Table of Contents
- i. Introduction
- Opening Statement
- Rationale of the study
- Scope and Delimitation
- Bird’s eye view of the paper
- ii. Theoretical Framework
- Synopsis: Children Who Live with Addicted Parents
- Effects on Parenting Capacity
- Statistics in United Kingdom and America
- Theories to support Social Work intervention
- iii. Legislative Framework
- Timeline of Legislative policies
- iv. Evidence Based Practice
- Addiction is a disease
- Children are victims
- V. Values, Ethics And Service User Perspective
- Silence versus Help
- Help versus Isolation
- The need for highly trained, specialised Social Workers
- Vi. Current Social Work Practices
- Issues around social work and present practices
- Vii. Conclusion
- Level of information and awareness of the issue
- Viii. References
Mind-altering substances have been used by individuals for thousands of years, from cigarettes and ecstasy and beyond. Due to the fact that they help people focus, provide a distraction from their normal forms of feeling, and help people feel as though they fit in with others around them, they have become famous. Psychoactive medicines have long been used by people for medical, educational, theological, and dietary reasons. Prehistoric intake arose from alcohol, wine, morphine, hemp, tobacco, caffeine, betel, coca, kava, qat, hallucinogens, among several other substances (Durrant and Thakker, 2003). The cross-cultural trade of commodities, including psychoactive drugs, intensified at the start of the new age when Europeans ventured across the seas. This suggests that tourism has intensified the dissemination of substance addiction around the globe where a cross-cultural interchange of habits has taken place. However a small number of reports are available. in this area, suggesting more study (Segev et al., 2005). As a possible issue, the rise of non-narcotic addicting substances loomed. Several pharmaceutical companies have successfully produced narcotic analgesics without recourse to opium in reaction to incentives generated in part by the introduction of the regulation regime and wartime shortages. The two coal-tar-based morphine replacements that German industries developed during the war, Demerol and methadone, were among the most popular inventions (Edwards, 1980). A new issue came to light as the 1950s ground to an end. Synthetically produced, with the frequency, non-narcotic drugs such as barbiturates, tranquilizers, amphetamines and some hallucinogens have come into medicinal usage (Austin, 1978). The substance addiction epidemic has hit crisis heights in less than a decade. The power regime, unprepared for the onslaught, will be rocked to its heart by the 1960s events. During the 1960s, driven by skyrocketing demand, illicit use of old and new substances flourished. Many rejected the ethos that informed the system, restricting access to drugs appeared as simply another manifestation of bankrupt establishment values. By the early 1970s, most observers, experts, and policymakers no longer supported an exclusive emphasis on supply control. Hardly a nation on earth could claim a drug abuse exemption. In addition to a public health problem possessing international dimensions, drugs posed a threat to national, social, cultural, and economic security (Barrows and Room, 1991).
Illicit substances or drugs are defined as substances which have actual or relative potential for abuse, scientific evidence of pharmacological effect, risks to the public health through psychic or physiological dependence liability (Manchikanti et al., 2004).
Several illicit drugs have been identified to have considerable abuse potential. These are heroin, cocaine, marijuana, LSD, phencyclidine, fentanyl and other drugs, alcohol, and smoking (Sutherland and Shepherd, 2002).
Recognition of the problems of children of people who abuse alcohol and other drugs has increased in recent decades. The estimates of at risk children born to drug-using women are likely to be low because those who do not seek prenatal care, those who do not give birth in hospitals, and those who continue drug use during pregnancy are not included in the count (Cuskey and Wathey, 1982). Forsyth et al. (1998) states
“Although there continue to be many questions regarding the extent and nature of the deleterious effects of in utero cocaine exposure, researchers generally agree that cocaine use during pregnancy results in an increase in the rate of premature births. Investigators have since found that children who have been subjected to cocaine linger in the hospital longer after birth and their elevated prematurity rate is a significant factor leading to these expensive hospital stays (Forsyth et al., 1998).
Some patients may cease drug use during pregnancy and then resume subsequent to the birth. There is also a sizeable group of drug-using women who are not reported by their physicians. Given the trend toward abuse of licit and illicit drugs, the likelihood of children being born to addicted women will continue to increase during the next decade (Kissin et al., 2001). This is a growing population of children who may experience impairment and disability, the extent of which is as yet unknown. The proliferation of the drug problem and the heightened attention to the needs of children and youth generated recognition that there is a distinct population, the children of substance abusers, who had unique characteristics that demanded attention (Herjanic et al., 1979). It was also apparent that an addicted mother with children required help for herself, her children, and her family. It is also widely recognised that parents who consume illegal drugs and alcohol are at risk of severe social, physical and emotional issues and have the ability to misuse harmful drugs on their own (Nunes et al., 2000). Assessment of older children of heroin-addicted and formerly addicted parents reveal that they suffer from emotional and cognitive problems; they express feelings of anxiety and insecurity, and are characterised by shorter attention spans than their peers (Moss et al., 1995). These problems may be related to parental substance abuse at home, compromised communications within families, unstable home lives, and the impact of HIV/AIDS on families, among other sequelae of drug use. Teenaged children of addicted parents also show increased incidence of behavioral problems at home and with their peers and are more likely to evidence academic failure, antisocial behavior, risky sexual behavior and drug and alcohol use (Rivinus, 1991). The risk of attachment to drug-using peers declines as close family ties exist; however the homes of drug-using teenagers indicate weak family control, parental antisocial activity, and misuse of parental substances. Similarly, a high frequency of disturbance, confrontation, loss of parental figures, and absence of solid, affectionate parent-child relationships is mirrored in the family history of drug-using parents (Kane-Cavaiola and Rullo-Cooney, 1992). Studies of addicted women show feelings of poor self-esteem, fear, stress, and severe issues such as alcohol and physical violence in their communities of birth. The childhood experiences of drug-abusing women can be characterized by maternal deprivation, lack of supportive family networks, maltreatment, low levels of family competence, and adverse family environments. As parents who were deprived of age-appropriate experiences in childhood, they approach parenthood with minimal bonding experience, unrealistic expectations, and without having learned adequate parenting skills (Anderson and Henry, 1994). They may require more assistance in parenting, as the interpersonal and environmental impacts of drug abuse compound the effects of in utero drug exposure. drug abuse is not only the problem of the individual but must be considered in the context of family and social systems. This discussion indicates there is need for research in this area (Uziel-Miller and Lyon, 2000).
