Harms to children from men’s heavy drinking: A scoping review

Abstract

Background:

Research has examined a range of impacts of women’s drinking on children. However, fewer studies have addressed the consequences of men’s heavy drinking on children. This review aims to identify and describe men’s behaviours and actions that arise from their drinking and are likely to cause harm to children, and the types of harms that stem from men’s drinking that children experience.

Methods:

Review articles from 1990 to September 2023 were included. Four health and social databases were searched for reviews that included terms relating to men, alcohol consumption, and child harms. From 1,873 identified articles, 19 articles met the criteria for inclusion.

Results:

Four broad topics were identified: relationships and families; violence and maltreatment; health, psychological and wellbeing impacts; and social and educational outcomes for children. Children may experience both direct and indirect harms associated with men’s drinking. The former includes examples where men’s drinking was linked to disinhibition, aggression, and physical assault. In the latter, men were absent resulting in being emotionally unavailable due to drinking. Internalising and externalising behaviours were common outcomes for children exposed to men’s drinking. Contextual factors such as poverty, cultural norms and patriarchal influences were interrelated and sometimes exacerbated harm to children from men’s drinking.

Conclusions:

This review highlights the immediate and longer-lasting consequences of men’s drinking for children, including family conflict, maltreatment, and emotional distress. Future studies should address gender disparities and consider the social factors present in cases where children are exposed to men’s drinking.

Introduction

Children, including adolescents, may be affected by their own consumption of alcohol and by others’ drinking (Kaplan et al., 2017; Laslett et al., 2019). The range of effects of others’ drinking on adults, termed alcohol’s harm to others has been increasingly explored (Karriker-Jaffe et al., 2018; Laslett et al., 2023; Ramstedt et al., 2015), yet less attention has been paid to the ways in which children may be affected by others’ drinking. The literature has identified harms to children throughout their development. In utero, children can be affected by foetal alcohol spectrum disorders (FASD) and a range of neurodevelopmental defects (Lange et al., 2017; Popova et al., 2012). Studies have identified how older children and young people model their parents’ drinking behaviours from an early age (Hutchinson et al., 2008; Rossow et al., 2016a), and many studies note that there is an increased risk of child abuse and neglect, and subsequent child protection service involvement for children of parents who use alcohol and other drugs (Famularo et al., 1992; Laslett et al., 2012c; Raitasalo & Holmila, 2016; Rossow et al., 2016a). This literature was previously described as that concerned with the children of alcoholics (COA; Braithwaite & Devine, 1993; Moos & Billings, 1982; Timko et al., 2014), but has since evolved to include a broader understanding of the impacts of parental drinking upon children. A 2017 study from the United States (US; Lipari & Van Horn, 2017) using national data from 2009–2014, found that some 6.1 million (12.1%) children under 18 years lived in two-parent households where at least one parent had an alcohol use disorder (AUD). Of children living in single-parent households with a parent with AUD, 1.1 million (6.3%) were in mother-only and 273,000 (9.3%) in father-only homes. A limitation of the COA literature, though it deals with protective as well as risk factors for children, is that it does not generally distinguish the gender of the parent/s (Park & Schepp, 2015a). Recent reviews (McGovern et al., 2020; Rossow et al., 2016a) reveal that non-dependent alcohol use by parents may be related to harms to children, although researchers have not investigated this as much as the consequences of parental AUD. It should be noted that terms such as parental AUD, harmful drinking, and problematic drinking are often used interchangeably in the literature. For clarity, this review uses the term heavy drinking to describe situations involving various amounts and patterns of parental drinking that may not necessarily be epidemiologically or clinically defined consumption, but may still affect children.

A European study utilizing data from the Standardized European Alcohol Survey project and Eurostat aimed to assess the prevalence of children cohabiting with individuals exhibiting problematic drinking patterns across 19 European countries (Tamutienė & Stumbrys, 2023). A four-item version of the Rapid Alcohol Problems Screen test (Cherpitel & Ye, 2015) to quantify problematic drinking behaviour was used. Prevalence rates of children residing with at least one person demonstrating a problematic drinking pattern ranged from 6.2% in Italy to 35.2% in Lithuania, totalling an estimated 9,271,150 affected children in the 19 European countries in 2015. Statistically significant differences (p < 0.05) were observed between men and women in the prevalence of respondents cohabiting with children and reporting problematic drinking patterns in 17 out of the 19 European countries. Results indicated a notable variation in the maximal relative gap between parental genders, ranging from 1.60 times in the UK to 24.72 times in Romania. Consequently, a significantly larger proportion of children in Europe reside with men compared to women exhibiting problematic alcohol consumption (Tamutienė & Stumbrys, 2023).

