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Is concern justified? Problems of definition and prevalence 37markedly over 10 years, from 39,996 in 1996/7 to 57,142 in 2006/7. Within theseadmissions, the number related to alcoholic liver disease almost doubled, from7,810 to 14,668 (NHS Information Centre 2009). The consequences of hazardouspatterns of drinking are also reflected in the steady rise in alcohol-related deathsfrom 6.9 per 100,000 in 1991 to 13.6 per 100,000 in 2006 (Office for NationalStatistics 2009).With this evident increase in problem drinking, it is of concern to find that accessto alcohol treatment has not kept pace. Many areas of England and Wales haveinadequate treatment facilities, accompanied by long waiting periods. The findingsfrom the Alcohol Needs Assessment Research Project (Department of Health 2005)found just 1 in 18 alcohol-dependent people were receiving treatment from aspecialist alcohol treatment agency. Recent initiatives, however, may start to increaseprovision, especially at the level of primary care.Adults with alcohol problems are more likely than those without to experiencepoor mental health. For example, Weaver and colleagues (2002) found 85.5% ofusers of alcohol services experienced mental health problems. Moreover, half ofthose in treatment for alcohol problems experienced ‘multiple’ morbidity that is theco-occurrence of a number of different psychiatric illnesses or substance misuse.The OPCS (Office of Population and Censuses and Surveys 1996) householdsurvey gives data on the rate of alcohol dependence by type of family unit. Unlikemental illness the rate of alcohol dependence for couples living together is similar(27 per thousand) irrespective of whether or not they have dependent children.Lone parents show a higher rate (38 per thousand) than that found for couples withchildren. These findings reflect those for mental illness and suggest that childrenliving with a lone parent are more vulnerable to the impact of parental drinkingthan children in households where adults live as a couple.Information on the numbers of children living with parents with alcohol problemscomes from Brisby and colleagues (1997). Their admitted approximate calculationindicates some 7% of parents are drinking at harmful levels. Through extrapolatingfrom census data they suggest that this indicates ‘some 800,000 children in Englandand Wales, 85,000 children in Scotland and something under 35,000 children inNorthern Ireland are living in a family where a parent has an alcohol problem’ (Brisbyet al. 1997, p.7). More recent studies suggest the number of children living withparents who misuse alcohol exceeds these earlier estimates, ‘more than 2.6 millionchildren in the UK live with hazardous drinkers, 705,000 live with a dependentdrinker’ (Munro 2011, p.26, paragraph 2.20; Manning et al 2009; Strategy Unit2004). Extrapolating from census data has inherent problems and is likely to be anunderestimation of the true picture, as the figures rely on parents acknowledging theextent of their alcohol consumption (Forrester 2000).Although not all children living with a parent with alcohol problems will suffersignificant harm, a retrospective study of adults who were the children of problemdrinkers found that, as children, they experienced significantly more negative
38 Children’s Needs – Parenting Capacityexperiences, were less happy and had a less cohesive childhood than was reportedby adults who made up the comparison group (Velleman and Orford 2001). Theauthors note ‘that all the association between parental problem drinking and childhoodproblems might be mediated via parental family disharmony’ (p.156). The findingssuggest that it is the link with family disharmony and violence that increases the riskof harm to children of problem-drinking parents.Drug misuseDrug use is not as common as alcohol consumption. Findings from the BritishCrime Survey 2009/10 indicate that one in three (36.4%) adults in the populationhave used illicit drugs at least once, suggesting that a large proportion of the adultpopulation have had some experience of illegal drug use even if it was in the past(Hoare and Moon 2010). This is a rather smaller proportion than that noted byLeitner and colleagues (1993) who reported that at least half the adult populationaged 19–59 had tried illicit drugs at some time in their lives. Cannabis remains themost likely drug to be used (the British Crime Survey estimates 6.6% of adults usedcannabis in the last year); the next most commonly used drug was cocaine, taken by2.4% of adults (Hoare and Moon 2010).Overall, the use of illicit drugs has been falling in England and Wales for severalyears. According to the British Crime Survey 2009/10, 8.6% of the adult population(aged 16–59) of England and Wales had tried an illegal drug during the last year, afall from the figure of 11.1% found for 1996. The use of the most dangerous drugs,Class A (under the Misuse of Drugs Act 1971) such as heroin and cocaine (duringthe last year), has also fallen from 3.9% in 2008/9 to 3.1% in 2009/10. Frequentillicit drug use is less prevalent, and the survey data suggested it applied to only3.3% of the population (Hoare and Moon 2010).Over the last 10 years, access to treatment for drug problems, especially heroinand to a lesser extent cocaine, has increased considerably. The development of theNational Treatment Agency (a Special Health Authority within the National HealthService) has not only ensured increased funding for existing agencies but has madesure that there is now better access to services in all parts of the country. At the timeof writing (2011), there are over 200,000 people being treated for drug problems inEngland and Wales, an increase of 4% on the previous year, and waiting times fortreatment have fallen; nearly all clients wait less than three weeks to start treatment(National Treatment Agency 2010). In England, over half (55%) of problem drugusers are currently in treatment (National Audit Office 2008, p.30).Research has also identified the co-morbidity of substance misuse and mentalillness. Three-quarters (74.5%) of users of drug services reported experiencingmental health problems (not formal mental illness); 30% experienced ‘multiple’morbidity, the co-occurrence of a number of psychiatric disorders or substancemisuse problems (Weaver et al. 2002).
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Which children are most at risk of
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PART III: CONCLUSIONS ANDIMPLICATIO
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BibliographyAbel, E.L. (1998) ‘Fe
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Bibliography 213Barnardo’s (2005)
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Bibliography 215Brandon, M., Bailey
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Bibliography 217Children’s Workfo
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Bibliography 219Davies, C. and Ward
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Bibliography 221Department for Heal
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Bibliography 223Edwards, A. and Smi
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Bibliography 225Flately, J., Kersha
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Bibliography 227Gottlieb, S. (2002)
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Bibliography 229HM Government (2011
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Bibliography 231Jaffe, P., Wolfe, D
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Bibliography 233Kolar, A., Brown, B
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Bibliography 235Margison, F. and Br
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Bibliography 237Merikangas, K., Die
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Bibliography 239Murray, L., Cooper,
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Bibliography 241Office for National
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Bibliography 243Priory Group (2006)
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Bibliography 245Royal College of Ph
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Bibliography 247Singleton, N., Bump
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Bibliography 249Swofford, C. D., Sc
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Bibliography 251Walker, F. (1995) Y
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Indexabuse see child abuse; child n
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Index 255children 16 years and over
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Index 257problem drug use 52, 53, 5
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Index 259eating disorders 54, 137,
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Index 261mothers’ problem drug us
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Index 263MARAC (multi-agency risk a
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Index 265cognitive and language dev
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Index 267definition 26domestic viol
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Index 269withdrawal symptoms 53, 56
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Index 2713-4 years 1335-10 years 14
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Index 273parental mental illness 30
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