The issue surrounding Social Work Intervention on Parents who are drug users, with focus on the impact of addiction in their parenting capacity is wide and broad. To understand the plight of social workers, ponder on the stories below:
A single mother with a one-year-old son lives despondently in their grungy apartment. She meets a person whom too soon enough became her boyfriend. The boyfriend is a substance abuser, who has a long history of violence and abuse. The mother and child moves in, unaware of the danger that lies ahead. The physical abuse started with a shove, which intensified in time. Neighbours noticed the bruises of the child but were too busy to pry. In less than two months, the boy is found dead in his cot, with multiple minor injuries, several broken ribs and a smashed back. The trial found his child’s carers his mother and her boyfriend guilty of murder.
Cecily, a ten-year-old girl lives with her parents in a rented house. One night her mother woke her up, signalling her to get her sparse belongings: three shirts, two pants and a jacket. The child, although sleepy and numb, complies, knowing well that she will sleep through the trip. Again, her parents decided to skip town.
Brandon was a different story. While his parents are partying at night in their modest home, he would lock his door, close the window and plunge into deep thinking. He would block the noise by reading books and more books. He got so used to the technique that it took him only a minute before the noise fades away. Brandon is a star student, excellent in academics and very good in sports. No one would have a clue as to how he managed with a slice of bread and curding milk for meals.
Jacques gasping for air, hid in the corner. That was close. Snatching old woman’s purse has been his business since he hit the streets. Sometimes he gets guilty, but no one would hire him even as an errand boy. He tried but only lasted for a week, the pay was bad, and the load of work was worse. Though he misses his mother, he will not come back. He knows it was only a matter of time before his father would get out of control and kill him.
These are only a handful of the numerous untold stories of children with one or both parents abuse drugs. (Addicted may be a too stronger word?) The use of traditional or personal stories “can be a rich source of relating human rights issues.” (University of Minnesota, 2006). There is no better way to introduce a topic with this broad area of concern, than with those stories mentioned above.
There is an estimated “300,000 to 400,000 drug users in the United Kingdom” (Home Office study, 2003) with the assumption of one child per addict. That will lead to the assumption that there are around the same number of children, going through any of the same circumstances in the stories presented earlier.
It is in clear understanding of the complexities of the issue around children with addicted parents that this type of social work intervention was designed. How can social workers help as the front liners of the government in combating child abuse, and rehabilitating families?
This paper will bring forth a realisation that, despite United Kingdom’s claim “as the leading trading power and financial Centre and is one of the quintet of trillion dollar economies of Western Europe” (The World Fact book, 2006) the difficulty it faces safeguarding its own children.
Rationale of The Study
This paper aims to achieve the following objectives at the end of the study:
- To provide a theoretical framework for understanding the role of social work intervention and their role in helping children with parents who misuse drugs
- To come up with an accurate assessment of the implementation of current social work policies in Britain; and
- To come up with a suggestion for the improvement of the services offered.
Scope and Delimitation
This paper is completed through the careful selection of materials made available in books, journals, briefs, primers and access to the internet. There is no actual survey and data collecting to help the premises of this study but has solely relied on published resources.
This study focuses to provide an answer to the question, whether drug addiction has an adverse effect on parenting capacity. If there is an effect, what should be done by social workers to arrest the situation?
This paper would carry you through the strategies of Britain to use social work action as a significant strategy to solve the issue of opioid use in the family sense. Chapter 2 of this paper would provide an abstract of the theoretical and philosophical context, since this is a rather wide-ranging topic and there is a limit to space. A rundown of the type of life that addicted parents’ kids experience. The author would also address the effects of substance addiction in relation to one’s parenting capacity, which will also include the current accessible statistical figures of drug abuse in the United Kingdom and the United States of America and the theoretical basis of involvement in social work.
Chapter 3 is the Legislative framework of this paper. It will give a timeline of the legislative policies of Britain and its highlight.
Chapter 4 is the evidence based practice. It will present evidence-based contention of parental addiction backed by past studies and analysis of experiences and recordings. These contentions are: “addiction is a disease” and “children are victims.”
Chapter 5 will cover the ethics, values and service-user perspectives. Service user stand point on social work intervention: Silence versus Help, Help versus Isolation and the Need for highly trained social workers focused on families with addiction.
Chapter 6 will discuss at length the issues around social work intervention and present practices.
Chapter 7 is the conclusion, which will draw out recommendations in answer to the objectives set at the beginning of the paper.
ii. Theoretical Framework
Synopsis: Children Who Live with One or Both
Parents Addicted to Drugs
In the United Kingdom, there is an approximate amount of 200,000-300,000 children with one or both parents who are severely opioid dependent. The same source indicates that 64% of these children have or reside with their families, 37% have lived with a parent (with or without a mother) and just 5% live in foster homes or care facilities. There are about 29,000 students, or about 2-3 percent, who are under the age of 16. It is also, in principle, right because most children remain under the influence of their parents before their nearest family partnership or the appropriate facilities for children are stripped away (Home Office, 2003).
An estimated percentage of children who “undetected or without help, guidance or assistance is around 95%” (Knight, 1994). It is disturbing to know that only a small number are recipient to social services available. The abused children identified only after they suffer severe symptoms of neglect, malnutrition or physical abuse otherwise, they live with their parents.
How do children live, based from the numerous journals and recorded interviews studied and collected, an accurate picture of their everyday life is presented?
The home life deteriorates. Parents frequently move from one house to another, to hide or run away from incurred debts, they take with them their child. This frequent change of environment can bring serious trauma to the child, dragged in the middle of the night for their parent’s fear of detection. The child is scared, as they have not yet fully grasped their parents’ circumstance. Subjected to a variation of inconveniences, the child is tired, from the long hours or travel, hungry for food may not be a priority especially for meth users. Fear and anxiety of their parents easily absorbed by the child, paranoia eventually develops (Stanton and Todd, 1992). Brook et al. (2006) however highlights that age of the children and severity of the parental drug misuse are important parameters determining the effects of drug abuse on children. They state that
“The children of drug abusers may be at elevated risk for maladjustment and problem behaviors, including substance use. A dad who abuses drugs may be less likely to generate cohesive and more stressful family environment, and his ability to form a caring and supportive relationship with his child may be seriously compromised, eg, as a result of emotional dysregulation or unavailability, lack of financial resources, comorbid psychopathology, and physical health problems. There may be weak and conflictual paternal bonds for adolescent children of fathers who use drugs, which place them at risk of externalising and internalising symptoms as well as problem behaviours.”