Compared to women, men are more likely to consume alcohol, and drink in excess (Bratberg et al., 2016; Greenfield et al., 2023; Livingston et al., 2018; Livingston & Callinan, 2019; Slade et al., 2016). Research has demonstrated that men are disproportionately affected by AUD and substance use disorders, compared to women (Rehm & Shield, 2019; Schuckit, 2009) and have been the focus of much research on alcohol consumption and alcohol-related problems (Bratberg et al., 2016; Livingston et al., 2018). Consequently, men’s drinking potentially affects a higher proportion of children than does women’s drinking. However, the consequences of men’s alcohol use on families and children have largely been overlooked by research, public policy, and service delivery (Dimova et al., 2021; Duncan et al., 2022;Farrugia et al., 2022; Zanoni et al., 2013). Rather the focus has, often disproportionately, been upon women (Scourfield, 2001). There are many reasons that men or fathers have been largely overlooked or excluded. For example, in child protection investigations, single mothers are often the main client base (Baum, 2016; Nygren et al., 2019; Zanoni et al., 2013). This is not to suggest that mothers are responsible for child maltreatment, rather that in these cases fathers may play a secondary caregiving role, or other complex reasons may exist. Fathers may be difficult to access, they may be more difficult clients, or they may be the perpetrators of family violence (FV) or intimate partner violence (IPV) from which the mother is fleeing (Graham et al., 2008).

Men’s drinking in a family context is related to direct and indirect harm to children (Karriker-Jaffe et al., 2023). There is consistent evidence that heavy alcohol use is linked with violence in IPV and FV settings (Greene et al., 2017; Leonard & Quigley, 2017; Ramsoomar et al., 2021), and is often witnessed by children. Alcohol use in these situations may exacerbate existing forms of violence by increasing the frequency and severity of violence (Roberts, 1987). Alcohol use has been associated with neglect and physical violence towards children (Laslett et al., 2012a). In addition to overt effects, there are other, potentially more nuanced ways in which men’s drinking habits can impact their family members. One such way is through diminished parenting quality, particularly when the father is under the influence of alcohol (Chassin et al., 1996; Rangarajan, 2008; Su et al., 2018). Heavy alcohol consumption can impair a father’s ability to establish a safe environment for his children, potentially elevating the risk of accidents or rendering the children more susceptible to harm from individuals other than the drinking father (Laslett et al., 2012b). Alcohol use by men may also have broader social and economic consequences for children, for example financial consequences due to men’s inability to work or obtain secure employment due to heavy alcohol consumption or AUDs (Kendler et al., 2017; Wilson et al., 2024).

This scoping review (a review of reviews) was informed by a socio-ecological perspective, and this approach explored how social factors influence ecological systems and vice versa (McLeroy et al., 1988). Children’s experiences of harm from men’s drinking are complex and may be influenced by individual-, family-, community-, and societal-level factors. A socio-ecological perspective considers the interconnectedness of these factors. This perspective identifies both the direct impacts associated with men’s drinking and the influence of broader social and cultural norms. A scoping review design allowed for a comprehensive and exploratory examination of the existing global literature, facilitating the synthesis and categorisation of how children can be affected by the drinking on men. More specifically, the objectives of this scoping review of reviews were to:

1. Identify and describe the types of behaviours and actions that arise from men’s drinking that are likely to cause harm to children.

2. Identify and describe the types of harms and outcomes to children that stem from men’s drinking.

3. Explore how socio-ecological factors may influence men’s drinking and potential harms to children.

Methods

We searched for peer-reviewed review articles to identify what is known about the consequences of men’s drinking for children. This scoping review draws on a range of research to include as many dimensions of potential harm as possible and to avoid missing relevant reviews (Pham et al., 2014). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used a guideline for this review (Tricco et al., 2018; see Additional File 1). The current scoping review was not pre-registered.

Overview of the Phases of the Search for Relevant Literature

1. Initial searches of PubMed, Medline, PsycINFO and CINAHL were undertaken in July/August 2022. Google Scholar was also used during the initial search.

2. Reference list searching and forward citation searching of relevant review articles was used to identify additional references.

3. A final database search was conducted in September 2023 for recently published articles.

Search Strategy

Database searching was used in Phases 1 and 3 of the search strategy. The database search included a range of terms across men’s alcohol use, children, and either harms or outcomes to children. The search strategy for PubMed is outlined below; this was adapted in minor ways to use for other databases. Filters were placed on the searches to include reviews or systematic reviews (PubMed); where a database did not have options to filter the search, the following search terms were added: ‘review’ or ‘systematic review’ or ‘scoping review’ or ‘narrative review’ or ‘literature review’. The database search performed in September 2023 used the same search terms as in the first phase of searching, however time filters were applied from 2022 to 2023. In addition to database searching, the first author searched the reference lists of included reviews, and searched papers that had cited the review (backwards and forwards searching). For the backwards and forwards searching, bibliographies were searched using Google Scholar.

Search Terms

The search strategy was structured as: ‘alcohol drinking’ [MeSH Terms] or ‘alcoholism’ [MeSH Terms] and ‘alcohol use’ or ‘alcohol abuse’ or ‘binge drinking’ or ‘binge alcohol consumption’ or ‘alcohol* drink*’ or ‘alcohol misuse’ or ‘harmful alcohol use’ or ‘risky alcohol use’ or ‘risky drinking’ or ‘alcohol use disorder’ or ‘alcohol addiction’ or ‘alcohol dependen*’ [title/abstract] and ‘men’ [MeSH Terms] or ‘male’ [MeSH Terms] or ‘men’ or ‘male’ or ‘father’ or ‘dad’ or ‘paternal’ or ‘step?father’ or ‘brother’ or ‘uncle’ or ‘grandfather’ [title/abstract] and ‘child abuse’ [MeSH Terms] or ‘child maltreatment’ or ‘family violence’ or ‘family conflict’ or ‘child neglect’ or ‘adverse childhood experience’ or ‘harm to children’ or ‘violence against children’ or ‘children of alcohol*’ [title/abstract].

