Integrating gender and children’s rights in services for families affected by drug use E-Book

Corina Giacomello

• Herausgeber: Council of Europe
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Veröffentlichungsjahr: 2024

Beschreibung

A practical tool with strong theoretical, evidence-based, legal grounds that can, at the same time, be adapted to each stakeholder’s needs, interests and possibilities.
After an initial publication on children whose parents use drugs in 2022, the Pompidou Group has continued research on this topic as part of an ongoing effort to give visibility to these children and to develop proposals for creating or strengthening services that both protect children and support families. It also intertwines with the effort of the Pompidou Group to integrate a gender dimension into drug and addiction policies.
This practical guide brings together the wealth of knowledge accumulated since the beginning of the project and sets out 108 concrete recommendations for member states, public institutions and nongovernmental organisations that work with children and parents affected by substance dependence.
The Children and families affected by parental drug use series comprises five volumes:

• Volume I Children whose parents use drugs – Promising practices and recommendations;
• Volume II We are warriors – Women who use drugs reflect on parental drug use, their paths of consumption and access to services;
• Volume III Listen to the silence of the child – Children share their experiences and proposals on the impact of drug use in the family;
• Volume IV Children and parents affected by drug use – An overview of programmes and actions for comprehensive and non-stigmatising services and care;
• and this new Practical guide Integrating gender and children’s rights in services for families affected by drug use.

Leseprobe

 

Integrating gender and children’s rights

in services for families affected by drug use

 

Children and families affected

by parental drug use

 

Practical guide

 

Corina Giacomello, Professor,

Autonomous University of Chiapas, Mexico

Contents

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Introduction

” Teachers and services must be patient with children. They must hear the voice of the child and... the silence of the child. It helps to be supported in everything without the danger of losing your house and being in an institution. It helps if the child can have a quiet home, a therapist for the parents, a school that understands and a network that supports with food, clean clothes, a clean house, quiet sleep, studying, going to school on time. Therapists are helpful but children do not like going to therapy.

This opening quote is from Alexis,1 a young boy from Greece. Straightforward and reflexive, his statement defines what these guidelines envision: children who are provided with safe spaces and people who listen to them in such a way that even their silence is understood. Children who can live in a safe home with the people they love, without having to be taken away and allocated to other families or to institutions. Boys, girls and non-binary children who see their rights to health, care, education, protection and participation fulfilled. Children who do not feel uncertain about their caregivers’ love for them.

Alexis’ vision does not end with children’s rights but encompasses their parents, since it is with them, as primary caregivers, that children are imagined in this holistic perspective, so frankly articulated by this assertive young boy and yet so hard to attain in the daily lives of families affected by substance dependence.

His comments were collected as part of the Pompidou Group project Children Whose Parents Use Drugs, which began in November 2020 and is currently ongoing at the time of publishing this guide.

1. Background

Children Whose Parents Use Drugs is a human rights-based project that lies at the intersection of children’s rights to health, education, development, participation, an adequate standard of living as well as the right to not be separated from their families, and people’s rights to not be stigmatised, discriminated against and criminalised because of substance dependence. It aims at building and consolidating narratives and practices that, while looking at parents and children in their own rights, address them also as a family.

It also intends to be a contribution to the development of a wider children’s rights perspective in drug policy and a more aware drug policy perspective in the children’s rights agenda. The project was born as a response to the invitation to the Pompidou Group secretariat to contribute to the discussions on the Council of Europe Strategy for the Rights of the Child (2022-2027).

Between November 2020 and December 2022, the project involved 18 countries2 and more than 300 people, particularly experts from academia, the public sector and non-profit organisations working in the fields of children-centred programmes and services aimed at strengthening protective factors and resilience; families with multiple vulnerabilities; prevention, drug treatment and harm reduction; and services for women victims and survivors of domestic abuse.

