TOPICS IN BEHAVIORAL HEALTH CARE
The Impact of Substance Use Disorders on Parents, Part I
Dennis C. Daley, PhD, & Joan Ward, MS
We met or talked via phone or e-mail with parents from all walks of life who have adolescent or adult children with a substance use disorder (SUD), many of whom have a co-occurring psychiatric disorder (COD). We also administered written surveys to parents attending a mutual support program or involved in the Pennsylvania Parent Forum sponsored by the Department of Drug and Alcohol Programs Parent Panel Advisory Council to ask questions about the impact of the SUD on them and their families, their experiences with treatment and recovery, their concerns and worries, and what helps them cope.
This first column reviews the impact of addiction, a more severe form of a SUD on parents, and what they say they need from professionals. We will share findings from our written surveys. In our next column, we will discuss how professionals can help parents and how parents can deal with an addicted child. We will also discuss how treatment and recovery can reduce the parental burden by providing them with the knowledge, the support, and the coping skills needed to meet the many challenges faced during a child's addiction, recovery or relapse.
Findings from Our Surveys
Our survey is not a representative sample of parents (n=71). Their children have an addiction, which is a more severe form of a SUD. Some findings are:
Respondents average age was fifty-six, and 82 percent were female. This is disconcerting since fathers are affected as well as mothers.
While their adolescent or adult children had all types and combinations of addictions, the most common were: heroin and prescription opioids (1); alcohol (2); cannabis (3); sedatives (4); and cocaine (5).
The average rating of the severity of the addiction was eight on a scale of one to ten. Thirty-five percent had an addiction for three to five years, 42 percent for six to ten years, and 19 percent for over ten years.
Nearly two-thirds of their children had been in formal treatment for their addiction four or more times, which shows that relapse is common.
Negative effects of the addiction on these individuals included social, psychiatric, financial, medical or dental, spiritual, and legal problems.
The Effects of a SUD on Parents
Not all parents are affected in the same way, and effects range from mild to severe. This includes both positive and negative effects as some parents and families become closer and more resilient as they cope with an addicted child. However, there are many negative effects as a child's addiction can disrupt the family system and cause an emotional and financial burden on the parent. Effects depend on the following factors.
Type and Severity of Addiction
Type and severity of addiction impacts the child's health and ability to function. For example, intravenous (IV) drug use increases the risk of acquiring or transmitting HIV or Hepatitis or a drug overdose. An expensive drug addiction often leads to criminal behaviors and incarceration, an inability to finish school, hold a job, meet financial responsibilities or care for young children.
Presence of a Coexisting Psychiatric Illness
An untreated psychiatric illness complicates recovery from addiction and often adds to the parental burden.
Behaviors of the Addicted Child
Children who steal from parents, sell heirlooms, lie consistently about their substance use, and display high risk behaviors such as IV drug use, sexual, criminal, violent or suicidal behaviors create considerable anxiety and worry for parents.
Support Available to the Parent
Support from family, friends, the community, and professionals can help parents deal with their reactions to the addiction and with the many challenges they face. Lack of support and connection with others contributes to isolation and feeling alone.
Coping Skills of the Parent
Parents need skills to manage emotions, negative thinking, and behaviors that impede recovery. For example, intense anger can lead the parent to lash out at the addicted child or show distrust even if this child is in recovery.
These include whether a parent's spouse has a SUD or does little to help address the addiction of the child, the number of children with an addiction, and whether the addicted son or daughter has children. Some parents take over caretaking responsibilities of grandchildren due to the impairment of their son or daughter.
Parents show a range of behaviors and emotional reactions to a child with a SUD. It is common to make decisions that are not in the best interest of their child despite potential negative results of these. Some professionals and parents in recovery use the term "enabling" to describe well-intentioned behaviors that do not help these children, but may contribute to the problem. Examples include taking over the child's responsibilities, bailing them out of legal trouble, supporting them financially despite their continued substance use, minimizing the severity of the SUD, blaming the problem on the substance, and rationalizing that the problem will get better despite the fact their child is not in treatment and/or recovery.
Dennis Daley: Before my mother died, she asked for financial help to post bond for an addicted brother. This was his third incarceration, and all were related to his drug addiction. My initial response was to say "Yes, I'll help, he needs a break." But after careful consideration I told my mother that that it was not in his best interest to avoid legal problems. During the ensuing incarceration he got interested in recovery, entered a treatment program after prison, and became active in recovery. I am convinced his time in prison made him examine his life, which led to his recovery.
While the stories parents shared with us are unique in some ways, their experiences are also similar in many ways, such as how they and other family members were affected by the SUD, the emotional and financial burden experienced, and how they coped with this serious problem. Some recurrent themes with these parents include the following:
Parents experience a range of feelings that affect their mental, physical, and spiritual health. Anger, anxiety, embarrassment, worry, depression, hopelessness, and feeling frustrated and overwhelmed are all too common. A recent article on CNN.com entitled "Being an Addict's Mom: It's Just a Very, Very Sad Place" captures the emotional burden of a mother of two addicted sons. As this mother became increasingly distraught she stated, "You almost wake up and get this haunting feeling, this horrible feeling that my God, I just wish I wasn't going to live today. Not that you would take your life, but you're so scared" (Wallace, 2014). Her fear was not for herself, but for her addicted sons.
