1.       Drug using fathers and the effects on their children

a) Relevant reports

Advisory Committee on the Misuse of Drugs. (2004) Hidden Harms: Responding to the needs of problem drug users. London:

The Hidden Harms report by the Advisory Committee on the Misuse of Drugs (ACMD 2003) estimated that there are between 250,000 and 350,000 children of problem drug users in the UK, representing 2-3% of all under 16 years olds.  Around 37% of fathers were still living with their children, compared to 64% of mothers.

The report noted that as children are more likely to live with their mothers, fathers may be less likely to declare their children, whom they may not consider to be dependent. The report may therefore have underestimated the number of male problem drug users who have children.

The report estimated that of drug users presenting to services in England and Wales over a five-year period (1996-2000), on average there were 2.07 children per father and 2.05 per mother.

This equates to roughly 149,000 children with a drug-using father and 68,000 children with a drug-using mother during this period.

The report noted that research has usually focused on mothers who misuse drugs and there has been virtually no research on the role of fathers who misuse drugs.

Barnard M and McKeganey N. (2004) The impact of parental problem drug use on children: what is the problem and what can be done to help? Addiction 99, 552-559.

In their narrative review, Barnard and McKeganey identified that problem drug use can impede parenting and the provision of a nurturing environment. They noted that research has concentrated on the impact of problem-drug using mothers rather than fathers.

The review also identified that few interventions for problem drug-using parents have been subject to rigorous evaluation. However, the authors noted that these interventions have shown that it is possible to recruit and retain parents, and that some positive behaviour change in the domains of drug use and family management have been reported.

Bancroft A, Wilson S, Cunningham-Burley S, Backett-Milburn K, Masters H. (2004) Parental drug and alcohol misuse. Resilience and transition among young people. Centre for Research on Families and Relationships, University of Edinburgh and the Joseph Rowntree Foundation. (http://www.jrf.org.uk/knowledge/findings/socialpolicy/064.asp)

This qualitative study was undertaken in Scotland, and explored the experiences of 38 young people, aged 15-27 years, who had at least one parent with a drug or alcohol problem.

b) Relevant references

References were identified through a Pubmed search (2000 onwards) using the following terms: substance-related disorders AND father-child relations, and suggestions from Network group.

McMahon TJ, Winkel JD, Luthar SS, Rounsaville BJ. Looking for poppa: parenting status of men versus women seeking drug abuse treatment. Am J Drug Alcohol Abuse. 2005;31(1):79-91.
Abstract: This survey of individuals seeking methadone maintenance treatment was pursued to document the parenting status of drug-dependent men and clarify ways their status as parents differs from that of drug-dependent women. Data concerning demographic characteristics, drug abuse history, and parenting status were systematically coded from the medical records of 362 men and 162 women seeking methadone maintenance treatment during a 12-month period. Analysis of parenting status by gender indicated that, although a greater proportion of women were the parent of at least one biological child, there were actually more fathers than mothers within the cohort. Among the parents, fathers were more likely to have been abusing opioids when they first became a parent, and they were more likely to be living away from their children. There were no significant gender differences in the number of children or the average age of children. The results suggested that fathering may be an important, but largely neglected, treatment issue for drug-abusing men.

Cooke CG, Kelley ML, Fals-Stewart W, Golden J. A comparison of the psychosocial functioning of children with drug-versus alcohol-dependent fathers. Am J Drug Alcohol Abuse. 2004 Nov;30(4):695-710.
Abstract: The present study compared the psychosocial functioning of children whose fathers primarily abused illicit drugs other than alcohol (n = 51) to children from a demographically matched sample of families whose fathers abused alcohol (n = 51). Children with drug-abusing (DA) fathers exhibited significantly more negative child behaviors on a standardized child-rating scale than did children from homes with alcohol-abusing fathers. In addition, a significantly greater proportion of children with DA fathers met clinical cutoffs indicative of psychosocial impairment (n = 23: 45%) than did children whose fathers abused alcohol (n = 5; 10%). Mediation analyses indicated that severity of drug, legal, medical, employment, and family problems partially mediated the relationship between type of family (i.e., families with fathers who had an alcohol problem versus families with fathers who had a drug problem) and children's psychosocial adjustment.