The information and reflections that nurture the project, its findings and recommendations have been collected through questionnaires, international and national focus groups, and semi-structured interviews with policy makers, experts, practitioners, women who use substances and children and young adults living in families affected by substance dependence. The products are a dedicated web page,3 two reports (Pompidou Group 2021a, 2021b) and four publications: Volumes I, II, III and IV of the series Children and families affected by parental drug use (Giacomello 2022, 2023b, 2023a, 2023c):

► Children whose parents use drugs – Promising practices and recommendations includes the analysis of 29 practices from 11 countries4 in the fields of a. family and children-oriented services that take drug use into account, including national strategies; b. programmes and services for people who use substances and their children and families, including data gathering and awareness raising; c. drug treatment services targeted at pregnant women, mothers and their children; and d. services for women who are victims and survivors of violence and use drugs, and their children. The publication contains operational recommendations in relation to the topics addressed in the analysis;

► We are warriors – Women who use drugs reflect on parental drug use, their paths of consumption and access to services is based on the participation of 110 women who use substances from nine countries,5 and who are or have been in treatment. It includes their insights and recommendations on the impact of parental drug use during childhood on their life and subsequent drug use. It also explores the barriers and facilitators to accessing services and how to improve the response of services both to women who use drugs, and to children with parents who use drugs;

► Listen to the silence of the child – Children share their experiences and proposals on the impact of drug use in the family is based on 33 interviews with children and young adults from five countries.6 They share how their parents’substance use has affected their life in terms of exposure to violence, a chaotic lifestyle and economic instability. They also talk about their parents’ love and their attempts to take good care of them. The children interviewed also describe their feelings, such as sadness, anger, fear, love and confusion, as well as their empathic understanding of their parents’ struggles. They identify protective factors: the presence of a parent who does not use substances, loving grandparents, siblings, friends who have gone through the same situations, understanding teachers, sports, art and music. They ask to be listened to and to be provided with reliable information on their parents’ condition;

► Children and parents affected by drug use – An overview of programmes and actions for comprehensive and non-stigmatising services and care analyses 33 programmes from 11 participating countries,7 which include a. actions in the field of data gathering; b. parenting programmes; c. social and integrated services for children; d. multidisciplinary, holistic approaches to working with families; e. services for women victims and survivors of gender-based violence; f. protocols of co-operation; and g. drug treatment services and residential communities for women and their children.

Another concrete outcome of the project is that the new Council of Europe Strategy for the Rights of the Child (Council of Europe 2022), adopted in 2022, includes in its objective “Equal opportunities and social inclusion for all children” the following: “Mapping, analysing and providing guidance on the situation of children suffering from addictive behaviours and children of parents using drugs”, thus identifying, for the first time, children living in families affected by drug dependence as a group with specific situations of vulnerability.

This guide represents years of collective learning, sharing and thinking. It brings together in a unified document the enormous wealth of knowledge, analysis and proposals developed by the project Children Whose Parents Use Drugs and the human rights legal framework that guarantees children’s rights as well as those of parents who use substances.

The next section offers an overview of the challenges faced by children and families affected by substance dependence. Subsequently, the concept of “hidden harm” is presented in relation to the three sections of the guide. The theoretical analysis is followed by an explanation of the scope and purpose of the guide, along with the basic definitions of terms used in this text.

2. The effects of parental substance dependence on children

” When I was younger, it was difficult for me because I lived with my parents and they were both addicts8 and from the time I was 6 years old I took care of my sister: I made her dress to go to school, or I looked for food for her because we didn’t have anything to eat. (Regina, Mexico City)

Regina, her sister Valentina and their mother Sonia participated in Volumes II and III of the Pompidou Group series on children whose parents use drugs. Regina and her sister experienced the challenges faced by children whose parents encounter difficulties in fully exercising their parenting role and responsibilities while being dependent on one or more substances. Regina, as the older sister, had to cope with the effects of neglect – for instance, they only went to school once a week – and her parents had a chaotic lifestyle, involving domestic abuse. Both Regina and her sister faced the additional challenges that having two dependent parents implies (Velleman and Templeton 2016), but at least they could rely on the protection of their grandparents (Galligan 2022).

