Crossing the line

07 November 2019

Is there such a thing as safe recreational drug use when you’re a parent? Journalist Helen Bird investigates why mothers take substances such as cocaine and the impact it could have on children.

A browse through Christmas and Mother’s Day merchandise proves how connected motherhood and drinking have become in the eyes of society: ‘Mum – you are GIN-credible!’ ‘Mummy needs wine!’ Posters and cards featuring slogans such as ‘The most expensive part of having kids is all the wine you have to drink’ and ‘Technically, you’re not drinking alone if your kids are home’ are intended to be lighthearted. But do they carry a more serious undertone? And when does using a glass of wine as an emotional crutch at the end of a difficult day lead to illicit and more dangerous substances?

It’s a leap that may not be as great as it sounds. After all, the social acceptability of enjoying a glass of wine or two once the children have gone to bed now seems to be spilling into daytime drinking, with the rise of ‘prosecco play dates’ – those mum-and-baby meet-ups with a ‘bring your own bottle’ policy.

But with cocaine use at a 10-year high in England and Wales, and a particular spike in more affluent households – from 2.2% in 2014-15 to 3.4% in 2017-18 (Home Office, 2018) – is recreational drug use among parents something that community practitioners (CPs) should be on the lookout for? And how much risk is a mother who occasionally uses drugs placing on herself and her child?

Hidden reality

A recent review of previous research estimated that 8% of children may live with a parent who has used an illicit substance in the past year – 2% with a class A drug user – while just 1% to 2% of parents self-report alcohol and/or drug abuse (McGovern et al, 2018). But since most of the evidence in the review relates to parental alcohol use, according to lead author Ruth McGovern, ‘there is limited evidence about the impact of non-dependent parental drug use’.

Professor Adam Winstock, consultant psychiatrist and addiction medicine specialist who founded the Global Drug Survey, says: ‘There is a huge amount of stigma, shame and guilt [among mothers] whether they use or they don’t use, about their perceived performance. So there won’t be much evidence over this because mothers particularly will be so uncomfortable about declaring or sharing that they might be drinking or using drugs.’

What’s more, how should problematic drug use among parents be defined? It’s a grey area, Adam says. ‘Mothers meeting up at lunchtime with babies and having Chablis or sauvignon blanc at 12 o’clock to get through the stress of looking after a child… I’m certain there would be people who would say: “That’s just mums coping with stress.”

‘Is there a difference if a mother is choosing to use cocaine or cannabis? I think it would depend on the individual circumstances for that parent and that child.’

Perhaps surprisingly, the NSPCC agrees, drawing on the findings of Cleaver et al (2011) in its current advice on parental substance misuse: ‘Most parents and carers who drink alcohol or use drugs do so in moderation and don’t present an increased risk of harm to their children.’ But, it adds: ‘Parents and carers who misuse substances often have chaotic, unpredictable lifestyles and may struggle to provide their children with safe care and clear boundaries’ (NSPCC, 2019).

Risky business

Being under the influence of any substance does not lend itself to caring responsibly for a child. ‘You’re less likely to be able to focus on that child’s needs; you might be less likely to be able to respond in an emergency – for example, getting in your car and driving,’ Adam says. And cocaine in particular, he explains, makes users ‘preoccupied with their own needs’, while impairing their judgement, reducing the need to sleep and suppressing appetite.

An added risk surrounds the source of illicit drugs, says Nuno Albuquerque, group treatment lead at UK Addiction Treatment Centres. ‘If someone buys a bottle of vodka, they know the bottle has been inspected for quality,’ he says. ‘With drugs that doesn’t happen, so when someone buys a drug it’s a surprise – we never know what’s inside.’

Meanwhile, the impact of parents’ drug use on their children – even controlled, non-dependent use – could be far-reaching. The McGovern review (2018) identifies a number of associations from existing studies – between maternal cannabis or cocaine use and an increase in behaviour problems, for example; and between mothers’ alcohol use in the postnatal period and an increased risk of sudden infant death syndrome; and between parental substance misuse and a greater chance of later use or misuse by their children.

The short-term effects of drug use on family life should not be forgotten, Adam notes. ‘It’s not just about the intoxicating effects, it’s about the after-effects. You might have got a babysitter while you go out and take a few lines of cocaine. But when the babysitter leaves, the children are back in your care and might have a very tired and irritable parent the next day as you’re coming down.’

