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5.6 Substance Misuse and Families with Children


This should be read in conjunction with the Joint Service Protocol re: Families and Children Affected by Parental Substance Misuse.

Definition of Substance Misuse

Substance misuse is the use of or dependence on a substance leading to social, psychological, physical or legal effects that are detrimental to the individual or others.  Substance use includes prescribed and non prescribed, legal and illegal substances including alcohol.


In July 2014, this chapter was updated with new definitions and guidance for maternity staff.


  1. Background
  2. Safeguards and Concerns
  3. Referrals
  4. Assessment and Initial Child Protection Conference
  5. Confidentiality
  6. Services for Pregnant Women
  7. Useful Resources

1. Background

1.1 The effects on children of the misuse of alcohol and drugs by one or both parents or carers are complex and may vary in time, which is why a thorough assessment of needs and risk of harm is important. In some cases the misuse of alcohol and drugs may be one factor which, when linked to domestic abuse or mental illness, may increase the risks to the child.
1.2 The circumstances of children must be carefully assessed not only to consider immediate risks but also the long term effects on the child of their parents’ substance misuse. Parental substance misuse can and does cause serious harm to children at every age from conception to adulthood.
1.3 An appropriate response to these children often requires the close collaboration of a number of agencies - both statutory and confidential voluntary agencies. These would include Health and Maternity Services, Adult Social Care and Children’s Social Work Services, Adult Drug and Alcohol Treatment Services, Courts, Prisons and Probation Providers.

2. Safeguards and Concerns

2.1 Parental substance misuse in itself is not a reason for considering a child to be suffering or at risk of suffering Significant Harm although it may be a contributing factor. 
2.2 A thorough assessment by all relevant agencies is required to determine the extent of need and potential level of risk of Significant Harm in every case.

Where there is concern that a parent is involved in substance use, the effect on the child needs to be considered, including:

  • The child’s physical safety;
  • Possible trauma to the child resulting from changes in the parent’s mood or behaviour;
  • The impact of the parent’s substance use on the child’s development including the emotional and psychological well-being, education and friendships;
  • The extent to which the parent’s substance use disrupts the child’s normal daily routines and prejudices the child’s physical and emotional development;
  • Impaired parenting capacity;
  • Intermittent and permanent separation or frequent visitors to the home;
  • Inadequate accommodation and frequent changes in residence and in cases of drug misuse, the following should also be considered:
    • The impact on the child of being in a household where illegal activity is taking place particularly if the home is used for drug dealing;
    • How safely the parent’s drugs and equipment are stored;
    • The impact on the unborn child as a result of maternal substance abuse.
2.4 The circumstances surrounding dependent, heavy or chaotic substance use may inhibit responsible childcare, for example, substance use may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks.
2.5 It is important to be mindful that misuse of drugs and/or alcohol by other significant people in a child/young person’s life, who are not primary carers such as a sibling, a parent’s new partner, other family member and frequent visitors to the home may place the child in an environment of substance misuse that may mean they are at risk of harm.

3. Referrals

3.1 Professionals, when confronted with a child in a substance-misusing environment must ask themselves “What is it like for a child in this environment?” If they cannot satisfy themselves that the child is not being harmed or in need, they must refer the child to Children’s Social Work Services - see Making Referrals to Children's Social Care Procedure

4. Assessment and Initial Child Protection Conference

4.1 Children’s Social Work Services will consider whether it is appropriate to undertake a  Single Social Work Assessment with a view to developing a plan for intervention in relation to all referrals.
4.2 Assessments will be conducted on an inter-agency basis and further guidance on such assessments can be found in the Joint Service Protocol re: Families and Children Affected by Parental Substance Misuse.
4.3 If at any stage it is considered that a child, including an unborn child, may be at risk of Significant Harm the Solihull LSCP Making Referrals to Children's Social Care Procedure must be followed.

The Children’s Social Work Service will consider this information and may as a result hold a strategy discussion/meeting. The purpose of a Strategy Discussion/Meeting is to determine whether there are grounds for a Section 47 Enquiry. See Section 47 Enquiries and Social Work Assessment Procedure

Section 47 Enquiries are conducted by a social worker and may involve the Police, and must be completed within 15 days of a Strategy Discussion.

Where concerns are substantiated and the child is judged to be at continued risk if Significant Harm, an Initial Child Protection Conference should be convened.

Child Protection Conferences are convened where children are considered to be at risk of Significant Harm. For further detail see Initial Child Protection Conference or Child Protection Review Conference.

5. Confidentiality

5.1 Confidentiality is important in developing trust between parents and staff in agencies working with them in relation to their substance use.

All agencies, both statutory and non-statutory, should have written procedures on confidentiality which provide for the sharing of information where there is concern about the wellbeing of a child who may be suffering or at risk of Significant Harm. When agencies start any work with substance-using parents or with pregnant women who use substances or children living with substance using parents, these procedures must be explained to them.

See also Information Sharing and Confidentiality Procedure.

6. Services for Pregnant Women


Staff providing care for pregnant women should ask sensitively, but routinely, about all substance use, prescribed and non-prescribed, legal and illegal, including alcohol.  If it emerges that a woman may have a problem with drugs or alcohol, she should be encourage to attend substance misuse services or specialist maternity services, and staff should offer to make the referral.

Maternity services should arrange a multi-disciplinary assessment of the extent of the woman’s substance use, including type of drugs, level, frequency, pattern, method of administration and consider any risks to the unborn child from current or previous use.

If Children’s Social Work Services are not involved, the obstetrician, midwife or GP should ask her consent to liaise with the local children’s social work service. If the woman does not consent, staff should consider whether the extent of substance misuse is likely to pose risk of significant harm to her unborn baby.  Consent is not required if the unborn baby is considered to be at risk of significant harm.

If significant risk seems likely and/or she continues to misuse substances or is unwilling to engage with the substance misuse services, a referral to Children’s Social Work services must be made so that consideration can be given to undertaking a Single Social Work Assessment to explore the impact of the substance misuse on the unborn baby and parenting capacity.

7. Useful Resources

7.1 The Children’s Commissioner for England has published a booklet to help children affected by parental or carer alcohol abuse. It helps children discuss what they can do to keep safe and how the alcohol abuse is affecting their life. The booklet is called ‘You are not on your own’ and is available here.