(Brook et al., 2006)
With this regular movement, the child’s health and natural development is at risk. Regular hours of sleep and a balanced, healthy meal are two basic need of the child that is not met. The child is most likely unable to attend school. Those who attend a regular school will have “difficulty in coping, as they normally do not perform well. They are described as sad, insecure children with low self esteem” (Hidden Harm, 2008). A significant percentage of these children are undetected or unrecognised by the proper child authorities. Most of them, although experiencing domestic disturbance “will look so much like their age-peer, with a wide range of intellectual abilities and social coping skills that they continue to slip by.” (Knight, 1994). However, Gance-Cleveland et al. (2008) indicate the importance of intervention in these children. They have proposed school-based support groups which can intervene in order to improve resilience in this population. In their study
“Major changes were reported in awareness of drug misuse. Gender disparities in coping and health outcomes and optimistic patterns in drug usage were indicated by the findings with conclusion that SBSGs may increase resilience in this at-risk population. However, there were gender differences in response to the intervention, and group facilitators should be aware that participants’ gender may influence response to the groups” (Gance-Cleveland and Mays, 2008). Knight (1994), a seasoned child counsellor in his published book, Elementary Age Children of Substance Abusers, recommended looking out for warning signs. These signs included:
- Neglected physical appearance
- Fluctuating academic performance
- Psychological symptoms
- People-pleasing behaviour
- Conflict avoidance attitude
- Problems controlling moods and behaviours
- Social isolation
- Attention problems
- Parental concerns
- Physical symptoms of abuse
The child may look and act normal, thus, unobserved. Children of alcoholics and drug users “learn to live the three basic rules: Don’t feel. Do not talk. Don’t trust.” (Quantico Sentry, 2008). It is a major challenge for the agencies and services concerned to detect a child in need.
At home the child, exposed to illegal acts. Unscrupulous parents use drugs at home, and the child by accident may witness the actual drug use. Schuler and Nair (2001) indicate that
“”Children exposed to violence suffer from symptoms associated with posttraumatic stress disorder (PTSD), which include mentally re-experiencing the traumatic event, avoidance, and numbing of responsiveness. Other behaviors associated with exposure to violence include increased depression, distress, aggression, anxiety, sleep problems, delinquent behavior, stress, and regression to earlier behaviors. Substance abuse in women is frequently associated with violence against these women, including physical abuse and rape. Substance-abusing women’s children are more likely to experience violence than non-substance-abusing women’s children (Schuler and Nair, 2001). These misdemeanours would change the child’s perception of the law and his beliefs in steady flow. Statistics show that children of substance users are very much more likely to grow up with alcohol and drug problems (Schulman et al., 2000).
On the other hand, children cope in a variety of ways. Addiction in the Family (2002), have concluded that a child may take on the following roles in order to cope:
The Responsible child. Looks after the family and other members who are not stable.
The Adjuster. Does not seem to care what is going on in the family and does not like to draw attention to him.
The Placator. Does not like negative feelings in the family and works hard at minimising conflicts.
The Acting-Out-child. Often engages oneself in negative behaviour to get attention and is usually a leader.
This is only the beginning of a complex challenge. As the victims themselves are hard to spot, the children themselves do not want to be discovered. As depicted in the stories earlier, for social work intervention to take place, first and foremost, the children should be identified.
Drug Addiction: Is There an Effect to One’s Parental Capacity?
To determine whether drug abuse has an effect to one’s parental capacity, we have to have a clear picture of what the study is trying to find out. The grounds and the standard addicted parent’s capacity are measured alongside with.
In the book The Child wrote, “Parenthood is the process of raising our children, from children to teenagers, that for years to come can have stability within the family. There is no greater obligation or difficulty, and for many people who do well, there is no greater satisfaction than seeing one’s children grow, learn and enjoy life.” (Olson and Defrain, 1994).
This study shall use their observations, being professional child observers, psychologist and an authority to family and life, to measure whether addicted parents can fulfill the foremost parental roles needed by the child. After the narrative, will follow an academic account drawn from various statistical resources and published work.
- Parents should be alert to their children’s needs and seriously committed to their physical welfare.
National Association of Social Workers (2000) noted “they that found these children often live in a dangerous, chaotic, neglectful, abusive and isolated environment and their basic needs for food, sanitation, medical and dental care regularly go unmet” (NASW, 2000).
- Parents should be sensitive to the capacity of a child at any given age, so that the rules they lay down are unreasonable.
It was established in the years past that continued drug use will cause damage to the brain; “Often associated with a neurological based disease such, which targets the brain’s reward system (mesolimbic dopamine), which controls judgment, executive functioning and impulse reside” (Ericson, 2008). In this case, even with the best intention, addicted parents are not capable of logical thinking; more so laying down rules for the children to follow. However, it has been demonstrated by research that development of resilience by social intervention may lead to awareness and development of logical thinking that may alter the behaviour of the children (Gance-Cleveland and Mays, 2008).
- Parents should create a structured environment so that their children know, in general what to expect, and when from one day to the next.
Addicts are notorious for being unpredictable and moody. A structured environment may be possible in very few cases, but generally, unworkable. Bender, E., (2004) states
“Children living in homes with alcohol-dependent or alcohol-abusing parents are at high risk of also becoming alcohol and drug abusers, with the potential of perpetuating the disease when they have their own children” (Bender, 2004).
- Parents should heed a child’s point of view and try to explain their own actions in an understandable way. They should make sure that the children see how their actions affect other people and how those actions could affect the child’s own future relationships.
Even if the addicted parent is able to explain to the child the concept of cause and effect, the result will be more damaging as it will bring more confusion to the child. Fals-Stewart et al. (2004) indicated
“Although the effects of paternal alcoholism on the psychosocial adjustment of children are well documented, the impact of fathers’ illicit drug abuse on their children is poorly understood. Children with drug-abusing fathers experienced more internalizing and externalizing symptoms than children with alcoholic or non-substance-abusing fathers. Interparental conflict and parenting behavior mediated the relationship between family type and children’s adjustment. Interventions to improve fathers’ parenting behavior and reduce partner conflict may lead to better adjustment among custodial children of drug-abusing fathers (Fals-Stewart et al., 2004).
