1. 1 Children of Substance Abusers in the Child Welfare System Naomi Weinstein, MPH, Director, Phoenix House Children of Alcoholics Foundation 646-505-2061 nweinstein@phoenixhouse.org

2. 2 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

3. 3 Critical Factors Parent’s use of drugs Child’s experience Family dynamics Relational issues Protective factors Systems involvement Environment

4. 4 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

5. 5 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

6. 6 Continuum of Addiction Use Dependence/addiction Treatment Recovery Relapse

7. 7 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

8. 8 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

9. 9 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

10. 10 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

11. 11 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

12. 12 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

13. 13 Dependence/Addiction Separation/Removal Loss and abandonment Fearful re: parent May live with AOD caregiver/family member Possibility of multiple placements No pause button

14. 14 Behavior Resiliency Successful adaptation despite challenges Personality traits + environment Contextual Dynamic process Enhanced by protective factors

15. 15 Behavior: Resiliency Wolins’ 7 Areas of Resiliency Insight Independence Relationships Initiative Morality Creativity Humor

16. 16 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

17. 17 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

18. 18 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

19. 19 Recovery New homeostasis Recovery the parent’s #1 priority Fantasies – unrealized Denial of family issues No AOD as a buffer Relapse potential Reunification issues

20. 20 Reunification When Families Reunify Honeymoon period Testing behavior = parental surprise Tantrums Defiance Jealousy Nightmares Clinging behavior Hypervigilence

21. 21 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

22. 22 Relapse Dashed hopes Child may re-enter care Renewed separation – erodes attachment Pre-recovery state for child Further cements lack of trust

23. 23 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

24. 24 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