TOPICS IN BEHAVIORAL HEALTH CARE
The Impact of Substance Use Disorders on Parents, Part II
Dennis C. Daley, PhD, & Joan Ward, MS
Our first article about parents focused on the impact of an adolescent or adult child's substance use disorder (SUD) on them and their families, as well as what they said they need from professionals to deal with this problem. We included findings from parents' survey in which they answered questions about their experiences with a child's SUD and treatment providers.
In this follow-up article, we discuss how treatment and recovery can help parents deal with an adolescent or adult child and their own issues. Throughout this article, Joan also shares her experiences having a son with a SUD. We begin with a summary of the effects of a SUD on the family and parents as a reminder of the burden this disease creates.
Effects of a SUD on Families and Parents
The effects of a SUD range from mild to severe depending on the type and severity of the SUD, whether or not the child has a co-occurring psychiatric or medical condition, behaviors of the child, support available to the parent, and the ability of the parent to cope with the problems, challenges, and emotional chaos associated with a SUD in the family. Effects of a SUD on parents may include:
Feeling guilty and blaming ones self for the child's SUD or not recognizing it earlier.
Emotional chaos or burden (e.g., anger, worry, fear, depression, sadness, embarrassment, frustration, feeling hopeless or helpless).
Grief over loss of a child who dies from the SUD, suicide, homicide or is incarcerated
Mental exhaustion resulting from chronic tension and stress, and dealing with the many negative effects of a SUD and the unpredictable behavior of their child.
Chaos affecting the family unit and members
Increase in stress-related illness
Worry about a grandchild born when their daughter is addicted during her pregnancy.
Despite the physical, mental or spiritual suffering of parents, most focus their energies on how to help or reduce the likelihood of a tragic outcome such as death from an overdoes, medical complication, accident or suicide. Parents worry about their child going to jail or prison, being unable to get or keep a job, being unable to support themselves or take care of their own children if they are parents, and not being able to live a normal life, which does not revolve around addiction. These worries take a toll on parents, which speaks to their need for understanding help, and support from professionals, families, friends, and other parents in recovery.
Help for Parents
The following is a discussion of ways that professionals can help parents and strategies for parents to help themselves and their families. If a parent has a substance use problems, the professional can help him or her get an evaluation and treatment as needed. The parents need to understand that if their own substance problem is not addressed, this can have a negative impact on the child with the SUD.
Joan's Reflection: When I first learned of our son's addiction to heroin, I was lost. Traumatized by my fears, I struggled with every decision. With the help of a mutual support group, I eventually realized that our son would not get well again until I did. Working my own recovery, which included educating myself about SUDs, treatment, and recovery, helped me support our son's recovery.
Professionals can educate parents about all the following areas:
Symptoms, cause. and effects of SUDs
Types of treatments (psychological, medications or combined)
Treatment settings (detox, rehab, outpatient, continuing care of other)
Ancillary services for individuals with SUDs (housing, vocational, financial, case management)
The recovery process and recovery resources (AA, NA, and other mutual support programs)
Causes and signs of relapse, and how to intervene early should a relapse occur
Professionals can also educate parents about other issues depending on the problems of the specific child, such as how use of prescription or synthetic drugs can lead to addiction or serious negative outcomes, co-occurring psychiatrics disorders or chronic pain.
If a parent learns the facts and learns about the realities of a SUD, there may be less of a chance of denying its existence hoping it goes away or feeling relieved the problem is not with a more dangerous type of drug. For example, some parents believe that if they have a "good child," they surely won't get into trouble with substance use. Other minimize the adverse effects of marijuana on their adolescent child, secretly appreciative the child is not using "hard drugs." Or, they may feel relief if a cocaine-addicted child relapses on alcohol or marijuana, but not realize the significant risk of cocaine relapse if alcohol or marijuana are used. Information us available from many sources such as bookstores, Internet sites, professional organizations, treatment centers, mutual support programs, and others. Parents can make a list of their concerns and questions to make sure they get the information they need from these sources.