Children living in families affected by substance dependence may experience anxiety, anger, depression, fear for their parents’well-being and shame (Advisory Council on the Misuse of Drugs 2003). They may also be required to take care of themselves, their siblings and their parents from a very young age (Tusla and HSE 2019a: 16). Children’s isolation and secrecy around parental drug use are strongly associated with stigma (Meulewaeter et al. 2022; Starlings Community 2022) and uncertainty about what is happening in their family (Velleman and Templeton 2016).

Parental alcohol and drug harmful use is one of the multiple adverse childhood experiences, that is, “stressful experiences occurring during childhood that directly impact on a child or affect the family environment in which they live” (Lorenc et al. 2023: 1). The term emerged in a study in the United States in the mid-1990s (Felitti et al. 1998) that found a strong interrelationship between adverse childhood experiences and severe chronic disease and premature death in adulthood. The original study identified seven adverse childhood experiences – abuse grouped by category: psychological, physical and sexual abuse; and exposure to household dysfunction grouped by category: substance abuse, mental illness, mother treated violently and criminal behaviour in household. This established a new field of study and a model of inquiry that has continued since.

These are related to risky health behaviours, chronic health conditions, low life potential and early death (Bellis et al. 2015). As the number of adverse childhood experiences increases, so does the risk for these outcomes: a “score” of four issues or more is seen to significantly increase the likelihood of a child engaging in risky future behaviour and of experiencing poor health outcomes compared with individuals with no adverse childhood experiences (Morton and Curran 2019: 11; Hughes et al. 2017). Furthermore, some adverse childhood experiences have greater impact than others (McDonagh, De Vries and Comiskey 2023); for instance, “the factor ‘feeling unloved’ as a child provided the single strongest predictor and may represent an overarching risk of post-traumatic stress disorder and continued substance use in later life among adults in treatment for an opiate use disorder” (ibid.: 1).

The literature is unanimous regarding the capacity for parental substance dependence to affect child outcomes: “It has become well accepted that children of substance misusers, compared to their peers whose parents do not misuse substances, are at heightened risk of experiencing a range of health, social and psychological problems” (Horgan 2011: 14).

Compared to their peers, children of parents who have developed substance dependence show increased rates of anxiety, depression, oppositional behaviour, conduct problems and aggressive behaviour as well as lower rates of self-esteem and social competence (Solis, Hussong and Reimuller Burns 2012: 5). Furthermore, when mental health problems and substance use disorders co-occur (which is the most common situation), children are at an elevated risk of poor outcomes (Dawe, Harnett and Frye 2008: 4).

The impact of parental drug use on children will vary according to external and internal factors, such as the child’s age and gender, the number and the roles of the caregivers that are affected by dependence, and the presence of protective factors. Evidence also shows that not all the children living in a family with harmful substance use are at risk of harm (Comiskey 2019).

As indicated by Velleman and Templeton’s review (2016) on the impact of parents’ harmful substance use on children, while each family and child are unique, the risks for children are greater if:

► there is exposure to multiple problems (the presence of domestic violence and abuse appears to be particularly potent);

► the child lives with two parents with problems;

► there is greater length and severity of the problems;

► there is significant “fall out” associated with problems, both within the family (e.g. disharmony) and outside (e.g. significant disruption, association with the criminal justice system).

On the other hand, children and families also have protective factors, that, in the authors’ analysis, are divided in three categories, summarised below:

► individual factors: internal locus of control; active agency; personal qualities and social skills; having a hobby; plans for the future/yearning for a better future; a sense of humour, and so on;

► family factors: supporting and trusting relationship with a stable adult who does not use substances harmfully; close positive bond with at least one adult in a caring role; consistency and stability in everyday family life; openness and good communication within the family, including open and appropriate discussion of family problems; adequate finances and employment opportunities/ income; good physical home environment; absence of domestic violence/ abuse, family breakdown and associated losses, among others;

► community/environmental factors: support from an adult/adult role model (e.g. teacher, neighbour); strong friendships and relationships with peers, including those that a young person can talk to about the problems at home; living in a community where there is a sense of caring, mutual protection, community engagement and supportive social networks; strong bonds with local community/community involvement; positive school experiences and influences; opportunities through education and employment; out-of-school/ community activities, and so on.

