The SAGE Encyclopedia of Abnormal and Clinical Psychology
Children of Parents With Substance Use Disorder
Contributors: Dennis C. Daley & Ralph E. Tarter Edited by: Amy Wenzel Book Title: The SAGE Encyclopedia of Abnormal and Clinical Psychology Chapter Title: "Children of Parents With Substance Use Disorder" Pub. Date: 2017 Access Date: April 13, 2017 Publishing Company: SAGE Publications, Inc. City: Thousand Oaks, Print ISBN: 9781483365831 Online ISBN: 9781483365817 DOI: http://dx.doi.org/10.4135/9781483365817.n250 Print pages: 643-644©2017 SAGE Publications, Inc.. All Rights Reserved. This PDF has been generated from SAGE Knowledge. Please note that the pagination of the online version will vary from the pagination of the print book.
Substance use disorders (SUDs) affect nearly one in five adults in the United States as well as their families and communities. Researchers, clinicians, and organizations such as the American Academy of Child and Adolescent Psychiatry and the National Association for Children of Alcoholics have identified numerous negative effects of SUDs on families and individual members, including children. The founders of Alcoholics Anonymous acknowledged that families were greatly harmed by alcoholism. Two of the Twelve Steps of Alcoholics Anonymous (and other twelve-step programs) are to identify and “make amends” to loved ones harmed by one’s addiction. Al-Anon and Nar-Anon were developed to help adult family members and Alateen for adolescents, thereby underscoring SUD as a family disease. This entry first reviews the effects of SUD on the family in general and on children in particular and then discusses various interventions for children of parents with SUD.
Effects of SUD on the Family.
Not all families or its members are affected by SUD the same way. The effects on the family system or its members depend on the type, length, and severity of SUD; history of relapse; mental health, medical, or social comorbidity; behaviors and functioning of the member with the SUD; support for family members within and outside the family; and family members’ coping skills and resiliencies. Families are also affected negatively by incarceration of the member with the SUD, removal of a child by social services, parental death from drug overdose, medical complications caused or worsened by an addiction, and accident or suicide of the member with the SUD. The effects on children are also determined by which parent has SUD (or if both parents have SUD), whether addiction was present during pregnancy, and degree of parental competence.
SUD harms the family unit when it becomes the central focus of family life or leads to parental absence, separation or divorce, or underfunctioning of either or both parents. Areas of family life commonly affected by SUD include communication, interaction, cohesion, mood, rituals, roles assumed by members, and rules guiding behavior. SUDs increase risk for family violence, child abuse and neglect, and poverty along with dependence on welfare assistance.
Effects of SUD on Children
Children with a biological parent with SUD are at heightened risk of developing SUD and other mental health disorders, including depression or anxiety, even if they are reared by adoptive parents who do not have SUD. Furthermore, children whose biological parents do not have SUD and who are reared by adoptive parents with SUD are also at heightened risk of developing SUD. Risk is, therefore, genetically and environmentally transmitted to children as approximately 50% of children raised by a biological parent with SUD will develop a SUD, which is at least 4 times higher than for children raised by parents without SUD. Having biological parents with SUD also elevates the risk for attention-deficit/hyperactivity and conduct disorders. During adolescence and adulthood, the risk for antisocial personality disorder (in males) and borderline personality disorder (in females) increases.
SUD in parents affects children in many ways that are harmful to normative socialization and healthy development. Adversity associated with living with a parent with SUD does not inevitably have profound or lasting negative impact on all children. Indeed, SUD in a parent may in some children potentiate resilience. Protective factors among children that can offset the risks for parental SUD include the following: (a) the child’s ability to manage emotions,
control impulses, resist peer pressure to use substances, and solve problems; (b) the child’s connection to supportive family members, school, church, or community; and (c) exposure to positive role models, open communication with parents as well as parental practices that are firm, consistent, and nurturing. Many of the founders of the Adult Children of Alcoholics/Addicts movement were reared in families with parental SUDs and used their experience to help others through writings, teachings, and clinical and advocacy work.
More commonly, however, a parent with an SUD devotes extensive effort and resources to obtain substances to avoid or attenuate withdrawal. Reduced self-control over emotions and behavior lowers the threshold for violence toward children and is the most frequent cause of abuse and neglect in children requiring protective custody. However, foster home placement, although protecting the child’s safety, impedes attachment or bonding to caregivers and, in older children, exacerbates feelings of rejection and abandonment.
Parental SUD also may negatively affect children indirectly through the spouse without SUD. For example, physical or emotional abuse by the parent with SUD to his or her partner impedes the partner’s child-rearing effectiveness. The child witnessing violent interactions is exposed to chronic stress and threat. Separation of the parents, including abandonment of the family by the parent with SUD, exacerbates the child’s vulnerability. This can lead to relocating to a poor neighborhood where the child is exposed to easier access to alcohol or drugs and deviant peers.
