Children in families with alkohol problems family focused alcohol treatment as prevention for the children

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1 Children in families with alkohol problems family focused alcohol treatment as prevention for the children Senior Consultant, Kit Broholm Danish Health and Medicines Authority

2 Children in families with alcohol problems How many are we talking about? It is estimated that about 122,000 children between the age of 0-18 grow up in families with alcohol problems 181,000 at the age between tell themselves that they grew up in families with alcohol problems 329,000 at the age of 35+ tell themselves that they grew up in families with alcohol problems In total 632,000 grew up in families with alcohol problems 1 The total Danish population is 5,5 mio. Source: 1. Danskernes alkoholvaner, Sundhedsstyrelsen og SIF, 2008

3 How many get problems 10% get a psychiatric diagnosis versus 5% of other children 40% have symptoms of strain and 50% are performing like other children 2 Sources: 2. Behavioral and Emotional Problems in Children of Alcoholic Mothers and Fathers, Helene Bygholm Christensen og Niels Bilenberg. European Journal of Child and Adolescent Psychiatry vol 9: , 2003

4 What does it mean for the children? 60,000 have a father or a mother who has been hospitalized due to an alcohol related illness 3 If their father or mother have an alcohol related diagnosis these children compared with other children are: about 2½ times more at risk of being admitted to a psychiatric ward as a child about 3½ times more at risk of being placed in out-of-home care about 2 times more at risk of attempting suicide About 8 times more at risk of being subjected to violence at home 4 Source: 3. Risikofaktorer i barndommen Mogens Nygaard Christoffersen, SFI, Langtidseffekter af forældres alkoholmisbrug. Mogens Christoffersen. Ugeskrift for Læger 166/41 4 oktober May 2015

5 What does it mean for the children If the mother has an alcohol related diagnosis the consequences for the children are that the mortality rate at the age of 27 compared to other children is doubled the risk of being admitted to a psychiatric ward is tripled the risk of being placed in out-of-home care is tripled the risk of attempting suicide is 2½ times bigger 5 Source: 5. The longterm consequences of parental alcohol abuse a cohort study of children in Denmark. Mogens Christoffersen. Journal of Substance Abuse Treatment 25 (2003)

6 Use of the health and social system Young adults in alcohol treatment About 40% of persons in alcohol treatment grew up with an alcohol problem 8 Partner and children with alcohol problems make use of the health system up to four times more than the general population 9 Placement of children: For 44% of children placed outside the home there is an alcohol and drug problem as part of the reason for being placed out-of-home Sources: 8. Behandlingsbehov hos alkoholmisbrugere, hvis forældre havde et alkoholmisbrug. Annette Søgaard Nielsen et al. Ugeskrift for læger. 21. august Substance abuse and family illness: Evidence from health care utilization and cost-offset research. Lennox R., Scott- Lennox J., Holder H. (1992). Journal of Mental Health Administration, 19 (1), May 2015

7 How does young adults experience the problems of growing up in a family with alcohol problems Risk factors when growing up in a family with alcohol problems Children in families with alcohol problems (%) Children in families without alcohol problems (%) Suicidal behaviour of the parents 32 % 1 % Death of parents 26% 10% Violence in the family (among parents, parents/brothers and sisters, parents/child) 19% 1% Parents divorced 46% 21% Exposure to repeated psychical punishment Exposure to sexual abuse from member of the family 18% 6% 13% 4% 6 May 2015

8 Adult life of children from families with alcohol problems Children in families with alcohol problems (%) Children in families without alcohol problems (%) Mental problems 36 % 6 % Eating disorders 14 % 7 % Suicidal behaviour 25 % 8 % Divorced themselves 21 % 10% Exposed to violence at some time in life 35 % 16 % Received intervention (psychologist, psychiatrist or own GP) Received prescribed medication for a mental problem 62 % 21 % 27 % 6 % Own alcohol problems 33 % 8 % Own alcohol problems (among men) 67 % 17 % Own alcohol problems (among women) 24 % 5 % Used hashish 43 % 22 % Used amphetamine or ecstacy 20 % 6 % Used anti-depressant drugs or sleeping medicine 29 % 8 % Experienced alcohol problems with partner 36 % 14 %

9 Adult life of children from families with alcohol problems (continued) The figures originates from a Danish study of 127 young adults from families with alcohol problems compared to a group of 189 adults from families without alcohol problems. Source: Helle Lindgaard: Voksne børn i familier med alkoholproblemer mestring og modstandsdygtighed, Center for rusmiddelforskning, May 2015

