It’s alcohol awareness week and it’s focus has been on substance use and families. It felt like the right time to post about Hidden Harm. What it is and what we can do about it.


What is Hidden Harm


Hidden Harm was originally a report of the findings in 2003 of the Advisory Council on the Misuse of Drugs (ACMD) inquiry on the children of problem drug users in the UK. It made 48 recommendations and the following 6 key messages for policy and practitioners:


  1. there are between 250,000 and 350,000 children of problem drug users in the UK – about 1 child for every problem drug user
  2. parental problem drug use causes serious harm to children at every age from conception to adulthood
  3. reducing the harm to children from parental problem drug use should become a main objective of policy and practice
  4. effective treatment of the parent can have major benefits for the child
  5. by working together, services can take many practical steps to protect and improve the health and well-being of affected children
  6. the number of affected children is only likely decrease when the number of problem drug users decreases


Although research around the impact of parental substance misuse had taken place before this, this was the first time it was brought to attention on a national level. Unfortunately, the recommendations were just that, recommendations. This meant that local authorities were not legally required to fulfill any of them. However, the report made a huge change in the services available to families affected by substance use and I was lucky enough to work for two of them.


Who are we talking about?


I like to think of Hidden Harm in a much wider context and it applies to both alcohol and other drugs. Firstly, the fact that it may be assumed from a lot of the research that Hidden Harm is prominent in lower-income families. This is not the case. In my opinion, there are many issues around substance use in ALL families, regardless of income, class or whatever else you want to call it.

The recent craze of humorous accounts of parenting such as “Hurrah for Gin” and “Why Mummy Drinks” are, granted, hilarious and the writers talk about difficult topics around motherhood in a brilliant way. However, the focus on downing alcohol could be seen as normalising drinking within the ‘middle-class mummy’ crowd, to a certain extent. The fact is, it doesn’t matter who you are, problematic substance use can affect anyone, from middle-class mummies to binge drinkers to the homeless fella on the street or a CEO of a multinational business. The harm to families is often hidden, often due to stigma and shame, regardless of who they are.

The other point to make is that substance use doesn’t just affect just the individual and children, it affects whole families.


What sort of substance use counts?


We can sometimes get hung up on the terminology of substance use. There’s binge drinking, substance misuse, dependency, addiction, and substance abuse disorder among many others. All we need to remember is that if a person has problems with drugs or alcohol, whether it is because they are using drugs or drinking because of their problems; or whether it is because the substance is causing them problems, then they need help. They are not the only ones, you need help too, and so do children.


Effects of parental substance use on children


Taken from “Secret Lives: Growing with Substance”, Harbin and Murphy (2006), they found that some of the main effects of substance use on children is:

  • Children may be born withdrawing from a substance
  • Lack of attachment to parental figures and periods of separation and loss
  • Poverty and lack of provision of basic needs
  • Age inappropriate levels of responsibility or caring for other children
  • Unpredictable, inconsistent lifestyle and instability
  • Stigma and shame
  • Living with secrecy and isolation
  • Exposure to aggression or offending

I wrote about this in my previous blog, Helping children with a drug or alcohol using parent.

Effects of parental substance use on parenting


When a substance user is a parent, their parenting skills, perceptions, emotional control and attachment towards their children is affected. If anyone has ever had a hangover with their children around the day after having one too many, it’s easy to see why the above is true. Once a substance becomes a priority for an individual, children are not. Even if alcohol or drugs is not a priority as such, the effects and after-effects will impact on parenting capacity.


What about adult carers?


Adult carers is anyone who is caring for a loved one with alcohol or drug problems and can access support for this role.

Adfam (Alcohol, Drugs and the Family) in The Care Bill: What does this mean for carers of drug and alcohol users? (2014) said 1.5million people who are ‘significantly affected’ by a relative’s drug use and 17% of the population are family members affected in this way.

UKDPC research has estimated that in the UK, at the very least:

  • nearly 1.5 million adults will be significantly affected by a family member’s drug use;
  • the cost of the harms they experience as a result amounts to about £1.8 billion per year; and
  • the support they provide would cost the NHS or Local Authorities about £750 million to provide if it was not available.

Have a look at this info from The Carers Trust. See my previous blog, Living with a drug or alcohol user- why you need help too.


So, what can we do about it?


In summary, in order to prevent the Hidden Harm and long-term effects of a substance use on the family, everyone in it needs to be supported. There should be no shame and you are not alone! There are some fantastic organisations out there locally. My service, The Vesta Approach can help anyone living with a drug or alcohol user. Email me for help at


I can help


If you are living with a loved one’s drug or alcohol use, I can help you.

For a safe space to share your situation, go to my closed group, Vesta Confidential, where family members living with a substance user support each other and get lots of information and advice from me.

My service, The Vesta Approach, supports families affected by a loved one’s substance use. You can access confidential support from me wherever you are in the world. I will help you to get your loved one into treatment and lead a better life. I offer face to face sessions in the Manchester (UK) area. You can also get help via Skype  and an online group therapeutic programme.

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Take Care.

See you next week,


Victoria x