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Definition

Substance misuse refers to the abuse of drugs and/or alcohol. Whilst there may be different treatment methodologies for adults with these problems, they are considered together because the consequences for the child are quite similar. Substance misuse refers to both illicit drugs, alcohol, prescription drugs and solvents, the consumption of which is either dependent use, or use associated with having harmful effect on the individual or the community.

Many substance misusing adults also suffer from mental health problems, which is described as Dual Diagnosis and there may be several agencies, from both Adult and Children’s Social Care, who are working with the family.

National Serious Case Reviews and Domestic Homicide Reviews have identified domestic abuse, parental mental ill health and drug and alcohol misuse as significant factors in families where children have died or been seriously harmed. Where all three issues are present, they have been described as the ‘toxic trio’.


Risks

Substance misuse can consume a great deal of time, money and emotional energy, which will unavoidably impact on the capacity to parent a child. This behaviour also puts the child at an increased risk of neglect and emotional, physical or sexual abuse, either by the parent or because the child becomes more vulnerable to abuse by others.’

Children’s physical, emotional, social, intellectual and developmental needs can be adversely affected by their parent’s misuse of substances. These effects may be through acts of omission or commission, which have an impact on the child’s welfare and protection.

Children may be introduced to drug and alcohol misuse at an early age by the behaviour of the parents and the availability of the substances within the home.

All agencies need to work together in tackling the problems caused by substance misuse in families in order to safeguard children and promote their well being. Parents who misuse drugs and/or alcohol may be good enough parents who do not abuse or neglect their children. It is important not to generalise or make assumptions about the impact on a child of parental/carer drug and/or alcohol use. It is, however, important that the implications for the child are properly assessed having full regard to the parents/carers ability to maintain consistent and adequate care. Equal regard should be given to each and every child's level of dependence, vulnerability and any special needs.

Where there is concern that a parent is involved in substance misuse, the impact on the child needs to be considered, including:

  • The child’s physical safety when the parent is under the influence of drugs and/or alcohol;
  • Children can suffer chronic neglect, from before birth and throughout childhood;
  • Possible trauma to the child resulting from changes in the parent’s mood or behaviour, including exposure to violence and lower tolerance levels in the parent;
  • The impact of the parent’s behaviour on the child’s development including the emotional and psychological well-being, education and friendships;
  • The impact on newborn babies who may experience foetal alcohol syndrome or other drug withdrawal symptoms;
  • The extent to which the parent’s substance misuse disrupts the child’s normal daily routines and prejudices the child’s physical and emotional development;
  • The impact on the child of being in a household where illegal activity is taking place particularly if the home is used for drug dealing and the children may come in to contact with risky adults;
  • How safely the parent’s alcohol and/or drugs and equipment are stored as children can be at risk of ingesting substances or injuring themselves on drug paraphernalia;
  • Children are particularly vulnerable when parents are withdrawing from drugs;
  • Dangerously inadequate supervision and other inappropriate parenting practices;
  • Intermittent and permanent separation;
  • Inadequate accommodation and frequent changes in residence;
  • Children being forced to take on a caring role and feeling they have the responsibility to solve their parent’s, alcohol and drug problems.

The circumstances surrounding dependent, heavy or chaotic substance misuse may inhibit responsible childcare, for example, drug and / or alcohol use may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks.


Cumbria Background

We know from working experience and research that there are a range of serious safeguarding concerns for the children of drug and alcohol users. While many parents with drug and alcohol problems manage to successfully look after their children there are others where their substance misuse has led to extremely poor outcomes for their children. A snapshot of social work teams in Cumbria in 2008 found that one third of all open cases had a substance misuse aspect. These were often combined with mental health and domestic abuse issues. This local research matched the national research.

  Number of Children  
Area 0 1 2 3 4 5 6 Blank Record Grand Total
Allerdale 100 41 36 11 9 1 - 41 239
Barrow in Furness 164 114 40 23 4 5 2 19 371
Carlisle 165 104 64 32 14 5 1 41 426
Copeland 48 35 23 7 2 - - 37 152
Eden 30 18 17 3 3 1 - 28 100
South Lakeland 110 47 16 10 2 - - 19 204


Indicators

There are many reasons why adults take drugs or drink alcohol. If doing so has negative consequences then it may be regarded as misuse. Parents may be aware that their behaviour has a negative impact on their child; there is a risk in focusing on the adult’s difficulty and in supporting their attempts to control their behaviour. The real impact on the child can be overlooked or seen as a secondary consideration.

