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 shornberger@nacoa.org www.nacoa.org

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!

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

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

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)

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

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.

Adverse Child Experiences Study

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

“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.

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.

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

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

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.

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.

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.

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

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.

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

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

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

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

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

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.

Examples of Successful Family Involvement Strengthening Families www.strengtheningfamiliesprogram.org Celebrating Families! www.celebratingfamilies.net Family Group Decision Making www.americanhumane.org/

National Web Resources Al-Anon and Alateen www.al-anon.alateen.org Faces and Voices of Recovery www.facesandvoicesofrecovery.org Federation of Families for Children’s Mental Health www.ffcmh.org Join Together www.jointogether.org National Association for Children of Alcoholics (NACoA) www.nacoa.org National Center on Substance Abuse and Child Welfare (NCSACW) www.ncsacw.samhsa.gov

National Web Resources National Center on Addiction and Substance Abuse at Columbia (CASA) www.casacolumbia.org National Clearinghouse for Alcohol and Drug Information (NCADI) www.ncadi.samhsa.gov National Institute on Alcohol Abuse and Alcoholism (NIAAA) www.niaaa.nih.gov National Institute on Drug Abuse (NIDA) www.nida.nih.org Substance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov

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