Parental substance use may be experienced and continued transgenerationally: on the one hand, people who use substances and are parents have often themselves been children who experienced adverse childhood experiences, including harmful alcohol and drug use, domestic violence and sexual abuse (McDonagh, De Vries and Comiskey 2023). Substance dependence may function as a coping mechanism: as expressed by Khantzian (ibid.: 6), “Suffering is at the heart of addictive disorders”. This was also widely reported by the mothers and fathers that participated in the Pompidou Group’s studies in 2022 and 2023 (Giacomello 2023a; 2023d), as demonstrated by the following testimonies.

” In fact, I started using at the age of 15, because I was abused and in fact afterwards it allowed me to have a sort of Band-Aid for my suffering.

(Eugenie, Switzerland) (Giacomello 2023a: 27).

” The women I have met in rehabilitation centres... they all come for the same reasons: they all come for abuse, for mistreatment, because their father is on drugs. They come for different stories of connection, but I think we all go through rape.

(Elisa, Mexico) (ibid.: 34).

” I could hear my mum crying when I was asleep.

I carried these things with me for years, from 13 to 20, because I didn’t understand, I could only hear my mother crying, but I couldn’t go near her because I was always a bit shy, insecure... I grew up with insecurity.

My life was “home, work and family”; I was afraid to go out because I knew there were always problems at home. I was always trying to protect my mum, she protected me and I protected her. I had few friends.

In my twenties, during the military service, I began to understand what life was about.

I started right away with cocaine, as I found it was my salvation, because... the insecurities, the fear, the anxiety... I fell in love with it right away. It made me feel like another person.

(Giovanni, Italy) (Giacomello 2023d: 42).

” With my weakness and insecurity... going out with friends, with the group, we started smoking weed at 14 and then at 16 I found heroin which was the thing that made me be with people, interact.

(Pietro, Italy) (ibid.: 44).

Furthermore, harmful substance use may expose parents to other situations and risks that trigger post-traumatic stress disorder (PTSD) (McDonagh, De Vries and Comiskey 2023; Staton-Tindall et al. 2013). Therefore, the child that the parent once was and the traumas that they may have experienced have to be taken into consideration.

On the other hand, children affected by parental substance dependence face a higher risk of drug involvement as well as mental health and behavioural problems (Galligan 2022: 18), which make the cycle more difficult to break (Meulewaeter et al. 2022).

To conclude this overview, it is important to remember that substance use is often only one of many issues faced by families (Cotmore et al. 2018; Dawe, Harnett and Frye 2008): parents, children and other caregivers or family members may face other challenges, such as complex traumas, mental health conditions, eating disorders, self-harm and suicide attempts (Bao and Lu 2023; Brohan et al. 2023; Rizk et al. 2021; SAMHSA 2016).

When approaching the interrelationship between substance dependence, parenthood and children’s rights it is important to also consider the environmental and community factors that might represent other sources of vulnerability and social marginalisation for children and parents, such as poverty, incarceration, unemployment, housing, racial and ethnic discrimination, social inequalities, violence and lack of family or social support. These are called “adverse community environments” and interconnect with adverse childhood experiences (Dietz and Ellis 2017).

In this regard, it is important to clarify that this guide does not directly address these complex issues, and this is not because they are not considered key for families and children. Mental health, housing, employability and working conditions, social inclusion, the right to freedom from torture and other cruel, inhuman or degrading treatment or punishment, the right to a fair trial and so on are all rights to which children and parents are entitled. They constitute states’ obligations established in international human rights treaties and in the European Convention on Human Rights and the European Social Charter, as described in Section 1.

Guaranteeing parents their rights is a primary step to make sure that their children have also access to them and that families can thrive. Substance dependence often intersects with other social conditions of vulnerability, stigma and exclusion and can be part of complex and painful experiences of trauma that sometimes span a lifetime, beginning from childhood (McDonagh, De Vries and Comiskey 2023).