Eligibility Criteria

Eligibility criteria for inclusion and exclusion are summarised in Table 1. For inclusion, reviews must have addressed the intersection between men’s drinking and harms or outcomes to children. While this is a broad criterion, our review was concerned with identifying and describing all types of harms to children resulting from men’s drinking. Initially, only review articles that were focused on men’s drinking were included for review. However, as there were too few of these, our eligibility criteria were revised to include parents’ drinking where review articles differentiated between the genders of the persons who drank. Inclusion required articles to be in English, peer-reviewed review articles or reviews as book chapters, and to include a method section. Reviews solely concerned with child/adolescent alcohol consumption as an outcome were excluded, due to extensive literature that covers this area (Rossow et al. 2016b) and this was deemed out of the scope of our review.

Table 1.

Inclusion and Exclusion Criteria for the Review of Reviews

Inclusions	Exclusions
Addressed the intersection of men’s alcohol use and consequences for children/families	Did not address the impact of men’s/father’s alcohol consumption on children
Distinguished between the gender of the parent and the consequences of their drinking on children	Did not distinguish at all between men and women’s drinking in the results section
Outlined either the consequences of men’s drinking for children; or the outcomes for children from men’s drinking; or the mechanisms behind the harm	Did not distinguish between alcohol or drug use (i.e., using ‘substance’) in the results section
Reviews of the literature (scoping, literature, narrative, systematic, or rapid reviews)	Grey (i.e., unpublished) literature
Book chapters or peer-reviewed journal articles	Solely focused on adolescent alcohol use as an outcome to parental alcohol exposure
Published in English	The effect of alcohol exposure in utero or other biological factors
Methods outlined	Child sexual abuse

Review Selection and Data Extraction

Results from the database search were downloaded and imported into EndNote. Initially, only titles and abstracts were screened by the first author. However, it became evident that the results section also needed to be included in screening because abstracts often discussed the impact of ‘parents’ drinking without identifying the parents’ gender. The first author assessed 42 review articles for full-text review. Following full-text review, 19 review articles were identified as relevant for inclusion and data extraction. Initial topics were identified by the first author who distributed the reviews among the group of five co-authors based on the preliminary topics. Data was extracted by all reviewers who collated this data into an Excel spreadsheet. The extraction information was revised iteratively as necessary. Extraction information primarily included:

1. Review characteristics: design, aims, country/region, total number of papers for review, number of male-specific studies included.

2. Outcomes: primary male-specific alcohol-related findings, outcomes for children, mechanisms of harm, contexts of harm or alcohol use (if relevant).

Data Synthesis

Data were extracted by all authors using a narrative synthesis approach to present a summary of the key characteristics, findings and topics among the reviews (Campbell et al., 2020). This process allows for a comprehensive summary of the review literature to identify patterns and similarities among the reviews. Preliminary topics were identified by the first author based on the common areas discussed and studies in the reviews. The preliminary topics were discussed and refined collaboratively through data extraction and synthesis among all co-authors. During this process, we examined the key findings and patterns across the included reviews. Topics were identified iteratively, with the final overarching topics aimed to capture the broad findings and insights from the included reviews.

Results

Characteristics of Included Reviews

In total, 42 reviews were full-text screened, resulting in 19 eligible reviews for analysis. Table 2 shows a summary of the characteristics of the included review articles. The reviews mostly included studies from high-income countries (HICs). Only three reviews (Giusto & Puffer, 2018; Huq et al., 2020; Jokinen et al., 2021) were primarily focused on low- and middle-income countries (LMICs). Only three reviews (Giusto & Puffer, 2018; Karriker-Jaffe et al., 2023; Park & Schepp, 2015b) were primarily concerned with men’s drinking; the remainder included both men’s and women’s drinking. However, even when both men and women were included and distinguished, often the reviews mostly discussed the impacts of women’s drinking on children. When the reviews discuss men’s drinking and their impact on children they most commonly were referring to fathers’ drinking but some reviews referred to the drinking of a wider range of men, including other family members and men in the community. Most reviews were either systematic reviews (n = 8) or narrative literature reviews (n = 5), two were reviews of reviews, one was a scoping review, one was a meta-analysis, one a rapid evidence review and one a critical interpretive synthesis. All reviews were peer-reviewed journal articles, except one which was a chapter in a book. Where it was possible to determine the proportion of male-specific literature included in the reviews, it was generally low. Five reviews (Chan et al., 2021; Choenni et al., 2017; Isobe et al., 2020; Orford, 1990; Zanoni et al., 2013) did not provide information about the number of gender-specific studies but did include some gender-disaggregated results. Some reviews included findings on ‘substance use’ which included both alcohol and drugs; where this was the case only the alcohol-related findings were reported in the present review.

Table 2.

