Frances Black (Independent) | Oireachtas source

I thank the committee for inviting us to come along today. We were all delighted to come. I want to speak on a specific issue of concern. I have worked in the addiction area since 2003 during which time I have learned a great deal, particularly from family members, about the impact of harmful drinking on families and particularly on children. We know that we have a huge problem with alcohol. Three people a day are dying from an alcohol-related illnesses, which is scary. Alcohol abuse costs the Exchequer €800 million a year. Approximately 1,500 hospital beds a day are occupied by people with alochol-related illnesses. Harmful drinking is a major issue.

I want to talk about the hidden harm element. The wide range of harms that are caused to children as a result of parental alcohol misuse is known as hidden harm. As the harm is often not publicly visible, that means that those children are often not known to the appropriate services and they suffer harm in a number of important ways that can impede their physical, emotional and social development.

These children can suffer in silence and they often to do not know where to turn for help. The impact of a parent's harmful drinking has a deep and long-lasting impact on their lives that may not fully emerge until young adulthood and beyond. For a child, harmful parental drinking can shape their every moment from the time they wake up to the time they go to bed. A child worries about whether his or her mam or dad will drink that day, what mood they will be in and whether he or she will go to bed hungry.

A child can take on the role of a parent in the family, making sure brothers and sisters are fed and getting them dressed and out to school. In the most severe cases, a family situation can deteriorate to the extent where children are emotionally abandoned, physically or sexually abused or neglected with dirty nappies going unchanged and children going without regular meals.

I have conducted some research on this matter and found an amazing women called Dr. Stephanie Brown who works at Stanford University. She talks about the developmental impact of parental alcohol misuse on children’s attachment and identity formation and the impact of alcohol misuse related trauma on all aspects of development. The earliest research emphasises the link between harmful parental drinking and mental health issues. This is the area in which I am specifically interested. We have found that children who are reared in homes where there is harmful drinking have a high rate of mental health issues and then we look at our suicide and addiction rates in Ireland. Children can go on to have alcohol or substance misuse problems themselves. Many researchers have found that children with parents who misuse alcohol can be more likely to experience symptoms of anxiety, depression or both, anti-social traits, relationship difficulties, behavioural problems and alcohol abuse themselves.

Children living with this trauma may develop a sense of self that is equated with defence. These defences are designed to keep the enemy out and to minimise anxiety, fear and the threat of humiliation. The defensive self or false self creates a deep sense of inauthenticity and a barrier to connectedness with others that exacerbates isolation and loneliness. The defensive mantle tends to be brittle, inflexible and self-reinforcing, with the potential to break down under stress.

Over time this cumulative trauma can engender trauma related symptoms such as depression, anxiety, hyper-vigilance, low self-worth and somatic disturbances such as head and body aches, chronic tension and so forth. It is shocking when one considers the evidence for all this. These symptoms, if left untreated, can become full-blown post-traumatic stress disorder, PTSD. They can lead to all sorts of life, learning, health, psychological and relationship complications and a desire to self-medicate. This is how the insidious baton of addiction gets handed down through the generations.

The problematic use of alcohol and other drugs is a complex issue and continues to be one of the most significant health and social challenges facing society today. Approximately one third of the people are engaged in harmful drinking. I am not talking about addiction but a binge drinking culture. This issue affects families and communities. It can have serious implications for the welfare and safeguarding of children from conception and throughout their lives. Children living with the everyday experience of the problematic use of alcohol may experience incipient or traumatic neglect, physical and emotional abuse, a lack of appropriate nurturing and adverse outcomes that may affect their adult lives.

I do not want to be repetitive so I will talk about what we can do to prevent this problem arising. I have seen the effects of alcohol and substance abuse through the work that I have done, in particular with families. Therefore, I know it is important that we have effective prevention and early intervention for children living in homes with alcohol or substance misuse. The children who live with parents who have drug and alcohol problems are among the most vulnerable in society. It is imperative that we ensure the best possible start in life for every child through effective prevention and early intervention.

We must also establish a holistic, recovery-based education and therapeutic programme for the adult children of alcoholics. There is a successful programme in America and there is evidence available to prove how well it has succeeded. The development and maintenance of a therapeutic alliance, or a quality treatment relationship based on mutual respect, is an essential component of effective treatment for individuals who are adult children of alcoholics. Empathy, respect and belief in the individual's capacity for recovery are fundamental service provider attitudes and values. Peer support and continuing care is also an option.

This issue should be recognised. The culture of drinking in Ireland, particularly harmful drinking, has an impact on society in terms of mental health, addictions and physical harm. There is an evidence piece in America called the adverse childhood experiences study or ACE for short. It centres on the impact of dysfunction in the home and how it can have an impact on people on a physical level in the form of stress related illnesses like cancer and heart disease. It is important to consider the future of health care and recognise that alcohol and substance abuse play a huge role in the lives of children. The impact is not recognised in health care at the moment. That is why funding should be made available for people who have been impacted by parental alcohol and substance misuse. If we do so, it will prevent the legacy of mental health and addiction issues, and even physical health issues, that have been passed down through the generations.

There should be a consensus that integration between mental health and addiction services is sorely needed and long overdue. Again, we can talk about dual diagnosis. There is now a pressing need for transformation to recovery oriented care in both systems. As my colleague, Senator Kelleher, has said, we must all work together to provide intervention services. I hope I have not talked for too long and I am sorry if I did so.