Rehab 4 Addiction

Research from the UK government’s Department of Work and Pensions (DWP) shows that children who are in families where there is conflict and one or both parents misuse substances will have poorer life outcomes.

In this article, we will look at the problem itself but also solutions that can be found to avert the poorest outcomes altogether.

The Numbers


The literature review of 66 academic papers, predominantly from the UK, US and Australia, was commissioned due to the abundance of children living in families with substance use problems.

The UK Children’s Commissioner estimated that in 2019:

  • 515,000 children live in a family where any drug is used.
  • 412,000 children live with an adult who is dependent on alcohol or drugs.
  • 308,000 children live with at least one high-risk alcohol misuser over 18 years of age.
  • 167,000 children live with an adult who uses Class A drugs.

The Office of National Statistics shows that in 2019, there were around 12.7 million children under 16 living in the UK.

Therefore, based on these statistics just over 4.1% of children are presented with any drug use.

Meanwhile, 3.2% of children live in families where one or more adult is dependent on drugs. As such this is a major issue that can lead to problems for a significant number of children as they grow up. 

Impact on Children

Impact on children

In this section, we will discuss the problem in detail. In the next, we will look at the best ways the DWP report showed to make their lives easier. 

How Children Respond to Family Conflict and Substance Misuse

Impact on Children

The literature review showed that:

  • Up to six months old, babies show signs of distress including a high heart rate.
  • Up to five years old, they may cry excessively, act out and withdraw into themselves.

Over a longer period, these impacts include:

  • Internalising and externalising their distress, through mental health issues and behavioural issues.
  • Some will develop substance misuse problems themselves.
  • Many have problems at school.
  • Some will have physical health problems.
  • Many will also have social and interpersonal problems that can impact making friendships and future romantic connections.

As can be seen in the next section, children see and experience different things that lead to them having adverse outcomes

Children’s Experiences of Family Conflict

Children and family conflict

Children will see conflict in the family manifest as:

  • Violence between the parents.
  • Some may be violent towards the child.
  • Verbal conflict, both when the misuser is intoxicated and sober.
  • The child may see the substance being misused.
  • Inappropriate behaviour may be done in front of the child.

Often, children were less concerned about substance use and more about the parental conflict at home.

These behaviours can impact the child’s outlook in the long term. At the same time, the report showed evidence that parenting can be impacted. This includes:

  • Poor supervision of the child while in normal activities.
  • Reduced warmth toward the child by the parent.
  • Poor relations between the parent and child.
  • Poor family cohesion as the parents argue and don’t work in unity.

Altogether these behaviours can impact the child through them not feeling loved, supported or engaging with their parents in the way that parents without substance misuse problems may exhibit.

Substance Misuse and Family Conflict

Alcohol misuse and children

What comes first? Substance misuse or family conflict? The evidence is not clear. There are three situations that families may encounter:

  • The parent may be a substance misuser at the child’s birth or develop their problem independently of the family situation, such as trauma or other circumstances.
  • Family conflict may lead to the parent resorting to drinking or drugs to cope.
  • Whether the problem has emerged from the family situation or not, conflict due to substance misuse may exacerbate the misuse problem.

This is why effective interventions are required to support the family to work together to function in the best possible way for the child to grow up happily.

In the next sections, we will look at the best interventions that could in some cases lead to substance misuse falling and family conflict reducing.

Interventions to Help Families


Of all the ways to resolve conflict and parental substance misuse, the best ways forward were found for either the couple or the family as a whole to work together.

Early intervention was found to be key, as was a multi-agency approach.

Therapies that tackled both the conflict within the family and the substance misuse problem at the same time were found to be the ones with the best outcomes.

Here we look at the two types of intervention that worked best.

Behavioural Couples Therapy

Couple's argument

Behavioural Couples Therapy (BCT) was found to have better outcomes for the families than an individual behavioural therapy like Cognitive Behavioural Therapy (CBT).

BCT resulted in longer-lasting and greater reductions in substance misuse as the parents could work together to support one another.

Some successful interventions included a combination of individual and couples therapy. Essentially the individuals learned coping skills and then came together to learn how these skills could work together in mutual support.

This technique has been shown to be effective where there is conflict but no substance misuse problems, yet it also seems to be effective in cases where substance misuse is an issue.

Whole Family Substance Use Treatment

Family Therapy

Unlike BCT above, children are brought into the treatment programme so everyone in the family unit can support the substance user.

The research found this technique has:

  • More engagement by the substance misusing parent.
  • Greater reductions in substance use than other therapies looked at.

There was some evidence that this was particularly effective where groups of families that were affected could do therapy together.

As with traditional group therapy of individuals, so commonalities and solutions could be communicated between family groups.

This is also cheaper to organise for the statutory authorities in question.

However, there wasn’t great evidence that families functioned better as a result of whole family substance use treatment. Nor, among the therapies tested, did any specific therapy stand out.

How These Worked

How it works

Both therapies shown in the report were shown to help families in the following ways:

  • The parent could better see the impact of their behaviours.
  • As a result, they could take more responsibility for their actions.
  • Improved communication between the parents and within the family could lead to better conflict resolution before the problem got out of hand again.
  • The substance user could improve their emotional skills and manage triggers more competently.
  • They could learn parenting practices and conflict management.

These five combined could lead to a road to recovery for the parent and the children involved would have better outcomes should the problem be reduced to an effective level.

Barriers to Engagement

Barrier to engagement

Not all families where such intervention was offered were successful, sometimes leading to family breakup or the problems we have described above in the child.

Five broad barriers were identified in the DWP report:

  • The parent or parents failing to recognise that there was a substance misuse or conflict problem in the household. The idea that ‘it’s only three pints a night’ or ‘just a couples’ spat’.
  • A lack of motivation to resolve either the substance misuse or the conflict. This might be one parent being fearful of the other, or a general disinterest in resolving the overall problem.
  • The social stigma of substance misuse, and the idea that getting the problem resolved could somehow impact the family’s social standing.
  • Fear of statutory services (children’s social services and other agencies) and their ability to take the child from the family.
  • Difficulty in accessing such group and family support services due to the ‘postcode lottery’ and the geographical unevenness of availability of such interventions.

These issues could be better dealt with in some cases with professionals offering food and transport to the therapy locations, childcare and providing interventions at the family home.



With so many children growing up with parents who have substance misuse problems it is important to intervene at an early stage to guarantee better outcomes for them.

The issue of geographical unevenness and the fluctuating availability of family intervention services for substance misuse problems needs to be addressed.

All of this is essential to ensure that children affected by substance misuse can get the help they need.


Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline.