A Family Perspective for Substance Abuse: Implications from the Literature

SUMMARY

This paper calls for researchers and treatment providers to increase their recognition of the role that family and family functioning has for understanding the incidence and impact of substance abuse. Substance abuse is identified as a family problem by exploring its occurrence within families as well as its impact on marital relationship, family violence, and child abuse and neglect. The impact of substance abuse on the roles of spouses and parents are examined, as is the impact of substance abuse on children at various developmental stages. The role of the family as participant in active substance abuse as well as a valuable treatment resource is also explored. Finally, the authors present recommendations for increasing the focus on family in substance abuse research.     

Illuminating the Black Box From Within: Stakeholder Perspectives on Family Drug Court Best Practices

This article describes a mixed-methods, concept mapping study in an urban family drug court (FDC) designed to identify keys to FDC success from stakeholders’ perspectives. Participating FDC team members and clients developed a set of items they deemed integral to an FDC, thematically clustered the items, and then rated their relative importance. Using these data, cluster analysis and multidimensional scaling generated 6 themes perceived as contributing to positive outcomes. Resultant concept maps revealed that, compared to team members, clients view relational aspects of the FDC as more important. The findings point to implications for future research and social work practice.     

Parental substance misuse and child protection in a British sample. A survey of children on the child protection register in an inner London district office

The relationship between parental misuse of alcohol and/or illegal drugs and child maltreatment has received considerable attention in the USA, while comparatively few British studies have been published. In both countries, research suggests that it is a large and growing problem and that it has a significant negative impact on children. This study looks at 50 families with 95 children on the Child Protection Register (CPR) in an inner London area through an examination of files and social workers' rating of parental substance misuse as a child protection concern. Parental substance use, as defined by social workers, was considered by social workers to be a cause for concern in 52% of families. Alcohol (in 24% of families) and heroin (in 16%) were the main substances of concern. Substance misuse was strongly related to neglect and cases were twice as likely to be subject to care proceedings. Very little involvement of substance misuse professionals in child protection procedures was found. Different profiles of social work concern were found for alcohol and for illegal drugs. Reasons for this difference and areas for further research are discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

The Effects of Childhood Sexual Abuse and Other Trauma on Drug Court Participants

Within the context of a larger study of drug court participants, this study examined the impact of traumatic experiences on psychiatric distress and on court outcomes. In the analyses, the participants (n = 229) were separated into 3 groups: childhood sexual abuse (CSA; n = 18), other trauma (n = 134), and no trauma (n = 77). The CSA group had higher mean scores on depression, anxiety, panic disorder, social phobia, somatization, and posttraumatic stress disorder than the other trauma group. Path analyses suggest that a history of trauma is a positive predictor of psychiatric distress and negative court events (positive urine screens, sanctions, etc.), with indirect effects on substance abuse severity, and failure in the drug court. These results suggest a need for the initial assessment procedure in drug courts to include a screening for trauma history, including CSA. They also suggest a need for trauma-informed care within drug courts.     

Parental substance misuse and child care social work: research in a city social work department in England

This research set out to establish evidence about the scale and impact of and response to parental substance misuse in child care social work teams in a city social services department in England. The article draws on some aspects of the data collected in the research, which includes: a snapshot survey of all child care social work caseloads in the city; group interviews with practitioners and parents in recovery; individual interviews with parents using a pilot project that focused on parental substance misuse. The research provides evidence of parental substance misuse as a key factor that needs greater consideration within child care social work assessments and as an issue to target in developing preventative responses to child welfare concerns. Child care social workers are shown to need specialist support in undertaking this task to best effect. Copyright © 2004 John Wiley & Sons, Ltd.     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

Working with Families Who Experience Parental Mental Health and/or Drug and Alcohol Problems in the Context of Child Protection Concerns: Recommendations for Service Improvement

