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NETWORK A national newsletter on substance misuse management in primary care


Jo-Anne Welsh outlines the effects of parental substance use on children, and approaches to working with children to build their resilience and improve their outcomes. Ed.


Young Oasis: a therapeutic approach to the needs of children of substance misusers


Brighton Oasis Project (BOP) is a women- only drug treatment provider. Since its inception over 13 years ago it has recognised the need to provide child care to allow women to access treatment and has met this need with provision of a crèche. This placed BOP in a position to observe the effects of problematic parental drug and alcohol use on children. In response to the need these children presented with, a therapeutic service for children affected by familial substance misuse, Young Oasis, was developed. There has been a growing body of knowledge identifying the potential harm of parental substance misuse on children and highlighting the role of adult treatment providers in safeguarding. However the focus on recognising children’s needs does not often extend beyond meeting child protection responsibilities. Hidden Harm1


notes that despite the fact


that most children of problem drug users do not meet the threshold for compulsory social services intervention, their experiences are characterised by a “pernicious lack of attention, care and interest that undermines these children’s wellbeing and development.”


Estimates of the extent to which parental substance misuse is a factor in child protection varies but a figure of around 70% is generally accepted. It is also important to consider the impact of problem substance misuse by other family members including siblings, parents’ new partners and other members of the extended family. Young Oasis works with children both in the


1 Advisory Council on the Misuse of Drugs (2003), Hidden Harm, Responding to the needs of the children of problem drug users HMSO


community and on a one-to-one basis from the projects’ premises to strengthen their resilience. Resilience in this context indicates a process or characteristic that improves the chances of a child bouncing back even when the odds are stacked against them2


.


So how does parental substance misuse impact on children’s emotional wellbeing? Many parents believe they protect their children from the knowledge they use drugs by avoiding obvious use in their presence. In reality, children will often be aware that there is a problem with substance misuse in the family and the parent’s desire to protect them from this can add to the burden the child carries; children can perceive at an early age that their family has a secret that is not to be shared3


. This secrecy can


add to the child’s problems as it makes it impossible to discuss their fears and concerns.


be aware that there is a problem with substance misuse in the family and the parent’s desire to protect them from this can add to the burden the child carries


“ children will often


At an early age children become aware of the potential involvement of the authorities, in particular social services. For some who have already experienced the impact of formal child protection procedures they may be particularly conscious not to disclose information that could result in their removal from the family home. One 8-year-old attending Young Oasis disclosed in her therapeutic sessions that she was lying awake at night worrying about her mum overdosing. In the following week’s session she immediately stated “mums not doing that stuff anymore”. This sums up powerfully the child’s need to share their concerns but at the same time protect and care for their substance misusing parent. Young Oasis works with children and young people to find a language for their emotions. Giving children a voice is the beginning of the therapeutic process. Interventions that bolster a child’s ability to recognise and name feelings, as well as to express them and ask for help, will enhance





2 Auman, K and Hart, A (2009) Helping Children with Complex Needs Bounce Back: Resilient Therapy for Parents and Professionals London


3 Barnard, M and Barlow, J (2003) Discovering Parental Drug Dependence: Silence and Disclosure Society Volume 17 ( 2003) pgs 45-56


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their resilience.


Much of the focus on the impact of parental substance use on children is based on concerns around attachment. Parents’ function as an attachment figure has been described as protecting and comforting when children cannot do so for themselves4


. If their carers are impaired


by substance misuse, there is a risk that a child’s ability to form secure attachments could be damaged, and that could have long-term effects on their emotional health. When discussing their parents, some of the children at the project have spoken of ‘talking to a wall’ or ‘not knowing what mood they’re in’. A parent’s emotional unavailability, whether they are unwell, pre-occupied, on medication, or using or withdrawing from drugs or alcohol, can adversely affect a child’s identity, self- esteem and ability to form attachments. Within the therapeutic relationship they may experience acknowledgement of their achievements, fostering of interests, the holding of boundaries, be shown self regulating techniques and be encouraged to ask for support when needed.


Young Oasis offers weekly one-to-one sessions for 5-18 year olds affected by familial substance misuse, in the first instance for a period of 16 weeks. However, we are conscious that many children are cared for by adults who find attending regular appointments difficult, and for this reason the service has much more flexibility than might be provide in adult therapeutic services. One of the therapies offered is integrative arts psychotherapy; this provides a confidential space for a child to explore difficult feelings alongside a therapist using the arts including clay, sand tray, puppets, image, metaphor, and music. Often children coming from a culture of collusion and secrecy have never told their story and they are confused. Integrative arts psychotherapy helps children to find a language for their emotions.


We have identified ways of working with children in schools and youth centres. In the past year we have worked with children aged 11-13 using a drama therapy approach. Far from the problem of parental substance misuse being hidden, the school could easily identify children affected by this issue. Parental substance misuse can affect children’s education and performance. Problems include poor concentration as thoughts are frequently dominated by anxiety and worry about their parents. Children are often required to take on levels of responsibility inappropriate for their age


Children and


4 McKinsey Crittenden, P (2008) Raising Parents Attach- ment, Parenting and Safety Willan Publishing


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