Alcohol and drug use are significant factors in Fostering and Adoption Medical Assessments. Their impact extends beyond immediate health risks, influencing long-term well-being and parenting capacity. This post explores the short and long-term effects of alcohol and drugs (specifically cocaine, opiates, and novel psychoactive substances) on health and parenting, with a focus on fostering and adoption contexts.
Alcohol Is a Drug: The Role of Availability
Alcohol is often overlooked as a drug due to its widespread social acceptance. However, its effects on health and behaviour can be just as profound as illicit substances.
Why Alcohol Is a Drug
- Alcohol affects the brain and body similarly to other mind altering drugs, altering mood, judgment, and behaviour.
- Its addictive potential and impact on health (e.g., liver disease, cognitive decline) underscore its classification as a drug.
The Role of Availability
- Societal Impact: The legal status and easy access to alcohol amplify its impact, contributing to high rates of dependency and alcohol-related harm.
- Personal Impact: Availability can shape drinking habits, with higher access often leading to increased consumption. In fostering and adoptive households, this raises questions about alcohol’s role in daily life and its potential influence on children.
Assessors should view alcohol use with the same scrutiny as illicit drugs during Fostering and Adoption Medical Assessments, recognising its potential to harm both the individual and the household environment.
Short-Term Effects on Health and Parenting
Alcohol
- Health Effects: Impaired judgment, reduced coordination, and lowered inhibition. Even moderate consumption can lead to accidents or neglect of responsibilities.
- Parenting Impact: Intoxication may cause lapses in supervision, inconsistent discipline, and emotional unavailability, harming a child’s sense of safety
Cocaine
- Health Effects: Increased heart rate, heightened energy, and risk-taking behaviour, often followed by intense crashes involving fatigue and depression.
- Parenting Impact: Episodes of use can result in erratic caregiving, neglect, and emotional instability, disrupting a child’s sense of predictability.
Opiates (e.g., heroin, prescription opioids)
- Health Effects: Sedation, slowed breathing, and impaired mental function. Overdose is a significant risk.
- Parenting Impact: Opiates often lead to neglect due to drowsiness or prioritisation of substance use over caregiving responsibilities. Withdrawal symptoms can further impact daily parenting tasks.
Novel Psychoactive Substances (NPS)
- Health Effects: NPS can mimic traditional drugs but with unpredictable potency and effects. For instance, Spice, can cause extreme agitation, hallucinations, or sedation – there is no indication from the names of these drugs what substances they contain.
- Parenting Impact: Use of NPS can result in erratic and dangerous behaviour, creating an unsafe and unpredictable home environment for children.
Long-Term Effects on Health and Parenting
Alcohol
- Health Effects: Long-term alcohol use is linked to liver disease, heart and circulatory system issues, mental health disorders, and decline in intellectual ability.
- Parenting Impact: Persistent dependency can undermine parental consistency, financial stability, and emotional availability.
Cocaine
- Health Effects: Long-term use may result in cardiovascular problems, mental health issues such as anxiety or paranoia, and cognitive impairment.
- Parenting Impact: Prolonged dependency often leads to financial strain, emotional unavailability, and a chaotic household environment.
Opiates
- Health Effects: Severe physical dependency, increased risk of infectious diseases (e.g., hepatitis, HIV), and long-term health conditions.
- Parenting Impact: Ongoing dependency can erode trust and stability, with potential exposure of children to unsafe environments or parental absence.
Novel Psychoactive Substances
- Health Effects: Long term use of NPS can result in severe mental health issues, organ damage, and dependence. The lack of consistency in drug compostion makes risks especially high.
- Parenting Impact: Prolonged use often undermines a parent’s ability to provide a safe, stable, and nurturing environment.
Implications for Fostering and Adoption Medical Assessments
Holistic Approach
- Assessors should evaluate the type, frequency, and impact of substance use on daily functioning. Both current use and history of dependency are critical factors.
Parenting Capacity
- Substance use affects caregiving consistency, emotional availability, and financial stability. These are core considerations in fostering and adoption decisions.
Recovery and Support
- However, do not lose sight of the fact that carers engaged in recovery through NHS services or peer-led programs may demonstrate the resilience and stability needed to support a child in care.
The Role of Testing
- Biological testing can provide valuable insights into recent or historical substance use. However, these methods have limitations and should always be used as part of a broader assessment.
Urine Tests: Useful for detecting recent use of many substances but cannot distinguish occasional from habitual use.
Hair Tests: Offer a longer detection window (up to several months) for substances such as alcohol and drugs but can yield spurious results due to external contamination or hair treatments.
Breath Tests: Commonly used for alcohol, they provide an immediate snapshot but are only effective for very recent consumption.
Blood Tests:
Liver Function Tests (LFTs): Can reveal liver damage caused by long-term alcohol misuse, such as elevated levels of enzymes like ALT and AST.
Full Blood Count (FBC): May indicate alcohol misuse through findings such as macrocytosis (enlarged red blood cells) or changes in white cell count.
Carbohydrate-Deficient Transferrin (CDT): A specific biomarker for long term alcohol consumption over the previous 2–4 weeks, used to detect heavy drinking patterns.
Key Consideration: While biological tests provide objective data, they do not account for individual behaviour changes or recovery progress. Results should always be contextualised within a holistic assessment of the carer’s overall parenting capacity.
Balancing Risks and Opportunities
Fostering and Adoption Medical Assessments must consider both the risks associated with substance use and the evidence of recovery. A carer who has successfully managed addiction may bring unique insights and empathy to a child’s needs, provided they demonstrate a commitment to a stable, substance-free environment.
The effects of alcohol and drugs on health and parenting are multifaceted, influencing both immediate caregiving and long-term family dynamics. By exploring alcohol alongside substances such as cocaine, opiates, and novel substances, Fostering and Adoption Medical Assessments can provide a comprehensive evaluation, ensuring decisions that prioritise the safety and well-being of children.
Author: Dr John Richmond. Retired drugs & alcohol treatment specialist.