Joan's Reflection: The challenge is helping a sometimes traumatized parent take in all of this information, as at first it can be overwhelming. What helped me the most was understanding addiction as a treatable, complex, brain-based disease, and understanding the difference between treatment and recovery. This knowledge relieved me of much of the frustration I had with our son's relapse and with my struggle to influence lasting change.
Accepting the Problem
Do not cover up the problem, and reduce or stop enabling behaviors. Some parents need help to accept that their son or daughter has a SUD, which is untreated, can lead to severe negative consequences, including death. Professionals can encourage the parent not to cover up the problem and not to take actions that contribute to the SUD such as bailing their child out of trouble at school or with the law or taking care of their financial or parental responsibilities without the child's commitment to getting help for the SUD.
Joan's Reflection: Understanding the difference between helping and enabling was one of the greatest challenges I faced. As parents, we often do what we think is in the best interest of our child without realizing some of our actions can backfire. Having someone help me develop a system to distinguish between the two would have been invaluable.
Getting Them into Treatment
Some parents need help to get their child to agree to get an evaluation and/or engage in treatment. There are many effective strategies to help the parents engage their child in treatment even though some kids resist help, insist they do not need it because their problem is "not that bad" or persuade their parents that substance use can be stopped without professional help. Leverage may be needed to persuade the child with the SUD to accept help. For example, children receiving financial support from parents may be expected to be active in counseling and mutual support programs to aid their recovery if they are to continue to receive this support. Consultation with a professional counselor can help parents figure out ways to get their child the professional help he or she needs.
Professionals can ask apparent for their input during the assessment and development of the treatment plan or after the child with the SUD returns to treatment following a relapse. Counselors can also assess the impact of the SUD on the family and parents, and determine what they may need in terms of treatment (e.g., family counseling and individual assessment for clinical depression) or recovery (e.g., involvement in a mutual support program for families or parents).
An adult child has the right to refuse parental involvement in the evaluation or treatment. However, if this child is dependent on the parent for support, the parent can negotiate to get involved in treatment. Sometimes a phone call to a professional involved in their child's care can help this process. Due to confidentiality requirements, parents need to be aware that their child must give written consent for them to talk to professionals involved in treatment.
Addressing the SUD's Impact
Professionals can help children in treatment for a SUD if they:
Educate them on the impact of their SUD on their family, parents, and others
Offer to engage the parent in their treatment and recovery
Get them to discuss family issues in individual and/or group sessions
Help them understand how Twelve Step programs can help with family issues (e.g., Steps Eight and Nine)
Educate them about mutual support programs for families and how these can reduce family burden, and link them to these programs or other parents involved in mutual support programs
Similarly, the parents needs to acknowledge the impact of the SUD on oneself, the family, and other members. This can help the parent see the seriousness of the SUD, It is best to view the problem as a "disorder" or "disease," not as a "drug" or "alcohol" problem. The problem is the pattern of substance use, which leads to a SUD, which in turns causes or worsens problems in functioning. Talking with a counselor, sponsor in Al-Anon or Nar-Anon or a mutual support program meeting are opportunities for a parents to discuss the SUD and impact on them and their families.
Professionals can provide support and counseling to parents, or help them get involved in family or personal counseling since not all programs or clinicians are qualified to provide family services. While parents usually enter treatment initially to help their child with the SUD, they benefit from understanding and dealing with the many aspects of a SUD within the family, such as enabling or doing too much for the child with no expectations from the child, protecting the child form consequences of the SUD, and/or taking over the child's responsibilities.
Parents benefit from help with the emotional, social, or financial burdens common in families in which a member has a SUD. Reducing the emotional burden- guilt, anger, anxiety, depression, frustration- on parents can lead to improved health and mental well-being. In our surveys, emotional distress was the issue identified by the largest number of respondents as one they needed help with the most. Sharing emotions with a counselor or other parents in recovery, and learning coping strategies can improve emotional health by reducing negative and increasing positive emotions.