Child abuse and neglect often occur within the context of multiple risk factors, in particular parental mental health (MH) and/or drug and alcohol (D&A) problems. Interventions aimed at improving parental MH and D&A issues can have a positive impact on children now, as well as in the future. However, implementing sustainable service models that facilitate positive change for families with multiple risk factors is challenging. The purpose of the present study was to gain feedback from key stakeholders on a service model targeted at families where there are parental D&A, MH and child protection concerns to identify possible strengths and limitations of the model. This identified possible strategies for service improvement from the perspective of discharged clients and clinical staff. Gaining feedback from key stakeholders on service models is increasingly recognised as central to service evaluation and development. Ten interviews were conducted with clinical staff and twenty interviews with discharged clients of a pilot service that works with families where the child or children are at risk of significant harm in the context of parental MH and/or D&A issues. The interviews with clinicians highlighted difficulties working with this complex client group and its impact on staff burnout. Clinicians suggested how the model could be changed to better support clinical staff from burnout. Interviews with discharged clients highlighted the importance of the relationship with the worker in establishing client engagement and facilitating change. The way in which these recommendations informed the design of the service model is discussed.     

‘If I Had a Family,There Is No Way That I Could Afford to Work Here’: Juggling Paid and Unpaid Care Work in Social Services

Drawing on three case studies in each of Australia, New Zealand and Scotland, this article explores how care workers employed in the social services sector negotiate their unpaid care responsibilities in the context of lean work organization and low pay. For younger workers, the unrelenting demands of service provision and low pay made any long‐term commitment to working in social services unrealistic, while many female workers experienced significant stress as they bent their unpaid care responsibilities to the demands of their paid work. However, male workers, less likely to have primary caring responsibilities, appeared less troubled by the prioritizing of paid over unpaid care work and less likely to self‐exploit for the job. At the same time, there is a widespread acceptance across different national and organizational contexts that the work/family juggle is a personal responsibility rather than a structural problem caused by the demands of underfunded and overstretched organizations.     

Work and Family in the 1990s

This review highlights four themes emerging from the work and family literature of the 1990s. The first theme evolves from the historical legacy of the maternal employment literature with its focus on children's well‐being. The second theme, work socialization, is based on the premise that occupational conditions, such as autonomy and complexity, shape the values of workers who in turn generalize these lessons off the job. Research on work stress, the third theme, explores how experiences of short‐ and long‐term stress at work make their mark on workers' behavior and well‐being off the job. Finally, the multiple roles literature focuses on how individuals balance roles, such as parent, spouse, and worker, and the consequences for health and family relationships. In addition to these four major themes, advances in work and family policy initiatives over the past decade are discussed. Suggestions for future research focus on addressing issues of causality, attending to the complexity of social contexts, linking research to policy, and developing interdisciplinary theories and research designs.     

The consequences of love: young people and family practices in difficult circumstances

In recent years, there has been a resurgence of sociological work exploring the importance and meaning of kinship. Much of this work has criticized the ‘individualization’ thesis according to which changes in family structures over time have been interpreted as reflecting a fundamental decline in family values. Highlighting continuities as well as change in family life, this work has also suggested ways to move beyond the individualization debate and to develop alternative frameworks for the study of contemporary families and personal life, notably through the analysis of related practices. For various reasons, this recent work has focused primarily on the experience and practices of adults in ‘ordinary’ rather than more difficult family circumstances. This article aims to complement this work by focusing on the difficult family experiences of young people affected by parental substance use. It is argued that it is important not to lose sight of such experiences in order that sociological thinking reflect the diversity of family practices and the resources available to support them, including at younger ages. In addition, the importance of developing concepts or a language facilitating the exploration and communication of the emotional and symbolic significance of these practices is emphasized.     

