1. Children of Alcoholics: What do we know and what we are learning
National Association of Social Workers
Specialty Practice Sections
Teleconference
October 24, 2007
Steve Hornberger
National Association for Children of Alcoholics

2. Addiction Hurts Everyone in the Family
Family members develop unhealthy ways of communicating with each other and coping with the addiction.
Rules in addicted families:
Don’t talk!
Don’t’ trust!
Don’t feel!
Strategies and programs for affected children and families need to Break these Rules!

3. Scope of the Problem
Over 22 million adults over 18 are dependent on alcohol or other drugs
More than 6 million children lived with at least one parent or family member who abused or was dependent on alcohol or illicit drugs last year, 10% of all children 12 or under
One in four children under 18 will live with a family member who is alcoholic or dependent on alcohol

4. Scope of the Problem
19.9% of unemployed adults over 18 were classified with dependence or abuse of illicit drugs
22.3 million classified as dependent or abusing drugs
15.7 million (77.6%) are employed
2.3 million received treatment for alcohol or drug abuse

5. The Gaps
Of the more than 20 million who needed treatment but did not receive it,
only 1.2 million (5.8%) felt they needed it (denial gap)
Of that 1.2 million, 441,000 (35.8%) said they made an effort , but were unable to get it (treatment gap)
Of that 1.2 million, 792,000 (64.2%) reported making no effort (motivation gap)

6. How does it affect the family?
Basic needs of children often overlooked
Impairment while high/intoxicated
Use of limited family resources on alcohol or drugs
Time spent seeking out alcohol or drugs
Time spent using alcohol or drugs
Co-occurring other problems

7. Clear Health Consequences
Family members use more medical and mental health services
Chronic emotional stress affects early childhood brain development
Adverse Childhood Experiences (ACEs) create lifetime health and mental health consequences.

8. Adverse Child Experiences Study

9. Lifetime Health Consequences
The more ACEs, the greater health consequences
Alcohol and drug addiction in the family creates or exacerbates other ACEs
Higher rates of major chronic diseases
Heart, cancer, stroke, diabetes, arthritis, mental illness
With multiple ACEs, average life expectancy reduced 10 years compared to general population

10. “But They Seem Fine”
Most suffer in silence and keep the family secrets.
Yet, they are our neighbors, our colleagues, our children, and so many of them are doubly impacted –
by losses associated with alcohol or drug problems and parental emotional neglect,
with mental health problems,
with family break-ups and its frequent economic losses and geographic moves.
Their problems create widespread social disarray, impair learning and impede healthy development.
They hurt, they need help, and they can be helped.

11. Attention to Children Critical
Addiction is a treatable disease, not a moral weakness, but living with it is emotionally and developmentally harmful to children.
Teachers, physicians, judges, clinicians, neighbors, faith leaders and social workers can offer hope and help to addicted individuals and their affected children and spouses, but first they must recognize they can and should act.

12. How Are Children Hurt?
Emotional abuse by both parents and or addicted siblings
Neglect and physical injury
Lack of discipline, structure
Social isolation and lack of normal “fun”
Permissive or over-reactive attitudes toward alcohol & drug use
Lack of positive role models

13. Children of Addicted Parents
May lack consistency, stability, or emotional support due to chaotic family environment
May be physically and emotionally traumatized by accidental injury, verbal, physical or sexual abuse due to parental drinking/drug use
May encounter permissiveness, neglect, violence, poor communication, under-socialization
Often feel abandoned by their faith community

14. Helping Professionals and community members need to Help
Affected family members get:
Information about addiction as a family disease
Information about the hope of treatment and the process of recovery
Information on community-based supports; such as Al-Anon and Alateen
Validation of their experiences
Reassurance that affected children and spouses need and deserve support and help…whether or not the addicted family member recovers… and encouragement to act.

15. You Can Help COAs
Talk to children of alcoholics and drug addicts and about them and their needs; explain disease and 7 Cs
I didn’t Cause it
I can’t Cure it
I can’t Control it
I can take better Care of myself:
by Communicating my feelings
making healthy Choices
by Celebrating myself.

16. Messages Children Need
You’re not alone.
It’s not your fault.
You deserve help, and there are safe people and programs that can help you.
Addiction is a health problem.
It’s OK to feel our feelings.
It’s important to talk; talking is not being disloyal to your family.
Treatment helps, and recovery happens.

17. People Outside the Family can Make a Difference
When treatment programs, schools and faith communities provide educational support groups for school age children…
Children gain clarity and hope
Family stress is reduced
Children’s sense of stigma and shame is reduced
Family recovery is enhanced
Treatment outcomes improve
School outcomes improve

18. The Challenge Lead – Communicate – Transform (wherever you are)
Vision: A school and community environment where children are safe, healthy, happy and educated as well as believe that there are nurturing adults who care about them.

19. What you can do
Take good care of yourself, family, friends and colleagues
Learn about addiction and recovery, advocate for system collaboration and become a change agent
Define and monitor outcomes at four levels, the status quo is not good enough
Be bold, imagine a community where people live better lives, where children are safe, healthy, happy and educated, where people achieve their aspirations
Provide hope

20. Resources SAMHSA’s Children Program Kit Goals:
To prevent addiction and mental health problems in the highest risk population – youth living in families with addiction – and to increase their capacity for resilience.
To lessen the confusion and provide support for children of addicted parents – both those in treatment and those not receiving recovery services
To enhance the recovery outcomes of parents in treatment

21. Structure of Children’s Program Kit
Three levels: grades 1-5, 6-8 and 9-12
Five activity option for each topic area
Six topic areas:
1. addiction 2. feelings 3. problem solving
4. treatment and recovery 5. safe people 6. coping
47 separate program activities

22. Children’s Program Kit includes:
Tools for therapists of parent clients
Letters to parents
Hand-outs for parents
Resource list
Evaluation tools
Staff in-service program materials
Program start up instructions

23. Some Emerging Issues
Role of family/consumer in design, delivery and evaluation of services
Expanding knowledge base on addiction as a brain disease
Disparities in healthcare
Paradigm shift on recovery
Definition of core competencies for social workers

24. Why Family Involvement
Increased involvement = increased ownership = improved outcomes
Services can be organized on a continuum from family friendly to family focused to family centered to family driven.
Goal: collaborative partnership of professional expertise, resources and experience with family expertise, resources and experience.

25. Examples of Successful Family Involvement
Strengthening Families
Celebrating Families!
Family Group Decision Making

26. National Web Resources
Al-Anon and Alateen
Faces and Voices of Recovery
Federation of Families for Children’s Mental Health
Join Together
National Association for Children of Alcoholics (NACoA)
National Center on Substance Abuse and Child Welfare (NCSACW)

27. National Web Resources
National Center on Addiction and Substance Abuse at Columbia (CASA)
National Clearinghouse for Alcohol and Drug Information (NCADI)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National Institute on Drug Abuse (NIDA)
Substance Abuse and Mental Health Services Administration (SAMHSA)

28. Closing thought
“A child is a person who is going to carry on what you have started. He is going to sit where you are sitting, and when you are gone, attend to those things which you think are important. You may adopt all the policies you please, but how they are carried out depends on him. He will assume control of your cities, states and nations. He is going to move in and take over your churches, schools, universities, and corporations…the fate of humanity is in his hands.”
Abraham Lincoln