Part 4: Specific support needs and concerns 151 National Guidance for Child Protection in Scotland 2021 Version 1.0 September 2021 Children and families affected by alcohol and drug use Guidance on neglect, domestic abuse and pre-birth child protection are adjacent in this section and closely inter-related. 4.122 Public, child and family health. Parental alcohol and drug use is a significant public health problem present in all income groups, cultures and areas of Scotland. Directly and indirectly, it contributes to the abuse and neglect of thousands of children and can cause harm through various forms of loss, through imprisonment, illness, disturbed and broken relationships and death. Parental alcohol and drug use overlaps and intersects with domestic abuse, neglect, emotional abuse and parental mental ill health as dominant reasons for child protection registration and the need for children to be looked after. There is a strong link between problem drug and alcohol use, deprivation, and trauma. In this context compassion, understanding and workforce resilience are essential within effective child protection. 4.123 Prevalence. The availability, relative cheapness and social acceptability of alcohol make it the substance with most widespread impact. Alcohol-related deaths are twice as high in Scotland as the rest of the UK. Over the last ten years, drug-related deaths have risen in Scotland and are the highest in Europe. Opioids are implicated in most drug-related deaths. The Psychoactive Substances Act 2016 creates a blanket ban on the production, distribution, sale and supply of psychoactive substances in the UK (which is underpinned by criminal offences and civil sanctions). However, novel psychoactive substances are still a growing cause of harm. NHS Scotland estimates 55,800 to 58,900 individuals had substance use problems in 2015-16. Of these, 71% were male, concentrated in the 15-24 age bracket. Drug problems in people aged over 35 is now a growing issue. 4.124 Significant harm is not an inevitable consequence of parental alcohol and drug use. The probability of significant harm will relate to the extent to which each child’s needs (as considered within the context of the My World Triangle) are met, blocked or disrupted by the causes, cycle, circumstances and consequences of seeking, paying for, using and experiencing substances by the parent(s). The significance and urgency of the impact will depend on factors to do with the drug, the pattern, the parents, the child, and the multi- dimensional impact upon safety, health, nurture and, by chronic interaction, to all aspects of wellbeing. Every drug-related concern about a child has a distinct context, history and degree of urgency. 4.125 Harm may be multi-dimensional , affecting physical and mental health and development, relationships, behaviour, identity and survival. This could include physical and neurological damage, or death in utero. Foetal Alcohol Spectrum Disorder (FASD) is the leading known worldwide preventable cause of neurodevelopmental disorder, with maternal use of alcohol during pregnancy leading to learning and behavioural difficulties. It potentially has lifelong implications, affecting not just babies and children but also young people, and adults and their families, who will be living with the impact of the condition. Where child protection concerns in pregnancy include the use of alcohol, this must form a focus for multi-agency support. 4.126 It is essential to consider and take steps to safeguard children from harm caused by access to substances in the home.