Alcohol & substance misuse – advice for all

It is estimated that around 200,000 adults are currently receiving treatment for substance misuse problems and of these one third are parents who have children living with them. Substance misuse may include experimental, recreational, poly-drug (use of more than one substance), chaotic and dependent use of alcohol and/or drugs.

If someone you care about, or work with, is drinking too much or taking drugs listed below are some organisations you can contact in confidence for advice and support:

Safeguarding children
Parental misuse of drugs or alcohol becomes relevant to child protection when the misuse of the substances impacts on the care provided to their child/ren.

Misuse of drugs and/or alcohol is strongly associated with significant harm to children, especially when combined with other features such as domestic violence, mental illness and should prompt careful consideration as to how best families can be supported and where necessary children/young people protected.

Children and young people can also place themselves at risk through their own use of drugs and/or alcohol. Such activity also increases their vulnerability to other forms of harm such as Child Sexual Exploitation.


Fetal Alcohol Spectrum Disorder (FASD)

Alcohol Exposed Pregnancy and FASD

Drinking alcohol during pregnancy can cause Fetal Alcohol Spectrum Disorder (FASD), a range of lifelong disabilities including physical, mental, behavioural and learning impairments. Symptoms of FASD include:

  • Facial abnormalities
  • Brain damage
  • Heart defects
  • Limb and kidney damage
  • Learning difficulties
  • Poor impulse control
  • Social and mental health issues

It’s commonly misdiagnosed as other disorders such as ADHD which have some similar symptoms. Recent prevalence research shows that FASD may affect up to 3.6% of children in Greater Manchester — that’s the equivalent of 1,238 children born each year.

There are many mixed messages and advice given to parents-to-be regarding drinking alcohol during pregnancy, however there’s only one safe approach.

#DRYMESTER is a health awareness campaign commissioned by Greater Manchester Health and Social Care Partnership. You can access further information, resources and links to support services here:


Other useful resources:

FASD prevalence leaflet

GM FASD powerpoint

Prevalence Infographic

Alcohol Exposed Pregnancy Booklet

GM Alcohol Exposed Pregnancy Programme –  Impact and Evaluation Report


The ‘toxic trio’

There is increased awareness of the frequency with which domestic and sexual violence, substance use and mental health problems co-exist, particularly in the context of safeguarding children and young people. Various terms have been coined to describe the concurrent experience of these three issues: the ‘toxic trio’, ‘the trilogy of risk’, and people with multiple and complex needs.

However, there is concern that terms such as the ‘toxic trio’ are problematic because they can lead to the parents – most often the mother who is frequently the victim of abuse herself – being deemed toxic or seen as the main source of risk, and therefore they don’t hold the perpetrator of domestic abuse to account for their behaviour.

Read more about this in an article on the Community Care website at

Wirral LSCB  have produced an excellent poster summarising the results of an analysis of serious case reviews which can be downloaded from their website at

SafeLives have produced a good summary power-point presentation which can be downloaded from their website at

In July 2018, The Children’s Commissioner published a report ‘Estimating the prevalence of the ‘toxic trio’: Evidence from the Adult Psychiatric Morbidity Survey’ available from their website at

Guidance for Practitioners

Safeguarding children from substance misuse
As with all dilemmas in respect of safeguarding children/young people, concerns can never be shared too early and making contact with your line manager/agencies lead officers, the Early Help Hub or Children’s Social Care will help you establish an appropriate response.

Safeguarding children must remain on the agenda of all services associated with drug and alcohol misuse, and likewise substance should misuse remains on the agenda of all services associated with parenting, family work and childcare.

Substance misuse (legal or illegal drug usage and/or alcohol consumption) by parents and/or carers does NOT on its own automatically indicate that children are at risk of abuse or neglect, although it is essential that practitioners recognise that this is a group for whom the potential associated risks are high.

The GMSP guidance aims to assist all agencies working with children, adults who are parents/carers or pregnant women and their partners in identifying situations where action is needed to safeguard a child or promote their welfare as a result of their parents’ alcohol and drug use; this can be found at

What is the impact of alcohol and/substance misuse?
Although there are some parents who are able to care for and safeguard their child/ren despite their substance misuse, parental substance dependence can cause significant harm to children at all stages of development. An assessment is required to determine the extent of need and level of risk of harm for each child in the family.

Children’s vulnerability may stem from the impact of substance misuse on parenting capacity as parents may have difficulty in organising their lives. For example, excessive alcohol intake or drug misuse may mean that parents are less attentive to a baby or child’s needs and the preoccupation with getting and using drugs means that parents place their own needs above those of their children. Therefore, children are likely to be at increased risk of, or experiencing, significant harm primarily through emotional abuse and neglect. The child/ren may also not be well protected from physical or sexual abuse.

What should you do?
It is important that arrangements are in place to enable children’s social care services and substance misuse (including alcohol) services referrals to be made in relevant cases. Where children may be suffering significant harm because of their own substance misuse, or where parental substance misuse may be causing such harm, referrals need to be made to Community Drug and Alcohol teams or alcohol services, in accordance with multi-agency procedures.

Where parental substance and/or alcohol misuse may be causing a child or young person significant harm referrals need to be made in accordance with local safeguarding procedures. Even where children or young people are not suffering significant harm, parents may find it useful to have additional support therefore referral arrangements also need to be in place to enable children and young people’s broader needs to be assessed and responded to.

