Governing Parental Drug Use in the UK: What’s Hidden in “Hidden Harm?”

In 2003, the UK Advisory Council on the Misuse of Drugs published Hidden Harm, the product of an inquiry that exposed the “problems” of parental drug use and its neglect by professionals. It outlined an extensive program of reforms designed to protect children from harm. Despite its far-reaching influence, it has rarely been subject to scrutiny, with analyses focusing on its impact instead. Drawing on Bacchi’s post-structuralist “What’s the Problem Represented to be” approach, we examine problematizations within Hidden Harm and their implications for the governance of family life. We illustrate how Hidden Harm produced a simplified version of parenting and child welfare within the context of drug use by largely equating drug use with “bad” parenting and child maltreatment and by ignoring the social determinants of health and the wider social ecology of family life. Using a tried-and-tested driver of policy change, Hidden Harm created a “scandal” about the lack of intervention by professionals that was used to justify and legitimize increased state intervention into the lives of parents who use drugs. Hidden Harm proposed simplistic “solutions” that centered on drug treatment, child protection and the responsibilization of professionals to govern “risky” parents. We argue these rationalities, subjectivities and strategies serve to marginalize and stigmatize families further and hide alternative approaches to understanding, representing and responding to the complex needs of children and families who are disproportionately affected by health and social inequalities. By uncovering what is hidden in Hidden Harm, we aim to stimulate further research and theoretically informed debate about policy and practice related to child welfare, parenting and family life within the context of drug use. We conclude with some ideas about how to reframe public discourse on parents who use drugs and their children, in tandem with collaborative responses to alleviate child poverty and inequalities.