Parents who are alcoholics: Towards a normative framework of integrative care and responsible parenting interventions

Parents who are alcoholics parent in a context of great concern regarding the harmful effects of parental alcohol use on child wellbeing and family life. The goal of this project is to develop a normative framework for interventions with alcoholic parents and their families. To this end, insight will be gained into selected interventions practices covering both addiction care and youth care perspectives. We will explore how stakeholders (parents and professionals) experience these practices, how they view the problems that alcoholism poses for parenthood and which solutions they consider. The project will further systematically reflect on the implications of a biopsychosocial and a normative approach to compulsive drinking. Thereby, it will in particular focus on the question, whether, and if so why and how, alcoholism undermines people’s decision-making capacity and as a consequence of that also limits their parental capacities, of even renders these non-existent. This has direct repercussions on the question whether and which potential child protection measures are justifiable, or required, from an ethical point of view. On the basis of both empirical ethical qualitative research and a normative ethical analysis, the project contributes to the development of an integrative normative framework for responsible family interventions in case of parental alcoholism. The project is guided by the following main research question: What are the contours of a normative framework for the care of parents who are alcoholics? The proposed project is of great relevance for the ZonMW-programme ‘Ethics and Health’. By addressing the topics of alcoholism and parenthood it targets important issues in both adult and youth mental health care. That is, conditions of adequate addiction care of alcoholic parents get discussed and in addition our project addresses youth mental health problems of the children concerned, as they are particularly at risk of such harm in case their alcoholic parents neglect or maltreat them. Against this background, the project has significant social and scientific relevance. The project’s social value derives from the high number of affected families in need of appropriate care. Moreover, recent policy developments might impact relevant practices and directly affect the target group. This holds for the increasing emphasis on early prevention in current Dutch youth care as well as for possibilities of coercion in ambulatory settings in upcoming Dutch mental health laws. The scientific value of this project arises particularly from the current situation in which a biopsychosocial model of addiction prevails, the ethical implications of which are still unclear. To date, ethical discussions mainly focus on biomedical approaches and whenever psycho-social findings are considered as well, both areas of research are considered independently, if not even opposed to each other. The proposed project will improve on this situation and consider a comprehensive biopsychosocial understanding of alcoholism. Moreover, it pays attention to moral discourses and takes philosophical discussion on the agency of alcoholics into account. Against this broad background, it reflects on residual capacities – if any – and relevant limits of alcoholic parents to parent a child. This will result in substantive contributions to a normative framework for interventions in families of alcoholic parents that establishes a fair balance between child welfare and protection and parental autonomy and capacities. Moreover, it will contribute to the question how to balance potential coercive child protection measures, like child-custody cases, with social or institutional responsibilities to provide effective and accessible care. In sum, this project comprises theoretical ethical analysis of the conditions of justifiable and desirable interventions and a qualitative empirical research that reveals the views and perspectives of stakeholders (professionals and parents) involved in both youth care and addiction care respectively. In its empirical part, it closely collaborates with Bureau Jeugdzorg Limburg (Youth Care Office Limburg) and the ‘Nijmegen Institute for Scientific Practitioners in Addiction’. The project will implement its results by means of articles in international academic journals and national professional journals. In order to reach the field of both professionals and parents more directly, we will also organize an invitational conference for professionals from youth care and addiction care from all over the Netherlands and produce a brochure as well as a fact-sheet on the topic where we present the results of the project in a maximally broad setting. The project will be conducted by well-experienced researchers who previously have been involved in medical ethical research on mental health topics related to the those targeted at in the proposed project and who also have broad experience with the planned empirical-ethical study.