Characteristics of Included Review Articles on Harm to Children from Men’s Drinking

Review	Aims	Design	Regiona	Number of Studies	Number of Gender-Specific Studiesb	Relevant Topics and Contexts
1. Karriker-Jaffe et al. (2023). Can alcohol policy prevent harms to women and children from men’s alcohol consumption? An overview of existing literature and suggested ways forward.	To provide evidence of harms experienced by women and children from men’s drinking; to assess the impact of cost-effective alcohol policies on these harms; to explore options for making policy and evaluations more relevant and inclusive of these harms; and advocate for a comprehensive approach that takes alcohol’s harms to others into consideration.	Review of reviews	Global – mostly HICs (Australia, US, Northen Europe)	29	29 (only 9 included child-outcomes)	Maltreatment, health, psychological and wellbeing impacts
2. Choenni et al. (2017). Association Between Substance Use and the Perpetration of Family Violence in Industrialized Countries: A Systematic Review.	To assess studies in industrialised countries investigating the association between substance use and perpetration of family violence.	Systematic review	HICs	96	N/A (only 27 studies included child-outcomes)	Family violence; maltreatment; poverty; intimate partner violence
3. Chan et al. (2021). Prevalence and Correlates of the Co-Occurrence of Family Violence: A Meta-Analysis on Family Polyvictimization.	To provide estimates of prevalence rates of family polyvictimization by synthesising the existing literature; to examine the effect sizes of the impact of one type of family victimization on other types of family victimization; and to investigate the correlated of family polyvictimization.	Meta-analysis	Global – mostly HICs	38	N/A	Family violence; intimate partner violence
4. Giusto and Puffer (2018). A systematic review of interventions targeting men’s alcohol use and family relationships in low- and middle-income countries.	To review interventions in LMICs assessing men’s alcohol use and its impact on family outcomes; to identify common characteristics among interventions that improved men’s drinking and relationship-based family outcomes; and describe the strategies and implementation methods.	Systematic review	LMICs	9	9 (only two studies included child-outcomes)	Family environment; poverty
5. Jokinen et al. (2021). A Systematic Review of Household and Family Alcohol Use and Adolescent Behavioural Outcomes in Low- and Middle-Income Countries	To identify research on the impact of excess alcohol consumption among household adults on adolescent developmental health outcomes in LMICs; and to explore whether the use of alcohol differs by individual family members in its impact on adolescent health outcomes in LMICs.	Systematic review	LMICs	43	5	Health, psychological and wellbeing impacts
6. Zanonia et al. (2013). Fathers as ‘core business’ in child welfare practice and research: An interdisciplinary review.	To address a gap in the child welfare literature by using an interdisciplinary approach to examine the issue of poor father engagement in child welfare practice; and identify the causes, importance to child outcomes and possible solutions.	Literature review	HICs	N/A	N/A	Neglect; poverty
7. Orford (1990). Alcohol and the family: an international review of the literature with implications for research and practice.	To comprehensively review literature on alcohol and the family from around the world.	Literature review	Global but predominately HICs (Australia, US and Canada)	N/A	N/A	Family environment; relationships; family violence; maltreatment
8. Solis et al. (2012). Understanding the diverse needs of children whose parents abuse substances.	To identify the potential service needs of children of substance using parents.	Literature review	HICs (predominately US)	10	5	Relationships; maltreatment; health, psychological and wellbeing impacts; social and educational impacts
9. Wlodarczyk et al. (2017). Protective mental health factors in children of parents with alcohol and drug use disorders: A systematic review.	To provide an overview of the current state of the research concerning protective mental health factors in children of parents with alcohol or drug use disorders.	Systematic review	HICs (all but one was from US)	11	4	Health, psychological and wellbeing impacts
10. Heimdahl and Karlsson (2016). Psychosocial interventions for substance-abusing parents and their young children: A scoping review.	To give an overview of efficacy research on psychosocial interventions aimed at substance-using parents with children up to 3 years old.	Scoping review	HICs (US, Finland)	22	1	Family environment; poverty
11. McGovern et al. (2020). The Association Between Adverse Child Health, Psychological, Educational and Social Outcomes, and Nondependent Parental Substance: A Rapid Evidence Assessment□.	To review published evidence reporting on adverse health, psychological substance use, educational, and social outcomes of children of non-dependant parents who use substances.	Rapid evidence review	HICs	36	18	Relationships; health, psychological and wellbeing impacts; social and educational impacts
12. Isobe et al. (2020). A critical interpretive synthesis of the intersection of domestic violence with parental issues of mental health and substance misuse.	To identify how research into the intersection of domestic and family violence with mental health and alcohol and other drugs inform practice with children and families.	Critical interpretive synthesis	HICs	40	N/A	Family violence; intimate partner violence
13. Park and Schepp (2015a). A Systematic Review of Research on Children of Alcoholics: Their Inherent Resilience and Vulnerability.	To identify the risk factors that make children living with parents with alcohol use problems more vulnerable; and to identify the protective factors that make these children more resilient.	Systematic review	HICs	39	4	Health, psychological and wellbeing impacts
14. Park and Schepp (2015b). Understanding Korean Families With Alcoholic Fathers in a View of Confucian Culture.	To interpret the dynamics of Korean families with alcohol use problems through the lens of Confucianism, using research conducted in South Korea.	Literature review	HICs (South Korea)	11	11	Family environment; relationships; health, psychological and wellbeing impacts; cultural, patriarchal and gender norms
15. Allen et al. (2022). Family focused interventions that address parental domestic violence and abuse, mental ill-health, and substance misuse in combination: A systematic review.	To identify family focused interventions that have combined impacts on parents’ domestic violence and abuse, mental ill-health, and substance use.	Systematic review	Global (predominantly HICs)	37	6	Family environment; family violence,
16. McGovern et al. (2021). Effectiveness of psychosocial interventions for reducing parental substance misuse.	To assess the effectiveness of psychosocial interventions in reducing parental alcohol or drug use.	Systematic review	HICs (Australia, US, UK)	25	3	Maltreatment
17. Peleg-Oren and Teichman (2008). Young Children of Parents with Substance Use Disorders (SUD): A Review of the Literature and Implications for Social Work Practice□.	To review studies on children of parents with alcohol or illicit drug use disorders that focus on the developmental period of children.	Literature review	HICs	10	2	Health, psychological and wellbeing impacts
18. Hameed (2019). The tripartite tragedy: Alcohol and other drugs, intimate partner violence and child abuse.	To explore the overall pattern of the association between alcohol and drug use and intimate partner violence; and to synthesise and integrate this information to relate to families experiencing alcohol or drug use, intimate partner violence, and child abuse and neglect.	Review of reviews	HICs	13	12 (not all studies include child-outcomes)	Family environment; relationships; family violence; intimate partner violence
19. Huq et al. (2020). A Systematic Review of Household and Family Alcohol Use and Childhood Neurodevelopmental Outcomes in Low- and Middle-Income Countries.	To identify studies of the impact of excess alcohol consumption among household adults on child developmental health outcomes in LMICs; and to explore whether nature of alcohol use differs by family members in its impact on child health outcomes in LMICs.	Systematic review	LMICs	28	10	Health, psychological and wellbeing impacts