To be healthy and to develop normally, children must have their basic needs met. If a parent is more concerned with funding an addiction, or is under the influence of drugs or alcohol, they are unlikely to be able to achieve this consistently. A disorganised lifestyle is a frequent consequence of substance misuse. Parents may fail to shop, cook, wash, clean, pay bills, attend appointments etc.

Substance misuse may affect a parent’s ability to engage with their child. It may also affect a parent’s ability to control their emotions. Severe mood swings and angry outbursts may confuse and frighten a child, hindering healthy development and control of their own emotions. Such parents may even become dependent on their own child for support. This can put stress on a child and mean they miss out on the experiences of a normal childhood.

Other consequences of substance misuse – lost jobs, unsafe homes (littered with half empty bottles or discarded syringes), broken marriages, severed family ties and friendships, and disruption of efforts made by a local authority to help – are also likely to negatively affect a child.

Any professionals, carers, volunteers, families and friends who are in contact with a child in a drug / alcohol-misusing environment must ask themselves “What is it like for a child in this environment?”.


Protection and Action to be Taken

Where there are concerns by practitioners involved with a family about a child living in the environment of substance misuse an assessment of the parent’s capacity to meet the child’s needs should take place to establish the impact on the child of the parent’s lifestyle and capacity to place the child’s needs before those of their own. A referral to Children’s Social Care in line with the Multi-agency Thresholds Guidance (including Referrals) should be made and the practitioners from adult services, or other relevant agencies, should work in collaboration with Children’s Social Care.

Where any agency encounters a substance user who is pregnant and whose degree of substance misuse indicates that their parenting capacity is likely to be seriously impaired, they must make a referral to Children’s Social Care.

The majority of pregnant substance misusing women will have been identified by maternity services and referred to the Substance Misuse Team. The Care Planning Approach / Care Co-ordination Approach will apply including input from the link midwives and a social worker from Children’s Social Care, who will be invited to any meetings taking place in respect of the child/ren. 

Where a newly born child is found to need treatment to withdraw from substances at birth, an assessment and a pre-discharge discussion should take place and consideration should be given to making a referral to Children’s Social Care in line with the Referrals Procedure before the child is discharged home.

Specialist Substance misuse services should be invited to and should attend and provide information to any meeting concerning the implications of the parent/carer’s substance misuse problems for the child, including Child Protection Conferences and Child in Need meetings.

There is a clear need to assess the impact of the behaviour on the child as well as the wider family and community context. Some adult services may be reluctant to share information because of concern about confidentiality. However, the needs to safeguard children should be paramount and agencies with information regarding the parent will have a valuable contribution to make. In these circumstances, practitioners should seek advice from the Safeguarding leads in their organisation, if they are unsure as to what information should be shared, or what action should be taken.

When practitioners make a decision to end their involvement with a parent/carer with substance misuse problems, or a child who is living with a parent/carer with substance misuse problems, they should always discuss their plans with the other services who are working with the family, before the case is closed. This is to ensure that any on-going needs can be addressed.


Procedures

Staff, that work with parents/carers who misuse drugs or alcohol must always consider the severity of the drug misuse and its impact on the children affected. Welfare Continuum - Intervention in Cases of Substance Misusing Parents (Appendix A) identifies 5 stages/levels of potential impact and the and Guidelines on Assessing the Impact on Parenting (Appendix B) provide guidance on issues to consider when assessing the impact on children of parental drug misuse. It is also appropriate to refer to Cumbria Children’s Services, Social Care Thresholds, as a guide to integrated working across all levels of intervention. Appendix C describes factors to consider in relation to Pregnancy and Neo-Natal Care and Appendix D does the same for Alcohol Use in Pregnancy.

For cases at levels one and two on the welfare continuum (advice and support) it will usually be appropriate for services to be offered on a single agency basis to support the carer to ensure that the impact on children is reduced.

For cases which reach level 3 (identified needs) it will be necessary to consider a multi-agency input to reduce risks to children. The worker involved initiating a multi-agency planning meeting using Early Help Procedures achieves this. These are implemented in Cumbria to achieve a co-coordinated input with an identified 'lead worker'. It may be appropriate at this stage to contact Children's Social Care to seek consultation and/or make a formal referral within the framework of Section 3 of Chapter 6 of these LSCB procedures so that support can be provided by Children's Social Care as part of a multi-agency package.

