The Queen's Award for Voluntary Service

Research

Research into the problems faced by children of parents with alcohol problems is necessary to increase understanding of the nature of this issue and to find out what can help, in turn influencing policy and services.

The Children Commissioner’s report “Silent Voices”, published in 2012, includes a rapid evidence assessment of the needs and experiences of children where there is parental alcohol misuse and explores this topic in depth. Download the report here.

The scientific literature on this topic is vast so we have also included a summary of some of the research below. However, please remember that this is not a systematic review and research in this field is being published all the time.

For a more general overview of alcoholism and how it affects the family, you may prefer to see the Information section.

The effects of parental alcohol problems

Alcohol consumption is the greatest risk factor for disease and disability in middle-income countries and the third highest in the world (World Health Organisation, 2011). Alcohol-dependence is characterised by behavioural, cognitive and physiological symptoms including “a strong desire to take the drug [alcohol], difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state” (World Health Organization, 2007).

The effects of harmful drinking spread wider than the individual consuming the alcohol, often impacting friends, family and colleagues before any negative health consequences can be identified in the drinker. The effects can be as damaging to the family as to the person drinking, with children being the most affected (Klingemann & Gmel, 2001).

Alcohol was found to be the most harmful drug in a recent study that ranked 20 drugs according to the harm they cause to the user and to others. Alcohol was given an overall harm score of 72 out of 100, whilst heroin and crack cocaine were ranked second and third with scores of 55 and 54 respectively. This is because alcohol is consumed by a greater number of people and is not only harmful to the individual but also has significant effects on others, and society in general. Alcohol scored especially highly for the economic cost to the country, which included direct costs such as healthcare, police, social services etc., and indirect costs such as loss of productivity and absenteeism. Alcohol also caused a greater number of family adversities (e.g. family breakdown and child neglect), increased the chance of injuries to others (e.g. through violence and traffic accidents) and produced a greater decline in social cohesion and the reputation of the community (Nutt et al., 2010).

Children are particularly affected, since alcohol becomes the drinker’s priority, often to the detriment of parental responsibilities, as increasing amounts of time are spent drinking or recovering from drinking. Parental alcohol problems are associated with negative outcomes in children, e.g. poorer physical and psychological health (and therefore higher hospital admission rates), poor educational achievement, eating disorders and addiction problems (West & Prinz, 1987; Girling et al., 2006), many of which persist into adulthood (Balsa et al., 2009).

A Danish study involving a cohort of nearly 85,000 children, followed from age 13 to 27, looked at the long-term consequences of parental alcohol abuse, identified through alcohol abuse related hospital admissions (Christoffersen & Soothill, 2003). Parental alcohol abuse was found to be a risk factor for other disadvantages including premature death, suicide attempts, drug addiction, mental illness and teenage motherhood, and for certain life experiences including parental violence and family separation.

Much research has focused on the development of alcoholism in the children themselves, who are at a 2-10 fold increased risk compared to children who do not have a parent with an alcohol problem (Lieberman, 2000). For example, Thompson et al. (2008) found that in a survey of over 43,000 adults in the USA, those with parental history of alcohol problems were more likely to have experienced alcohol-dependence themselves than those who had no history of parental alcohol problems (23.1% compared to 9.6%). Similarly, in a recent cross-sectional study of over 3000 young adults in France, people with alcohol-dependent parents were almost twice as likely to be dependent on alcohol or cannabis themselves compared to people with no history of parental alcohol dependence (Melchior et al., 2011). Other studies have focused on drinking during adolescence, when many of our health-related habits are formed; for example, Chalder et al. (2006) surveyed over 1700 adolescents aged 13-15 in Wales and found that children of parents with alcohol problems were more likely to report drinking two or more alcoholic drinks per week than children of parents without alcohol problems (22.8% compared to 16.5%), to have been drunk in the last 3 months (44.0% compared to 35.7%) and to expect to be drunk during the next 2 weeks (18.2% compared to 11.1%). These children also showed differences in their reported reasons for drinking, with more children of parents with alcohol problems reporting drinking ‘to forget their problems’ (15.8% compared to 6.4%) and ‘to get drunk’ (21.1% compared to 12.0%) and fewer reporting that they drank because they liked the taste of alcoholic drinks (32.0% compared to 47.9%). In a large, nationally representative study in the USA, young people aged 12-17 with an alcohol-dependent parent were more likely to have used alcohol, tobacco and marijuana in the past 12 months (Obot et al., 2001).

