A report by DEMOS was presented in the House of Commons on the 11th December by Jonathan Birdwell, Emma Vandore and Bryanna Hahn. The report is the latest in a series of studies looking at parents and the influence their drinking has on when their children begin drinking, the amount they drink and long term effects (when aged 34). The report, ‘Feeling the Effects’, looks at 50 troubled families who have sought help for their problems with drinking and investigates how a joined up, non judgemental and supportive approach would be effective in helping children escape the risks of following their parents (often single parents, unemployed, mental health problems and coming from parents who were alcoholics, violent or abusers).
The scale of Parental alcohol misuse
Demos cite research which found that more than 2.5 million children, including 90,000 babies, in the UK are living with a parent who is drinking alcohol ‘hazardously’ by exceeding the Government’s recommended weekly unit consumption levels. Moreover, according to figures in the Government’s Alcohol Strategy, 33% of adults in alcohol treatment (approximately 31,000 individuals) are parents with childcare responsibilities, while a further 20% are parents whose child lives elsewhere.
From domestic abuse to lack of parenting, young people and children can suffer significant harm as a result of a parent’s drinking problem. Figures from the National Society for the Prevention of Cruelty to Children (NSPCC) show that children who have a parent abusing alcohol are over three times more likely to report physical abuse than children who do not have such a parent. Even for the many children of alcoholics who do not suffer direct physical or sexual abuse, the effects of growing up with an alcoholic parent can be deep-seated and long lasting.
The authors state ‘’While our overarching theme is to help all parents be better parents we do not advocate doing so in an overly patronising way. It is difficult enough being a parent, even when the stresses of daily life are relatively light. For families struggling with mental health issues, debt, lack of self-confidence, children getting into trouble with police, worklessness and a whole host of other issues, the very last thing they need is someone telling them they are a bad parent. However, approached in a positive way, many parents welcome support that improves their parenting style. Often this simply involves explaining to parents that parenting style and consumption of alcohol have an impact on their children’s drinking behaviour; sometimes it requires more frequent but light-touch interventions, such as encouraging children to speak about their feelings or confronting parents with the impact of their behaviour and levels of alcohol consumption through identification and brief advice (IBA). For some families who have extensive and complex problems, which include ‘harmful’ drinking, more intensive ‘whole family’-based support is required, including parenting classes and workshops”.
Role of midwives
The report highlights that the importance of training for midwives and GPs to recognise parents who may be misusing alcohol and to advise them or refer them to services, if needed, should remain critical. This must be done in a sensitive manner that does not lead to demonising parents. Given the frequency of contact, the midwife is a key contact point, with the potential of intervening before the child has been harmed. However, midwives should also focus on providing advice to parents – particularly mothers – about parenting and alcohol consumption in the years after their baby is born. For the most part, advice is limited to behaviour for the duration of the pregnancy. But there is no reason why midwives cannot provide advice about parenting style during the early years and its connection to their child’s life outcomes.
‘At risk’ families and family-based interventions
The research with families and frontline workers of family-based alcohol programmes suggests there are three key aspects for good family-based support for parents with alcohol problems: Namely, consistent and trusting personal relationships between the key worker and the family tailored; personalised support based on the specific situation of the family; and ongoing support, even if this is light touch.
The report draws attention to The Government’s ‘troubled families’ initiative, where Government money is being funnelled. The ‘troubled families’ agenda is based on the idea of providing comprehensive, ‘whole of family’ support for those families with multiple problems that cost the state large amounts of money. The authors state: “While alcohol and drug misuse are ‘third tier’ criteria for identifying ‘troubled families’, it is likely that alcohol misuse will factor in many if not a majority of these families, alongside a range of other problems. In this respect the profile of ‘troubled families’ will be similar to that of the 50 families whom we interviewed for our research. Thus, the interventions provided as part of the ‘troubled families’ agenda should take into account the lessons discussed in this report, as well as the experience and expertise of charities and organisations providing family-based interventions across the UK. Those responsible for delivering the ‘troubled families’ agenda must work closely with local health and wellbeing boards, as well as charities already delivering family intervention projects to ensure efforts are properly joined up and coordinated. One final risk worth mentioning is the stigma that many families might feel by being described as a ‘troubled’ family or a ‘neighbour from hell”.
For parents in general
Previous Demos research suggests that parenting in general across the whole of the population can have a large impact on whether children become hazardous drinkers, both as teenagers and later in life as adults. In recent years, research has demonstrated the importance of character skills – such as the ability to delay gratification, practise moderation, and have a sense of responsibility and general respect for others – for achieving better life outcomes, including the moderate and responsible consumption of alcohol. The development of character skills depends on many factors, but parenting style has the greatest impact.
Feeling the effects also draws attention to DEMOS findings from ‘Under the Influence’ in the early years (ages 0–5). The study concluded that the most important element of parenting is the warmth and affection that a parent gives to their child; at 10 years old, and until the age of 16, the most important aspect of parenting becomes the consistent enforcement of discipline.
DEMOS’s research finds that the odds of being a tough but kind parent decreased with frequency of drinking (the amount drunk on these occasions is not mentioned, however). The odds of being ‘tough love’ parents exponentially decreases by 26% for fathers, and 38% for mothers, every time a child’s perception of his or her parents’ drinking behaviour changes from ‘never’ to ‘sometimes’, ‘sometimes’ to ‘often’, and ‘often’ to ‘always’.