Notes:

^aRegion or country level income was either defined within the review or if this was not the case, countries were classified as high, middle or low income using the World Bank classification (see https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html).

^bGender specific studies refers to the proportion of studies that distinguished between men and women’s drinking (this was determined only by where the review had reported on the gender of the person who drinks among the individual studies, however, if we could not determine the proportion without hand-searching individual studies it is marked as N/A.

Topics Identified within the Literature

While our findings were categorised into four broad topics, many actions, behaviours and associated harms or outcomes overlap. Figure 2 provides a summary of the topics present in the literature and the contexts in which harms or outcomes occur. Our findings fell into four areas: relationships and family, violence and maltreatment, health, psychological and wellbeing impacts, and social and educational outcomes for children. Some additional contextual factors were present within the reviews, such as poverty, gender inequalities or norms, and social and cultural norms.

Figure 2.

Multiple and Intersecting Actions (Left) and Outcomes (Right) Affecting Children from Men’s Drinking

Relationships and Family

Family Environment.

In the first topic identified, family and household environmental factors were considered in six reviews (Allen et al., 2022; Giusto & Puffer, 2018; Hameed, 2019; Heimdahl & Karlsson, 2016; Orford, 1990; Park & Schepp, 2015b). Only one review (Giusto & Puffer, 2018) was primarily concerned with men’s drinking. In the five reviews that included both men’s and women’s drinking, most had limited information on men or used gender-neutral terms. All six reviews found that heavy drinking by men in the family was associated with negative outcomes in the family context, such as marital discord, conflict, and disrupted family cohesion. Direct and indirect exposure to the increased violence and conflict within the household were both found to negatively affect the child’s family life, children’s development, and their mental and physical wellbeing, as well as contribute to abuse and neglect (Hameed, 2019). As a result of men’s drinking, Park and Schepp (2015b) identified the burden that the family faces due to men not fulfilling their family duties, which sometimes included a financial burden when men were unable to be employed and provide for the family due to alcohol consumption.

Relationships.

Five reviews focused on the association between heavy drinking parents and the parent-child relationship (Hameed, 2019; McGovern et al., 2020; Orford, 1990; Park & Schepp, 2015b; Solis et al., 2012), and not all studies included in the reviews were gender-specific. Fathers’ alcohol consumption was associated negatively with parental bonding; while the parent-child relationship was negatively related to both mothers’ and fathers’ heavy alcohol consumption. Children of heavy drinking parents were significantly less likely to feel emotionally close to their father, due to the impact of heavy alcohol consumption upon the father’s behaviour, conflict within the home, abdication of family responsibilities, or estrangement. Hameed (2019) noted that the intersection of alcohol and other drug (AOD) use and IPV has an adverse impact on parenting behaviours and styles, which may lead to adverse impacts on children. This review emphasised that these parenting behaviours have implications in relation to child abuse or neglect.

Violence and Maltreatment

Family Violence.

Six reviews included results on FV (Allen et al., 2022; Chan et al., 2021; Choenni et al., 2017; Hameed, 2019; Isobe et al., 2020; Orford, 1990). Family violence as a topic refers to child maltreatment, sibling violence, IPV, and elder abuse. Children may be the direct targets of violence, or they may witness violence against another family member (or members). Both situations—child maltreatment and IPV—victimise children, but they are often researched as distinct forms of FV. A meta-analysis of family polyvictimisation conducted by Chan et al. (2021) showed that when a family experienced IPV, the odds were about 3.6 of child abuse and neglect within the same family at a later stage. Importantly, children’s exposure to IPV has been recognised as a distinct form of child maltreatment (Kimber et al., 2018; McTavish et al., 2016). Hameed (2019) examined alcohol, IPV, and their associations with child abuse, and noted the deleterious consequences of children exposed to IPV. The findings from these reviews demonstrate that there is a small to moderate effect size for the association between alcohol and IPV, with a higher rate of men perpetrating violence against women than women against men Both heavy alcohol consumption and IPV created a toxic family environment in which the safety of children was compromised. There nevertheless remains a gap in research on the association between men’s alcohol consumption, FV and harm to children.