The Strengthening Families Programme (SFP) 10‐14 and substance misuse in Barnsley: the perspectives of facilitators and families

The aim of this study was to evaluate the Strengthening Families Programme for young people aged ten to 14 and their parents (SFP 10‐14) in Barnsley, a northern English city, based on the experience of facilitators and families who had participated in the programme. A mixed methods design blending both quantitative and qualitative data was used in the study carried out in two phases over a nine‐month period in 2005. Quantitative data were collected through: the SFP 10‐14 Parent/Caregiver Survey Questionnaire, the SFP 10‐14 Young Persons' Survey Questionnaire and the Strengths and Difficulties Questionnaire. Questionnaire data were compared at the beginning of the SFP 10‐14 programmes (weeks 1–2) and at the end of the programmes (week 7). In addition, two focus group meetings were held with families who had undertaken the SFP 10‐14 programme; and three focus group meetings were conducted with facilitators of SFP 10‐14 programmes. Once quantitative and qualitative data had been analysed separately, a synthesis of the main findings from both approaches was then completed. Following the programmes, parents reported significant changes in communication limit setting, emotional management, prosocial behaviour and drugs/alcohol use. Total difficulties scores were also significantly different pre‐ and post SFP 10‐14 programmes. For the young people, communication, and emotional management were improved and their drugs/alcohol use was less. Their total difficulties scores were also significantly different. Qualitative evidence indicated that families who participated in the study found the SFP 10‐14 useful in preventing young people's alcohol and drug use in terms of: learning more about alcohol and drugs, using knowledge and skills to reduce behaviours that might lead to alcohol and drug use and, for young people, dealing with peer pressure that might lead to drug and alcohol use. Parents/caregivers and young people reported that the SFP 10‐14 had played a part in improving family functioning through strengthening the family unit. The findings from this exploratory study suggest that the SFP 10‐14 may be a useful primary prevention intervention in helping to prevent drug and alcohol misuse in young people. Copyright © 2009 John Wiley & Sons, Ltd.     

Work/Care Regimes: Institutions,Culture and Behaviour and the Australian Case

Increasingly around the industrialized world, labour markets rely upon the paid work of women, many of whom have dependents. Such changing patterns of paid work by women — and by men — are located within work/care regimes that are more or less hostile to the needs of paid workers who care for others. This article sets out a model of work/care regimes and locates the Australian case within international and historical contexts. In Australia, the unchanging normative male worker archetype dominates institutions of work and care, while the cultures of motherhood and fatherhood remain stoically resistant to renovation. In the meantime, the behaviour of working women runs ahead of these unchanging cultures and institutions, creating a policy interest in ‘reconciling’ work and care, but a failure to provide it. The reasons for this failure are outlined.     

Parental substance misuse and statutory child protection in England: Risk factors and outcomes

Parental substance misuse is a significant child welfare issue and associated with increased risk of child maltreatment. The aim of the present study was to understand what social care outcomes children who live with parental substance misuse have, and to assess factors associated with those social care outcomes over a two-year period. The paper reports on a retrospective longitudinal study of 299 children all living with parental substance misuse and referred to one local authority in England. Data were collected from children's social work case files about procedural social care outcomes and factors which may be associated with those outcomes. Using cluster analysis, a new typology of children's longitudinal trajectories through the children's social care system was developed, consisting of five distinct types. Analysis indicated that some children received too little intervention from children's social care despite ongoing concerns, while other children were potentially unnecessarily caught up in the social care system. Factors associated with children having the poorest outcomes were: caregiver instability resulting from substance misuse, parenting capacity and household instability. The study's findings indicate that some children who live with parental substance misuse are at significant risk of harm, but others are not and may be better supported through non-statutory services such as early help.     

Brief Screening and Intervention for Alcohol and Drug Use in a College Student Health Clinic: Feasibility,Implementation, and Outcomes

Abstract

Objective: Evaluation of the Brief Alcohol Screen and Intervention in College Students (BASICS) in a university primary care setting. Participants/Methods: Undergraduates (N = 449) participated in BASICS and electronic surveys assessing frequency/quantity of alcohol and drug use, psychosocial and mental health outcomes, and demographic information. Data were collected at baseline and 6-month follow-up between August 2006 and August 2008. Results: Drinking and drug use decreased between baseline and 6 months. Participants reported an increase in protective factors and in readiness to change alcohol-related behaviors, and a decrease in alcohol-related consequences and in distress symptoms. Heavy episodic drinking at baseline significantly moderated the changes in number of drinks in a typical week and in a typical weekend, and number of drinks on the occasion drank most on a weekend. Conclusions: BASICS can be implemented in a primary health care setting and university students may reduce their alcohol and/or drug use.     

