Parents who use substances

Drinking alcohol or using drugs does not make someone a ‘bad’ parent. Many Australian parents use alcohol and other drugs in a low-risk way. Other parents use alcohol and other drugs more heavily and cope well, doing the best they can in difficult circumstances.

However, many families Child Safety works with can use substances in a way that negatively affects their ability to parent and in some cases leads to a child being harmed. The effects of problematic substance use can have immediate or lasting impacts on the child’s safety, wellbeing, development and behaviour.

Engaging with parents using substances

To understand the dangers and risk posed by a parent’s substance use, have up-front and frank conversations with parents. This involves looking at more than what and when they drink or use. 
Motivational interviewing is a tool which can help navigate tough conversations. This approach draws on empathy and self-awareness to partner with the parent, ask questions and listen to their answers. Focus on identifying choices available and looking for solutions (University of Wisconsin-Madison, School of Social Work). 

Using substances to cope and survive

Research is clear about the links between childhood trauma, pain, suffering, abuse and violence, and problematic substance use.

A parent with problematic substance use has likely experienced pain or suffering from their childhood or are currently experiencing pain from violence, neglect, sexual abuse, mental health, oppression, racism, disadvantage or poverty.

Seeing and understanding the challenges a parent has faced and how their experiences may have led to or maintain their substance use is important. Helping parents make this connection and sharing this can be a catalyst for change.

For Aboriginal and Torres Strait Islander people, the disconnection from cultural practices, traditions and roles has caused enduring hurt to Aboriginal and Torres Strait Islander people’s identity and sense of belonging to family and community. Problematic substance use exacerbates these experiences and can impact on how Aboriginal and Torres Strait Islander children are raised. 

When you help parents see their strengths, how they have used substances to cope and survive, and the times when they have been able to create safety for their children, you give them courage to see themselves as a survivor.   

Respectful engagement 

Every parent is a person in their own right. Every parent has things they hold close, value and want for their life.

Social justice, ethical practice, and the Framework for Practice principles guide our work with parents, focusing on fairness, curiosity, and respect. This involves engaging with them in ways that help them feel valued beyond negative labels, assumptions, and stereotypes. Every parent has a unique story.

Use respectful and curious engagement, which means:

• taking the time to listen and really hear their story—understanding past or current pain and suffering, and helping them reveal their strengths and resilience
• wanting to know about who they are, how alcohol and other drugs use has taken hold of their life, and how you can help them overcome their problematic use and create safety for their child
• helping them find choices and have self-determination in pathways for treatment and recovery
• making sure everything you ask a parent to do has meaning and purpose (for example, don’t ask parents to do drug screens for the sake of it)
• recognising errors in practice, ways that power or privilege have been misused or been oppressive, and responding to this, reflecting on it and repairing it
• advocating on their behalf, making sure they are not held back, oppressed, disadvantaged or shamed in your, your colleagues’ or other professionals’ practice. 

Stigma and shame

Stigma and shame are some of the biggest barriers for families dealing with problematic substance use. They can stop a parent or child from ‘opening up’ and talking about how alcohol and other drugs affects their lives.  They be a barrier, stopping a parent who need treatment and support from accessing or staying in treatment and recovery.

Helping the parent focus on their health and sobriety, rather than dwelling on feelings of shame, is important.

This is a particular barrier for Aboriginal and Torres Strait Islander peoples, and people of Culturally and Linguistically diverse backgrounds. In many CALD communities in Australia there is a self-reliant approach when dealing with personal or family problems and challenges, for fear of blame by others in the wider community.

The stigma and shame a parent may feel during recovery can also take its emotional toll. Help them overcome this so it does not take control and derail their recovery. Connect them with support groups of other parents who have walked the same path to recovery. Alcoholics Anonymous Australia, Narcotics Anonymous Australia and SMART Recovery all have excellent resources for parents.

Stigma can affect a parent with problematic substance use, as the parent:
•    is less likely to seek help or treatment
•    may experience high discrimination and feel abandoned, rejected or ashamed
•    is more likely to quit treatment due to stigma and shame.

