Helping Children Affected by a Parent’s Substance Use Disorder

Children of parents with SUDs are at increased risk for alcohol and drug use, behavior problems, school problems, depression and anxiety, and medical problems. Children can appear fine on the outside but suffer quietly on the inside, especially if they keep feelings, fears, and worries bottled up. Not all people, including children, are affected by a parent’s SUD in the same way. Strong connections with school, religious community, adults and mentors (teachers, coaches, relatives, friends), and involvement in meaningful activities (academic, creative, athletic, social) may help offset some of the negative impact of living in a family with an SUD. Many children show resilience and cope with difficult situations, including having a parent with an SUD.

Treatment and Recovery for the Family

For the overall family, recovery involves changing how the family functions. It not only has to adjust to the sobriety of the recovering member (if this person is in recovery) but also has to make changes to function more effectively as a unit. Areas the family may need to address include accepting the SUD, stopping behaviors that reinforce substance use, improving communication, shifting family roles, reestablishing boundaries between generations, and building family togetherness. In some families, problems such as violence or abuse must be addressed. Professional treatment may be needed to address these issues and make changes in how the family functions. The change process can continue after treatment in mutual support programs.

How Substance Problems Affect the Family Unit

A family unit is a system in which various parts have an impact on other parts. This chapter looks at how families, concerned others, and friends are affected by a loved one’s SUD. Any family member may be hurt by a loved one with an SUD. The effects may vary among families and among members within the same family, but emotional pain and disruption of family life are common. Attention often centers on the member with the SUD, while overall family pain and distress are ignored. Individuals with SUDs often “underfunction,” which means that other members of the family have to pick up the slack and “overfunction.” This dynamic may change how family members communicate or relate to one another. The effects on families vary from mild to severe—in which a family is torn apart by an SUD.

Treatment of Substance Use Disorders

People do not respond the same way to any one particular treatment approach in any particular setting. Some need more intensive and/or extensive treatment than others. It is not unusual for a person with a severe SUD to engage in several episodes of treatment before sustaining recovery. For those who are physically addicted, medical detoxification may be needed before they can benefit from other types of treatment. Treatment is helpful only to the extent that a person sticks with it and uses the guidance of professionals and peers in recovery. The person with an SUD may use any combination of treatment programs, services, or community recovery supports. Treatment includes detoxification; rehabilitation; individual, group, and family therapy; other services (case management, vocational or leisure counseling, medical evaluation); and medications.

Psychiatric Illness Co-occurring with a Substance Use Problem

The combination of an SUD and a psychiatric disorder is called dual or co-occurring disorders (CODs). Rates of SUDs are especially high among individuals with antisocial or borderline personality disorders, bipolar illness, and schizophrenia. Having one disorder raises the risk of having the other. Psychiatric illness can affect how quickly a substance problem develops and response to treatment. It can also affect relapse to substance use. The effects of alcohol or other drugs can cause or worsen psychiatric symptoms. Suggestions are given for handling psychiatric emergencies, including suicide threats. An overview of the treatment options for patients with dual disorders is given.

Causes of Substance Use Disorders

SUDs take many forms, and there are many reasons why an individual develops a problem. Substance problems can begin at any time in life. Having an SUD is not a matter of weakness, lack of willpower, or being “bad.” SUDs result from a complex interaction of genetic, psychological, social, and cultural factors. These disorders tend to run in families, so scientists believe a person inherits a predisposition or vulnerability to SUDs that interacts with environmental factors, increasing the risk of developing a problem. SUDs affect people of every age, race, ethnicity, religion, gender, and occupation. Some people develop a problem in early life, while others do so later in life. For some, a SUD develops gradually over years. For others, it happens quickly.

Alcohol and Drug Problems

A substance problem is any negative outcome from prescription drug misuse, illegal drug use, or binge drinking. These problems often lead to substance use disorders (SUDs). Any substance use can cause problems. The real issues are a person’s reasons for using, and whether that substance use is part of a substance use disorder. Family members often think of the drug as being the problem when it is really the person’s pattern of use and reasons for using that are the problems. Drugs come and go and are replaced by new ones all the time. SUDs and addiction are people problems that involve drugs.

Recovery for Individual Family Members

It is common to initially get involved in a family member’s treatment mainly to support him in getting and staying sober. However, as we start learning about SUDs, recovery, and the impact on family members, we may realize that involvement in our own recovery offers us a chance to address our personal issues, make changes, and grow as people. Recovery refers to learning about SUDs and their impact on us, healing from emotional hurts we experienced, and making changes so that we feel better about ourselves and more in control of our lives. This chapter provides an overview of mutual support groups and online resources.

How Substance Problems Affect Individual Family Members

The effects of SUDs on family members are well documented. Some people grow stronger through exposure to an SUD in their family despite negative effects. They show resilience. There is evidence that children of parents with an SUD are at higher risk for problems than are children whose parents do not have an SUD. Problems include those related to substance use, health or mental health, trouble with the law, and problems at work or in school. Parental SUDs underlie many family problems such as divorce, spouse abuse, child abuse and neglect, welfare dependence, and criminal behaviors. Studies show that women who use alcohol or drugs during pregnancy are more likely to have premature births.

Recovery from a Substance Use Disorder

The chapter discusses the many possible paths that those with SUDs can take to recovery. Recovery refers to everything that a person with an SUD does to manage the problem and make positive changes. Abstinence is a first step for those who choose this goal, but the real work of recovery is staying abstinent over time and making personal changes to support this. Recovery is not short term; it is a process that takes place over years for many people with SUDs. People with more severe problems may require professional help. Those addicted to opioids or alcohol may also benefit from medications to help sustain recovery.