When concerns reach level 4 (identified concerns) a referral will need to be made to the Children's Services Social Care team on the basis that the child/children may be at risk of significant harm as a consequence of the drug misuse using the procedures in Chapter 6. Children's Services will consider the need for a formal initial assessment and will progress to establishing a multi-agency strategy meeting if the grounds for a formal section 47 investigation are met to determine whether the child is at risk of significant harm. If a Section 47 investigation is initiated or there are multiple concerns Children's Services staff will initiate a core assessment coordinating the input from all agencies involved with the children.

Children's Services staff conducting child and family assessments will use the Guidelines on Assessing the Impact on Parenting (Appendix B) as a tool to assess the impact of the drug misuse on the care of the child(ren).

Cases which reach level 5 (protection) are those where it is determined after a Section 47 investigation that children are at risk of significant harm and need to be made subject to Child Protection Plans. Legal action may also be required to ensure the immediate safety of children. If the drug misuse places the child(ren) at long terms risk consideration must be given to alternative permanent care arrangements to ensure their needs are met.

The assessment should inform the plan for multi-agency intervention to help reduce the impact of parental substance misuse on the care of children. In many cases a multi-agency coordinated support plan will be sufficient to ensure that the children/s needs are met. Where it is established that children are at risk of significant harm as a consequence of drug misuse, it will be appropriate for this intervention to be managed within the framework of the child(ren) becoming subject to a Child Protection Plan. Where there is evidence from the assessment that the concerns are not being addressed and there is a risk of long-term harm to the child(ren), consideration will need to be given to removal of child(ren) from the situation of risk and consideration given to arrangements for permanent substitute care to ensure that the child(ren) needs are met.

It is paramount that when working with families that the evidence of prevalence is taken into account. Both national and local research consistently points across all teams towards substance misuse being an issue in a third of all Social Care cases. It should therefore be always considered when undertaking any assessment.


Issues

Parents’ own needs will need to be addressed and supported. Sometimes access to appropriate treatment resources is limited which may cause delays in providing services however the child’s needs must not be put on hold without a contingency plan.

Confidentiality is important in developing trust between drug using parents and staff in agencies working with them in relation to their substance misuse, however, practitioners must always act in the best interests of the child and not prioritise their therapeutic relationship with the adult.

When a woman with a substance misuse and/or problem attends for antenatal care, she should be encouraged to contact the Substance Misuse Team for assessment and advice on the treatment options available to her.


Welfare Continuum - Intervention in Cases of Substance Misusing Parents

Click here to view the Welfare Continuum - Intervention in Cases of Substance Misusing Parents Table.


Guidelines on Assessing the Impact on Parenting

This checklist has been adapted and expanded from guidelines produced by the Standing Conference on Drug Abuse (SCODA 1997).

Children in the family – provision of good basic care

  • How many children are in this family?
  • What are their names and ages (wherever possible, include dates of birth)?
  • Are there any children living outside the family home and, if so, where?
  • What arrangements are made for the care of the children whilst the carers are misusing alcohol/drugs. The type and method of administration of the drugs (including prescribed drugs). This is relevant to what the children are exposed to and witness e.g. use and management of drug paraphernalia. Is there a supportive partner who does not use drugs/ alcohol? If they do, does their level of use also cause concern?

For each child:

  • Is there adequate food, clothing and warmth for the child? Are height and weight normal for the child’s age and stage of development?
  • Is the child receiving appropriate nutrition and exercise?
  • Is the child’s health and development consistent with their age and stage of development? Has the child received necessary immunisations? Is the child registered with a GP and a dentist? Do the parents seek health care for the child appropriately?
  • Does the child attend nursery or school regularly? If not, why not? Is s/he achieving appropriate academic attainment?
  • Does the child present any behavioural, or emotional problems? Does the parent manage the child’s distress or challenging behaviour appropriately?
  • Who normally looks after the child?
  • Is the child engaged in age-appropriate activities?
  • Are there any indications that any of the children are taking on a parenting role within the family (e.g. caring for other children, excessive household responsibilities, etc.)?
  • Is the care for the child consistent and reliable? Are the child’s emotional needs being adequately met?
  • Is there a risk of repeated separation for example because of periods of imprisonment (e.g. short custodial sentences for fine default)?
  • How does the child relate to unfamiliar adults?
  • Are there non-drug using adults in the family readily accessible to the child who can provide appropriate care and support when necessary?
  • Does the child know about his/her parents substance use?
  • Is there evidence of drug/alcohol use by the child?

