Supporting Parents with Addictions

Substance misuse — including alcohol dependency, drug use and addiction — is one of the most common factors in parents being referred to parent-and-child foster placements. Many parents in your care may have complex histories involving substances, and it is important to understand both the risks and how to provide harm-reduction support in a non-judgemental way.

Your role is not to be a specialist addiction worker, but to understand the context, support the health and wellbeing of both parent and baby, and work closely with the professionals around the family.

Alcohol in Pregnancy

Alcohol is the most commonly used substance in pregnancy. There is no known safe level of alcohol consumption during pregnancy, and heavy or binge drinking significantly increases the risk of Foetal Alcohol Spectrum Disorder (FASD). FASD is a lifelong condition affecting the brain and body that results from alcohol exposure before birth, and is the leading cause of non-genetic developmental disability in the UK.

If you are caring for a pregnant woman who is drinking, it is important to raise this sensitively with the midwife or health visitor. She may need specialist support from an alcohol maternity service, and harm reduction is better than no change at all.

Illegal Drugs in Pregnancy

Drug use in pregnancy can affect the baby in different ways depending on the substance. Babies born to mothers who have used opiates (such as heroin or methadone) may go through neonatal abstinence syndrome (NAS) — a withdrawal process that requires medical care. This can be frightening and distressing for parents, and your role in supporting them emotionally at this time is significant.

Cannabis, cocaine, and other substances also carry risks to the developing baby. The most important thing is that the woman is honest with her midwife, who can ensure appropriate monitoring and support.

Supporting Harm Reduction

Substance misuse is complex and often deeply rooted in trauma, mental health difficulties, and adverse childhood experiences — many of which you will find in the histories of parents in your care. A non-judgemental, harm-reduction approach is most effective.

• Work with the specialist team around the family — including addiction workers, midwives and health visitors who specialise in substance misuse
• Help the parent to attend appointments and engage with treatment
• Understand that recovery is rarely linear — setbacks are part of the process
• Keep the focus on the baby’s safety while supporting the parent’s progress
• Keep detailed, factual records of any concerns

After the Birth

Breastfeeding is generally still encouraged even where a mother is on a methadone programme, as the small amount of methadone in breast milk can actually ease neonatal withdrawal. Your health visitor or specialist midwife can advise on this. Where a mother is using other substances, specialist advice should be sought before encouraging breastfeeding.