Additional risks and factors

When a child’s life becomes riskier

Having a parent with problematic substance use has a huge impact on a child. Having a parent who also has a co-occurring condition puts a child’s safety at even more risk (see following paragraphs) .

Alcohol, other drugs and mental health issues

You will work with families where problematic alcohol and other drugs use and  a mental illness or mental health condition coexist. This is called a co-occurring condition (previously known as 'dual diagnosis' or 'comorbidity').

You may find it hard to distinguish whether a parent’s behaviour relates to a mental health condition or their problematic alcohol and other drugs use. Your role is to assess how the co-existing conditions impact on parenting and the child’s safety.

‘The realisation that mental illness and substance abuse can be linked is quite recent, so research is scant.’ Victorian Better Health Channel (2019), Substance misuse and mental illness—dual diagnosis.

The influence of alcohol and other drugs on a parent’s mental health

Some patterns of alcohol and other drugs use can cause mental health problems or exacerbate existing ones. For example:

• Problematic use of psychostimulants (such as amphetamines and methamphetamines) increases the risk of psychosis.
• Cannabis use can trigger psychotic symptoms, especially in people vulnerable to mental health issues.
• Heavy use of alcohol can worsen pre-existing anxiety disorders and depression and increase the occurrence of agoraphobia and social phobias.
• Increase in alcohol and other drugs use to cope with trauma-related mental health  conditions can interfere with the brain’s natural processing of trauma. An attempt to reduce substance use may cause trauma symptoms to worsen, creating a cycle of using drugs and alcohol which manages yet exacerbates symptoms.
• Using alcohol and other drugs for self-medication can lead to psychological dependence.

Drug-induced psychosis

Drugs like methamphetamine, speed, cannabis and hallucinogens can result in psychotic symptoms if taken frequently for long periods of time, even if there is no pre-existing mental illness. This is commonly known as drug-induced psychosis.

Early symptoms of psychosis are gradual and progress as the drug use continues. Aside from delusions (a false fixed belief) and hallucinations (seeing something that isn’t there), here are some symptoms to look for:

• changes in emotion; no emotional response
• difficulty expressing feelings; a ‘flat’ appearance or no emotional expression
• increased paranoia, such as a belief people are following them or hearing voices in the walls
• social withdrawal
• incoherence in thought and actions; disorganised speech
• erratic, violent, unpredictable behaviour.

The symptoms of a drug-induced psychosis will usually subside once the person stops using,  however, some parents may require medications or mental health support.

Alcohol, other drugs and domestic violence

You will find many children belonging to families where both problematic substance use and domestic violence are present. It is important you are aware that alcohol and other drugs may exist alongside, and possibly in response to, domestic violence, even if violence was not the reason for the intake.

Always be curious about potential acts of protection and responses by children and women. Your conversations about domestic and family violence matter.

Read more about a woman’s and man's experience of alcohol and other drugs in the Working with parents section. (Working with women and Working with men.)

Alcohol, other drugs and sexual abuse and exploitation

Having a parent who has problematic alcohol and other drugs use can increase the risk of sexual abuse and exploitation of a child in the following ways:

• Children may be at risk of sexual abuse by a parent if the parent has a predisposition to abuse due to loss of inhibition (Dawe et al., 2007). Children are also at risk of sexual abuse from extra-familial perpetrators, especially when the child is at risk of supervisory neglect.
• Sexual abuse offenders often target children whose families are under stress.
• Stressors such as problematic alcohol and other drugs use have been shown to increase the risk of child sexual abuse, particularly abuse that is perpetrated by someone outside the immediate family. Researchers believe this is because parents who are distracted, consumed and overwhelmed by their alcohol and other drugs use may provide less supervision and be less alert to risk.
• Parents who are under stress may also be in greater need of support (both financial and practical), and this makes them more susceptible to manipulation and coercion or more willing to allow a suspected offender into their lives and the lives of their children.

Supplying or using alcohol and other drugs can become the backdrop that enables sexual abuse in the following ways:

• An offender may encourage, supply and facilitate a mother’s substance use to create opportunities to sexually abuse her child while she is intoxicated or drug affected.
• Alcohol and other drugs may contribute to the secrecy and dependence between a mother and her partner.
• Alcohol and other drugs may be used to manipulate and coerce young people for sexual abuse or sexual exploitation.

Read more about child sexual abuse in the practice kit Child sexual abuse.