Another issue is parents being put in a position to take care of grandchildren even if they are not financially or emotionally ready or able to do this. They may do this out of love and to avoid the potential of the child being removed by child protective services. Finally, some parents may need help with grief if they lost a child due to a drug, overdose, an accident, medical complication cause or worsened by the SUD, suicide, being a victim of a homicide or incarceration.
Mutual Support Programs
Professionals can provide information about programs for families are parents, link with specific programs or other parents in recovery if possible, and monitor their involvement. some communities offer mutual support programs specifically for parents, but unfortunately many communities do not have these programs. In our experiences, parents who get involved un mutual support programs like Al-Anon, Nar-Anon or others benefit immensely from the help and support of others who have experiences similar problems. such programs can help the parents move from focusing on the child to focusing on oneself and/or other members of the family, rather than expending most energy towards the child with the SUD.
Interactions and Communication
Professionals can help parents learn specific ways to deal with children who have a SUD, such as not protecting them from negative consequences of the SUD or repeatedly bailing them out of financial or legal trouble. If the adolescent or adult lives at home, parents may need some help to set realistic guidelines and expectations regarding treatment or recovery. Also, professionals can help parents understand relapse and learn common indicators or warnings signs to increase the odds of early identification and action should a relapse occur. Parents need to refrain from showing anger, hostility, blame and monitoring their child like they are the police and the child is a criminal.
A parent can support recovery through open discussions of recovery, such as "How are you AA/NA meetings?" "How was group counseling session today?" "You seem to like talking with (a peer in recovery or sponsor),' or discussing their own recovery, like "We had a great discussion last night about relapse at our Nar-Anon meeting" or "We learned our intentions to help you in the past were good, but the way we went about it was wrong when we constantly nagged you. We are working on not doing this and respecting your recovery."
Building on Strengths and Resiliencies
Involvement in religious or spiritual activities, stay active with friends and families to share activities and support, and focusing on personal needs can help parents stay balanced.
Joan's Reflection: For a long time I struggled with telling friends and other family members about our son's addiction. This not only contributed to feeling isolated, but also diminished the network of support I had available to me. Professionals can help parents navigate this process by helping them decide who to tell and how to tell them. Other parents in mutual support programs can also help with this issue.
A common challenge for parents is not letting their emotional, mental, social or spiritual stability depend on the status of their child, and how this individual is doing. For example, we have seen many parents move from well-being to feeling upset, angry, anxious, and/or depressed after their child relapsed. The parent has to separate their personal recovery from that of their child. Additionally, some parents have to accept that their child does not want recovery, no matter what they or others do to influence him or her.
There are many ways professionals can assist parents struggling with their child's SUD. However a professional's affiliation with the family is time-limited. Professionals can further assist family members with their continued recovery efforts by connecting them to a support network such as Parent Support Network, sponsored by the Partnership for Drug Free Kids, offers a toll free help line, intervention and treatment resources, and peer-to-peer coaching with professionally trained parent coaches. The National Family Dialogue, sponsored by SAMHSA, seeks to connect families on the national level and provides opportunities for education, advocacy, and collaboration. Also, connecting parents to Al-Anon, Nar-Anon or other community support programs can facilitate their recovery. Links to these sites and additional resources are listed in the "Resources" section of this article.
Parents who get involved in their own recovery put themselves in a position to gain greater control over their emotions by using the support of others in recovery and making positive changes in their own lives. They can still focus on helping their child, but taking care of themselves is also needed to regain emotional stability. Many professional and mutual support resources can help parents learn more about what they can and cannot do to help their loved one and help themselves. Parents who engage in recovery often report substantial positive changes over time.
The following are some websites that can provide resources and assistance to families dealing with a SUD.
The following books can also help parents and provide information on dealing with SUDs in the family.
Bottke, A (2008). Setting boundaries with your adult children. Eugene, OR: Harvest House
Daley, D.C., & Douaihy, D.C/ (2014). A family guide to addiction and recovery: How to help yourself and your love ones. Murrysville, PA: Daley Publications
Daley, D.C., & Spear, J. (2003). A family guide to coping with dual disorders: Addiction and psychiatric illness. Center City , MNL Hazelden.