Fals-Stewart W, Kelley ML, Fincham FD, Golden J, Logsdon T. Emotional and behavioral problems of children living with drug-abusing fathers: comparisons with children living with alcohol-abusing and non-substance-abusing fathers. J Fam Psychol. 2004 Jun;18(2):319-30.

Abstract: 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. The purpose of this study was to compare the adjustment of children living in families with drug-abusing fathers (n = 40) with that of children with fathers who abused alcohol (n = 40) and children with non-substance-abusing fathers (n = 40). 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.

Kelley ML, Fals-Stewart W. Psychiatric disorders of children living with drug-abusing, alcohol-abusing, and non-substance abusing fathers. J Am Acad Child Adolesc Psychiatry

Abstract: The present study examined lifetime psychiatric disorders and current emotional and behavioral problems of 8- to 12-year-old children living with drug-abusing (DA) fathers compared to children living in demographically matched homes with alcohol-abusing (AA) or non-substance-abusing fathers. Children's lifetime psychiatric diagnoses were determined using the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version. In addition, both parents completed the Pediatric Symptom Checklist. Substance-abusing fathers were recruited from an outpatient treatment program. Children who lived with DA fathers were more likely to have a lifetime psychiatric diagnosis (i.e., 53% versus 25% in AA homes and 10% in non-substance-abusing homes). Compared to children in the other groups, children in DA homes were more than twice as likely to exhibit clinical levels of behavioral symptoms. Children living with DA fathers were more likely to experience a lifetime psychiatric disorder and more negative behaviors compared to children living with an AA father or non-substance-abusing parents.

Fals-Stewart W, Kelley ML, Cooke CG, Golden JC. Predictors of the psychosocial adjustment of children living in households of parents in which fathers abuse drugs: the effects of postnatal parental exposure. Addict Behav. 2003 Aug;28(6):1013-31.

Abstract: The purpose of this study was to examine the relationship between the psychosocial adjustment of children living in households of parents (N=112) in which fathers were entering treatment for substance abuse and the following sets of variables: (a) parents' sociodemographic characteristics, (b) parents' dyadic adjustment, (c) fathers' substance use severity, and (d) parents' psychological adjustment. Mothers did not meet current criteria for a psychoactive substance use disorder on alcohol or other drugs; moreover, based on reports by parents, none of the children was not exposed prenatally to illicit drugs. Results of hierarchical-by-blocks regression analyses revealed that each of the variable sets made a significant unique contribution to the prediction of children's psychosocial adjustment. Furthermore, the following variables within the sets were also found to be significant: (a) parents' age, (b) weekly family income, (c) frequency of male-to-female physical aggression between the parents, (d) frequency of fathers' substance use during the previous year, (e) diagnosis of antisocial personality disorder of fathers, and (f) mothers' level of psychological distress.

Brook DW, Brook JS, Rubenstone E, Zhang C, Singer M, Duke MR. Alcohol use in adolescents whose fathers abuse drugs. J Addict Dis. 2003;22(1):11-34.

Abstract: This study examined the interrelation of several domains, including father attributes, father-child relations, peer influences, environmental factors, and youth personality, as they related to adolescent alcohol use. Several aspects of the father-child relationship were also examined as possible protective factors against adolescent drinking. Subjects consisted of 204 HIV-positive and HIV-negative drug-abusing fathers and their adolescent children between the ages of 12-20. Data were collected via individual structured interviews of both the fathers and the youth. Results indicated that several items from each domain were related to adolescent drinking, and that an affectionate father-child bond had a protective effect. Moreover, hierarchical regression analyses demonstrated that the youth's personality mediated between all other domains and adolescent alcohol use. There was also a direct effect of peer influences on adolescent drinking. Findings extend the literature on the specific mechanisms which link parental substance use with adolescent alcohol use in a high-risk population.

Haugland, BS. (2003) Paternal alcohol abuse: Relationship between child adjustment, parental characteristics, and family functioning. Child Psychiatry & Human Development, 34(2):127-146.