Maltreatment.

Five reviews included results on child maltreatment (Choenni et al., 2017; Karriker-Jaffe et al., 2023; McGovern et al., 2021; Orford, 1990; Solis et al., 2012) and one review (Zanoni et al., 2013) covered results on neglect. Orford (1990) undertook a very thorough review of alcohol’s role in the problems experienced by families. A section of this work was on children and child abuse or neglect (child maltreatment), and there was often differentiation between father’s and mother’s drinking. Still, very few reviews were identified that met our criteria, and Orford identified only a few of these papers. Choenni et al. (2017) provided a recent comprehensive review and found 27 studies on child maltreatment, of which five were about fathers, three about mothers, and the remainder (six) though about child maltreatment, did not report gender of parent (according to the review). The authors found an association between father’s alcohol consumption and harsh punishment of children (i.e., corporal punishment) although they note that ‘the link between alcohol use and child maltreatment is less straightforward for fathers than for mothers’ (Choenni et al., 2017, p. 43).

Health, Psychological and Wellbeing Impacts

Nine reviews explored the association between men’s drinking and health, psychological and wellbeing outcomes for children (Huq et al., 2020; Jokinen et al., 2021; Karriker-Jaffe et al., 2023; McGovern et al., 2020; Park & Schepp, 2015a; Park & Schepp, 2015b; Peleg-Oren & Teichman, 2006; Solis et al., 2012; Wlodarczyk et al., 2017). Park and Schepp (2015a) identified protective or risk factors affecting children, or considered their resilience or vulnerability. They found that negative parent-child relationships were related to internalising difficulties like depression among adults whose parents had an AUD, and importantly found that these effects could be ‘buffered’ when there were secure relationships or better parenting by a non-AUD parent (often the mother). Additionally, Jokinen et al. (2021) found associations between exposure to fathers’ alcohol consumption and adolescent outcomes including suicidal ideation and behaviour, depression, and anxiety. A concept in the literature they identified is when children whose parents have an AUD took on caretaking roles, termed ‘parentification’; this can lead to poor self-concept, a sense of isolation, and other emotional problems such as difficulties with trust later in life. Other reviews have also focused on resilience (e.g., Wlodarczyk et al., 2017) and identified positive coping strategies such as engagement with religion, active planning, and obtaining social support that may mitigate negative outcomes.

Solis et al. (2012) explored interactions of parental psychopathology and parental heavy drinking, also examining effects at different stages of children’s development. One finding that other reviews also noted was that the number of relatives with an AUD affected risks: ‘Boys with multiple generations of male alcoholic relatives (e.g., a father plus other biological male relatives) show deficits in verbal and abstract reasoning, verbal learning, performance IQ, and memory compared to boys without an alcoholic father’ (Solis et al., 2012, p. 4). They reported learning difficulties (reading, spelling, and arithmetic) that reflected these classifications but differed somewhat from early (six to eight years old) and mid (nine to eleven years old) childhood through adolescence (12 to 14 years), suggesting the interplay of resilience and risk factors in relation to children’s difficulties. Therefore, an important feature of this review was to consider the roles of alcohol and psychopathology together.

A systematic review by McGovern et al. (2020) marshalled evidence from 36 papers covering 33 studies on the association between adverse child health, psychological, education and social outcomes, and nondependent parental substance use. Fathers’ alcohol consumption was found to be associated with numerous negative child health outcomes: child injury including accidental injury of children up to five years old; included were poisonings, increased days of hospitalisation, bad diet, low weight, and dental problems. Regarding externalising behaviour, fathers’ alcohol consumption was associated with aggressive behaviour for boys but not girls, including hyperactivity at 42 months, conduct difficulties and disruptive disorders. The authors also found mixed results related to fathers’ alcohol consumption and internalising behaviours such as depression. In addition, they found associations between fathers’ tobacco and alcohol consumption, and drug and alcohol consumption in adolescents. Other reviews were generally not as gender-specific in their findings, either in terms of which parent had the AUD, or the sex of the child who was most affected. Many reviews concluded that additional and more detailed longitudinal studies are essential to advance our understanding, especially of complex risk and protective factors affecting children, and the interplay of resilience and risk variables.

Social and Educational Impacts

While less widely discussed, some social and educational outcomes for children were present in the reviews analysed. The association between educational outcomes and parental heavy drinking was specifically addressed in McGovern et al. (2020), where they found that fathers’ alcohol consumption was linked with educational challenges such as school-related behavioural problems and lower educational attainment. The authors also found that school behavioural problems including truancy, absenteeism, suspensions, attention difficulties and conduct problems were associated with paternal alcohol ‘misuse’. Disruptive family environments where the father was a heavy drinker were also linked with alcohol consumption and adverse schooling outcomes for children. McGovern et al. (2020) also found, based on a Swedish study, that in families where the father had an alcohol-related hospital admission, children were more likely to not qualify for secondary school. Fathers’ heavy drinking was also associated with school-related behavioural issues among children under 10 years old, where school-related behavioural problems were exacerbated if there was marital conflict within the household. Educational outcomes were also explored in Solis et al. (2012), where they found an association between maternal alcohol consumption and negative impacts on children’s cognitive functioning and poorer academic achievement. However, the authors noted that the findings were inconsistent and lacked detail on father’s alcohol consumption and children’s cognitive and academic functioning.

