Forgotten - the children of addicts

Drug addiction in many ways is not a forgotten issue. It is often mentioned and never far from sight. We may be aware of the addicts, familiar with the political debates surrounding classification of drugs, have heard of the celebrity rehab centres, but are we fully aware of those non-addicts who are equally affected by addiction? Whilst drug addiction may be easily evident, the hidden harm to those closely related to addicts is much less obvious.

Working in the criminal justice system as a solicitor for eleven years and more recently, working as Deputy Chair of the Addictions Working Group investigating the current level of addiction in the United Kingdom, I have had plenty of opportunities to witness the family breakdown that so often occurs as a result of addiction. Children and families of addicts are often silent witnesses to the decline of their loved ones who find themselves increasingly dependant upon drugs. The nature of addiction is such that it causes the addict to focus virtually exclusively on themselves for large amounts of time. Whilst there may be times when they are capable of caring for their children and communicating with their family and friends, there are times when the addict cannot think beyond themselves and where their next fix will be coming from. The potential for harm to relationships and support networks is high; the stakes are raised even higher when considering the harm that could occur to the children of addicts.

Before progressing any further, it is necessary to establish the definition of a problem drug user. Problem drug use can be defined as: ‘having serious negative consequences of a physical, psychological, social and interpersonal, financial or legal nature for users and those around them. Such drug use will be heavy, with features of dependence. It is likely that the prevalence of problem drug use is wider than statistics suggest, the definition above tending to point towards the highest end of frequency of consumption. In 2004, according to the National Drug Treatment Monitoring Service, there were an estimated 287,676 problem drug users in England alone . The UK as a whole has in the region of 360,811 adult problem drug users.

In 2003, the Advisory Council on the Misuse of Drugs published the ‘Hidden Harm’ report. Their findings estimated that between 1996 and 2000, 43% of problem drug users were parents with dependant children. In 2003, the report estimated that there are 200,000 and 300,000 children of drug users in England and Wales. Added to this there are an estimated 41,000-59,000 children in the same position in Scotland. This represents 2-3% of all children in England and Wales and 4-6% of children in Scotland. Not all of these children live with their parents. In 2001 57% of drug misusing parents did not live with their dependant children. However, it is worth noting that these figures are estimates taken from the English and Welsh drug misuse treatment service. It is likely that these estimations are conservative in their scope and that the figures may well be much higher.

In one sample of 77,928 parents with problem drug use, 46% had their children living with them, 54% had their children living elsewhere and 5% had children living in care. This means that 46% of these children are dealing with problem drug use on a daily basis. The remaining 54% are adversely affected by the problem even if they are not in direct contact. A risk profile has been developed which defines eight possible risk factors to the children of problem drug users, four drug-related risks and four social risk factors. All are indicators of potential social insecurity. The drug related risk factors are: daily heroin use with the use of illicit drugs; regular stimulant use; sharing of injecting equipment. The social risk factors are: unstable accommodation; living alone or with strangers; living with another drug user; criminal justice involvement. Evidence would suggest that the percentage of parents living with children reduces as the risk scores increase. However, it is also the case that where children are at home, there is less sharing of injecting equipment, regular use of stimulants or unstable accommodation.

Many features of problem drug use adversely affect bringing up children in a safe and supportive way. Polydrug use, where more than one substance is taken on a regular basis, is a common phenomenon. Combinations of heroin and benzodiazepines or heroin and cocaine are common. Many problem drug users will regularly combine their drug misuse with tobacco, alcohol and/ or cannabis. Polydrug users are more at risk of unpredictable effects to their drug use, reducing their capability of parenting or even responsible living. Furthermore, problem drug users are more likely to inject their drugs, especially heroin users. Injecting makes the drug more effective and therefore better value for money. However, the obvious dangers associated with injecting drugs include overdose, unconsciousness, contracting blood-borne viruses and even death. Problem drug users are also more likely to live in poverty and be socially excluded. Added to this is the fact that ‘many have had difficult childhoods, fared badly at school or have significant mental health problems. Their drug use may thus be only one of several factors that may affect their capacity as parents.’