- Parents should permit children to solve their own problems, when possible, even if they have to manipulate situations that will give the child training in solving problems.
“ In a home devoid of parental love, limits and consistency, the child develops ‘survival skills’ early in life.” (Cermack, 1985) The informal training of solving household problems is very exhaustive that it is feared that children are “forced too soon to take on responsibilities that are not age-appropriate at all” (Association of Children of Alcoholics, 2002).
- Parents need to show affection and express approval for good behaviour.
“When a child shows effort to bond with addicted parents through good behaviour, and are thwarted the result is confusion and intense anxiety.” (Cermack, 1985).
- In general, parents should provide for the welfare of the children: physically, and emotionally.
This paper is safe to conclude that they (addicts) are not capable of proper parenting and care for their children, based on the concepts of responsible parenting used to measure the parental capacity of an addicted person.
To better understand the effect of drug addiction vis-a-vis one’s parental capacity, the stages are broken down into two parts, the pre-natal stage and the after birth stage. It is a dreadful reality that harm can be before the child is born. With or without the effects of drug use during pregnancy, when the child is actually born, bigger harm awaits (Eiden et al., 2002).
At the pre-natal stage, maternal drug use may cause either of the following:
- A hindrance in the fetal growth and development (Householder et al., 1982).
- Physical abnormalities such as cleft lip, club foot, low birth weight (Householder et al., 1982).
- Mental abnormalities such as autism, ADHD (Kron et al., 1977).
- Medical predicament such as HIV infection or viral Hepatitis, in case of contaminated syringes with shared intravenous drug abuse (Moss et al., 1995).
If the child is born normal and unscathed physical and emotional neglect, inadequate or no adult supervision, inappropriate parenting practices, exposure to toxic substances at home, interrupted education, mismanagement of the home because the parents are either uneducated or illiterate. Adverse or severe exposure of these practices may cause mental and emotional stagnation, diseases and a wide range of psychological problems (Lief, 1977).
The risk and harm the child faces may only be reduced if the number of addicted parents reduce as well. Treatment and rehabilitation of the addicted parent will be beneficial to the health, safety and development of the child. For the meantime that the parents have not yet sought help, there are programs that provide the services in answer to the child and family’s need. The biggest challenge is to measure with accuracy the effects of improper parenting to the child. Children are notorious of their resiliency. While others cope and survive the circumstances, some will be injured and damaged irreparably (Ronel and Haimoff-Ayali, 2009).
Statistics in the United Kingdom and America
|United Kingdom||United States of America|
|Number of Addicted Parents||200,000-300,000(estimate of one child per addict)|
|Number of Minor Children Living with Addicted Parents||2-3%|
|Number of Child Abuse Related to Drug Use|
|Number of Child Death Related to Drug Use|
Disclaimer: the statistics above are educated estimates by several valid organizations handling the treatment, recovery and rehabilitation of drug addicts. The figures are drawn from the statistical records of hospital admission, arrests and social worker’s report among many others. There appears to be a substantial number of users who are undetected and stay ‘underground’.
Theories to Support Social Work Intervention
“The foremost responsibility of any society is to nurture and protect its children.”
– (Vail & Knight, 1995)
The elements are broken down and identified in order to get to a deeper interpretation of what social work action is all about.
Social work- Structured work, by offering therapeutic support, advice and assistance in the context of social programmes, to advance the social needs of a society, and specifically the vulnerable.
Social Services- Benefits and facilities such as food subsidies, education, health care, and subsidised housing, provided by a government to improve the life and living condition of the children, disabled, elderly and the poor in the national community.
Intervention is an influencing force that occurs in order to modify a given state of affairs.
There are different levels of intervention:
- Macro– intervention through a national scale, taking the society as a whole
- Mezzo– intervention in the social work practice or the agencies and organisations
- Micro– intervention in families and individuals
Why is there a Need for Social Work?
As early as the biblical times, alms giving and other charitable works were in practice. Charity is the root of social work, because of the nature of giving, and of taking responsibility to improve the living condition of the poor. In England, it started at the end of feudalism in England where the rising number of poor families became a threat to the community. Thus, the government designed a special programme to care for them, providing them food subsidies, shelter and medical benefits. As it is written in the first line of this section, “it is the society’s responsibility to nurture and protect.” As long as there are unfortunate, poor, deprived people, there lies the need for social work and its services (James et al., 2004).
Why is there an Intervention?
Drug abuse is a psychosocial phenomenon, and parental drug abuse has clear social and community implications. Medical interventions may reduce the drug abuse in parents, but it would be inadequate to create changes in the social level. Social research has indicated that social interventions may induce permanent changes in the addicted parental population by creating awareness, fostering support to the affected families and children, and motivating the addicts to come back to the mainstream (Wahab, 2005).
Using evidence based knowledge; a social worker will be to function as an intermediary of concerned parties. Moreover, they have the foresight to know how events will unfold in every given situation. That is the reason for intervention, to come up with valid, educational method to change or improve human behaviour through the study of past experiences, theories and practices. Paterson et al. (2001) describe the use of a theoretical framework to guide the development of the research question. They argue that it assists the reviewer to define relevant concepts in the literature review research question and to identify the scope of the review (Paterson et al., 2001, 93-110). Thorne et al (2004) argues that the application of a theoretical framework is not essential to any research study and might have the effect of introducing bias into the study. She argues that researchers might be led in a particular direction because of the framework that is imposed and fails to be responsive to the data that are collected (Thorne et al., 2004, 1342-1365).
iii. Legislative Framework
This chapter focuses on the Legislative framework of the United Kingdom to prevent the flourishing of the drug trade. A timeline of the legislative policies that geared to contain the problem of drug use and misuse presented. ‘drug’ referred in this section includes cannabis, cocaine, opiate, meth- amphetamine, opium, heroin and morphine to be precise.