Professionals in all agencies must recognise that they have a primary duty to safeguard and promote the welfare of the children and young people.

For those children or young people who are suffering, or at risk of suffering, significant harm, joint working is essential to safeguard and promote the welfare of the child (ren). All agencies and professionals should:

  • be alert to potential indicators of abuse or neglect;
  • be alert to the risks that individual abusers, or potential abusers, may pose to children;
  • share and help analyse information so that an assessment can be made of the child’s needs and circumstances;
  • contribute to whatever actions are needed to safeguard and promote the child’s welfare;
  • take part in regularly reviewing the outcomes for the child against specific plans;
  • work co-operatively with parents, unless this is inconsistent with ensuring the child’s safety;
  • be alert to the degree of intoxication, withdrawal or drug and alcohol seeking behaviour which may pose a risk to children & young people.

Where children are not suffering significant harm, referral arrangements also need to be in place to enable children’s broader needs to be assessed and responded to.

A child may be considered to be at greater risk of harm where substance use is uncontrolled and chaotic, if the parent/carer alternates between states of severe intoxication and periods of withdrawal, especially if substances are mixed i.e. combinations of different drug and alcohol combined with drugs.

Research indicates that the risk factors for the safety and welfare of the child may be heightened during periods of withdrawal – with parents/carers exhibiting a reduced responsiveness to the child’s needs and increased levels of anxiety relative to themselves as individuals.

There is a body of evidence which practitioners can look at and use in their assessments which can be found from the links below and from the GMSP online procedures.

The Alcohol Identification and Brief Advice e-learning project (Alcohol IBA) helps professionals to identify those individuals whose drinking might impact their health, now or in the future and to deliver simple, structured advice aimed at reducing this risk. Courses available include delivering alcohol IBA in four settings:

  • Primary Care
  • Community Pharmacy
  • Hospitals
  • Dental Teams.

Practitioners can find these courses on the e-learning for healthcare website at

Sources of advice 

The alcohol care management team provide a community care service for individuals experiencing any difficulties linked to alcohol use. This may include assessment for residential rehabilitation and arranging rehab that most meets an individual’s particular needs. For information visit the MCC website at

Details of a wide range of care and support groups for people who have issues to do with alcohol misuse can be found on the Help and Support Manchester website at

If you are worried about drugs, or worried about someone you know taking drugs, visit FRANK.

FRANK offers free and confidential advice about drugs 24 hours a day and can refer you on to local drugs services. Call FRANK on 0800 77 66 00 or Text FRANK on 82111 or visit their website at

FRANK also provides a wide range of information about drugs and their effects, as well real life stories and interactive material on their website at

All drugs carry risks. Some of the health risks involved in using any illegal drugs are:

  • the user can never be sure of exactly what they are taking
  • what is bought is unlikely to be pure, and they wont know what it has been mixed with
  • not knowing the strength of what has been bought could lead to accidental overdose
  • they cant be sure what effect the drugs will have, even if they have taken it before
  • it is often very dangerous to mix different drugs, and this includes taking drugs and drinking alcohol
  • if needles, syringes or other injecting equipment is shared there is a serious risk of dangerous infections being spread such as HIV and hepatitis B or C. Injecting can also damaged veins.

In addition, unlawful possession of a controlled drug is a criminal offence. A drugs conviction can cause problems obtaining a travel visa to enter some countries. It can also affect job prospects. An employer may check if an applicant has a criminal record or any past convictions.

Legal highs
Just because it’s legal, doesn’t mean its safe! FRANK offers free and confidential advice about legal highs on their website at


Al-Anon Family Groups provide support to anyone whose life is, or has been, affected by someone else’s drinking, regardless of whether that person is still drinking or not – contact their confidential helpline on  tele: 020 7403 0888  or visit their website at

Childline has some very useful information for young people and their families – contact them on tele: 0800 1111  or visit their website at

Drink Aware -raises awareness about alcohol, health issues, legislation and drinking on their website at

Drinkline – if you are worried about your own or someone else’s drinking, contact Drinkline for a confidential conversation – call free on 0300 123 1110  or for more information visit their websites at  and

Drugwatch have some great educational guides on children’s health – from newborn to preteen to promote children’s well-being by knowing what to look out for – find out more on their website at

Drugwise – provides evidence based information on drugs, alcohol and tobacco on their website at

Families Anonymous run self help groups for families and friends of those with a drug or related behaviour problem; details can be found on their website at

FRANK – the National Drugs Helpline (also called Talk to Frank) is a website for young people providing free, confidential drugs information and advice 24 hours a day – visit their website at

Lifeline Eclypse is a citywide service for children, young people and families affected by substance misuse issues. The Treatment Team work with young people under 19 years who are using or at risk of using drugs and alcohol. The Family Team work with children affected by parental substance misuse and their parents to promote resilience and family unity. For more information visit their website at  or telephone  0161 8392054 – they are based at 41 Thomas street, Manchester.

National Association for Children of Alcoholics provides information, advice and support for everyone affected by a parent’s drinking on its website at

NHS Choices website at

National Treatment Agency (now NHE) provides information for healthcare professionals and partners on the website at

Re-Solv founded in 1984, Re-Solv is the UK’s leading agency working to end volatile substance abuse and support those whose lives are affected by these and other ‘legal’ highs (such as gases, aerosols, petrol, glues, solvents, poppers, laughing gas, ‘legal highs’); find out more on their website at

Further research and learning



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