Parental problem drug use has a profound affect on the children involved, especially but not exclusively when the child lives with the parent. The various risks to the child during its growth and development are of a complex nature. The common features of problem drug use which have an impact on any child involved can be defined as: physical, psychological, social and interpersonal, financial, and legal. The child is at risk of injury, especially where the parent is an injecting drug user. As touched upon earlier, there are also the physical risks of drug misuse to the parent that can have effects on the children. Living with a problem drug user equates with many and varied psychological risks. The domination drugs play in a parents’ life is a significant issue. Parents may display inconsistent and unpredictable behaviour towards the child or suffer from illnesses such as depression and chronic anxiety. There is also the potential for role reversal, with the child acting as carer for the parent. Family break-up is more likely and often leads to or exacerbates the financial situation of the parents. It has also been proven that teenagers who grow up without their biological father are much more likely to take drugs. At age 15, 22.4% of boys from lone-parent families have taken some drugs. This compare to 10.8% where there is an intact two-birth-parent household. Housing, employment, criminal offending and serious poverty are just some of the social and interpersonal features of a problem drug user. There is likely to be an unreliable financial situation, often resulting in lack of money to pay for basic necessities. Finally, the problem drug user is also more likely to commit a criminal offence and be arrested and imprisoned or be subject to a probationary order.

It is generally accepted that the children of problem drug users are considerably at risk. What is not yet quantifiable is the effect of problem drug use on children who no longer live with their parents. Anecdotally I would like to surmise that in a great many cases, these children are likely to suffer indirectly. It is difficult to attribute lack of positive outcomes to children who have been looked after by family, friends, social services or been adopted. However, we do know that ‘looked after’ children are more likely to do badly at school, engage in criminal activity, become homeless and become dug dependant themselves. What is also measurable is the effect problem drug use can have on an unborn child and in a child’s developmental years. Therefore, even a child adopted at birth, may have developmental and other problems as a result of being born to a drug-dependant mother. It is clearly arguable that the children of problem drug-users are at risk whether or not they still live with their parents. ‘Parental drug use has the potential to interfere with virtually all aspects of a child’s health and development.’ Whilst some children are resilient to cope with the above experiences, it is obvious that there is much hidden harm to these children, much of which will never be attributable to drug use.

In 1998, the Government launched its National Drugs Strategy in an attempt to bring under control and tackle the growing drug addiction epidemic in the UK. However, what started its life with a focus on four key areas, ‘Young People, Communities, Treatment and Availability’ , has transmogrified into, ‘Reducing availability; preventing people from using drugs; Reducing and rehabilitating existing users; Out of crime, into treatment’. One ex-Drug Action Team Co-ordinator I recently met, believes this shift in focus has significant implications in the way in which problem drug use is tackled in England: ‘this subtle change towards a coercive, punitive style of language is epitomised in authorship of key documentation moving from inter-departmental, cross-Government ownership to that of a Home Office specialised Directorate, with an accentuated undertone of threat to the public and a necessary response of protection. In this context, treatment and rehabilitation options have become a sub-set to the imperative to ‘break the cycle of addiction’ with the focus on the treatment of offenders, to the exclusion and detriment of the wider population who may wish to seek holistic care responses to the life-controlling condition of addiction.’ It also removes the human element that is so essential to many in rehabilitation, that of the support of family and friends.

Whilst the Government has meant well in its attempts to tackle the problem drug use crisis and ‘protect’ communities from the effects of drug misuse, it has done so in a typically ‘top down’ way. There has been a removal of power from individuals, perceiving all drug addicts as a threat to society and implementing a one sided drugs strategy. The fundamental weakness of the drugs strategy comes from the fact that, ‘the issue of ‘protection’ naturally leads people to question ‘who is being protected from whom?’ when the majority of those presenting to services would also be assessed as vulnerable.’ The implication is that drug users are ‘other’ and separate to the rest of society, therefore losing their identity as mothers, fathers, sons and daughters. Rather than being members of our community ‘deserving and demanding compassion – they become those to be ‘treated’, processed and done to.’ ‘The approach employed by the Drug Strategy culminates in a ‘we know best’, paternalistic attitude which serves to disempower local commissioners, service providers, communities and drug users themselves.’

In its drug treatment programmes, the Government has first and foremost sought to reduce the harm caused by drug addiction. According to the agency, Drugscope, ‘harm reduction focuses on 'safer' drug use and has also been developed as a way of educating young people about drug use, rather than telling young people to 'Just Say No'. Some people say that it [harm reduction] condones or promotes drug use but people who support it say it is realistic and helps keep drug users safe and alive and respects choice and individual freedom.’ However, this policy lends itself to target driven treatment. It focuses on reducing the number of new addicts, the number of current users of illegal substances, the number of drug related deaths, and ultimately the reduction of drug related crime. One example of a harm reduction based treatment is the prescription of methadone or similar opiate substitutes. Whilst this might serve to reduce the numbers of heroin users, those maintained on methadone experience its own set of related problems. For example, the need to collect a prescription on a daily basis. As a result the policy does not enable an ex-user to fully engage in their community. It makes finding and securing a job or working at any kind of regular activity very difficult. As harm reduction treatment receives more Government funding there are therefore many less abstinence based, drug treatment programmes available for those who might chose them.

