What can we do to improve the lives of families affected by parental substance misuse?

Professor Jane Barlow introduces Parents Under Pressure™, our programme to support families where parents have a drug or alcohol problem

Mother and baby in a garden Parents who misuse substances don’t always have difficulty looking after their children. But as well as the complexities of living with a drug or alcohol problem, many experience other challenges. These may include mental health problems and their own experiences of abuse (in childhood and adulthood). Given this, it’s not surprising that this group of parents can find it hard to care for their children. And some can become involved in the child protection system.

Although we know a lot about the problems faced by this group of parents, we still have limited knowledge about how to support them to care for their children. Recently, the NSPCC and the University of Warwick have been working together to better understand what works to improve outcomes for these families. In this blog, the first in a series of four, I’ll be introducing the Parents Under Pressure™ programme and explaining how we know it works.

What are we doing to help?

Parents Under Pressure™ is a programme aimed at helping parents who are on a treatment programme for drug or alcohol problems to build their parenting skills, manage their emotions and develop a better relationship with their child. This helps them create a safer environment for their child, and support their child’s development. Parents Under Pressure™ was developed by Professor Sharon Dawe of Griffith University, Australia and Dr Paul Harnett of the University of Queensland. It’s underpinned by recognition of the importance of the parent–child relationship. The quality of this relationship is related to the parent’s ability to provide sensitive, responsive and nurturing caregiving - something that can be compromised when the parent is coping with extra stress, such as past trauma or recovering from substance misuse.

Parents Under Pressure™ is made up of 12 modules. Practitioners visit mums and dads at home to carry out an assessment before creating a tailored programme for each family that suits their needs. Sessions are conducted in the home and last between 1 and 2 hours, but parents can access additional support outside the treatment session for issues such as housing, legal advice and school support.

Through Parents Under Pressure™, parents are helped to recognise their strengths and identify potential challenges by:

  • using video feedback;
  • sharing discussions with the practitioner; and
  • completing exercises using the parents’ workbook.

Mindfulness exercises help parents to manage strong emotions and impulsive behaviour. Exercises to help them become fully present ‘in the moment’ during daily activities include taking pleasure in watching their child sleep, having a bath or playing.

Parents learn techniques such as ‘urge surfing’, understanding cravings and learning to manage negative moods without the use of substances, to reinforce what they’re being taught in their drug and alcohol treatment.

Parents Under Pressure™ sessions also cover life skills such as improving problem-solving abilities, or engaging with people who can provide support. And practitioners help parents with day-to-day issues such as housing and finance, which helps them to put everything they’re learning into practice.

All this helps parents to respond sensitively to their children’s needs and build a more secure home environment.


How do we know if it works?

The Parents Under Pressure™ programme in Australia has been evaluated and shown to be effective in reducing the risk of child abuse in families where parents are on drug treatment programmes and children are aged 3-8. But we wanted to know if it could work in the UK, and with parents of children aged 3 and under. So we conducted 1 of the most rigorous forms of evaluation to assess the effectiveness of a programme – a randomised controlled trial.

100 families were randomly assigned to either the Parents Under Pressure™ group or standard care (this means they received treatment for their substance misuse problems but no extra parenting support). We asked both groups of parents to complete questionnaires about their attitudes towards parenting, their psychological functioning, and their child’s emotional and behavioural wellbeing at 3 timepoints - before they were assigned to their group, and 4 months and 6 months later.

What did we find?

The risk of child abuse was reduced in the families who took part in the Parents Under Pressure™ programme, and this was sustained 6 months after completing the programme. In contrast, the risk of abuse in families where parents received standard care was the same after they completed their treatment and increased 6 months after.

There were also significant improvements in parents’ capacity to manage their emotions, their overall psychological wellbeing and depression; although no differences in parenting stress levels were noted between the 2 groups.


The results of the Parents Under Pressure™ randomised controlled trial make a significant contribution to the evidence base about ‘what works’ to improve outcomes for families where parents have a drug or alcohol problem.

Look out for the next blog in this series, when we will focus on what we learnt by undertaking the randomised control trial and the challenges we faced.

For more information about the results of the trial, read the full evaluation report.

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