Mothers who drink ‘always’ are more likely to have children who drink at hazardous levels in adulthood: 16-year-olds who perceive their mother to drink ‘always’ were 1.7 times more likely to drink hazardously themselves at the age of 34 than those who reported that their mother drank ‘sometimes’. This was true after controlling for a variety of demographic factors. The father’s drinking behaviour was not statistically influential on this.
The report calls for information campaigns to clarify advice to parents on how to speak to their children and teenagers about alcohol, as well as the best approach to allowing their teenagers to drink alcohol under parental supervision. Demos’ research suggests that at the age of a teenager’s typical initiation to alcohol (between 13 and 16 years old), consistent and strict discipline, combined with limiting the availability of alcohol to teenagers, is the best approach to ensure that children do not develop a hazardous relationship to alcohol. Information campaigns for parents should take a clear and unequivocal line on this point.
Parents who are drinking too much but are not dependent drinkers
Identification and brief advice could help to get parents thinking about their alcohol consumption levels and to modify their behaviour. As noted in The Government’s Alcohol Strategy, IBA is a quick and simple intervention for those who drink above the guidelines but who are not accessing alcohol support services. According to the Government’s Alcohol Strategy, IBA “has been proven to reduce drinking… at least one in eight at-risk drinkers reduce their drinking as a result of IBA”. However, the Alcohol Strategy makes no mention of whether IBA includes specific advice to parents about the impact of parenting on their children’s alcohol consumption, and the impact of their own alcohol consumption. IBA should include this information where the recipients are parents or have childcare responsibilities. Local health and wellbeing boards in local areas with high levels of parental alcohol misuse especially should prioritise the use of IBA with parents.
The number of 16–24-year-olds who said they had a drink in the past week fell from 70% in 2003 to 48% in 2010. An even more dramatic decrease has occurred among young children between the ages of 11 and 15 having reported drinking alcohol (55% of 11-15 year olds haven’t drunk alcohol). However, many people continue to drink at hazardous levels, causing significant damage to themselves, their families and their communities. Moreover, alcohol-related harms are unevenly spread across the UK, with problems of alcohol misuse especially concentrated in the north east of England, Scotland and certain urban areas in the UK. Excessive drinking hurts families in a number of ways, from family and relationship breakdown to violent and sexual abuse, as well as through quieter harms such as missed meal times or weaker social bonds for children afraid to bring friends home from school. Many of these children go on to repeat the pattern and use alcohol excessively to cope with traumatic life experiences.
Key protective factors between parents’ drinking behaviour and offspring drinking
The analysis identified a number of factors that appeared to protect offspring from drinking hazardously as adults.
Gender - Gender appears to have an impact in predicting against binge drinking at the age of 34, with women being 63.8% less likely to binge drink than men in the exact same circumstances.
Ethnicity and religion - A second protective factor worth consideration when looking at binge drinking age at 34 is the ethnicity of cohort members’ mothers. By far the largest proportion of all binge drinkers (over 97%) had mothers of British ethnicity. Those who had mothers of non-British ethnicities are 47.7% less likely to be binge drinkers at age 34 than those with British mothers There is only a small difference in the type of religion and the strength of religion as a protective factor, with the highest rate being among Buddhists at 26.7%.
Help for the most vulnerable - what they value most
The report found “Good support is most importantly non judgmental, consistent and stable. Practical solutions are appreciated most, followed by understanding and friendship – someone to talk to. A key aspect of well-appreciated support is having ‘someone to talk to, day or night”(3). Given the high degree of worklessness, and the fact that boredom is often cited as a reason to drink, giving people ‘something to do’ is also important – from practical help towards finding a job such as computer classes, to stress relief like reflexology or yoga. For some, being able to access support services from home was important because of the need for childcare, lack of a car and poor public transport networks. Unfortunately, such help appears to be rare and the route towards it is often littered with stressful and unsuccessful attempts to address the problem.
A major issue for people on the cusp of recovery was the lack of help, for example with mental health issues, for people still drinking: “The councillor won’t see you while you’re drinking; it’s a vicious circle: no one will see you because you’re drinking but you’re drinking because you need help”.
The most common support for children came in the form of mentors or specialist help at school. Some attended sessions intended for young carers, or saw psychologists. Many of the children were not able to express fully how these interventions had helped, because of their age. Some said it was nice to have someone to talk to and some liked meeting other children experiencing similar difficulties. Many enjoyed getting out of the house and trying new activities, some of which are designed to relieve the stress of being a young carer or just to open up new horizons. However, some children thought there is a stigma attached to services, so reject it. Some parents complained that services stop in the school holidays.
The report makes a valuable contribution to the quandary of how we can engage parents regarding their alcohol use and the effects it has on their children. For parents in general, being good role models, setting boundaries and sticking to them and being kind but firm leads to long term results in terms of lower risks of binge drinking among their offspring. Parents are notoriously difficult to reach as their children get older but schools outreaches to parents while teaching about alcohol in PSHE lessons offer one route. Engagement via behaviour change advertising strategies as well as via social media and emphasising social norms that it is not inevitable that their children will drink, or drink to excess, are also helpful.
The report proposes a logical joined up approach for vulnerable families based on it’s interviewing of 50 dependent families from across the UK.