Alcohol consumption during pregnancy can lead to Fetal Alcohol Spectrum Disorder (FASD), including fetal alcohol syndrome (FAS), alcohol-related birth defects (ARBD) and alcohol-related neurodevelopmental disorder (ARND), which directly affects development before children are even born (Mukherjee et al., 2006). Epidemiological evidence in the UK is limited but FASD is thought to be the leading cause of mental retardation in the Western world (Abel & Sokol, 1987), with a prevalence in the USA of at least 2 to 7 per 1,000 (May et al., 2009). Effects of FASD include attention problems, learning and memory deficits, and socioemotional problems (Jacobson & Jacobson, 2002). Offspring of mothers who consumed three or more glasses of alcohol at any given occasion during pregnancy are at a further increased risk of alcohol problems themselves, even when maternal drinking during childhood is adjusted for (Alati et al., 2006).

Other problems co-occur with parental alcohol problems such as abuse, financial insecurity, parental mental health problems, divorce or death of a parent due to alcohol-related ill health, injury or suicide. Early life experiences such as neglect and bereavement can also affect brain development and lead to emotional, social and cognitive impairments (Dube et al., 2001).

The Stress-Strain-Coping-Support model has been proposed to help explain how family members are affected by another’s alcohol or other drug use (Orford et al., 2010). The model suggests that living with a parent with an alcohol (or drug) problem is stressful and so puts children at risk of physical and/or psychological health problems. The availability of coping mechanisms and social support affect the level of stress experienced.

Clearly, not all children of alcoholic parents develop problems, suggesting some are more resilient. Resilience in this context is defined as occurring when there are successful outcomes despite threatening circumstances (Masten et al., 1990). Protective factors that contribute to resilience, allowing children of problem drinking parents to cope and become confident and caring adults, include the supportiveness of a non-alcoholic parent, higher parental education level and a larger number of sources of support such as other family, people in the community and teachers (Werner & Johnson, 2004). Kroll (2004) reports that many children of substance-misusing parents would like to have someone they could talk to in confidence about the problems in their family and some would like the opportunity to meet others in similar situations, or have time away. The problems faced by these children and their needs are often hidden (Kearney et al., 2003), and so forms of support that do not require parental involvement are necessary.

Prevalence of children affected by parental alcohol problems

Despite the needs of children of substance misusing parents being mentioned in recent national policy (Velleman, 2010), the focus has been on parents who use illicit drugs, and there is little epidemiological evidence regarding the number of children affected by parental alcohol. National prevalence figures are key in providing adequate services. However identifying affected children is challenging because problem drinking often remains hidden within the family (Harwin et al., 2010). Parental alcohol use is likely to be under-reported in studies where alcohol consumption is self-reported, due to ‘social desirability bias’ (Maloney et al., 2010), and in studies using treatment centre figures, as many problem drinkers never come into contact with professionals.

The Alcohol Harm Reduction Strategy suggests there are 780,000 - 1.3 million children affected by parental alcohol problems in the UK (Prime Minister's Strategy Unit, 2004). However, these estimates, originally reported in Eurocare and COFACE (1998), are out-dated and were calculated from studies in European countries with different alcohol consumption patterns. The lower estimate is based on adolescents in Denmark reporting a parent being hospitalised with an alcohol-related illness. Since many problem drinkers are never hospitalised, or their illness is not identified as associated with alcohol, this is likely to be an underestimate of the problem. The upper estimate is calculated using the number of children who experienced harm from parental alcohol use reported in the Finnish national alcohol policy.

A recent analysis of household survey data by Manning et al. (2009) suggests that the prevalence rate in the UK is much higher. From the 2004 Health Survey for England and the 2004 General Household Survey, it was calculated that 28-30% of children live with at least one binge drinking parent, equating to 3.3 to 3.5 million children. They also analysed the National Psychiatric Morbidity Survey, which suggested that 2.6 million children (1 in 5) lived with a hazardous drinker and 705,000 with a dependent drinker.

Find the References used above, here

Nacoa commissioned research

Despite being carried out more than a decade ago, Nacoa’s research remains the largest UK survey of children of alcoholics to date.

In 1992, Nacoa commissioned Nielsen Consumer Research to conduct a survey through telephone interviews of a nationally representative sample of 1000 UK adults to measure the size and scale of the problem of alcoholism in the UK and its effect on the family.