“..that warm feeling that [alcohol] gave me was what I interpreted love would feel like..” Lived experience of excessive alcohol use and care proceedings by mothers in the family justice system in the UK
Introduction
Mothers entering public law proceedings face many challenges relating to their capacity to demonstrate behaviour change in line with prescribed standards of good enough parenting (Brown, 2006; Doab, Fowler, & Dawson, 2015; Sykes, 2011). For mothers where excessive alcohol use has been identified, the behaviour change required to retain care of their children will primarily focus on lasting changes to their use of alcohol, such as achieving abstinence from alcohol (Harwin, Alrouh, Ryan, & Tunnard, 2014). Whilst the incidence of parental substance misuse within allocated social work caseloads is commonplace, little is known about the extent of maternal alcohol use, the harms associated with varying patterns of alcohol use, and the factors which may impact it (Adamson & Templeton, 2012; Forrester & Harwin, 2008).
In 2013 an internet poll on a UK parenting website asked mothers about their alcohol consumption. 57.4% stated they were drinking >13.5 units a week, and 83% cited the need to alleviate stress as a primary reason to drink, although it should be noted this survey was most likely subject to responder bias and its results and conclusions were not peer reviewed (Netmums 2013, reported by Bogg & Bogg, 2015). Whilst these figures provide some insight into the use of alcohol by some mothers, little is known about how mothers make changes to their alcohol use, given the concomitant needs they often have in shouldering the majority of childcare responsibilities. Whilst maternal alcohol use does not necessarily lead to poor parenting, excessive use of alcohol and other substances is associated with child neglect and maltreatment (Doab et al., 2015; Marcenko, Lyons, & Courtney, 2011).
Historically, women's alcohol use has been positioned within British society as a perennial issue, with women's excessive use of alcohol subject to complex and contradictory conceptualisations encompassing gendered, economic, social and political hegemonic discourses (McErlain, 2015). For example, the UK Government's alcohol harm reduction strategy (Home Office, 2012) references women 11 times, whilst men are referenced just four times, situating women's binge drinking as of greater concern than men's (Blackman, Doherty, & McPherson, 2015), yet men are consistently found to consume more alcohol and drink at harmful levels more than women (Craig & Mindell, 2014). Despite its harms, alcohol occupies an established socio-cultural role in British life, and is fully accepted within British consumer society as a commodity like any other, to be consumed as a marker of identity and lifestyle (Mackiewicz, 2015).
The extent to which women's alcohol use is cause for concern continues to be obfuscated through stigmatising and highly gendered rhetoric pathologizing women's use of alcohol as a form of transgressive femininity (Rolfe, Orford, & Dalton, 2009; Skeggs, 2005). The popular media in Britain depicts women's drinking as unfeminine, immoral and irresponsible (Rolfe et al., 2009), especially for women from socio-economically disadvantaged backgrounds (Mackiewicz, 2015). As Skeggs (2005) highlights, the disgust reserved for single mothers during the 1980s is now levelled at working-class women who visibly drink to get drunk.
Traditional discourses concerning feminity and sexuality arise from historical, social, institutional and political processes embedded within a wider intersectionality. Intersectionality recognises identity formation as made up of many psycho-socio environmental factors, such as access to education and health resources, culturally dominant practices, gender-based violence and economic status (Clark, Handlovsky, & Sinclair, 2015). Through the lens of intersectionality the concept of the “universal woman” and the notion of universal experiences can be questioned when encountered (Clark et al., 2015 p.128).
Biological, gender-related and psycho-socio-cultural factors intersect with and impact upon observed alcohol-related behaviours, consumption and the trajectory of alcohol use disorders. Women who drink heavily are at an increased risk of medical conditions, and are more likely to have co-morbid mood and anxiety disorders than their heavily drinking male counterparts (Dawson, Goldstein, Moss, Li, & Grant, 2010). This is predictive of further heavier alcohol consumption. Alcohol dependency in adulthood has been linked to adverse childhood events involving emotional, sexual and physical abuse and witnessing intimate partner violence in childhood (Anda et al., 2002; Escobar-Chew, Carolan, & Burns–Jager, 2015; Felitti, 2009; Salmon, 2011). Women with experiences of childhood abuse and victimisation are further considered to be at an increased risk of re-victimisation in adolescence and adulthood (Escobar-Chew et al., 2015). Experiencing more than one traumatic life experience has been shown to have a cumulative effect on symptom complexity, with repeated traumas being associated with multiple symptoms. In addition to post-traumatic stress, these include somatic conditions, depression, dissociation, anger and anxiety, and this is often referred to as complex trauma (Briere, Kaltman, & Green, 2008; Courtois, 2008; Escobar-Chew et al., 2015).