The table shows the name of the policy or program, the year implemented and a brief description of its coverage.
|Name of Policy||Year||Coverage|
|Pharmacy Act||1868||Restrict the availability of dangerous drugs such as opiates and cocaine|
|The Dangerous Drugs Act||1920||Limit international trade, use and advertisement of cocaine and opium|
|The Dangerous Drug Act||1965||Regulation and control of the manufacture and distribution of narcotics, stimulants, depressants, hallucinogens and anabolic steroids|
|The Misuse of Drugs Act||1971||Control the possession and supply of controlled drug-like substances in cooperation with the international agencies against international drug trafficking|
|TackliTackling Drug Misuse||1985||Prevention, intervention, treatment and rehabilitation of drug users|
|Children’s Act||1989||Provide for local authority services in answer for the child’s need (shelter, family, respect among others.|
|Tackling Drugs Together to Build a Better Britain||1998||Provides reinforcement and protection from the wide spread drug problem in Britain.|
|Assessment Framework for Children In Need and their Families||2000||A scientific methodology that is utilised as a framework for professional services and treatment for children in need.|
|Every Child Matters||2003||Giving the wellbeing of kids a collective concern|
|Common Assessment Framework||2004||Based on offering comprehensive frontline programmes around the needs of children and young people|
One of the latest legislation is the Drugs Act of 2005, which is more comprehensive in approach the welfare of the users are taken into consideration rather than the mere control of the distribution and use of drugs. This law is potent as it has police powers to support the implementation of the program. Among the many aims are, to increase the effectiveness of drug intervention programs and for the offenders to comply with treatment and rehabilitation. The offender this time not shoved to the prison walls but given a chance to correct himself through the various programs set by the government. Police powers work alongside with the court for better management of the offense.
To date a program, Drugs: Protecting Families and Communities, a 10-year drug strategy commencing in the year 2008 to end in the year 2018 to reduce the use and demand of illegal drugs in United Kingdom. Its four main strands of work are:
* Protecting neighbourhoods through rigorous enforcement to counter the supply of narcotics, drug-related violence and anti-social crime behavior.
A big difficulty to overcome is quick access to narcotics. The strongest approach to launch the fight against narcotics is to strengthen and enforce current regulations to eliminate the availability of drugs on the street. To illustrate that the government is sincere about this initiative, drug-related crimes, such as trafficking and sale, should include a stringent and fearless implementation of the legislation. Anti-social attitudes triggered by opioid usage are not accepted.
* Harm reduction for infants, young people and communities impacted by the abuse of drugs
Understanding that the opioid epidemic is stronger inside the home, the programme should be safe or made safe for children and the impacted households. Kids are the worst affected people, among others, and should be looked at all the time. With the support of municipal government, the police, the nursery and the children’s services, an efficient social worker network should function hand in hand to ensure that the interests of children are addressed and that they are safe all the time.
*delivering modern addiction prevention and societal reintegration methods.
This approach is very empowering and humane. As the offender is caught, instead of incarcerating him, he is brought to treatment center or rehabilitation program where he is treated in the hope coming back to full function, and as a member of the society. The stigma is lessened, and the offender does not lose hope, nor give up.
*public information campaigns, communications and community engagement
Education is a powerful tool. To educate the community of the danger and evil effects of drug addiction is a start of empowering the children and the community to make a choice. For children already caught in a lineage of addiction, this information campaign will give them the idea where to turn to, what to do, where to go in case they want to talk, seek help or need counseling.
The program’s strategy is hard hitting and direct to the point. It covers all bases, and if implemented properly, Britain in ten year’s time will be a better and safer place. It is true that assessment framework is a must in delivering social work to the intended population. Practice also is increasingly requiring the generic guidelines contained in the assessment framework. From the current framework, it is very difficult to frame generalisation. It has been argued that for the most part, they are highly individual documents in terms of range and depth of the content, the extent to which they are evidenced, the quality of evidence used, and implicit expectations as to the skill bases of assessors. Moreover, the assessment framework is not in itself a panacea to ensure good practice. It has also been said that even with the most comprehensive frameworks, the social workers will still need supervision in practice and a comprehensive training on assessment based on the frameworks (Crisp et al., 2007).
iv. Evidence Based Practice
Evidence based practice (EBP), according to the American Psychologist Association “the integration of best available research with clinical expertise in the patient’s characteristics, culture and preferences. It helps keep the knowledge up to date, supplements clinical judgment, save time and can improve care and even save lives.” (APA, 2006).
In this part, EBP’s will be presented in relation to the subject “social work intervention on parents who are drug users (focusing on the impact of drug misuse on parenting capacity).”
Addiction Is A Disease
In the year 1967, the American Medical Association has declared that alcoholism is a disease. It is only late in the 20th century that Drug Addiction is widely accepted as a disease as well. There may be a continuing debate on this, but it is generally accepted in the Social Work field as a valid assumption (Mann et al., 2000).
Here are some grounds to support that claim:
Addiction is a neurological based disease, more closely related to Tourette ’s syndrome.
Erikson (2007) in his book, The Science of Addiction: From Neurobiology to Treatment, claimed that the “primary site of this disease is the brain’s reward system (also known as the mesolimbic dopamine system) closely connected to the center of the brain, especially centers in the orbitofrontal cortex, where judgment, ‘executive functioning’ and impulse control capacities reside.” (Erickson, 2007).
Leshner of the Federal Government National Institute of Drug Abuse contend, “ When you get to an addicted state, it is a disease of the brain” ( Talking With Alan I. Leshner, PhD, National Institute on Drug Abuse Director, 2001).
Hyman (2007) has not lost hope, as he presented a scenario to this effect: “take heart patients, we don’t blame them for having a heart disease. We ask them to diet, manage their medication, and take care of them. The addicted person- we should not blame them, we should treat them as having a part of the responsibility for their recovery.” (Hyman, 2007).
In the beginning, the use of drugs is a choice; but after prolonged use, a semi-permanent damage will cause neurological changes in the brain and the nervous system. So that addiction is no longer an issue of will power, for an addicted person will lose control; this lose of control is indefinite, it may be weeks, months and for some, years (Hyman et al., 2006). With the knowledge that this is indeed a disease, people around the addict should stop blaming themselves. Teenaged children of addicted parents also show increased incidence of behavioural problems at home and with their peers and are more likely to evidence academic failure, antisocial behavior, risky sexual behavior and drug and alcohol use (Gance-Cleveland, 2004). These findings are consonant with earlier studies of a similar group of children during early childhood; unsuccessful completion of developmental tasks can result in attention deficits, poor impulse control, and impaired attachment to others, which are risk factors and predictors for later drug and alcohol use. Knowing that a disease can be cured through medication, treatment and therapy, the stigma is now reduced (Hogan, 2003). More than half of these children have poor prognoses for school success and age-appropriate socio-emotional development. The 6- to 17-year-old children of drug-using parents are characterized by increased problems in school, and by behavioral and adjustment problems at a greater rate than a comparison group of their peers (Kumpfer. and Johnson, 2007). According to Erickson (2007) treatment may include “intensive individual, family and group counselling.” (Erickson, 2007).
