1. 1 Children of Substance Abusers: Intergenerational Substance Abuse and Resiliency Naomi Weinstein, MPH, Director, Phoenix House Children of Alcoholics Foundation 646-505-2061 nweinstein@phoenixhouse.org

2. 2 Critical Factors Parent’s use of drugs Child’s experience Family dynamics Relational issues Protective factors Systems involvement Environment

3. 3 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

4. 4 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

5. 5 Continuum of Addiction Use Dependence/addiction Treatment Recovery Relapse

6. 6 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

7. 7 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

8. 8 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

9. 9 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

10. 10 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

11. 11 Dependence/Addiction Separation/Removal Loss and abandonment Fearful re: parent May live with AOD caregiver/family member Possibility of multiple placements No pause button

12. 12 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

13. 13 Recovery and Reunification New homeostasis Recovery the parent’s #1 priority Fantasies – unrealized Denial of family issues No AOD as a buffer Relapse potential Reunification issues

14. 14 Reunification When Families Reunify Honeymoon period Testing behavior = parental surprise Unification, not re-unification Child may be stranger to parent Reality v. fantasy Child’s problems Emotional baggage Grief and loss for past home

15. 15 Relapse Dashed hopes Child may re-enter care Renewed separation – erodes attachment Pre-recovery state for child Further cements lack of trust

16. 16 Behavior Resiliency Successful adaptation despite challenges Personality traits + environment Contextual Dynamic process Enhanced by protective factors

17. 17 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

18. 18 How to Help Prevention services and programs Psycho-education for kids w/ parents in tx 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 Reunification support Strengthen access to protective factors Help kids identify resiliencies Aftercare includes family issues