Children with a parent with SUD have a lower capacity to exercise cognitive controls over their emotions and behavior. Compared with peers whose parents do not have SUD, cognitive deficits include distractibility, poor foresight, low persistence to goals, making risky decisions, and poor concentration. These impairments jeopardize academic performance that in turn may promote social maladjustment. These children also exhibit more problem behaviors such as overactivity, restlessness, impulsivity, thrill seeking, and aggressivity, all of which may reflect poor self-regulation. Poor control of emotions can show in irritability, anger, depression, and anxiety and can impede adjustment.
The disposition of children of parents with SUD thus promotes conflict with adults and rejection from peers, which can lead to forming friendships with peers who reinforce deviant behaviors, including substance use. Truancy from school, early-age-onset sexual activity, and risky or thrill-seeking behaviors further promote a trajectory toward adverse outcomes. The risk for these outcomes is pronounced where the parent cannot provide adequate supervision or is in conflict with his or her children. In the absence of a strong parent-child bond or communication, the child is prone to disengage from the family and become more closely involved with risk-promoting peers.
A large array of other factors affect the child’s psychological development and socialization. The mother’s pregnancy is frequently unplanned, which, combined with poor parenting skills and little interest in or resources for child rearing, biases the child’s developmental trajectory to adverse outcomes. In the absence of secure child-caregiver attachment, disruptive behaviors during childhood and subsequent risk for antisocial lifestyle are amplified. In addition, mental health disorders in one or both parents with SUD may deprive children of having their health and security needs satisfied. SUDs also commonly lead to chronic unemployment and poverty, thus further depleting resources for competent child rearing. When incarceration of a parent with SUD occurs, protection of the child is additionally diminished.
Grassroots outreach spearheaded by the National Association for Children of Alcoholics advocates for attending to the special needs and circumstances of children who have a parent with SUD. Considering that SUD has a prevalence rate approaching 20%, and commonly has transgenerational continuity, it is a high priority to target interventions to the large segment of the general population who are offspring of parents with SUD. Children can benefit from education, prevention, intervention, or treatment services depending on the impact of a parent’s SUD on them and available services.
Following are interventions that can help children affected by a parent’s SUD:
Pregnant mothers dependent on opioids can be converted from illicit or prescription drug dependence to an opioid replacement therapy such as methadone or buprenorphine. These medications control the neonatal abstinence syndrome (NAS) for newborns. The mother can also get help to engage in ongoing addiction treatment and engage in mutual- support programs, both of which can have a positive impact on their sobriety, and hence their ability to parent a newborn. A parent with an alcohol, cocaine, or other SUD can be linked to appropriate treatment services to facilitate detoxification, rehabilitation, or other treatments needed, based on the severity of the SUD and related problems. Treatment and recovery can enable the parent to assume a more effective role as a caregiver to his or her children. Children whose parent is active in professional care for SUD can be provided education, support, and counseling (or referral) to help them understand SUDs and deal with its impact. They can be involved in sessions with the parent, alone, or with other families, depending on the age of the children. Children in treatment for a mental health problem who have a parent with SUD can be assessed for the impact of the SUD on their mental health and functioning. The treatment team can help the child deal with these effects as well as determine if an intervention is needed to help a parent not in treatment to receive care for his or her SUD. Children suspected of having a mental health problem or SUD should be assessed and offered treatment for these disorders. Their parents should be involved in this treatment. If available, children can engage in programs for kids to help them learn about parental SUD and develop skills to deal with the impact on them. Adolescents can be linked to Alateen, a mutual-support program that is part of Al-Anon Family Groups. Alateen is a fellowship of young people affected by a parent’s SUD who share their experiences, strengths, and hopes with one another. They discuss with one another their experiences, struggles, and ways to cope with these issues and how to use the “tools” of the Al-Anon program (meetings, Twelve Steps, twelve traditions, sponsorship, readings, slogans, other activities). Some teens benefit from Alateen chat meetings online in which they share and interact with others affected by a parent’s SUD.
See also Alcoholics Anonymous; Attention-Deficit/Hyperactivity Disorder: Risk for; Conduct Disorder: Risk for; Substance Use Disorders and the Family
Dennis C. DaleyRalph E. Tarter http://dx.doi.org/10.4135/9781483365817.n250 10.4135/9781483365817.n250 Further Readings Griffin, K. W., & Botvin, G. J. (2014). Preventing substance use among children and adolescents. In R. K. Ries, D. A. Fiellin, S. C. Miller, & R. Saitz (Eds.), The ASAM principles of
SAGE SAGE Reference Contact SAGE Publications at http://www.sagepub.com.
addiction medicine (5th ed ., pp. 1572–1579). New York, NY: Wolters Kluwer. Suchman, N. E., Pajulo, M., & Mayes, L. C. (Eds.). (2013). Parenting and substance abuse: Developmental approaches to intervention. New York, NY: Oxford University Press. Tarter, R., Horner, M., & Ridenour, T. (2012). Developmental perspective of substance use disorder etiology. In H. Shaffer (Ed.), APA addiction syndrome handbook: Vol. 1. Foundations, influences, and expressions of addiction (pp. 261–287). Washington, DC: American Psychological Press. Alateen for Teens (part of Al-Anon Family Groups): http://www.al-anon.org/for-alateen National Association for Children of Alcoholics: http://www.nacoa.org
The SAGE Encyclopedia of Abnormal and Clinical Psychology