Describing parental substance use (identify sources of information, including conflicting reports)

  • Is the drug use by the parent: Experimental? Recreational? Chaotic? Dependent?
  • Does the user move between these types of drug use at different times?
  • Does the parent misuse alcohol?
  • What patterns of drinking does the parent have?
  • Is the parent a binge drinker with periods of sobriety? Are there patterns to their binging?
  • Is the parent a daily heavy drinker?
  • Does the parent use alcohol concurrently with other drugs?
  • How reliable is current information about the parent’s drug use?
  • Is there a drug-free parent/non-problematic drinker, supportive partner or relative?
  • Is the quality of parenting or childcare different when a parent is using drugs and when not using?
  • Does the parent have any mental health problems alongside substance use? If so, how are mental health problems affected by the parent’s substance use? Are mental health problems directly related to substance use?

Accommodation and the home environment

  • Is the family’s living accommodation suitable for children? Is it adequately equipped and furnished? Are there appropriate sleeping arrangements for each child, for example does each child have a bed or cot, with sufficient bedding?
  • Is the accommodation safe and secure for the children?
  • Are rent and bills paid? Does the family have any arrears or significant debts?
  • How long have the family lived in their current home/current area? Does the family move frequently? If so, why? Are there problems with neighbours, landlords or dealers?
  • Are other adults sharing the accommodation? If so an assessment of them should be undertaken.
  • Do other drug users/problem drinkers use the accommodation? If so, are relationships with them harmonious, or is there conflict?
  • Is the family living in a drug-using/ heavy drinking community?
  • If parents are using drugs, do children witness the taking of the drugs, or other substances?
  • Are children exposed to intoxicated behaviour/group drinking?
  • Could other aspects of drug use constitute a risk to children (e.g. conflict with or between dealers, exposure to criminal activities related to drug use)?

Procurement of drugs

  • Where are the children when their parents are procuring drugs or getting supervised methadone? Are they left alone? Are they taken to unsuitable places where they might be at risk, such as street meeting places, flats, needle exchanges, adult clinics?
  • How much do the parents spend on drugs (per day? per week?) How is the money obtained?
  • Is this causing financial problems?
  • Do the parents sell drugs in the family home?
  • Are the parents allowing their premises to be used by other drug users?

Health risks

  • Where in the household do parents store drugs/alcohol?
  • Do the children know where the drugs/alcohol are kept?
  • What precautions do parents take to prevent their children getting hold of their drugs/alcohol? Are these adequate?
  • What do parents know about the risks of children ingesting methadone and other harmful drugs (e.g. breathing in smoke)?
  • Do parents know what to do if a child has consumed a large amount of alcohol?
  • Are carers seeking adequate help from drug/ alcohol services for treatment and support?
  • Are they in touch with local agencies that can advise on issues such as needle exchanges, substitute prescribing programmes, detoxification and rehabilitation facilities? If they are in touch with agencies, how regular is the contact?
  • Is there a risk of HIV, Hepatitis B or Hepatitis C infection?

If the parent(s) inject:

  • Where is injecting equipment kept? In the family home? Are materials kept securely?
  • Is injecting equipment shared?
  • Is a needle exchange scheme used?
  • How are syringes disposed of?
  • What do parents know about the health risks of injecting or using drugs?

Family and social supports

  • Do the parents primarily associate with other substance misusers, non-drug users or both? What is the level of this contact?
  • Are relatives aware of parent(s)’ problem alcohol/drug use? Are they supportive of the parent(s)/child(ren)?
  • Will parents accept help from relatives, friends or professional agencies? What is their perception of this help/ support?
  • Is social isolation a problem for the family?
  • How does the community perceive the family? Do neighbours know about the parents drug use? Are neighbours supportive or hostile?

Parents’ perception of the situation

  • What do parents think of the impact of the substance misuse on their children?
  • Is there evidence that the parents place their own needs and procurement of alcohol or drugs before the care and welfare of their children?
  • Do the parents know what responsibilities and powers agencies have to support and protect children at risk?

Pregnancy and Neo-Natal Care

Introduction

Pregnancy may act as a catalyst for change presenting a 'window of opportunity'. Drug users may not use general health services until late into pregnancy and this increases the health risks for both the mother and child. Individualised care will be provided for substance using women, in line with polices and guidelines of the unit at which the women selects to access maternity care.

