the harm to children from parental problem drug use should become a main objective of policy and practice.’ So says the landmark 2003 report Hidden harm – responding to the needs of children of problem drug users.

That report, the product of three years of enquiry by the ACMD, ran to more than 100 pages and laid out 48 recommendations covering everything from data collection to the role of the criminal justice sector. So more than two decades, eight prime ministers and 14 secretaries of state for health later, has that stated aim become ' a main objective of policy and practice’?

A good way to judge that is to follow the money. If it’ s a‘ main objective’ then it’ s reasonable to expect it to attract a proportionate share of funding. In 2025 Adfam reported its findings from the first ever England-wide survey of local authority spending on specialist drug and alcohol family support services. While these services may not be the only support available in an area, they’ re often the only place within local drug and alcohol systems where the focus is on the non-using carer or parent; the person who so often looks

after the children, manages the finances and provides much needed stability.

The level of funding allocated to these vital local services provides a good indication of the importance placed on their work. Of the 150 local authorities that Adfam contacted, half were unable to say if they spent anything at all on services supporting the families and carers of people with alcohol or drug problems. Of the areas that were able identify an amount, the average allocated from their total drug and alcohol budget was less than 2 per cent. Thirteen areas reported that they spent nothing at all.

The Hidden harm report clearly and unequivocally evidenced the profound negative effects that parental drug use has on children. Many of those effects can last a lifetime.

Since then, a growing body of research has demonstrated the very positive impact a nonusing parent or carer can have, and shown how that person can become the most important protective factor in a child’ s life. Yet for every pound spent from publicly funded drug and alcohol budgets, less than 2p is spent supporting the many nonusing family members, including children, impacted by someone else’ s drinking or drug use.

Local authorities must take some responsibility for this – it is they, after all, who allocate the funding and commission the services. While Adfam found that some areas are spending next to nothing, others are earmarking close to 10 per cent of their budget on family support – which indicates that there is room for local decision making and some areas are choosing to support those affected by a loved one’ s substance use.

That said, even the most supportive councils tend to focus their attention on the priorities set by successive governments. It’ s hardly surprising that some areas struggle to know what they spend on support for those affected by a loved one’ s substance use, when their funder – central government – never asks them. Government regularly collects information on how much is spent from substance misuse budgets to fund residential rehabilitation, needle exchanges and the cost of medications. It has asked for annual plans on how councils will provide services to rough sleepers, but it doesn’ t ask for – and doesn’ t know – how much money is allocated to help families. Nor does it know how many of those affected are helped, or what that help looks like, or crucially how many

Government regularly collects information... but it doesn’ t ask for, and doesn’ t know, how much money is allocated to help families.

children that help supports. Indeed government doesn’ t even know what help if any children receive when a parent engages with a government-funded drug or alcohol service.

The Hidden harm report ends with this:‘ In conducting our inquiry, our eyes were opened to an aspect of drug misuse of which most of us had been largely unaware. We hope this report will open the eyes and minds of many more people and stimulate a compassionate and practical response on a large scale.’

An admirable sentiment, but over two decades on – even though the eyes must have been opened – it seems that for many children and families, government is still looking the other way.

Philip Breslin is an independent consultant working with Adfam.

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