Governing Parental Drug Use in the UK: What’s Hidden in “Hidden Harm?”

Abstract

In 2003, the UK Advisory Council on the Misuse of Drugs published Hidden Harm, the product of an inquiry that exposed the “problems” of parental drug use and its neglect by professionals. It outlined an extensive program of reforms designed to protect children from harm. Despite its far-reaching influence, it has rarely been subject to scrutiny, with analyses focusing on its impact instead. Drawing on Bacchi’s post-structuralist “What’s the Problem Represented to be” approach, we examine problematizations within Hidden Harm and their implications for the governance of family life. We illustrate how Hidden Harm produced a simplified version of parenting and child welfare within the context of drug use by largely equating drug use with “bad” parenting and child maltreatment and by ignoring the social determinants of health and the wider social ecology of family life. Using a tried-and-tested driver of policy change, Hidden Harm created a “scandal” about the lack of intervention by professionals that was used to justify and legitimize increased state intervention into the lives of parents who use drugs. Hidden Harm proposed simplistic “solutions” that centered on drug treatment, child protection and the responsibilization of professionals to govern “risky” parents. We argue these rationalities, subjectivities and strategies serve to marginalize and stigmatize families further and hide alternative approaches to understanding, representing and responding to the complex needs of children and families who are disproportionately affected by health and social inequalities. By uncovering what is hidden in Hidden Harm, we aim to stimulate further research and theoretically informed debate about policy and practice related to child welfare, parenting and family life within the context of drug use. We conclude with some ideas about how to reframe public discourse on parents who use drugs and their children, in tandem with collaborative responses to alleviate child poverty and inequalities.

Practice implications of phenomenological research with substance-using parents whose children were subject to social care interventions

“…Theme 4 focused directly on participants’ views about social workers’ professional practice, which included the views that social workers should work more collaboratively with parents; that there should be more continuity and fewer staff changes; that social services should make greater efforts to keep families together; that goals and deadlines should be more realistic; that social workers should avoided shaming in their communication; that social workers should focus more on parenting skills and less on drug use; and that drug treatment programmes themselves should be more effective. This is consistent with calls for more genuine collaboration with parents who use drugs, and for policy and practice to move away from individualised risk-based models and towards public health models of childcare and protection (Whittaker et al , 2020).…”

“…The view that parental substance use is almost inherently harmful to children has been challenged since the publication of the Hidden Harm report (Whittaker et al , 2020), and it has been recognised that having a secure parental relationship can be a significant protective factor for children of substance using parents (Dawe and Dawe, 2007). Best (2012) argued for a general transformation of drug treatment in which “mutual aid groups”, owned and directed by the members, bridge the gap between clients and professionals.…”

“I Grew Up Amidst Alcohol and Drugs:” a Qualitative Study on the Lived Experiences of Parental Substance Use Among Adults Who Developed Substance Use Disorders Themselves

“…This study provides insight in mechanisms that may contribute to feelings of loneliness, shame, social isolation, low self-esteem and lack of social support experienced by children of parents with SUDs (97)(98)(99)(100). In this sense, the effects of secondary stigma became apparent for those relatives who are associated with stigmatized individuals, including parents with SUDs (101)(102)(103)(104)(105). It may be prudent to note that in this sample, parents did not receive substance use treatment during offspring's childhood and adolescence, what may possibly be explained by, amongst others, the impact of stigma and discrimination on parents' willingness to seek help and preventing access to treatment (103,106,107).…”

“…Given the disruptive effect of stigma on family cohesion in families with parental substance use, with relatives often experiencing to be "invisible" (99), this study emphasizes the need for applying a developmental and interactional perspective on social support to children and parents with SUDs, as stated by Newcomb ((110), p. 54): "Social support can no longer be considered strictly an external force impinging upon the individual; rather, it must be viewed as an evolving developmental and interactive process between an individual and his or her social environment." Although children of parents with SUDs experience need for connectedness and receiving social support from trusted adults (97,111), which has been shown to be protective in this group of children at-risk (112), feelings of shame and self-blame related to the upbringing may hamper help-seeking in children, with implications for long-term mental and physical health (104,113,114). Previous studies showed that also among parents with SUDs, other mental health difficulties often co-occur (115).…”

Questioning policy representations of women’s alcohol consumption: Implications for social work

“…A special issue of the International Journal of Drug Policy highlighted different applications of the WPR ‘problematisation’ framework as an analytical approach to the study of drug policy (Houborg et al., 2020, Denmark). In the UK, this research is related to the policy production of vulnerable subjects (Brown and Wincup, 2020), the governing of parental drug use (Whittaker et al., 2020) and constructions of dangerous drug-using mothers (Flacks, 2019). This analysis from the UK focused on health, drugs and child protection, and how ‘the problem of parental drug use is framed’ in policy documents, such as Hidden Harm, Three Years On (2003) and all government drug strategies since 1995 (Flacks, 2019).…”