The Drug Strategy focus on ‘out of crime, into treatment’ is commendable in its aims. When so much crime is drug-related, there is undoubtedly a need to address the problem. However, from my experience, it is fair to say that on the ground, the reality is that however much the Government invests in drug rehabilitation in prisons, they are not adequately tackling the supply of drugs into those institutions. One ex-prisoner and reformed drug addict describes how, whilst in a young offenders institution, ‘in all my time [in prison] I never had a single night without drugs.’ This is a common experience. Many drug users’ habits intensify whilst in prison as there is little else to occupy the minds of the prisoners and evidently, drugs are readily available. During my time as a solicitor, I would regularly hear from my clients how drugs were thrown over the walls of the prisons to be collected by inmates and dealt within the confines of the prison.

The strap line of ‘Treatment Works’ is used to underwrite the quality of provision, when the National Treatment Outcome Research Study (NTORS) notes that some individual drug treatment services achieved markedly better client outcomes than others, and that four to five years after treatment, over half of the respondents were still using illicit opiates. A more accurate summary of these findings would appear to be ‘Treatment works, or it doesn’t.

Much of the discussion so far has set the scene for the scope of the drug misuse problem that exists. However, the purpose of this paper is to highlight the hidden harm that occurs to the children of addicts. This involves a look behind the statistics.

The Government is aware of the vulnerability of children of addicts and problem drug users. The Hidden Harm report was the result of an inquiry into this issue by the Government’s Advisory Council on the Misuse of Drugs. The reports’ statistics clearly illustrate the scale of the number of children of problem drug users without even taking into the account the number of young people using drugs in their own right. The issues involved are hugely complex and there will never be a simple solution to the crisis of problem drug use and addiction. It is certainly fair to say that we are unlikely to ever reach a 0% level of drug use. In spite of the Government’s well-founded intention to solve the problems of problem drug use, I want to suggest they are failing vulnerable children and young people, and failing the drug-using parents.

There is little recognition of the vulnerability of the drug-using individuals themselves. More often than not, the drug-using parents are likely to be the product of a dysfunctional childhood themselves. These problems are rarely isolated to one individual or fail to span generations. Like so much in the breakdown of society, patterns emerge and a cycle develops which becomes very difficult to escape. Those living in poverty are characteristically more likely to experience poor outcomes in life. Where poverty exists a chain reaction occurs whereby the family or individual are more likely to experience other problems, which in turn exacerbates the poverty, and so the cycle continues. Breaking the pattern of the cycle is largely down to identifying the main causal factor affecting all other areas of life or a significant determination to remove oneself from the situation. Dealing with drug dependency can be one way to achieve this.

Problem drug use is just one of a long list of problems that directly or indirectly cause, or are caused, by poverty and social exclusion. The list includes, amongst other things, criminal offending, teenage pregnancy, unemployment, substance misuse, failed education. It can seem like an impossible task for any government to tackle all of these issues. However, dealing with the root causes of social exclusion and the poverty cycle are an essential part of dealing with the crisis of problem drug use. Tackling one without the other will result in long-term failure to tackle either. Furthermore, policy makers have a mandate to care for all in society, including the most vulnerable. The Government has made a great many steps to deal with these issues, but by attempting to control the solving of these problems via central Government, they have created a bureaucratic system that assumes, in the vast majority of cases, a one-size fits all approach. Anyone with even a vague understanding of human nature knows that fitting each individual into a mould will result in a lack of positive outcomes. To fully tackle the issue of problem drug use, we need to promote a holistic treatment system, empowering the local communities and families around the addicts to help and support voluntary or community based treatment programmes where possible, freeing them from excess bureaucracy. The Hidden Harm report was a well-intentioned document considering a crucially important issue, which until 2003 had not been directly considered by the Advisory Group on Drug Misuse. However, I believe the Government let down the children the report sought to protect by failing to respond to the recommendation of the report for two years after its publication.

Developing and promoting a truly holistic approach to treating problem drug use is crucial. Whilst the National Drug Strategy may include elements of holistic treatment within the context of its Drug Interventions Programme , there is still a strong tendency to refer to treatment as completely separate from addressing each individual drug users life and their needs. Treatment is not merely about the providing exit routes for drug users, it’s about addressing their real needs but also the causes of their problems. Some drug treatment services follow this approach already. The service provided by Phoenix House is one that deals with all aspects of a drug users life. Via an abstinence based treatment plan, addicts are able to deal with their habit, whilst at the same time considering why they may have got to their place of drug dependency and abuse. Projects like Phoenix House receive referrals from the Criminal Justice System when those involved in drug-related crime can be sent to rehab instead of conventional custody. However, there are very limited numbers of services across the country offering this sort of treatment.