In summary, given the premise that drug addiction is a disease, one should first be able to accept that fact and to stop denying addiction. In many cases, an addict would defend himself that he could ‘stop if he wanted to’ – that is a fallacy, a false claim. Addiction needs proper management, therapy and professional help to get better. As it was stated earlier the control of the individual is lost indefinitely. His inability to think or decide for himself and his family is not due to his selfishness but a neurobiological malfunction caused by excessive or prolonged drug use (NIDA Services Research Monograph Series, 1979). It is the family’s responsibility therefore, to seek for help. In the situation where the parents are both drug users, the closest family member or a social worker may step in to facilitate help. In this way, the addict can seek treatment, and in time, can function normally again (Stanton and Todd, 1982).
Children are Victims
Children are victims, is the second EBP that is presented in this paper. The National Association of Children of Alcoholics (1998) conducted a study on the impact of parental addiction to the children; the following are their observations:
- Children of addicted parents experience greater physical and mental health problems and higher health and welfare costs than non-addicted families.
- Children of addicted parents have higher rate of behavioural problems
- Children of addicted parents score lower on tests and school achievements, and they exhibit other difficulties in school. They have higher rate of absenteeism, and more likely to leave school or repeat a grade.
- A relationship between parental addiction, physical addiction and emotional child abuse has been largely documented in a large proportion of child abuse and neglect cases.
- Alcohol abuse is specifically associated with physical maltreatment; while substance abuse is associated with sexual abuse (Zucker and Fitzgerald, 2000).
Several concerned organisations have been formed to specifically to protect children from physical harm and abuse. In United Kingdom, the program ‘Every Child Matters’ was designed to provide for basic services to ensure the every child’s well being. Perceptive of child victims, the program has devised legislations and committees in aid for prevailing problems (Sheppard, 2008). “Social services play a central role in trying to improve outcomes for the most vulnerable and a key measure of success will be achieving change through closing the gap between their outcomes and those of the majority of children and young people” (Every Child Matters, 2009).
The problems of the children are further aggravated by the fact that the drug-abusing mothers extremely difficult to engage in meaningful planning activities. Planning is an ongoing activity. These mothers are perceived as cases where tremendous social work activities were deemed necessary, since most frequently, these mothers used to pursue a downhill path. The psychopathology of their situations is usually combined with prominent social deprivation which often would be too despairing. Contrary to social stigmatisation, it is a fact that these mothers often are affected profoundly, perceived by the social workers to be a situation of severe hopelessness. These mothers enter into detoxification with no avail, the treatment resources often fail associated with failure to engage with these mothers at a meaningful level (Payot and Berner, 2000).
The substance-abusing parent affect child in a wide-spread manner. These effects unfortunately follow the child into adolescence and then into adulthood. Few of the recognised factors are cognitive difficulty, conduct problems, and poor judgment. These are just few of the important sequelae. Surprisingly, similar results were seen in the case of numerous drugs such as alcohol, cocaine, or other illicit drugs. Apart from affecting biologically the adolescent starting from the perinatal period, parental drug misuse often leads to a disrupted, chaotic home, and financial insecurity. In the teen age, they are often exposed to illegal substances and violence. Ultimately, most of these adolescents slowly progress to drug abuse (Silverman and Schonberg, 2001).
v. Values, Ethics and Service User Perspective
This section will carefully look into the considerations or the grounds on which an addict or his family members refuse to obtain professional help. In the presence of a variety of programs, locally and nationally operated, there are prevailing concerns as to why the families still chose to battle addiction by themselves.
Silence Versus Help
The deafening silence of children is a major hurdle that social workers have to get past. “Children in homes with drug abuse need to know that it’s okay to talk about the problem, without having to feel scared, ashamed or embarrassed. They no longer have to lie, cover up and keep secrets. They should be encouraged to find someone that they trust — a teacher, counsellor, foster parent, or members of a peer support group” (Child Welfare Information Gateway, 2007). Identifying a child in crisis is the first and the hardest step towards help. McAllister (2006) observed, “Children are resilient in nature, they tend to roll with the punches.” The problem with this resiliency is the impact on the child can vary from mild to severe, and will not be detected until it has reached its breaking point.
“Children of Addicts’ suffering is most often hidden because of the ‘no talk’ rule created by the family in an effort to avoid the stigma and shame associated with addiction” (Herzog & Kaplan, 2000).
How can a social worker or local community break this silence is a challenge. An information drive is reinforced in schools and other places where a child often visits. The school and the church is the best way to start; the arcade or the gaming area in local malls is also a viable place. The fact that children are easily intimidated of adults, the use of colourful and attractive posters to drive the message across is more practical. Information and Hotline numbers, with the promise of confidentiality should be in the poster/ad. Children feel safer that they are unidentified. When reach out to others by talking to a professional, they will slowly understand their situation. Help is not far anymore.
It is important that the child must learn the 7 C’s in dealing/coping with their parents’ addiction. Formulated by Breshears wrote for US Department of Health and Human Services, here are the essential C’s for survival:
- I did not CAUSE it.
- I cannot CURE it.
- I cannot CONTROL it.
- I can CARE for myself,
- By COMMUNICATING my feelings
- Making healthy CHOICES and
- By CELEBRATING myself.
It is equally important that while the society is cushioning the pain that children of addicted parents go through, it should not alienate the parents who are victims themselves. Stronger reinforcement of the already existing programs should be implemented along with visible and reachable social workers. There is already a wide range of programs to cater every need of recovering addicts.
There might be simple issues that has to be addressed, or a personal confusion that triggered the use of drugs in the first place. The eventual lose of control that may be arrested by the help of a professional. Social work intervention is geared not only to rescue the child, but more so to rehabilitate and treat the addicted parent so as, eventually he will be a functioning person in the society.