10 The additional costs of municipalities in Denmark for people with excessive alcohol consumption: Registered persons with alcohol related illness in hospitals Registered persons in alcohol treatment Municipal co-financing of health costs Municipal transfers and payments Additional costs for the group of excessive alcohol consumption compared to control. Denmark DKK 469 million DKK 2055 billion Additional costs for the group of excessive alcohol consumption compared to control. Municipality with 50,000 citizens DKK 4,3 million DKK 18,7 million Placements and assistance DKK 591 million DKK 5.4 million Personal and practical help DKK 516 million DKK 4.7 million Municipal costs in total DKK 3631 billion DKK 33 million Source: Egne beregninger på baggrund af data fra Danmarks Statistik, Landspatientregisteret, Sygesikringsregisteret, Lægemiddelstatistikregistret, EOJ-data fra kommunerne og Det Nationale Alkoholbehandlingsregister. 6 May 2015

11 What characterizes families with alcohol problems? 1. Centralising around the drinker 2. Denial of the alcohol problem 3. Isolation in the family and in relation to friends 4. Changing of roles children take over grown up responsibility 5. A high stress and conflict level 6. Unpredictability 7. Violence or emotional neglect

12 What characterizes children in families with alcohol problems? They are different 50% do well. But there is a higher risk for developing: Behavioral and relational disturbances distrust, lack of knowledge about how normal families are functioning Cognitive difficulties and school problems Risk of developing their own alcohol or drug problems Risk of developing psychological problems, low self esteem, anxiety, eating disorder or depression Helle Lindgaard: Family focused alcoholtreatment- a literature study about the effects of family treatment, 2006 The National Board of Health

13 Documentation about methods which can be used Two literature studies of the international literature but in Danish: - Familier med alkoholproblemer et litteraturstudium af familieorienteret alkholbehandling (Helle Lindgaard) - Familieorienteret alkoholbehandling et litteraturstudium af familiebehandlingens effekter (2006) (Center for Rusmiddelforskning, Aarhus Universitet) National clinical guidelines for treatment of alcohol dependence point at: Family focused alcohol treatment is more effective than individual treatment. It promotes well-being in the family also for relatives and promotes the numbers of abstinent days Treatment for relatives especially partners even though the drinker does not want treatment - motivates the drinker to go to treatment and promote well being in the family, better coping and a tendency of fewer depressive symptoms. - National Clinical Guideline for treatment of alcohol dependence (2015)

14 Children in families with alcohol problems are invisible because of the taboo The parents and the children keep the problem a secret The alcohol treatment centers just focus on the person who drinks The social services department only know of children whose parents are clients Often they don t see the alcohol problem but only the social consequences They don t know how great a strain alcohol is in children s lives In kindergarten and schools the professionals may see that the child doesn t feel well but don t see it as their job to find out if alcohol may be the problem. Alcohol is seen as a private matter

15 Municipality strategies and projects Focus on collaboration between the pedagogical sector where they meet children with problems and where they see parents on a daily basis the social sector where they have the responsibility for families and children with social problems, and the alcohol treatment sector where they only had the responsibility to treat the drinker

16 Change of the routines in these three sectors: Early detection strategy in the pedagogical sector A focus on alcohol habits in the social sector combined with a focus on the children if an alcohol problem is detected A focus on family treatment in the alcohol sector Cooperation agreements among the three sectors Professionals from alcohol treatment in the social sector Professionals from the social sector in alcohol treatment

17 Implementation network A network of 25 project leaders with knowledge about children in families with alcohol problems had the task of promoting: Education of the professionals in the alcohol treatment and education in early detection of the professionals in the social and pedagogical sector Cooperation agreements among the three sectors Alcohol policy in the municipalities

18 The tasks for the state level Documentation Material about the documentation to the three sectors Creating the project strategy and supporting the network of 25 project leaders Developing an education in basic alcohol treatment and family focused alcohol treatment Making an analysis of the costs for the municipalities related to families with alcohol problems Campaigns and public debate

19 New developments of the implementation project concerning family focused alcohol treatment mio. Early detection in the social, pedagogic and health sector competences and cooperation agreement. Shift from individually focused treatment to family focused treatment: Individual sessions, sessions with the couple, sessions with the whole family, group for the partners, the children, and the drinkers. Permanent money for treatment of children and young people under 25 growing up in families with alcohol problems 267,8 mio. from