Behind the scenes

But why are mothers in particular choosing to use drugs in the first place – especially those who do so while caring for their children? One study looking at alcohol use among Scottish women in early midlife suggested alcohol ‘facilitates time out from responsibilities’ while ‘excessive drinking reconnected some mothers with their younger, carefree selves’ (Emslie et al, 2015). Boredom could be another reason, suggests Nuno. But of course, there could also be darker forces at play.

‘If you’re seeing a mother who’s choosing to be intoxicated while caring for her child, you have to ask a number of questions,’ says Adam. ‘It’s unlikely that drug and alcohol use is the only issue. I’d be looking at whether it’s masking mental health issues.’

This is where the role of CPs is so crucial, he adds. Jess*, a health visitor based in Yorkshire, suggests that in affluent areas, drug and alcohol use is ‘more hidden’. ‘But the fact that [mothers are] hiding it means it is a problem,’ she adds.

Jess reports that mothers were unlikely to disclose ‘anything bad’, suggesting the fear of having their children removed or of being arrested stops them from talking about even occasional recreational drug use.

Ruth, who is lecturer in public health research at Newcastle University, says: ‘It is essential that practitioners develop trusting and non-judgemental relationships with people and that any responses are proportionate,’ she explains.

Adam agrees that each case should be assessed on individual circumstances. ‘Practitioners will have to consider whether or not evidence of episodic drug use places a child’s care at risk,’ he says. ‘Drug use per se would not place a child at risk. If there are other child protection issues it might be more of a risk.’

But Michelle Moseley, lecturer in primary care and public health nursing at Cardiff University, says: ‘Parents under the influence supervising children, even the day after use, place the child at potential risk. SCPHNs therefore need to take an authoritative approach [Sidebotham, 2013] to their practice when assessing risk.’

Adam suggests that their ability to take a tactful approach to their questions puts CPs in an ideal position to identify and support mothers who are using drugs as a way of coping. ‘They could ask: “This looks like a really busy time for you, how do you cope?” or “How have you coped in the past with situations like this?”’ he advises.

‘It’s something just for me’

Mother-of-one Sophie*, 32, tells her story:

My daughter is now 22 months and I’ve done cocaine a handful of times since she was born. I’d say I’ve taken it recreationally since university. Of course I stopped drinking and taking it while I was pregnant, and although I found that tough at first I started to feel so much healthier for not doing it. I vowed never to take cocaine again.

But being the first in my friendship group to have a baby means they’ve continued their lifestyle as before. When I was finally ready for a night out after becoming a mum, I had such a great time enjoying a few drinks and feeling like me again. Then someone brought out a bit of coke and I was talked into taking a line or two. The next day I felt ashamed but at the same time I’d had such a brilliant night with my friends.

Although I’d never use it while my daughter is in my care, the comedown definitely affects my mood and energy, so I’m probably not the best mum I can be. This makes me feel really guilty, but I still end up giving to temptation the next time I’ve had a couple of drinks and the opportunity comes up. I know I should probably stop now I’m a parent, but it’s so tough at times. Is it wrong to look forward to a bit of an escape for a few hours? I know I’m still a good mum and this feels like something that’s just for me.

*Name has been changed

Mother’s little helper?

We should be reminded that drug use among parents is not a new phenomenon. The Valium that doctors prescribed to housewives in the 1960s and 70s was known as ‘mother’s little helper’, indicating that the stresses were felt then too. But in addition, Adam stresses, it’s important that practitioners don’t fixate solely on mothers. ‘It’s not just Mum’s drug use, it’s Dad’s drug use,’ he says. ‘I’d be much more worried if both parents were regularly under the influence.’ Ruth agrees that both parents’ drug use should be considered. Her review concluded that there was unclear evidence of whether maternal or paternal drug use was more impactful on children (McGovern, 2018).

While not all drug use leads to addiction, there is always going to be an increased risk, Nuno adds. ‘It’s like showing yourself to the enemy,’ he says. And Ruth’s study concludes: ‘The prevalence of adverse outcomes in children whose parents are non-dependent substance misusers highlights the need for practitioners to intervene with this population before a parent has developed substance dependency.’

Vigilance is certainly needed but ultimately, for practitioners, context is crucial. ‘You can be a fantastic parent and not use drugs, but using drugs does not preclude you being a good parent,’ says Adam. ‘And you can be a poor parent and not use drugs.’

Building good relationships with parents will also foster more honest conversations, it seems, and encourage mothers – and fathers – to confide when they’re struggling to cope.



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