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Children of Substance Abusers

in the Child Welfare System

Naomi Weinstein, MPH, Director, Phoenix House Children of Alcoholics

Foundation646-505-2061

nweinstein@phoenixhouse.org

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Assumptions Child affected by parent’s use COA/COSA – lifelong status Children not “cured” when parent enters

recovery Lots of ways to support and help

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Critical Factors Parent’s use of drugs Child’s experience Family dynamics Relational issues Protective factors Systems involvement Environment

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Parent’s Use

Pattern of use Drug of choice Rate of addiction Parent’s gender and role Age of child Duration of addiction Family living situation

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Parent Behavior and Illicit Drugs

Drug subculture “counter” values

“beat the system” Disdain for authority Focus on money and materialism

Exposure to drug sales, violence, theft, prostitution

High stakes consequences Systems involvement

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Continuum of Addiction

Use Dependence/addiction Treatment Recovery Relapse

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Dependence/Addiction

Family Dynamics

Centrality of AOD Secrecy and denial Broken promises, no

trust Lowered inhibitions Higher aggression Neglect

Shame, blame and guilt

Conflict Parent-focused

parenting Social isolation

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Dependence/Addiction

Family Rules

Don’t talk, don’t trust, and don’t feel No expectations Stay in control If something goes wrong, blame someone Don’t be selfish

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Dependence/Addiction

Consequences for Children

Ignored Pulled into conflicts Can’t study Abused and

neglected Parentified Afraid to bring friends

home

No access to emergency services

Chaotic family structure

Lack good role models

Domestic violence exposure

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Dependence/Addiction

How COAs/COSAs Feel

Sad Afraid Lonely, invisible Traumatized Angry Worried Love parent Ashamed

Guilty, responsible Embarrassed Parental Confused Depressed Anxious Loyal to parent Hopeful

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Dependence/Addiction

How COAs/COSAs Behave

Experiment w/ AOD School problems Social problems Run away Withdraw/ignore Perfectionism Alternative

relationships

Doesn’t trust Hypervigilant Hoards Psychosomatic

problems Anxious/depressed Comedy Aggression/anger

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Dependence/Addiction

When Children are Removed

Eating and sleeping disorders Depression Emotional withdrawal Physical aggression and disruptive behaviors Academic problems Truancy Harder for kids 8+ yrs Symptoms often misdiagnosed

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Dependence/Addiction

Separation/Removal

Loss and abandonment Fearful re: parent May live with AOD caregiver/family

member Possibility of multiple placements No pause button

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Behavior

Resiliency

Successful adaptation despite challenges Personality traits + environment Contextual Dynamic process Enhanced by protective factors

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Behavior: Resiliency

Wolins’ 7 Areas of Resiliency

Insight Independence Relationships Initiative Morality Creativity Humor

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Behavior: Resiliency

Survival Skills of COAs/COSAs

Soothe and calm unpredictable people Negotiate peace in a “war zone” Stretch limited resources Find solutions to difficult problems Prevent unavoidable disaster Please unpleasable people Cope in a crisis Sense of humor Responsibility and loyalty Perserverence

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Treatment

Parental apologies Fantasies and expectations Separation

Limited visits with parent Not sure of parent’s whereabouts Fear re:parent’s well-being “Broken promises” – tx issues

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Treatment

Intervention for COAs/COSAs

Simultaneous program Age appropriate Impact of PSA on family Changing response to family situations Intro to addiction Intro to self-help groups Communication skills Understanding of risk Identification of resilience

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Recovery

New homeostasis Recovery the parent’s #1 priority Fantasies – unrealized Denial of family issues No AOD as a buffer Relapse potential Reunification issues

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Reunification

When Families Reunify

Honeymoon period Testing behavior = parental surprise

Tantrums Defiance Jealousy Nightmares Clinging behavior Hypervigilence

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Reunification

Other Issues

Unification, not re-unification Child may be stranger to parent Reality v. fantasy Child’s problems Emotional baggage Grief and loss for past home Past caregivers

doubts sobriety potential renegotiate roles and boundaries

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Relapse

Dashed hopes Child may re-enter care Renewed separation – erodes attachment Pre-recovery state for child Further cements lack of trust

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Long-term Consequences

Suicidal ideation Hyperactivity AOD use Child abuse and neglect Domestic violence Depression and anxiety Somatic problems Workplace, parenting and other relational issues

for adults

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How to Help Access community-based services (Alateen,

support groups, special counseling) AOD Tx centers Mental health centers Schools (student assistance programs) Family service agencies Talking to kids

Family systems work Reunification support Identify resiliencies Aftercare includes family issues