Attracting and maintaining women in drug treatment services is vital (Hepburn 1993) as follow-up studies demonstrate that the long-term outcome in women who enter a methadone treatment programme during pregnancy is better in terms of their pregnancy, childbirth and infant development, irrespective of continuing illicit drug use (Finnegan, 1991). Women attending treatment services usually have better antenatal care and better general health than drug using women not in treatment, even if they are still using illicit drugs (Batey & Weissel 1993). Therefore Drug and Alcohol Services will prioritise all pregnant women with drug and or alcohol problems to allow for the earliest engagement possible.

Engagement of a drug and or alcohol using partner in treatment is an important aspect of enabling the pregnant women to achieve progress at the earliest possible stage.

Management of Antenatal Care

The key aims of management are to attract the women into health care treatment services, provide antenatal care and stabilize or reduce drug use to the lowest possible dose. Professionals should advise and discuss with parents the harmful impact of their continued substance misuse on their children and this should be recorded.

It is important that no agency worker advises a pregnant woman to stop using drugs or alcohol without first referring the matter to the midwifery service or discussion with the key worker in addiction services. The immediate withdrawal of such drugs or alcohol could result in premature birth or miscarriage.

Good co-ordination and information sharing between relevant parties is imperative.

Given the possibility of early delivery, it is recommended that a meeting is held between 24 weeks - 32 weeks gestation to ensure that care and support is appropriate to the needs of the woman the baby and her immediate family and that plans are in place for the family post-delivery. This should reduce the need for emergency child protection proceedings at birth. The parents should be informed about all meetings and supported and encouraged to attend. 

Where agencies or individuals anticipate that the unborn baby may be at risk of, a referral to Children's Social Care must be made as soon as the concerns are identified.

Effects of Substances on the Foetus and Baby

It is important for clinicians to note that some of the effects of different drugs used during pregnancy are broadly similar and are largely non-drug specific. Intra-uterine growth retardation and pre-term deliveries contribute to increased rates of low birth-weight and increased prenatal mortality rate. These outcomes are multi-factorial and are also affected by factors associated with socio-economic deprivation, including smoking (Kaltenbach &Finnegan 1997).

Higher rates of early pregnancy loss and third-trimester placental abruption appear to be major complications of maternal cocaine use. Increased rates of stillbirth, neonatal death and sudden infant death syndrome are found. Heroin has been shown to have a direct effect on foetal growth and an association with pre-term delivery. It has also been shown to result in a higher rate of small-for-date babies, even when allowing for other compounding factors and the expression of neonatal abstinence syndrome (NAS). There is shown to be a significant correlation between methadone dose and NAS.

Maternal Health Problems

There are a number of health problems in pregnancy, which need to be discussed with the woman and reviewed throughout the pregnancy. These include general nutrition, risks of anaemia, dental hygiene and complications from chronic infection related to injection practice. These all contribute to the increased rate of obstetric complications and premature delivery found in drug using women. Drug using women are at high risk of antenatal and postnatal mental health problems.

Neonatal Withdrawal

Many babies will not need paediatric interventions, but it is important to have access to skilled neonatal paediatric care. However, all babies of substance using mothers will be subject to a withdrawal scoring sheet, which some women might interpret as intervention.

Signs of withdrawal from opiates are vague and multiple and tend to occur 24-72 hours after delivery. They include a spectrum of symptoms such as a high-pitched cry, rapid breathing, hungry but ineffective sucking, and excessive wakefulness. At the other end of the spectrum symptoms include hypertonicity and convulsions but these are not common. Neonatal withdrawal can be delayed for up to 7-10 days if the woman is taking methadone in conjunction with benzodiazepines. Benzodiazepine use causes more prolonged symptoms, including respiratory problems and respiratory depression.

Postnatal Management

Breastfeeding should be encouraged, even if the mother continues to use drugs, except where she uses a very high dose of benzodiazepines, crack/cocaine. Specialist advice should be sought if she is HIV positive. Methadone treatment is not a contraindication to breastfeeding.

Health professionals should note that the care of the pregnant drug user and the safe delivery of the baby is just the start of care. Continuing support, which may need to include parenting advice and skills training, may be desirable both pre and post-discharge if the ideal outcome of maintaining mother and child together is to be achieved

Discharge Planning

To ensure that care and support continues on discharge a planning meeting should be considered and arranged on an individual basis if required. Prior to discharge all information should be reviewed and plans documented in the case notes, with liaison on discharge to relevant agencies. Relevant agencies will be notified of the discharge plan and the midwifery services will contact Substance Misuse Services to ensure continuation of prescribed medication. Details of the discharge plan should be entered onto the Early Help Assessment.