Contextual Factors.

Complex and co-occurring socio-ecological factors became evident in the reviews analysed, with the potential for exacerbating problems associated with men’s drinking. Below we highlight some of the co-occurring factors that were present in the data.

Poverty.

Broader ecological factors such as poverty were addressed in a small proportion of reviews analysed here. Giusto and Puffer (2018) reviewed interventions for men in LMICs and found that the high rates of poverty were associated with worsened individual and family consequences. Other socio-economic related problems such as persistent unemployment, economic instability, low education, and homelessness are framed as risk factors for negative outcomes for children (Choenni et al., 2017; Giusto & Puffer, 2018; Heimdahl & Karlsson, 2016; Zanoni et al., 2013). These complex social and economic factors often co-occurred alongside heavy drinking and were often found to exacerbate problems within the family and household.

Cultural, Patriarchal and Gender Norms.

Patriarchal and gender norms were only discussed in two reviews. Giusto and Puffer (2018) reviewed studies from LMICs, where they note that specific cultural norms related to gendered power dynamics and masculinities are present. The authors found that patriarchal norms that put men in a position of power were associated with higher levels of men’s alcohol consumption and alcohol-related consequences for children and families. They found that hegemonic norms were associated with increased violence in the household, where children may be the direct victims of violent behaviour or exposed to IPV.

Through the lens of Confucianism, Park and Schepp (2015b) conducted a review of research in South Korea. Strong patriarchal values present in South Korean society shape how the roles and responsibilities of men are perceived. In the context of men in families, usually men are thought of as the ‘head of the household’ and are respected as authoritative figures. However, because of heavy drinking, men often were no longer able to support their families and fulfil the role of an authoritative figure. The authors note the power shift between fathers and children as children were often left to take on responsibilities such as doing chores and taking care of younger siblings (i.e., parentification), sometimes resulting in ambivalence towards their fathers.

Intimate Partner Violence.

Some reviews were situated within an IPV context, where alcohol was a factor within the broader context of IPV (Allen et al., 2022; Chan et al., 2021; Choenni et al., 2017; Hameed, 2019; Isobe et al., 2020). Mostly these reviews identified male-perpetrated IPV towards women; children were rarely the subject of the review but they were included due to their exposure to violent situations. A noteworthy exception was a review on the intersection of IPV, mental health, and substance misuse where children are involved (Isobe et al., 2020). Despite the specific framing of this review, the authors noted a distinct lack of a gendered lens, particularly on gender and fatherhood in the context of programmes or interventions for alcohol and drug consumption. Isobe et al. (2020) also found that compared to discussions about women and children, discussions on men and fathers were distinctly lacking, even with the gendered nature of the underlying issue of IPV.

Discussion

This review found that certain behaviours and actions that arise from men’s drinking are likely to cause a range of harms to children. Figure 2 illustrates the common actions or behaviours associated with men’s drinking and the outcomes for children. Direct consequences included family conflict, child maltreatment, and exposure to violence which resulted from heavy drinking, intoxication, AUD, or withdrawal. Some short-term consequences evolved into longer lasting consequences, with implications extending into adulthood (Park & Schepp 2015a). Our review shows that actions or behaviours associated with men’s drinking have multifaceted effects on children, with some overlapping outcomes, emphasising the complex connection between men’s drinking and the impact on children. Additionally, socio-ecological factors may exacerbate men’s drinking and related harms to children.

Consistent evidence in the reviews suggested that children exposed to men’s heavy drinking or AUDs face an increased risk of internalising (anxiety, depression) or externalising (behavioural problems, social issues) behaviours. These behaviours may be attributed to disrupted family dynamics, exposure to unpredictable or volatile behaviours due to drinking, psychological stress, and the stigma associated with heavy drinking, which may collectively impact children’s emotional wellbeing and social development. Internalising behaviours were not limited to childhood, but extended into adulthood, where maladaptive role expectations of themselves, difficulty accepting authority, and problems with intimacy and trust were evident within the literature reviewed (Huq et al., 2020; Jokinen et al., 2021). This is consistent with the broader literature that suggests some children whose parents have an AUD experience internalising and externalising behaviours (Bickelhaupt et al., 2019; Meulewaeter et al., 2022). However, these outcomes may reflect the dominant approaches and frameworks of the studies utilising a narrower psychological approach or a family systems perspective, potentially limiting a comprehensive understanding of the complex and diverse impacts of men’s drinking on children. A review by Heimdahl and Karlsson (2016) about interventions for parents who use substances and have young children notes that the problems associated with children who are exposed to men’s drinking are broad, and have multiple social and structural contexts, however a narrow psychological focus often does not correspond with how the problems are defined within the articles. The dominance of focusing on individual psychological outcomes and interventions may overshadow the importance of the underlying social and structural contexts of children and families exposed to men’s drinking. Future research should potentially broaden the focus to gain a more nuanced understanding of additional child-outcomes.