This study examines possible risk factors associated with child adjustment in a sample of children with alcohol abusing fathers in Norway (N=37). Factors included are socio-economic status, severity of the fathers' alcohol abuse, parental psychological problems, and family functioning. Children of alcohol abusing fathers were found to have more adjustment problems assessed by CBCL compared to a general population sample. The findings further suggest that child adjustment in families with paternal alcohol abuse is the result of an accumulation of risk factors rather than the effects of the paternal alcohol abuse alone. Both general environmental risk factors (psychological problems in the fathers, family climate, family health and conflicts) and environmental factors related to the parental alcohol abuse (severity of the alcohol abuse, the child's level of exposure to the alcohol abuse, changes in routines and rituals due to drinking) were related to child adjustment. The results indicate the need to obtain both parents' assessments of child adjustment, as the fathers' assessment was associated with different risk factors compared to the mothers'.

Parke RD. Substance-abusing fathers: descriptive, process and methodological perspectives. Addiction. 2002 Sep;97(9):1118-9; discussion 1120-2.

No abstract available. (Editorial)

McMahon, T and Rounsaville, B J. Substance misuse and fathering: Adding poppa to the research agenda. Addiction, 2002; 97(9): 1109–15.

Abstract: Although a number of socioeconomic forces have converged across cultures to make fathering one of the more prominent social issues of the new millennium, the status of substance-abusing men as fathers is rarely acknowledged in the conceptualization of public policy, service delivery or research focusing on the adverse consequences of drug and alcohol abuse. In this commentary, the authors call for the substance abuse research community to expand understanding of fathering occurring across cultures in the context of chronic substance abuse. Building upon research being undertaken with other populations of fathers, the authors argue there is need to clarify (a) the number of substance-abusing fathers, (b) patterns of reproduction among substance-abusing men, (c) ways in which substance abuse contributes to compromise of fathering, (d) ways in which compromise of fathering contributes to psychological distress in substance-abusing men, (e) ways in which compromise of fathering affects developmental outcomes for children, and (f) ways in which clinical and preventive intervention might be used to minimize the harm associated with paternal substance abuse.

2.       How fathers can be active around drug prevention

Velleman R, Mistral W, Sanderling L. (2000) Taking the message home: involving parents in drugs prevention. London: Home Office

This research study evaluated five drug prevention programmes for parents that were supported by the Drugs Prevention Initiative (DPI). 

·         Research evidence on substance use and parent-child relationships suggests that boys want more communication about drugs from their fathers, and are influenced by their father’s behaviour.

·         In the five programmes evaluated, the majority of participating parents were women. When men did attend it was more likely to be for a one-off session.

·         Two projects (Essex and Stockport), which recruited a fairly high proportion of fathers suggested that contributing factors included: a good home-school relationship; invitations addressed to the whole family; one-off sessions in the evening; and participation from a number of middle-class families. However, no project had firm evidence to support reasons for the attendance or non-attendance of men.

DrugScope. (2004) Drug Education for Hard to Reach Parents. London; DrugScope

The aim of the Drug Education for Hard to Reach Parents Project was to develop innovative models and materials for informing and educating this parent group about drugs. The report highlighted the need to involve parents in drug education. The note reports that fathers may represent a group of parents that are hard to reach as they tend to have quite a low involvement with schools, where the majority of drug education programmes are initiated. Two of the case studies described in the report may be of interest.

East Lothian – drug using parents

Drug information and support sessions were delivered along the lines of a “Tupperware party style” model. Participants organised their own support sessions that met group specific needs in a safe, neutral and mutually agreed venue. The activities covered a broad range of topics including the benefits of exercise, healthy eating. Improving self-esteem, basic first aid, social work issues, post-natal depression and relaxation techniques. The model on which this project was based is presented in the following paper: Riper H, Bolier L, Elling A. (2005) The home party: “Development of a low threshold intervention for ‘not yet reached’ parents in adolescent substance use prevention”. Journal of Substance Abuse 10:141-150

Sheffield  - fathers of drug users

Family support through group work was provided to fathers whose children were using drugs. The activities involved outreach and home visits to fathers, support group meetings in a informal setting, support groups facilitated by male volunteers, and a rolling programme of drug education in schools.

3.       Other information:

Fathers and Drug Education Pilot Project (2001)

http://wachpr.curtin.edu.au/html/projects/project_detail_FDEPP.html 

The aim of this Australian project was to investigate the feasibility of developing communication strategies that actively engage fathers/father figures in the drug education of their high school-aged children. After consultation a father-based communication intervention was developed and piloted in 6 secondary schools with children aged 12-15 years and their fathers.