The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse

This study examined the impact of the Affordable Care Act (ACA) on gender and racial and ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy or binge alcohol use (n = 52,496) and those with alcohol use disorder (AUD; n = 22,966). Difference-in-differences models estimated service-related disparities before (2008–2009) and after (2011–2014) health care reform. A subanalysis was conducted before (2011–2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy or binge drinking were excluded from substance use disorder (SUD) treatment and unmet need outcome models due to insufficient cell size. Among heavy or binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. Mental health (MH) treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. Although there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.     

The Community Context of Family Structure and Adolescent Drug Use

Using data from the National Educational Longitudinal Study (NELS), this article investigates a number of hypotheses used to explain the relationship between family structure and adolescent drug use. In particular, using linked community‐level data, an explicit examination of hypotheses drawn from a community‐context model is conducted. These hypotheses posit that the impact of family structure on adolescent behavior is, in part, explained by the different types of communities within which families reside and that community characteristics moderate the impact of family structure on drug use. The results of multilevel regression models fail to support these hypotheses; adolescents who reside in single‐parent or stepparent families are at heightened risk of drug use irrespective of community context. Moreover, adolescents who reside in single father families are at risk of both higher levels of use and increasing use over time. A significant community‐level effect involves jobless men: Adolescents are at increased risk of drug use if they reside in communities with a higher proportion of unemployed and out‐of‐workforce men.     

Allegations of child sexual abuse in parenting disputes: An examination of judicial determinations in the Family Court of Australia

This study examined Family Court of Australia (FCA) judicial determinations in parenting disputes when allegations of child sexual abuse (CSA) are made by an interested party, usually the mother. For the study, 156 published judgments from 2013–2015 were examined to measure how often allegations of CSA are substantiated, suspected to be true, and disbelieved. The characteristics most common in substantiated versus unsubstantiated cases, evidence of abuse presented, and resulting parenting orders were assessed. Findings indicate that, against international comparisons, FCA judges substantiate cases very conservatively, with rates of substantiation much lower than in other studies. Allegations made by mothers against fathers were disproportionately unsubstantiated, as were those which did not fall under the Magellan case management system. Cases where the only evidence of CSA was a child’s disclosure and parent’s allegation were common in both substantiated and unsubstantiated cases, meaning that a lack of other evidence does not preclude a positive finding of risk of CSA by the FCA. Those cases also involving a protection order against the accused were more likely to be substantiated. Confirmation biases and a judicial tendency to err on the side of false negatives are discussed.     

The Child in the Family of a Drug-Using Father: Attachment Styles and Family Characteristics

SUMMARY

The study examined the impact of family characteristics and parental attachment styles on the children of drug-using (DU) fathers in fifty-six families (n = 168) in Israel. Of the DU fathers, 60.7% were characterized by avoidant attachment style. Among the non-DU mothers, 53.6% were characterized by secure attachment style, 42.9% by avoidant style, and 3.6% by anxious/ambivalent style. Surprisingly, family cohesion and adaptability scores were similar to the Israeli norm, perhaps because the DUs had completed detoxification treatment and participated in rehabilitation programs. Of the children, 61.8% were characterized by secure attachment style, 21.8% by avoidant style, and 16.4% by anxious/ambivalent style. Stepwise regression to predict children's attachment styles revealed that maternal security of attachment and paternal anxious/ambivalent style predict similar attachment styles among the children. The important combined effects of spousal attachment styles on the children are discussed.