AFFECTED FAMILIES

Helping Families and Children Cope With the Substance Use Disorder of Someone Close

Substance use disorders impact not only the millions of Americans who have a problem with alcohol and/or drugs, but also their families, friends, and children. People of all generations have been affected by substance use disorders. As many as 74 percent of Americans said in 2005 that addiction to alcohol has had some impact on them at some point in their lives, whether it was their own personal addiction, that of a friend or family member, or any other experience with addiction.¹

My life began October 18, 2000. That day, for the first time ever, I began to live life on life's terms, without the use of any mood- or mind-altering drugs. That was the day I began the journey to being a responsible worker, a loving sibling, and a good mother to my four children. My family saw the worst; they've also seen the growth and changes. I used to be the neighbor everyone wished would move away, the sister you didn't invite to dinner, the mom you didn't talk about. Today, I live my life knowing I am a productive member of society and a role model to my children and grandchildren. This year, God willing, I will celebrate six years clean. I am a recovering addict who proudly and openly admits that to anyone. My addiction affected everything in my life. My recovery does as well. Stacy A. Spain Mother, Artist, Seamstress		Furthermore, 41 percent of public reports encouraging a loved one to seek help for an alcohol problem.2 Yet help is available, and like other chronic mental disorders, substance use disorders are medical conditions that can be treated effectively.3 People in recovery can and do rejoin their families, their jobs, and their lives in their communities. Substance use disorders involve the dependence on or abuse of alcohol and/or drugs. Dependence on and abuse of alcohol and illicit drugs, which include the nonmedical use of prescription drugs, are defined using the American Psychiatric Association's criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Dependence indicates a more severe substance problem than abuse; individuals are classified with abuse of a certain substance only if they are not dependent on that substance.4 For more information on the criteria used in defining dependence and abuse, consult the 2004 National Survey on Drug Use and Health, which is available on the Web at www.oas.samhsa.gov/nsduh.htm. Much has been written about substance abuse, dependence, and addiction; many studies have used different terminology to explain their findings. To foster greater understanding and avoid perpetuating the stigma associated with these conditions, the phrase "substance use disorders" is used as an umbrella term to encompass all of these concepts.

Substance use disorders can severely compromise parents' ability to provide a secure and nurturing home for children.⁵ In 2001, more than 6 million children lived with at least one parent who abused or was dependent on alcohol or an illicit drug.⁶ Children of parents with substance use disorders are generally considered at high risk for biological, developmental, and behavioral problems, including the risk of developing a substance use disorder of their own.⁷

Studies examining the effects of prenatal exposure to alcohol and drugs on the health and early development of children are uncovering the biological vulnerability of children. Yet comparatively little attention has been given to postnatal environmental factors that may negatively impact children's development. A quarter of children whose mothers have substance use disorders exhibit behavioral problems in school.⁸ Children of people who have an alcohol use disorder also exhibit symptoms of depression and anxiety more than children of people who do not.⁹

It is important to be aware of your family's habits, particularly when it comes to safe driving habits. In 2004, 10.2 percent of teens ages 16 or 17 and 20.2 percent of 18- to 20-year-olds said they drove under the influence of alcohol at least once in the past year.¹⁰

Additionally, a growing number of elderly adults have substance use disorders. The number of substance abuse treatment admissions among people aged 55 and older increased by 32 percent between 1995 and 2002.¹¹

People aged 65 or older make up only 13 percent of the population, yet account for nearly one-third of all medications prescribed in the United States.¹² Older patients are more likely to be prescribed long-term and multiple prescriptions, which could lead to unintentional misuse.¹³ They also require lower doses of medicines because the body's ability to metabolize many prescriptions decreases with age, making them more susceptible to the effects of a drug.¹⁴ Signs of an alcohol- or medication-related problem among the elderly that family members should look for include memory trouble after having a drink or taking medicine, loss of coordination, and changes in sleeping habits.¹⁵

Support for Families of People With Substance Use Disorders

People who have substance use disorders may become increasingly isolated from their families. Beyond the nuclear family, extended family members may have a range of emotions, including abandonment, anxiety, fear, anger, concern, embarrassment, guilt, and even the desire to ignore or cut ties with the person with a substance use disorder.¹⁶

But there is hope, and family members can play a critical role in supporting loved ones on their path of recovery-ultimately bringing healing to the entire family. A major study published in the Journal of the American Medical Association in 2000 is one of several studies that demonstrate the success of treatments for substance use disorders.¹⁷ Treatment of both mental and substance use disorders can help prevent the exacerbation of other health problems, including cardiac and pulmonary diseases, according to the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Health Disorders in 2002.¹⁸

Treating the intricate needs of people who have family members with substance use disorders requires a team of professionals that extends beyond the support found in a traditional treatment and recovery setting.¹⁹ A child or other family member needs to recognize that he or she is not the cause of a relative's substance use. Another important lesson is that even though people can't "cure" their relative's substance use disorder, they can help the family member through recovery by caring for and supporting them.²⁰