Prescribing Drugs for Pregnant Drug Users

Substitute prescribing can occur at any time in pregnancy and is lower risk than continuing illicit use. It has the advantage of allowing engagement and therefore identification of both health and social needs as well as offering the opportunity for brief interventions and advice to improve outcomes. (Note specialist advice must always be sought) Expectant mothers who are drinking dependently should be referred as a matter of priority to a Drug and Alcohol Service and not be advised to stop without supervision due to the risk of withdrawal.


Alcohol Use in Pregnancy

It has been suggested that that foetal alcohol syndrome is the biggest cause of non-genetic learning disability in the Western world and is the only one that is 100% preventable (McNamara, ibid)

"Not every child affected by prenatal alcohol exposure will experience severe learning disability, but learning disabilities are common...The primary... damage that alcohol exposure causes is to the central nervous system...it is important to emphasise that little is known about factors determining whether a child will develop alcohol-related problems, or how significant these will be. There is no cut off point that indicates that a specific amount of alcohol at a specific time will create certain types of problems, and less will not... mothers who maintain adequate nutrition even though drinking may give birth to children less severely affected than mother's who have poor nutrition". See the Foetal Alcohol Syndrome website.

The Child

The effects on children of the misuse of alcohol by one or both parents or carers are complex and may vary in time, which is why a thorough assessment of needs and risk of harm is important. In some cases the misuse of alcohol may be one factor which, when linked to domestic violence or mental illness, may increase the risks to the child.

The circumstances of children must be carefully assessed not only to consider immediate risks but also the long-term effects on the child of their parents' alcohol misuse.

The children of parents who misuse alcohol are at increased risk of developing alcohol problems themselves and of being separated from their parents. Research demonstrates that children who themselves start drinking at an early age are at greater risk of unwanted sexual encounters and injuries through accidents and fighting.

Concerns

The health and development of an unborn child may be affected by the parent's alcohol misuse and newborn babies may suffer foetal alcohol syndrome which as a result may interfere with the parent/child bonding process.

Babies may experience a lack of basic health care and poor stimulation and older children may experience poor school attendance, anxiety about their parents' health and taking on a caring role for the parent or siblings.

The parent's practical caring skills can be affected by the misuse in the following ways:

  • Lack of attention to basic physical needs;
  • Lack of control of emotions;
  • Impaired judgement.

Further Information

Unity - Drug and Alcohol Service Cumbria

Address

Six centres plus outreach:

  • Carlisle - 113-117 Botchergate, CA1 1RZ;
  • Workington - 6 Finkle Street, CA14 2AY;
  • Whitehaven - 21B Lowther Street, CA28 7DG;
  • Barrow - 92-96 Duke Street, LA14 1RD;
  • Penrith - 2nd Floor Clint Mill, CA11 7HW;
  • Kendal - 39 Strickland Gate, Whitehorse Yard, LA9 4LT.

HMP Haverigg

Contact: Ashley Gibson, Unity Community Development Lead,

113-117 Botchergate, Carlisle, CA1 1RZ

Telephone 01228 882299
Fax 01228 882290
Website www.gmw.nhs.uk
Accessibility Contact individual centres for information
Opening Hours SPACE 09:00 - 17:00 with locality variations - some evening opening

NHS run alcohol and drug recovery service which offers inspirational care and supported recovery for people living with substance misuse problems across Cumbria.

With bases in Barrow, Carlisle, Kendal, Penrith, Workington and Whitehaven, as well as developing services in HMP Haverigg, Unity offers all strands of recovery focused alcohol and drug treatment.

Our services are available to anyone - from those showing early signs of substance misuse to those who have lived with an addiction for years and to family members requiring support.

As soon as somebody makes that first step towards recovery they will access the most appropriate care for them with a plan tailored specifically to their needs.

Adfam - support to families affected by drugs and alcohol.

Coap - children of addicted parents and people - the young people living with a family member with an addiction.

Dual Diagnosis - A Good Practice Handbook

NHS Choices Care Programme Approach

Hidden Harm - Responding to the Needs of Children of Problem Drug Users

NSPCC Serious Case Reviews

Think Child, Think Parent, Think Family

Postnatal Care - NICE Clinical Guidance 37


Amendments to this Chapter

In August 2015, a link was added to Postnatal Care – NICE Clinical Guideline 37 in the Further Information section.

End.