A cultural taboo? The muted issue of alcohol abuse

Overconsumption of alcohol is a substantial factor in many accidents and health problems presented to health care services and are also an important cause of diseases globally and nationally. Alcohol problems put heavy strain on families and children and have potentially long-term health effects on the children. Several studies show that problem drinking often is kept as a family secret and that children experience lack of social support and professional help. Practice dilemmas encountered by professionals working with parental substance misuse are well documented. Some have described the difficult balancing acts required by professionals to develop a helping alliance with these families. In times when economic constraints are increasingly imposed on health care services, a service which meets the needs of family members, particularly children, is of vital importance. When it comes to children of patients with alcohol problems, Norwegian law obliges professionals to have an awareness of and, if necessary, intervene without request. Within health policy and services, focus regarding alcohol problems has shifted from the individual problem drinker to the affected family. Nevertheless, such approaches have often ignored the needs of affected family members themselves, and appropriate service provision to this group is still limited. The family focus in the addiction field has also fostered discourses blaming or pathologizing affected families. This project aimed to develop new knowledge about mechanisms that contribute to concealment and taboos related to alcohol problems, and implications of this. We also aimed to explore processes in everyday life that contributed to or prevented possibilities for identifying harmful alcohol use. We explored how health care professionals and other professionals approached harmful drinking from the perspectives of relatives. We carried out a qualitative interview study with adults who grew up in families with problem drinking parents. Our sample included nine individuals, three men and six women aged 25-54 years. They were recruited to interviews by professionals at two alcohol and substance abuse clinics in Oslo/Norway. The participants were asked about the help and services they had received and how their needs were met during childhood and adolescence. The interviews also dealt with childhood experiences in everyday life, and the impact of their parents` alcohol problem on their everyday lives. The data material were analysed with systematic text condensation, a method for thematic cross-case analysis (Malterud 2012). Goffman`s sociological perspectives on social interactions were used as theoretical frame of references in the articles. In spite of obvious needs, the participants had not received professional help during their upbringing. They described the feeling of being betrayed by professionals and adults who never asked about their situation or responded to their needs. Still, they also recalled significant situations with adults, who had provided safety, protection and normality in everyday life during childhood and adolescence. In the first article, we explored from childhood experiences, the preconditions for professionals being able to identify and assist families with alcohol problems (Werner and Malterud 2016). The participants described how they struggled to restore social order within the family and to act as normally outside the family, aiming towards an idealized version of the family. The second article focused on the participants` experiences from childhood and adolescence regarding how health care professionals and other professionals related to parental drinking problems. The participants described professionals who did not respond to or engage in underlying problems of children and parents. We have explored this non-responsiveness further. The third article is in progress. We focus on the participants experiences of significant situations with adults in childhood and adolescence. We explore how these supportive situations were defined, aiming to understand opportunities and limitations for translation of lay social interaction to professional encounters.

Overconsumption of alcohol is assumed to be a substantial factor in many accidents and health problems presented to primary and specialist health care services. Research indicates that health care professionals find it challenging talking with patients ab out alcohol. Several studies show that problematic drinking patterns are kept as a family secret, that children can become informal caregivers for their parents and experience lack of help and support from professionals or social network. In times when ec onomic constraints are increasingly imposed on health care services, a service which meets the needs of patients and next of kin, particularly children, is of vital importance. Early intervention and identification will contribute to reducing problems lat er in life. An important question is whether a growing specialised health care service manages to take a holistic patient approach and a family or child approach as well. This project seeks to explore the complexity of alcohol and problem drinking, how it is perceived by health professionals and how they respond and relate to it. The aim of this project is to develop new knowledge about the implications of concealment and taboos related to the problematization of alcohol use. This will be done by explor ing professionals` reflections about episodes in which patients come for treatment for illness or injury while under the influence of alcohol, and the way this is handled. We will focus on factors that promote or prevent professionals from bringing up alc ohol as an issue in the encounter, and when or how health professionals relate to or contact the patients` next of kin. Our attention will be directed towards interactional processes that can contribute to a better understanding and management of alcohol and problem drinking, and associated dilemmas and challenges. The data will be generated by in-depth interviews with professionals from hospital and emergency wards.