Commentary on Welford, Danielsson & Manhica: The complexity of life conditions among offspring exposed to parental SUD.

Knowledge regarding the complexity of life circumstances of children exposed to parental substance use disorder may be important to reduce negative consequences related to parental substance use disorder, such as NEET status.

Welford, Danielsson & Manhica [1] have reported that exposure to parental substance use disorder (SUD) before the age of 17 years is associated with increased risk of being not in education, employment or training (NEET) during early adulthood. This conclusion is founded upon register‐based analyses, adjusted for birth year, domicile, origin, psychiatric diagnosis, household income and parental psychiatric diagnosis. This is an acknowledged analysis strategy we have often applied ourselves. However, are we at risk of losing information regarding complexity on our path to reduce bias?

Results from the study also indicated that most children of parents with SUD had experienced multiple difficult life circumstances, including low income and parental psychiatric diagnosis. In line with these results, other studies have reported that offspring of parents with alcohol use disorders are more likely to have multiple adverse experiences [2, 3]. However, by adjusting for factors that may be causally related to NEET status we can lose sight of the complexity of difficult childhood circumstances, an understanding of which is important in order to tailor interventions to groups at risk. Studies within the addiction field could benefit from research within the area of adverse childhood experiences (ACE), which have shown a cumulative negative effect on a range of adverse outcomes related to the total load of adverse life experiences [4, 5, 6]. The adverse life circumstances described in the study from Welford et al., such as parental SUD, parental psychiatric diagnosis and low income, are most probably long‐lasting characteristics of the childhood situation. It is therefore likely that the total load of life difficulties matters when it comes to affecting how life develops for these children, and that life difficulties often are inter‐related [7].

In line with results from the study of Welford et al., previous studies have reported that adverse childhood experiences, including household substance disorders, are socially patterned [8, 9]. Individuals with low socio‐economic statuses report more ACEs [8]; however, ACEs are also thought to impact adult income, education attainment and employment [10]. In the study by Welford et al., four out of 10 exposed to parental SUD were in the lowest income quintile at age 16 years, which is more than twice as many as those who were not exposed to parental SUD. Thus, in addition to growing up within a family environment that may be dysfunctional due to parental SUD [2], life opportunities may also be limited by household income. Low household income may be a result of low parental education, unemployment or other conditions that may cause economic instability. Welford et al. account for this by adjusting for income; however, some of the complexity of children growing up with multiple life difficulties may be lost.

The study presents inadequate parenting due to parental SUD as a possible mechanism as to why children with parental SUD have an increased risk of becoming NEET. However, low parental education or marginalization within the labour market among parents with SUD could also limit parental resources in supporting their children academically. Adjusting analyses for income may be insufficient to account for these possible factors. Further, the majority of children exposed to parental SUD were also exposed to other parental psychiatric diagnoses (80%), compared to a very small minority among children not exposed to parental SUD (2.3%). This also contributes to a heavier life load on these children, making it understandable that educational attainment may be difficult to pursue.

Investigating the complexity of the situation of children exposed to parental SUD is essential for the development of multi‐faceted interventions that could reduce negative consequences of parental SUD, such as NEET status. Interventions should be tailored according to the complexity of the situation for each youth and address multiple systems such as school, family and leisure time and social activities. They could, for example, include help with homework or other educational supportive interventions, treatment related to parental SUD and/or mental illness, parenting programmes to support the development of parenting skills, work or educational opportunities to parents to improve family economy, therapeutic support or group therapy to children to deal with adverse consequences of living with parents who have SUD and/or mental illness and financial support specifically aimed at inclusion of the children in leisure activities. Such broad approaches would probably also be beneficial linked to other adverse outcomes related to parental SUD than NEET status.

DECLARATION OF INTERESTS

None.

AUTHOR CONTRIBUTIONS

Siri Haugland: Conceptualization. Tonje Stea: Conceptualization.