That said, faith based groups are significant providers of holistic, abstinence based treatment programmes. Central to these programmes is the place of family and community. I have met many people, such as my ex-client mentioned below, for whom family stability and acceptance is not a feature of their life. I recently met one young woman living at a Victory Outreach UK home. The ethos of Victory Outreach UK is to provide Christian homes for young people in need. The story this woman told was one of never knowing what it was to be in a safe and secure family. Leanne had never experienced what it was to be truly loved by a family. Addicted to drugs and caught in the middle of the criminal justice system, she had a bleak future. Through the work of Victory Outreach UK, her life has been turned around.

When someone says to me about family values I didn’t know what that meant, but now I have a real family and I feel I actually belong somewhere…My answer to anyone trapped in the cycle of abuse and drugs is homes where people feel loved, valued, respected and offer a haven away from destructive influences. Leanne

Whilst not directly related to the hidden harm inflicted upon children by the drug use of their parents, it serves to highlight the cycle that exists and which needs to be broken in an addict’s life to enable them to move on and away from addiction. Treatment centres such as Victory Outreach, run by faith based organisations or voluntary groups need help and support. They need a non-bureaucratic system to enable them space to help treat problem drug users who deserve to see their life fully changed.

When I became a Member of Parliament and was handing over my legal cases to my successor I spent some time looking back at old files. I thought about the characteristics of the criminal clients I had come into contact with. Invariably, they are young men, who show irresponsibility. Often they are drug addicts with learning difficulties and are from homes in which there was a single parent. They invariably had little or no contact with a father and no older male role model. One such client was my first client at Enfield police station. He was a young man who had previously had high expectations for his life —he had hoped to be a weightlifter for England—but had, sadly, been tempted by drugs. His lack of discipline and respect showed itself in what was the first of many criminal offences. Over the years, he became one of the most prolific offenders in Enfield. It was not uncommon for him to commit 100 burglaries in a week. He went on to become my last client. He is currently in Pentonville serving a stretch of three years for robbery.

During the 11 years that I have known him, there have been periods of stability in his life. The stability in his life came when, as a father of two young children, he did show responsibility albeit for short periods of time. He was then able to reconnect with society. When he took his responsibility as a father seriously, that connection was made. He suddenly woke up to the fact that he had duties and responsibilities in society. That had a profound effect on him not committing offences. Yes, he was no doubt helped by drug treatment and testing orders and by probation supervision, but of most significance, as he would say himself, was when he faced his responsibilities as a father. It is that challenge that we need to face. The cost to Enfield of those 100 burglaries a week and the cost to his family and to others have been because of that individual and others like him. The big challenge for such people is to reconnect with society and with being fathers, and to take their responsibilities seriously. It is significant that when I visited that person in the cells at Enfield magistrates court or at Pentonville he was often distraught or in tears. The bravura of being a prolific offender had peeled off and he was just a young child in many ways. The first thing that he would always say was that he wanted his father and that he wanted his father to show some interest in him. That had a profound effect on him, and it is now showing itself across the generations as he fails to take his responsibilities as a father seriously. We must tackle the issue of fatherhood, not only for his benefit but also for that of the community.

Finally, it is crucial that the family of problem drug users are supported. Many grandparents and other members of extended family look after the children caught up in the consequences of drug addiction. In many cases, the grandparent ends up with responsibility for their own child and their grandchildren. The work of voluntary organisations such as ADFAM should be encouraged, supported and developed as a crucial element to the problem drug use issue. The vision of ADAFM is to see, ‘a United Kingdom where every family member facing problems with drugs or alcohol will have access to a range of specialised services.’ A central element to the work of ADFAM is that the local community and families are the best people to respond to the problems caused by drugs and alcohol. To this end, ADFAM offer a community development programme, training communities to work out solutions to their local needs, providing the training or networking required to get the project, such as family support group, started. ADFAM believe that local needs require a local response. Supporting the work of organisations such as ADFAM would make a massive impact on the hidden harm issues relating to the children of addicts. Local, community based projects are essential in helping addicts out of drug dependency and vital in supporting the vulnerable families tied up in the cycle of addiction purely through birth.

If you would like a full copy of the article including footnotes, please email david@davidburrowes.com