Help Versus Social Isolation
The other challenge that may come in seeking for help is the ‘labelling’ process that families of addicts go through. “Applying a label to some children may increase vulnerability, diminish self-esteem and negatively affect their personal relationship with peers and school personnel.” (Sher et al., 1997). It is in their lack of maturity and understanding that they are ashamed to admit their reality. The isolation or the stigma that comes with being a son or a daughter of an addict is a social disease in itself. This limited perception of people is one of the main reasons why addicts and their family members do not come out in the open. A big number of children unrecognised, they remain ‘hidden’ partly in the fear that being known would be a greater task. “Children of Addicts/alcoholics’ suffering is most often hidden because of the ‘no talk’ rule created by the family in an effort to avoid stigma and shame associated with addiction.” (Herzog & Kaplan, 2000).
According to Sher et al. (1997), for those who come out, “negative characteristics with ‘children of substance abusers’ label can serve as a self fulfilling prophesies for those whom label is applied to.” It seemed that there is no half way or balancing act in this problem, but there is actually a way. Support groups organised so that the coping ability of a person is boosted in knowing that she/he is not alone in his struggle. To know that there are others going through the same ordeal and people who truly cares for their stories is a catalyst for recovery. Groups like “Families Anonymous’, ‘Adult Children of Alcoholics’, ‘National Association of for Children of Alcoholics’ are few of a hundreds of support group that will provide assistance and strength during the course of treatment and recovery. The stigma may be impossible to expunge, as it is already a deep-seated social disease, but the coping mechanism of the addict or his family will be strengthened so that social discrimination will cause little or no harm at all.
The Need for Highly Trained, Qualified Social Workers
Specialising in Addiction in The Family
It has been stated that social workers cannot come up with a one-size-fits-all approach. There are different familial, cultural and societal influences on a person, and an approach may work for one person, may offend- or just be unhelpful to- another. The need for highly trained social worker, equipped with the knowledge and mastery of the issue is essential to the process (Dattalo, 1997). It is common knowledge that social workers deal with a wide scope: from the young offenders, people with mental health problems, school non-attendees, drug and alcohol abuses, learning and physical disabilities to the elderly. It could also either be individual, family or group counselling, set in home, school, hospitals or organisations. It is through training, education and experience in the field that a social worker learns the rope of intervention. This process would take three years at the minimum (Palmer, 1997). What happens during the first years of work would remain unknown. If only the scope work is downsized and targeted, and that social workers assigned to a certain case is knowledgeable, preferably an expert, there is less time and effort wasted. Guidelines for prevention, education, treatment, and research programs that focus on the unique situation of children and address the needs of drug-using pregnant women and their children are of paramount importance. A review and redefinition of system policies and procedures is necessary to ensure that parents are evaluated not only in terms of their addiction but also as members of a family.
Children by nature are fragile. An adult can make or break a child. If a social worker has mastered the science of child intervention, he/she would take less time to know the details because that professional is trained to detect and read the slightest signal coming from the child. A far away look, a tapping in the table, scared-weary eyes, all those are signals that has to be read and understood for the first time, otherwise, the chance to communicate is gone.
Specialisation is not only a closing in of targets. It is also an effective way to survive. Specialised assignments for social workers will lessen, if not eliminate confusion in the workplace. The focus on details is also important, and the more the social worker is familiar with the given circumstance, the more he is confident of his ability to help and reach out for others in need. Social workers in concentrated field can provide better support, enable to bridge the service user to the services available, can guide and help more children and families.
It is the obligation of the centre and of the local local government to ensure that all workers employed with children and young people and parents are supported by specific policy and practises on factors relating to children’s wellbeing, such as access to health services, schooling, assessment of special needs, safety from corporal punishment and dangerous substances, including tobacco and alcohol. Central and municipal agencies should be specifically dedicated to tracking, assessing and commenting on child care to ensure policy-making.
Goals are reached and children are not discriminated against on the grounds of age, ethnicity, sexuality or impairment, or any other factor that is not the creation of the person.
A broad variety of events include social work for children and communities directed at protecting children, promoting their well-being and working to support children to live with their families. It occupies a contested territory where the state intervenes in family life (Sheppard, 1995). Children and family programmes have experienced a number of regulatory and systemic shifts in recent years, which are framed by large pieces of legislation throughout the UK. This also provided a position for social workers to relate to the evaluation of children’s and young people’s needs, to shield them from damage and to consult and to interact with other related organisations, such as accommodation, education and wellbeing, to provide programmes in collaboration with them and their families that support children’s well-being and protection.
British Association of Social Workers. (1996) identified eight areas of importance when considering ethical dilemmas in social work: (1) confidentiality and privileged communication; (2) truthfulness; (3) paternalism and self-determination; (4) laws, policies, and regulation; (5) whistle-blowing; (6) distributing limited resources; (7) personal and professional values; and (8) ethical decision making (British Association of Social Workers, 1996). Throughout the course of a career, most social workers encounter situations for which no completely desirable solutions can be found because each alternative has its own set of undesirable outcomes. National Association of Social Workers (1999) further define ethical dilemmas as situations “when a social worker cannot adhere to professional values or when adhering to one ethic requires behaving counter to another” (National Association of Social Workers, 1999)
In contemplating ethical dilemmas, the point of ethical discourse is not necessarily to arrive at an immutably “right” solution. Value lies in thoughtful review and discussion. Through the process of ethics discourse, a more complete understanding may be reached, alternative courses of action may appear, and, if not, there may be at the very least an appreciation that whatever decision was reached was the result of informed and thoughtful consideration rather than the singular expressed preference of a party involved in the patient’s care.
The prominent approaches discussed in this section are not exhaustive. They provide an introduction to various ways of thinking about and intervening to address substance use problems. Additional approaches described are scientifically based and include the following: supportive-expressive psychotherapy; individualized drug counseling; a combination of behavioral and nicotine replacement therapies to assist people experiencing nicotine dependence; numerous behavioral strategies that incorporate vouchers to support abstinence from cocaine and other drugs as well as housing-related outcomes; and the Matrix model which incorporates relapse prevention, group therapy, self-help, education about drugs, and family therapy to assist people with reduction of stimulant and other drug use. Much of the research regarding family-oriented intervention in the substance abuse field has focused on adolescents and the following models have a developing evidence base: multisystemic treatment, multidimensional family therapy, and brief strategic family therapy (Munson, 2000)).
Vi. Current Social Work Practices
United Kingdom has, over the years envisioned a drug free society. From the 1800’s to the present, England has dealt with drugs and substance abuse with an iron clad hand. For unfathomable reason, addiction is not only rampant, also widespread and deep-seated. Social work practices are intervention programs designed by each government to safeguard its people, from harm, from potential danger, for assistance, for support. It is a band aid solution that is working. What are current challenges social workers face?