However, this guide is conceived as a tool that, for the purposes of scope, length and theoretical underpinning, cannot include all the topics and interventions that should be guaranteed in all realms and at every level of parents’ and children’s lives. Such an effort would be most likely unattainable in this kind of document, or would lack a clear orientation and practical purpose.

Therefore, the guide is complementary to the existing work of state agencies and civil organisations. It aims at fostering changes in mentalities and practices in the particular and vastly complex intersection of the suffering, ambitions and paths of parents and the questions, rights and dreams of children. It means to contribute to views and collaborative ways of working that do not address parents’ and children’s rights and conditions as juxtaposed and services as separated silos, but that aim at working through integral approaches that can understand and support, in non-judgmental ways, the multiple issues and unique circumstances of each person and each family.

3. Hidden harms

Since the publication of the ground-breaking UK report Hidden harm –Responding to the needs of children of problem drug users (Advisory Council on the Misuse of Drugs 2003), the experience of children affected by parental dependent substance use has become widely characterised as “hidden harm”, a concept that encompasses individual and family situations as well as the response of services, and societal beliefs and stigma at large (Galligan 2022).

The concept of “hidden harm” has also been adopted in Ireland. As outlined in Ireland’s “Hidden Harm Strategic Statement” (Tusla and HSE 2019a: 8): “The term Hidden Harm encapsulates the two key features of that experience: those children are often not known to services; and that they suffer harm in a number of ways as a result of compromised parenting which can impede the child’s social, physical and emotional development.”

The present guide embodies the two elements in the above explanation and adds two new ones, in order to more fully understand, and thus address, the issues faced by children and families affected by drug dependence. These are: the impacts of drug-related policies on parents and gender-based violence and discrimination against women and girls who use substances. The four aspects are interlinked and should be addressed in a comprehensive manner in order to guarantee the child’s well-being, through the fulfilment of children’s rights by also promoting and guaranteeing the well-being of their parents. The following figure outlines the four dimensions of hidden harms that underpin the development of this guide.

Components of hidden harm to children in families affected by substance dependence

Source: Advisory Council on the Misuse of Drugs (2003); Comiskey (2019); Council of Europe (2012); Mutatayi et al. (2022); Giacomello (2022, 2023a, 2023b, 2023c); Tusla and HSE (2019a, 2019b).

Children are positioned at the centre because they lie at the core of this guide. The focus on children’s development and well-being (Ius 2021: 75) is not intended to be juxtaposed to their parents’ well-being but as complementary and interrelated. Children are the starting point from which to look at all the other issues at stake and the caregivers, services and social structures involved in The Child’s World.9 They are also the primary beneficiaries of the guide, but in a way that takes into account and cares for the needs and strengths of the people around them: their parents, siblings, other caregivers – such as grandparents – so that while each person is listened to, supported and empowered (Dawe, Harnett and Frye 2008) according to one’s circumstances, family members are understood and strengthened as individuals and in relation to each other (Staton-Tindall et al. 2013).

Putting children at the centre implies giving them visibility and ensuring that they are aware of their rights and are empowered to take action and, if they need it, seek help and know where to find it. This means that children are empowered to use their voice and that there are clear channels (helplines, schools, youth associations, non-profit organisations, religious groups, public institutions, etc.) that are capable of encouraging children’s participation, as well as detecting and referring situations that require support. It also means that children are listened to in the processes and decisions that concern them individually or collectively and that their views are given due weight in accordance with their age and maturity (Council of Europe 2012), as rights holders with agency and opinions.

