Here are some of the closing comments:
Implications for children's well-being and development
The psychological consequences for children of low levels of parental involvement, including low or erratic levels of emotional responsiveness, separation from parents and unstable or inconsistent caregiving environments have been well-researched, though not specifically in the context of parental drug misuse. Low levels of involvement by parents who are present in the home, such as minimal supervision and monitoring, has been linked with a range of negative outcomes for children, and especially risk for conduct and emotional problems (Patterson and Stouthamer-Loeber 1984; Simons et al. 1994).
Parental emotional responsiveness has been identified as an important predictor of positive social development. Across childhood, sensitive attunement of parents to children's capabilities and to their developmental tasks seems to promote emotional security, behavioural independence and social competence, as well as intellectual achievement (Demo and Cox 2000). Responsive caregiving has been found to act as a mediator of the effects of adversity on children's well being (Egeland et al. 1993). Low parental emotional responsiveness, on the other hand, has potentially negative implications for children's development and welfare and for the security of attachment relationships (De Wolff and van Ijzendoorn 1997). These relationships need to be investigated in the context of parental drug misuse, where the physiological and psychological effects of drug intake and withdrawal, as well as the social context may have particular implications for children's risks and outcomes.
Finally, it has long been recognised that instability and discontinuity of care-giving pose threats to children's emotional well-being. Recent literature suggests that family instability may have a negative impact on children's sense of emotional security in the family and sense of control over their immediate environment (Ackerman et al. 1999). The particular implications for children being reared in the context of parental opiate dependence, which may be chronically relapsing, need investigation. The significance of separations that occur in the context of parental drug use, and its correlates, such as imprisonment, hospitalisation and death of parents due to drug misuse, needs urgent attention from researchers. The impact on parent-child relationships of the enforced separation brought about by parental incarceration, under the constraints of prison visiting policies, which may limit parent-child physical contact, and in the context of parental drug use and its associated stigma, is an important avenue for future research.
Implications for support
The clearest implication arising from this study is that support should be targeted at families as systems, rather than at drug users as individuals. It should focus on ensuring continuity, not only of instrumental caregiving, but also of emotional caregiving to children, particularly through periods of critical transitions associated with the changing lifestyle and patterns of drug use and treatment of their parents when parental ability to sustain positive involvement may be especially low. This research also highlights areas of particular vulnerability in the course of daily life, such as early mornings. Programmes are needed that target these periods and that help reduce risks for children. Such programmes should recognise that opiate dependence may be chronic, with periods of more intense support needs.
Social services need to be alert to the risk that children may be in need of substitute parental care at short notice and/or for unpredictable lengths of time and make suitable arrangements with extended family members or professional carers. Interviews with professionals linked to these families, reported in Hogan and Higgins (2001a), revealed a concern amongst professionals that grandparents were being expected to pick up the pieces very often and that they were often themselves in need of support. Sometimes grandparents were reluctant to let their drug using son or daughter resume their parental role or there was conflict between the parent and the grandparents. Hogan and Higgins conclude that 'family support is often a complex issue that requires greater understanding' (2001a, p 27).
The children in this sample were not receiving any counselling or support which was geared specifically to helping them to deal with their parent's addiction. Such support might be needed in many cases. Also parents who are addicts may need advice and support around their parenting role and the consequences of their addiction for their children. Since some parents and children are coping well most of the time, an open door service might be well suited to the needs of many parents and children. Such a service should be oriented towards the family not just the addict. The need for more intense, individual interventions may be expressed or identified more easily when parents and children have ready access to a family-oriented service, which does not seek to pathologise their behaviour or their experience.
Parents' reports indicate that drug misuse affects parenting in specific ways, which have a negative impact on parental capacity to be emotionally available and responsive to their children on a stable basis over time. The implications for children's well-being and development need further study. Future research should explore children's subjective experiences of family relationships in the context of parental drug misuse, and especially children's experiences of security and closeness within their families. Support services should be family-oriented and designed to provide long-term support for families, with the capacity to provide increased support during periods of particular vulnerability.