- Tension in Delivery of Social Work Services in Rural and Remote Area (Turbette , 2009).
There is a noted tension in the delivery of social work services in rural and remote areas of England. Some of the people do not understand the aim of the government and the services it provide. In this context, suggestions that the social worker role is not limited to the ‘delivery’ the services; also to educate the community as to the services, programs and aim of the government. Social services should be proactive, and not merely reactive.
Interventions are defined as “those practices that aim to investigate a potential problem and motivate an individual to begin to do something about his substance abuse, either by natural, client-directed means or by seeking additional treatment” (SAMSHA, 1999).
A regular information drive would be helpful in soliciting the cooperation of the community. A partnership should be made with the locals, orienting in the culture of certain community. Open trust and sincere alliance will be helpful in the long run of events.
- High Level of Intellectual and Emotional Demand and Exposure to Violence. (Ifsw, 2008).
There is an unmistaken high level of intellectual and emotional requirement for social work. The every day physical demand is bearable but the emotional need is sometimes overpowering. Before, during and after an unpleasant case the social worker absorbs the same turmoil as the victim.
- Shortage of Social Workers in United Kingdom. (Mallon, 2009)
A 13,000 job vacancies needed to be filled to augment 1.2 Million social workers. Qualified applicants opt to work in a quieter social work area, away from children services. (Mallon, 2009)
- Hiring of Inexperienced, Untrained Social Workers. (Owen, 2009).
Instead of social worker vacancies, the hiring of untrained social workers cause problems in interpreting and implementing of well thought policies and services. This unmatched job hiring is a menace in providing social services for the disadvantaged. Well-meaning new recruites try their best to do their jobs, but are lacking in training and capacity to do so. This is disaster happening. An article published in April 2009 revealed that United Kingdom has inexperienced, fresh graduates from America as social workers. Novice and untrained, these ‘kids’ are out on a trial-and-error basis, at the expense of children’s life and government’s resources (Zook, 2001).
- Less Outside Interference
In the recent message in the website of the British Association of Social Workers, it revealed the pressing problems of their profession, allowing people to define and redefine social work for them. There should be less interference from outsiders, as these social workers are professionals. To interfere with their professional judgment is not only an insult also a backward step to achieve the goals they have set early on.
Currently there are rehabilitation services available to parents or individuals; however nothing is available for families as a whole or just the children and this maybe an area that could be improved. The content of services include the generating mechanisms of change initiated when the service users are in contact with the social workers. These generative mechanisms are introduced to help promote the enabling mechanisms and to neutralise, or to at least reduce the effects, of the disabling mechanisms in enabling service users to achieve their desired outcomes (Kaplan, 2005).
Holistic training is required for qualified social workers in understanding drug misuse – relate this to the initial question on how this will help the family.
It is important to recall both the problems and successes of the past in social work education when preparing for the next century of social work. Similar to those faced by early social work educators, some of the challenges for social work education in the next century are: the need to recruit qualified students and faculty, and the need to promote understanding between social work programmes, levels, and membership organisations. The relationship between social work practise and education has continued to be reciprocal throughout the growth of social work education, responding to the need to train social workers who are prepared for practise. Instead of focusing on the users, social workers need to recognise and address the needs and views of the child and the child should remain the focus of any evaluation (Austin, 1997).
It is clear that to serve their clients effectively, social workers need to have a strong foundation of understanding with regard to drug and alcohol use, abuse, and consequences. Social workers can apply their uniquely holistic, ecological techniques based on empirically supported research to provide the best care for clients they serve in both the fields of substance abuse and general practise. Legislation, regulation, and adequate funding are critical to protecting addicted families’ health and well-being. More programmes are needed to address the needs of pregnant women and parents who are substance abusers, and for child care and child development services (Leighninger, 2000).
The family is known to have a fundamental effect on the developing boy. A caregiver who is emotionally and physically present is important for stable child and teenage development. During childhood and adolescence, parent-child relationship issues can persist. Formoso and colleagues (2000) find that the use and delinquency of juvenile substances are strongly associated with dysfunctional caregiving, lack of successful parenting skills, and bad control of the household. Conversely, a reduced risk of initiating drug use is associated with good parental control and supervision (Chilcoat et al., 1995). Young people can also be protected by strong parental relationships, whereas unhealthy parental experiences put young people at risk of substance use and addiction. To ensure that parents are assessed not only in terms of their addiction, but also as representatives of a family, a study and redefinition of framework policies and procedures is needed. This is especially true for pregnant women and moms, when epidemiological research and family studies indicate that thousands of addicted mothers do not access maternal care, parenting, or psychiatric care or drug misuse treatment. Further interventions are required to meet the concerns of pregnant mothers and parents who are consuming drugs, and for day care and child growth facilities. It needs innovative methods that maintain confidentiality, safety from punitive measures, and parenting skills growth. Children’s issues are mostly preventable and it is possible to mitigate the consequences of parental addiction. Legislation, legislation, and sufficient resources are crucial to maintaining addicted families’ wellbeing and well-being. Although these interventions can be expensive, they would be much less costly than institutional hospital-based treatment of the problems of children’s perinatal substance use and rehabilitative or custodial care and social education will go a long way to safeguarding the wellbeing of future generations with the support of policies and programmes.
Within child protection studies, social work has clearly developed a place of prestige as a discipline. All of the successes and notable findings produced from this active time of exploration will be difficult to highlight. The emphasis on accountable practise was aligned with the extension of testing programmes and an interest in establishing guidelines for best practise (Anderson, 2004). In some situations, these criteria have been developed from predominant logic or opinion on the skills and expertise necessary to perform well as a front-line worker, agreement among experts or key stakeholders in academia and state agencies, and/or realistic knowledge acquired from current appraisal or cross-sectional study studies (Austin, 1978). These principles are an essential framework on which experience and expertise may be developed. In the last decade, however, emphasis has centred on the need to critically assess the validity of practise conclusions and results produced by studies with notable limitations in order to shift towards more evidence-based practise models, to prioritise critical thinking and to concentrate on more advanced longitudinal outcome research that rigorously measure the effectiveness or failure of various practises This current events/trends represent an evolution of outlook and spirit that when manifested, would draw on information already learned from an ongoing investigative phase and further advance knowledge about the effectiveness of initiatives directed at addressing specific challenges experienced by children and families.
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