The elements “undetected or unreferred to services” and “impacts of substance dependence” are interlinked and imply several spheres of intervention that aim at strengthening children’s well-being and that of their families. The areas of intervention that will be developed in the guide imply:

► the recognition and embodiment of children as rights holders and citizens (Council of Europe 2020a), with rights and capacities to influence decisions about their lives (Section 1);

► the conceptualisation and visibilisation of children affected by their parents’ substance dependence as a group that faces a specific source of vulnerable situations, and that is entitled to specific actions and support from services, including schools, and families (Sections 1, 2 and 3);

► children’s participation in the processes and decisions that concern them and in the design, implementation, monitoring and evaluation of the policies and programmes that affect them directly or indirectly (Sections 1, 2 and 3);

► the development of a national strategy that names, collects data on and listens to children and families affected by substance dependence. Such a strategy sets out the mechanisms for collaborative and multidisciplinary actions for social services and substance use prevention, early intervention, treatment, care, recovery, rehabilitation and social reintegration services (Section 2);

► the development and consolidation of co-ordinated, multidisciplinary work methods in the fields of social services and substance use prevention, early intervention, treatment, care, recovery, rehabilitation and social reintegration services (Section 3) that aim at supporting children and families at the same time and overcome the “silo” effects that flow from the formal organisation of practice and disciplinary domains.

The third aspect of hidden harm, the “impact of drug policies”, intersects with the previous two but from the perspective of parents as targets of drug-related policies and their children as affected by them. It should be kept in mind that most people do not use alcohol and other drugs in a way that compromises their self-care and the care of their children. Nevertheless, “for some parents, regular or intensive drinking or drug use can seriously affect their ability to care and respond appropriately to their child’s basic needs for nutrition, intimacy, security, health and learning” (EMCDDA 2010: 5). Lack of information as well as conflicting information on drug use-related services (ICAAN 2022), social stigma, the feeling that they are being judged by services, criminalisation and the fear of losing custody of their children may keep parents away from services or dissuade them from disclosing their parental status when undergoing treatment (EMCDDA 2012). This in turn leads to children being undetected and unreferred to services and to the continuation of the harms that children may be suffering because of their parents’ dependence (Advisory Council on the Misuse of Drugs 2003), as well as the suffering experienced by parents who use substances because of lack of support, guilt, shame and stigma.

The impact of drug policies is comprised of two main dimensions: on the one hand, the presence, availability, access and quality of substance use prevention, early intervention, treatment, care, recovery and social reintegration services and, on the other, the design and implementation of supply control efforts, particularly the criminalisation and incarceration of people accused of drug-related offences. Both dimensions have consequences for children and parents.

The first aspect is addressed in Sections 1 and 3 and aims at guaranteeing that children are always taken into consideration by substance use prevention, early intervention, treatment, care, recovery, rehabilitation and social reintegration services and that the well-being of parents and experiences of complex traumas are addressed and supported.

It goes beyond the scope of this guide to address the second point and provide orientation on how the criminal justice system should define and sanction drug-related offences. Nevertheless, issues related to the impact of parental incarceration on children (Jones and Wainaina-Woźna 2012; Murray et al. 2014; Nowak 2019) and non-custodial measures for women who are primary or sole caregivers of small children (UNODC 2011, 2020a) are addressed in Section 1.

Furthermore, as indicated in part 2 of this introduction, parents who use substances may have experienced post-traumatic stress. As highlighted in Ireland’s “Hidden Harm Strategic Statement” (Tusla and HSE 2019a: 27):

The collective needs of families should be addressed in a comprehensive and co-ordinated way by all services. International evidence shows that many parents presenting for treatment have experienced post-traumatic stress as a result of domestic violence and childhood sexual abuse. This may require a reframing of service provision with a whole-family focus embedded within an understanding of a wider trauma agenda.

The incorporation of a trauma-informed approach in treatment services is addressed in Sections 1, 2 and 3.

The element of “gender-based violence and discrimination against women and girls who use substances” draws on the fact that patriarchal structures (Walby 1990) in society as a whole as well as in drug use circuits and treatment settings may lead to gendered forms of hidden harms against women. Stigma, guilt and shame are particularly acute for women who use licit and illicit substances or manifest other addictive behaviours such as excessive and compulsive video gaming, gambling, online shopping, streaming or social network use (Council of Europe 2022b) and for those who are pregnant or mothers, given the gender-related social mandates that see women who use drugs as unfit for motherhood (Mutatayi et al. 2022). Structural, social and economic barriers often stand between women and services, especially if women cannot attend treatment accompanied by their children or cannot count on alternative services for their care (UNODC 2018).