Often women in abusive and violent relationships are isolated from their friends and family by their partners, minimalizing their sources of support and creating a void in which alcohol use can become a crutch upon which women rely to function (Galvani & Toft, 2015). These obstacles to regular attendance with services contribute to a backdrop of cognitive, medical and psychiatric complexity. Women are more likely to seek help from non-alcohol related health services, rather than alcohol specific services (Erol & Karpyak, 2015), possibly to guard against stigma and shame and feelings of guilt (Rolfe et al., 2009). There are additional barriers relating to childcare concerns, and poor mental and physical health (Doab et al., 2015) make it harder for women to navigate and achieve regular attendance with services (Galvani & Toft, 2015).
A growing body of research evidences how the physical sensations and emotions experienced during a traumatic event are experienced as distressing and distrupting physical reactions in the present (Van Der Kolk, 2014). States of hyperarousal or hypoarousal are common, often triggering self-management behaviours, such as the use of alcohol (Van Der Kolk, 2014). The emergence of trauma informed practice is in response to this growing evidence base. Key components of this approach include: maintaining personal safety, teaching empowerment and new coping skills and gaining insight into how mental health and substance use are linked to trauma (Chung, Domino, & Morrissey, 2009). Service structures and systems may inherently be retraumatising to service users through a lack of integration and flexibility, and through service user involvement, these can be remodelled to be trauma informed (Chung et al., 2009).
Parental alcohol misuse is more prevalent than parental illicit drug use, and likely to come to the attention of services later (Adamson & Templeton, 2012). Excessive parental alcohol use may be especially hidden for mothers who fear being judged as not living up to social constructions and liberal ideals pertaining to being a “good mother”, including being emotionally and financially supported to devote unlimited amounts of time, love and physical labour in order to raise healthy children (Banwell & Bammer, 2006; Brown, 2006; Salmon, 2011). However, many women experience mothering as more frustrating, isolating and difficult than they first anticipated and feel under pressure to live up these ideals (Banwell & Bammer, 2006).
Mothers entering public law proceedings are typically experiencing a range of socio-demographic and psychosocial difficulties. These include intergenerational substance misuse and a lack of family and social support, experiences of being in local authority care themselves as children, poor psychological health, histories of trauma, intimate partner violence, alcohol and illicit substance use, low educational attainment, poverty, and being left to the task of parenting alone (Marcenko et al., 2011; Doab et al., 2015; Escobar – Chew et al., 2015). Moreover, mothers find their experiences of being in court to be both alienating and traumatic (Broadhurst et al., 2015; Hunt, 2010).
Adding to this picture is the inconsistent provision of training and lack of guidance and tools for social workers to use in assessing and working with parental substance use (Galvani, Hutchinson, & Dance, 2014). The conditional and time limited nature of social work interventions, as shaped by welfare policies, creates further barriers to social workers engaging mothers in a relationship and adds to feelings of distrust on both sides (Featherstone, Broadhurst, & Holt, 2011).
Given that mothers with an identified history of excessive alcohol use whose children enter care proceedings face considerable psycho-social-cultural, medical and family justice system related challenges, little is known about how these mothers go about making lasting changes to their alcohol use in order to retain care of their children. Using Interpretative Phenomenological Analysis (IPA) the aim of this study was to explore the understanding and sense-making women apply to both their alcohol use and their position as mothers in the processes and systems around care proceedings.
Section snippets
Theoretical Approach
Interpretative Phenomenological Analysis (IPA) provided the analytic framework for this study. Its ideographic focus is concerned with how individuals experience, make sense of and relate to novel or complex events or process (Larkin, Watts, & Clifton, 2006; Smith & Osborn, 2007). Drawing upon Heideggerian and hermeneutic phenomenology and interpretation, IPA is concerned with the person in context (Larkin et al., 2006; Smith & Osborn, 2007). Heidegger questioned the Western preoccupation with
Results
This paper focuses on two areas of investigation: how mothers make sense of their alcohol use, and how mothers make sense of the systems and processes around care proceedings. See Table 1 for super-ordinate themes, and sub-themes within these areas.
Discussion
Participants contextualise and make sense of their alcohol use as being primarily relational, a function of their intrapsychic worlds, for example using alcohol to ameliorate intense fear and provide some form of emotional regulation to cope with previous and ongoing negative situations or trauma. (e.g. Dawson et al., 2010). Alcohol use is further understood as playing a role in facilitating interpersonal relationships such as within intimate relationships, the family and wider community
Conclusions
This exploratory study forms a valuable contribution to the literature in an area which is currently under-researched and poorly understood. Future research designs should consider how best to reach this population of women, so that a more representative sample can be studied.
Increased training, awareness and delivery of trauma informed practices across statutory and third sector agencies would clearly be of benefit to these mothers and to the professionals wanting to connect with and engage
Acknowledgements
This study was supported by the Nuffield Foundation http://www.nuffieldfoundation.org/bridging-evidence-gap-family-proceedings
CRediT Roles
Maggie Boreham: data curation, formal analysis, investigation, methodology, project administration, resources, software, writing original draft.
Sally Marlow: conceptualisation, formal analysis, funding acquisition, investigation, methodology, supervision, writing (review and edit).
Gail Gilchrist: conceptualisation, funding acquisition, investigation, methodology, supervision, writing (review and edit).
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