Government led action to address the harms to "children of alcoholics" has been promised following efforts by a number of MP's to raise the profile of the issue. Nicola Blackwood, the public health minister, promised a new strategy after hearing a deeply personal account by MP John Ashworth of his experience of having an alcoholic father.
MP Liam Byrne has been leading an All Party Parliamentary Group (APPG) which last week released a manifesto [pdf] during national Children of Alcoholics week. MP Caroline Flint also spoke out on her experience of “secrecy, shame and fear” due to having a parent with an alcohol problem.
The manifesto calls on the Government to take ten actions, including a national strategy for 'Children of Alcoholics' (COAs), local funding to support alcohol services, further education and awareness, a plan to change attitudes and action on price and availability. It states there is 'a patchwork of poorly funded and disjointed support services at the local level', and that COAs are falling through the gaps of adult and children's social care systems and public health.
Protecting children from alcohol related harms: not so simple
Few would argue against the importance of protecting children from alcohol harms, and indeed the evidence shows that children of problem drinkers are at significantly higher risk of a range of later life problems including dependency. Local authorities and related services of course have obligations to protect children under safeguarding laws, though the manifesto also highlights many children live with parents who drink at risky or harmful rather than dependent levels. Many areas may have trained front-line roles in early interventions such as IBA, though recognising early on where alcohol may be an issue for a child's well-being may still be seen as difficult.
The manifesto though states a 'shocking picture of support', highlighting that none of the 138 Local Authorities (LAs) who responded to its survey had a specific COA strategy. However LAs typically have local alcohol strategies covering a range of actions including ambitions to deliver coordinated activity to reduce the harms to children and young people. Neither guidance from PHE or NICE advise areas having specific strategies for children of problem drinkers, though identify responsibilities through a range of local agencies including safeguarding strategies. Other manifesto actions may be considered of varying effectiveness when measured against Public Health England's (PHE) recent evidence review, with educational approaches typically seen as ineffective in contrast to addressing price and availability.
Others may question use of 'alcoholics' in the manifesto - generally avoided by treatment and policy roles mainly due to its potential for stigmatisation and that it may overlook greater numbers of at-risk drinkers. An absence of an alternative 'everyday langauge' to cover all alcohol problems may be part of the issue, whilst accepting 'alcoholism' is often seen as important for drinkers who identify with abstinence based recovery. Calls for use of 'person first language' by treatment and policy roles - for example 'person with an alcohol use disorder' - may seem impractical, but have underpinned changes in the US based DSM-V criteria for substance disorders. Indeed the manifesto identifies reducing the level of stigma associated with alcohol problems as a key objective, and may wish to see similar effort to those seeking to reduce stigma in mental health.
MPs on the APPG are clearly committed to improving recognition of the issue, and their work could be seen as valuable for pushing actions to better protect children as well as measures that may reduce alcohol harms more broadly. The Government has stated that it has no intentions to develop a revised national strategy to replace the much-criticised 2012 version, but with with evidence of cross-party committent, advocates may be hopeful of progress to come.