Guilt and Shame (i.e., The Blame Game)
Parents wonder why their child (or children, as some have more than one with a problem) developed a SUD and what they could have done differently that may have prevented this. When we listen to what they have done to help their child, we wonder if they could have done anything differently-they did so much and gave so much of themselves as parents who love and care about the welfare of their child.
Joan Ward: I struggled constantly with feelings of guilt as we worked to help our son overcome his heroin addiction. No matter how much I learned about the disease of addiction, there was always a part of me that thought, "You were the mom" as though that title alone should have empowered me with the ability to change the outcome.
Heartache and Heartbreak over Loss of a Child
Parents may feel traumatized from losing their loved one to an addiction, which controls the life of their child and becomes a central focus of the family. Sadly, some parents had children who died from accidents, overdoses, suicides or other factors associated with their SUD.
The family mood may become tense as considerable time is directed toward the member with the problem, sometimes at the expense of the other family members. Communication and interactions among members are affected in many ways, such as changes in family rituals related to daily life or special occasions, too much arguing about how to handle the child with the problem, too much negativity or marital discord that can end in separation or divorce. This chaos is evident in one parent's comment that, "Basically, the addiction destroyed our life as we once knew it. We no longer are the same family, never will be."
The affected child may steal money or sell things stolen from parents to support an addiction. Parents often spend considerable sums of money on treatment, legal expenses, and other things to support their child both during the active phase of the problem and during recovery.
Caring for Grandchildren
Despite unconditional love for their grandchildren, some parents find themselves in the position that if they do not care for the grandkids, social services may take custody of these children. Caring for grandchildren takes time, energy, and financial resources, which can create an additional burden, especially on parents with full-time jobs. Parents may end up caring for more than one child or caring for young children who require most of their time and energy. As one mother stated, "My husband and I are spending our retirement years raising our daughter's children. After eight years, we are pretty exhausted."
How to Help the Member with the SUD
Despite the suffering of parents, most wonder what to do to help their loved one get help or reduce the likelihood of a tragic outcome such as death from an overdose or disability from an accident. Parents worry about their children going to jail or prison, being unable to get and keep a job, being unable to support themselves or take care of their own children, and not leading normal life that does not revolve around the addiction or multiple relapses.
What Parents Ask For or Need from Professionals
Some parents criticize or reject their children because of the addiction. They may judge them negatively as they believe their child has made bad choices. Others have trouble accepting addiction as a life-threatening disease or disorder. However, we believe most parents do all they can to try to help their child deal with the addiction.
Parents express a need for help from professionals in the following areas, most of which relate to their loved one who has the SUD. Many parents assume the role of helper with their child and ignore their own needs for help and support from others that can be provided in counseling, mutual support programs or both. Additionally, most do not receive counseling or education because they are not contacted by the professionals providing treatment to their son or daughter.
Information about SUDs
Parents want to understand SUDs-causes, effects, and treatments. This can counteract confusion that is experienced as parents try to apply logic to understanding a SUD, a disorder that defies logic. Parents also state that siblings and other relatives need to better understand addiction and related problems, so they can provide support to the addicted child and the parents rather than judge them.
Help for Co-Occurring Disorders
Parents want help finding a program that can treat both a SUD and a co-occurring psychiatric disorder (COD). They want to know what type of mental disorder their loved one has and the most appropriate treatment, and know how a SUD and COD interact and impact on each other.
Parents want to get their loved one into a treatment program initially or following a relapse. Multiple relapses or a relapse following a sustained period of recovery are disheartening to parents who often ask what they can do to help prevent their child from relapsing. They want to learn ways to support the recovery of their loved one and hope this reduces the risk of relapse. Some feel responsible and think they could have done something to prevent the relapse.
Given that addiction creates many problems, parents want help locating other medical, social, vocational, financial or housing services needed to support the recovery of their son or daughter.
Help for Self
To a lesser degree, parents want help dealing with the impact of their son or daughter's SUD on them and other family members. While parents usually recognize the adverse effects of a SUD on the family, the help they often request is for the member with the SUD. They often put their own needs or the needs of others in the family aside even though the personal burden is high. Failure to address their own needs often leads to additional suffering over the long run. Our next article will focus on help available for parents.
Despite the many adverse effects of SUDs on parents, treatment programs often do not include them in the evaluation or treatment.
The research and clinical literature addressing parents with addicted children is limited with very few clinical trials (most from many years ago) and programs to address their needs.
Parents will be involved in the treatment and recovery of their child. Whether it's by design or behind the scene, they will have an impact on the outcome.
Questions to Consider
Do you ask clients about relationships with their parents and how the addiction may have impacted them?
What do you or your organization offer to educate and support parents whose son or daughter has a SUD?
What could you do differently to focus more on the concerns and needs of parents when you are working with their son or daughter?
What gets in the way of involving parents? Is it systems issues? Resources? Something else?
Daley, D., & Douaihy, A. (2014). A family guide to addiction and recovery: How
to help yourself and your loved ones. Export, PA: Daley Publications.
Wallace, K. (2014). Being an addict's mom: It's just a very, very sad place.
Retrieved from http://www.cnn.com/2014/08/26/living/addiction·parents/