and disclosure.  Children and Society, 17(1), 45–56. https://doi.org/10.1002/chi.727

Canfield, M., Radcliffe, P., Marlow, S., Boreham, M., & Gilchrist, G.  (2017).  Maternal substance use and child protection:  A rapid evidence assessment of factors associated with loss of child care. Child Abuse & Neglect, 70, 11–27.  https://doi.org/10.1016/j.chiabu.2017.05.005

Children’s Commissioner’s Office. (2020). Childhood Vulnerability in England.  Retrieved January 2022, from  https://www.childrenscommissioner.gov.uk/chldrn/

Diaz, R., Gual, A., García, M., Arnau, J., Pascual, F., Cañuelo, B., Rubio, G., Dios, Y., Fernández-Eire, M. C., Valdés, R., & Garbayo, I. (2008). Children of alcoholics in Spain: From risk to pathology. Social Psychiatry and Psychiatric Epidemiology, 43(1), 1–10. https://doi.org/10.1007/s00127-007-0264-2

Gorin, S.  (2004).  Understanding what children say about living with domestic violence, parental substance misuse or parental health problems. Joseph Rowntree Foundation. Hagstrom

Hogan, D., & Higgins, L.  (2001).  When parents use drugs:  Key findings from a study of children in the area of drug using parents. Children’s Research Centre.

Park, S., & Schepp, K. G. (2015). A systematic review of research on children of alcoholics: Their inherent resilience and vulnerability. Journal of Child and Family Studies, 24, 1222–1231. https://doi.org/10.1007/s10826-014-9930-7

Park, S., & Schepp, K. G. (2018). A theoretical model of resilience capacity: Drawn from the words of adult children of alcoholics. Nursing Forum, 53(3),  314–323. https://doi.org/10.1111/nuf.12255

Ronel, N., & Levy-Cahana, M.  (2011).  Growing-up with a substance dependent parent:  Development of subjective risk and protective factors.  Substance Use & Misuse, 46(5), 608–619 https://doi.org/10.3109/10826084.2010.527417

Velleman, R., & Templeton, L.  (2016).  Impact of parents’ substance misuse on children: An update. British Journal of Psych Advances, 22, 108–117.

Photo Credits

• Photo by Michał Parzuchowski on Unsplash
• Photo by Gaby Fishman Fosbery on Unsplash
• Photo by Tammy Gann on Unsplash
• Photo by Zhivko Minkov on Unsplash