Stigma can influence how practitioners and other professionals see the parent with problematic substance use. Parents may:
•    be held in poorer regard compared to other parents
•    be seen as not motivated
•    not get enough professional or quality time because of avoidance
•    have limited opportunity to recover because of the belief they can’t change or are hopeless.

Guilt, remorse and shame are very raw emotions during the early recovery stage and can be gnawing, harmful and all-consuming emotions that creep into every aspect of family life. Once a parent has started to come down and intoxication wears off, they feel the shame, guilt and remorse and the heavy realisation they are accountable for what has happened. These overwhelming feelings can be a trigger to use again.

Engaging with pregnant people

A person who is pregnant and fears having their baby taken away needs you to engage with hem so they feel safe enough to talk with you and other professionals. This role requires you to be mindful of the power and authority you hold as a Child Safety practitioner and of how families may view you.

Be mindful Aboriginal and Torres Strait Islander pregnant people may be hesitant to access prenatal or alcohol and other drugs care during pregnancy for several reasons which may include: 

• holding close traditional ceremonies and beliefs about pregnancy and birthing that go against western practices. This may be a barrier to getting mainstream prenatal care
• not having information about or be able to access Aboriginal antenatal services or health workers, particularly in remote areas
• being unaware of the impact of substance use on them or their baby
• being fearful their engagement with a support service may result in their baby will be taken from them.

It is important practitioners actively work to offer help and support to a pregnant person to achieve their goals. Examples of active efforts includes:

• negotiate longer times for prenatal appointments
• negotiate consistent health workers for prenatal appointments if possible
• offer practical assistance to get to appointments if possible
• use a variety of methods to remind them of upcoming appointments
• if appointments are missed, stay supportive and curious about why
• ask how you can be of the most use
• link the pregnant person to the hospital social worker
• link them to cultural or other supports.

Give the pregnant person information about the potential effects problematic substance use can have on their unborn baby, and what to expect when the baby is born, for example:

• what medical care the baby may need
• where they will be cared for.

Help the pregnant person to think about and come up with questions for their nurses about the birth and care of their baby once born.

The best interventions for pregnant people are holistic and person-centred. These interventions look at the specific needs of each pregnant person who uses substances both at a practical level such as safe housing and financial assistance to mental health care, and the right treatment for their problematic substance use. 

Holistic care should encompass a range of health and psychosocial domains and address any practical barriers to the pregnant person getting treatment such as transport, money, housing, violence.
Treatments can include withdrawal or medical treatments with specific drugs, as appropriate, psychosocial interventions and nutritional support.

After delivery, follow-up and coordination is particularly important, including ongoing alcohol and drug treatment, medical management, health and developmental assessment of the baby, parenting support, contraceptive advice, and referral for additional support services.

Antenatal planning with Queensland Health

Expectant parents need Queensland Health and Child Safety practitioners to work together. Pre-planning is an essential part of casework with expectant parents. Some things to explore with service providers and the parents prior to the baby’s birth include:

• minimising the shame and stigma parents may feel
• monitoring for neonatal abstinence syndrome
• engaging alcohol and other drugs professionals to support parents during the antenatal period—including getting involved in prenatal care and appointments
• current substance use, and what this may mean for the birth, their behavioural and emotional presentation and any worries you have for their baby once born
• supports needed in hospital and once discharged
• where parents are up to in their readiness for change and how professionals can work together with them to motivate and sustain change
• breastfeeding (if this is what they want) and how she might do this safely.

Involve clinical and other health professionals during the hospital planning meeting (via phone or in person) to ensure advice is shared.

Listening and responding to parents

There are some common things parents with problematic substance use may say because of denial, hiding, minimisation, fear, worry, stigma or shame. There are also effective ways practitioners can respond:

When engaging with Aboriginal and Torres Strait Islander parents, remember it may be best to avoid direct questions at first. A yarning approach can work better. So instead of asking direct questions, suggest two alternative scenarios. 

For example, ‘Some people get the shakes when they stop drinking and some people are fine. What is it like for you when you stop?’

Where possible, men are generally encouraged to speak with men and women with women, particularly when unfamiliar to the Aboriginal or Torres Strait Islander parent or their community.