Social and ecological factors such as gender inequalities, patriarchal family structures, and economic disadvantage can exacerbate harms to children from men’s drinking (Wilson et al., 2024). The review by Giusto and Puffer (2018) focused on LMICs, highlighting contexts with greater gender disparities than in high-income countries. The authors found that at the family level, violence and men’s alcohol use were perpetuated by strong patriarchal norms and hegemonic masculinities. The insights from Giusto and Puffer’s review on the intersection of cultural norms, gendered power dynamics, alcohol consumption and violence in LMICs are important for informing understandings of similar issues within HICs, as IPV and FV remain a considerable issue in HICs. Despite the socio-economic and cultural differences between LMICs and HICs, unequal power dynamics may contribute to the perpetuation of IPV and FV in both contexts (Kuskoff & Parsell, 2020; Ozaki & Otis, 2017). However, Giusto and Puffer’s (2018) review is consistent with notions of gender inequalities and male-perpetrated IPV and FV where rates are higher in societies with greater gender inequalities (Roberts, 2012; Roberts & Nuru-Jeter, 2012; Roberts et al., 2013). Gender inequalities can have differing outcomes for children in different cultural contexts. For example, Park and Schepp (2015b) focused on studies from South Korea, where cultural, patriarchal values and gendered expectations of men’s roles in families are evident. In this context, men who drank heavily often ended up lacking the ability to socially and financially support their families, which resulted in children holding negative emotions such as shame and resentment towards their father. While Park and Schepp (2015b) do not focus on IPV or FV and men’s alcohol use, the findings suggest that broad cultural elements intersect and exacerbate negative outcomes for children. Interventions for men, children, and families should target overlapping and complex issues such as gender inequalities, gender-based violence, socio-economic disadvantage, mental health, and alcohol and other drug use.

Our findings show the proportion of male-specific review literature was low, with only three articles analysed focusing on men’s drinking. While some reviews did distinguish between parental gender in their findings, many used gender-neutral language (i.e., parent, caregiver, family) which further obscures the knowledge about men’s drinking and child-related outcomes (Zanoni et al., 2013). In addition, traditional cultural and social norms of parenthood are evident across the review literature analysed here, where women are generally seen to be the primary caregivers of children. These cultural beliefs tend to define ‘mothers’ as ‘parents’ (Heimdahl & Karlsson, 2016) often resulting in a misleading focus on the mother’s alcohol use and overlooking the father’s consumption (McGovern et al., 2020). Given the extensive research on men’s use of alcohol, it should be reasonable to include men’s heavy alcohol consumption in research on children as they so often have been the subjects of more substantial alcohol use consequences, such as AUD.

Limitations

This review aimed to present an overview of the review literature including evidence about the impact that men’s drinking may have on children. However, some methodological limitations regarding the review design, measures, and definitions were encountered in this scoping review. Methodological limitations of a scoping review such as bias in study selection and challenges in synthesising various study designs may impact the generalisability of the findings presented. Additionally, as the present article is a review of review articles, there may be variations in the quality of articles which could affect the comprehensiveness of our review. Furthermore, important reviews may have been overlooked in the search stage of this review due to a language bias because only reviews in English were reviewed. Additionally, the search was primarily conducted by the first author rather than using multiple independent authors in the search and selection of review articles.

A limitation of many reviews to date is that their searches have primarily identified publications from HICs, especially so from the US. However, a recent review considered studies from LMICs with many studies from India, Brazil, Turkey, South Africa, Kenya, Rwanda, and a smattering from many other countries (Jokinen et al., 2021). This review found quite heterogeneous results across countries, but mental health outcomes were identified in several country studies seen as stemming from stress related to alcoholism and family fighting. Despite this, only three reviews analysed here focused on LMICs compared to 17 focused mostly on HICs. The number of reviews relevant to LMICs are likely to increase if more studies on men’s drinking and related harms to children are funded and conducted, as these reviews could highlight important contextual and cultural factors that are often overlooked in reviews focusing on HICs. Despite the limitations, this review provides important insight into the consequences of men’s drinking for children, and it also highlights gaps within the review literature on gender-disaggregation and potential bias towards mothers.

Conclusions

Our review highlights the range of consequences stemming from men’s drinking for children, encompassing conflict, maltreatment, and absence that potentially negatively affect children’s mental and physical health, or have social and educational outcomes. Notably, children exposed to men’s drinking, or drinking father’s absence, face increased risks of internalising and externalising behaviours, which can be attributed to disrupted family dynamics, exposure to unpredictable behaviours due to drinking, psychological stress, and stigma or shame associated with heavy alcohol use or absent fathers. However, the prevalent focus on psychological or family systems approaches may limit a comprehensive understanding of the broader societal and structural contexts that may exacerbate harms to children, or could potentially mitigate the harms. Gender-neutral language in many studies and reviews on parents’ drinking and child outcomes obscures the problematic role of men’s drinking in family settings. Future studies should disaggregate data on gender of parents and caregivers of children to provide a greater understanding of the role of parental gender in contexts of heavy drinking and caring for children. Future studies should also consider interrogating the socio-ecological context of men’s drinking and potential consequences for children. Policy interventions should adopt a holistic approach that addresses individual-level factors but also family, social and cultural factors that influence children’s experiences in families affected by men’s drinking.

Figure 1.

PRISMA Flowchart