Finding and Assisting Children of Families With Addictions
By Kristine Hitchens, PhD, LCSW-C, LCADC, CCDC
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based protocol used by professionals in various settings to identify people who are experiencing problems related to addiction. During SBIRT, social workers can be mindful that children are affected by parents’ addictions and that parents often are in denial about this impact.
Children often need help processing what they have experienced as witnesses to addiction, but they frequently don’t receive that help. Social workers can help bridge that gap by integrating information regarding children’s needs and available resources into conversations with their adult clients.
While SBIRT is intended to be a relatively focused activity, it is possible to examine and discuss the impact of parental addiction on children as the consequences of use are explored. When key facts are shared with parents, it may help plant a seed, making it easier for parents to accept treatment resources available to children and other family members.
Approximately 7.5 million children under the age of 18 live with an alcoholic parent, according to 2012 statistics from the Center for Behavioral Health Statistics and Quality. Children of addicts (COAs) are up to four times more likely than other children to develop substance abuse and mental health problems and are at greater risk of abuse, neglect, and trauma (Anda et al., 2002; Substance Abuse and Mental Health Services Administration, 2004). Typical problems, thoughts, and feelings for children of addicts include the following:
• Anger at both the addicted and the nonaddicted parent for lack of support and protection. Internalized anger may lead a child to self-harm. Externalized anger may make a child aggressive toward other family members, especially siblings, or peers.
• Anxiety regarding situations in the home and/or the addicted parent’s health. COAs may respond to this anxiety by becoming protectors, including shielding younger siblings from the addicted parent and related problems or helping the addicted parent by throwing away the substances or hiding car keys. Many COAs experience physical symptoms of their worry, such as headaches, stomachaches, and difficulty sleeping.
• Confusion, especially if parents make promises that are not kept, offer excuses for the addicted behavior and related problems, and cannot keep household schedules consistent.
• Depression stemming from a sense of hopelessness and helplessness.
• Embarrassment regarding parents’ behavior. It is common for children to keep addiction a secret because of overt or covert messages received from parents. The secrecy adds to feelings of shame and fear, making it less likely that children will seek help.
• Guilt if children believe they are part of the reason their parent is addicted. Some children draw this conclusion based on correlations. For example, if siblings argue and a parent becomes angry, screams at them to stop, and then begins to drink or drug, the children may think that if they were “better kids” then the parent wouldn’t be so overwhelmed and wouldn’t need to abuse substances. Other children are given direct messages from the addicted parent, such as “You kids are driving me crazy. I need a break from you.” Children can interpret subsequent substance abuse as their fault.
• Relationship problems related to a lack of trust of others and negative personal feelings.
• School issues due to difficulties focusing and attending to higher order cognitive tasks.
• Substance abuse made more likely due to the influence of both nature and nurture (American Academy of Child and Adolescent Psychiatry, 2011).
Protective factors can make a substantial difference in the overall health of COAs. However, if no problem is identified, acknowledged, or accepted, then access to protective resources is limited. Therefore, whenever possible, social workers should do the following:
• Screen for the impact of parental or other family members’ substance abuse on children.
• Briefly intervene via education regarding children’s needs. It is likely that parents will experience some level of denial regarding how they impact their children, so they may resist recommendations for treatment for their children. Responding appropriately to pushback using motivational interviewing skills can help parents work through their denial and related fear, guilt, and shame.
Motivational interviewing allows the social worker to be a part of the change process and typically involves expressing empathy through reflective listening, developing discrepancy between clients’ goals or values and their current behavior, avoiding arguments and direct confrontation, adjusting to client resistance rather than opposing it directly, and supporting self-efficacy and optimism (Miller & Rollnick, 2013).
• Refer to treatment, such as a child therapist or appropriate specialty program for children found in some schools and addiction treatment centers. The goal of treatment for COAs should be based on the 7 Cs: I didn’t Cause it. I can’t Control it. I can’t Cure it. But I can take Care of myself by Communicating feelings, making good Choices and Celebrating myself.
• Follow up by reconnecting with the parent within the first few weeks after referral to treatment to review progress and obstacles. Reinforce the plan, boost confidence and commitment, address questions, and share concern for the family’s well-being.
SBIRT provides social workers an opportunity to begin the application of the 15 core competencies that the National Association for Children of Alcoholics recommends social workers practice:
1. Understand substance use disorders (SUDS), including the causes, prevention, progression, consequences, and recovery.
2. Understand the biopsychosocial, cultural, and spiritual ramifications of SUDs as they impact COAs and their families from neonatal development through all stages of life.
3. Understand the impact that SUDs have on parenting abilities and the consequences for children.
4. Understand the intersection of SUDS and other family, health, and social problems, including family violence (intimate partner violence and child maltreatment); mental health conditions; physical health; crime (vulnerability to victimization and risk of criminality); poverty, unemployment, and homelessness; educational and vocational opportunities; and social/cultural biases, including race, ethnicity, class, sexual orientation, and disability.
5. Value the importance of early intervention and prevention of SUDs, as well as the prevention of mental health conditions and social problems for COAs and their families.
6. Engage COAs in a manner that is respectful and nonjudgmental of their parents.
7. Screen and assess COAs using developmentally appropriate assessment tools and methods.
8. Identify, evaluate, and utilize existing research relevant to COAs and their families.
9. Use developmentally appropriate and empirically supported interventions with COAs and their families and evaluate the effectiveness of the interventions being used.
10. Understand the concept of resiliency and how risk factors can be diminished and protective factors can be facilitated in COAs.
11. Help children identify developmentally appropriate formal and informal supports in their lives and work with them to enhance their resiliency and mitigate the impact of parental SUDs.
12. Know how to access formal and informal community resources on behalf of COAs and their families.
13. Provide referrals for appropriate services and supports to COAs and their families.
14. Know social policies pertinent to COAs and their families.
15. Advocate for individual clients as well as identify and advocate for appropriate policies to help COAs and their families.
Children of people with SUDs often are hidden. Denial and secrets make it difficult for them to get the help they need to weather the storm of parental substance abuse. If an opportunity presents itself to reach out, it should be seized; social workers are in an excellent position to do this.
While some families show obvious signs of distress, others become good at masking their pain. SBIRT provides an opportunity to examine substance abuse, reveal its impact, and help families become well again.
— Kristine Hitchens, PhD, LCSW-C, LCADC, CCDC, is director of family services at Father Martin’s Ashley in Havre de Grace, MD.
Anda, R. F., Whitfield, C. L., Felitti, V. J., et al. (2002). Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatric Services, 53(8), 1001-1009.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. 3rd ed. New York, NY: Guilford Press.
Substance Abuse and Mental Health Services Administration. (2004). Children of alcoholics: A guide to community action. Retrieved from http://store.samhsa.gov/shin/content/MS939/MS939.pdf.