Early in my recovery, I often found myself asking, "Why did I end up a person with an addiction to alcohol and other drugs?" I also asked how it could be that at age 21 I found myself in my counselor's office on the campus of my university, admitting I had a problem. Admitting with great humiliation and disgust that I was an alcoholic and was just like my father. I did not know it was a disease. I did not know how bad it had gotten. A year later, shortly after celebrating a year of sobriety with my father, both of us sober, he relapsed and died. I had made a secret promise that if my father died I would drink again. I wanted to know him. I felt I deserved it. But, when the time came and I received the call telling me he had been found dead at age 54 (due to an overdose of alcohol), alone, in the kitchen of our nice home on the nice golf course in nice suburban Maryland, drinking was the last thing that I wanted to do. In fact, I made another promise to God and to myself shortly after he died. I had heard that for every person who dies addicted to alcohol and other drugs, another one gets sober. I decided one night shortly after the funeral that I was going to be the one who got sober. I promised that my father would not have died in vain. Today, I continue to do my best to keep that promise and live a life that reflects it. As a result, I have been blessed with a wonderful life with 11 years of recovery. I am married, employed, and vote. I participate fully in life! I continue to discover the things about which I am passionate. That passion guides how I live my life and I do all of it sober today. Eleven years ago, I was a scared little boy in a young man's body. Today, I am a man who understands, on most days, that life is a mystery full of joy and pain, but misery is optional. I do not know where my life is going, but I trust and believe in my heart that as long as I stay sober, my life will be:  Always this or something better. And for that, I am very grateful. Dan Griffin Person in Recovery, Husband, Son, Citizen

Learning how to treat substance use disorders just like any other chronic disease can help family members understand how to best support a relative who has a substance use disorder. If a substance use disorder is affecting your family, please refer to the SAMHSA publication What is Substance Abuse Treatment? A Booklet for Families at http://kap.samhsa.gov/. You can also order the publication through SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) on the Web at http://ncadi.samhsa.gov/ or by calling 800-729-6686.

The Importance of the Family's Role in Treatment

Fortunately, family members can help people obtain treatment and work to erode societal stigmas against people in recovery by celebrating their successes. Substance use disorder treatment programs with family-oriented approaches can make a difference. Family therapy helps people with substance use disorders use a family's strengths and resources to develop ways to live without alcohol and/or drugs.²¹

Family therapy can also help the family make important relationship and environmental changes affecting the member with a substance use disorder. For example, therapy may help other family members work together more effectively and help their relatives set personal goals. Family therapy can also help families recognize their own needs and provide healing for each other, and help prevent substance use disorders from moving from one generation to another.²²

The Impact of Stigma and Discrimination Within Families

While substance use disorders are medical conditions, and treatment is highly effective, stigma and discrimination can plague people who are in recovery, even within families. Stigma and discrimination present a barrier for people with substance use disorders who wish to access treatment. They also inhibit the ongoing recovery process. Stigma detracts from the character or reputation of a person. For many people, stigma can be a mark of disgrace.²³ In 2004, 21.6 percent of the 1.2 million people who felt they needed treatment but did not receive it indicated it was because of reasons related to stigma.²⁴

Stigma can keep family members from disclosing a relative's substance use disorder, which is counterproductive when they are trying to encourage the person to seek treatment. Results from a recent study suggest that families of people with a drug use disorder are viewed by society in the most stigmatizing manner, when compared to families of people with mental illness or emphysema. Society views them as more responsible for the onset of the disorder, and they may feel more ashamed of their family member.²⁵

Discrimination, on the other hand, is an act of prejudice. It can include denying someone employment, housing, accommodation, or other services based on the revelation that the person is receiving treatment or has previously been treated for a substance use disorder.²⁶ Discrimination ignores the fact that substance use disorders can strike people of any age, gender, race, ethnicity, education level, and geographic area.²⁷

Families report being blamed by other community members for a relative's disorder and accused of being responsible for any relapses the affected person may experience.²⁸ Furthermore, family members are more directly affected by the disorder themselves and more likely to be socially avoided.²⁹

In particular, stigma and discrimination can affect parents whose children have a substance use disorder or are in recovery. Many families are more comfortable revealing that their child has depression or attention deficit disorder than disclosing that their child is using illegal substances, and are more willing to discuss the problem in a group setting to get help. Conversely, many family support specialists report that when the mental health diagnosis is more severe-for example, a bipolar disorder-families find it more socially acceptable to talk about their child's substance use than to divulge that their child needs an antipsychotic medication. Yet a survey by the Parent/Professional Advocacy League suggests there is a need for integrating treatment of both mental health and substance use disorders together when they co-occur in adolescents.³⁰

Families may fear potential consequences if they disclose a relative's illegal drug use, such as legal ramifications. However, a delay in receiving treatment can actually lead to more encounters with the police and court system.³¹ Once people with untreated substance use disorders find themselves in the criminal justice system, the system can give them access to treatment programs. In fact, there is an ongoing trend toward addressing drug use disorders with treatment, rather than with punishment.³² With this in mind, it is important to overcome stigma and help get affected family members an assessment by a health care professional as soon as any problem is recognized.

Talking about a family member's substance use disorder will, in fact, help combat societal stigma because when open discussion occurs, people will realize they aren't alone. Creating an open dialogue about overcoming stigma toward people with substance use disorders and their families can help build a stronger, healthier community.

Tools to Help Affected Family Members in Treatment

One tool to help parents support their children with substance use disorders or in recovery is a campaign titled "15+ Make Time to Listen.Take Time to Talk," directed by SAMHSA's Center for Mental Health Services' National Mental Health Information Center. This campaign provides practical guidance to parents and other caregivers about how to create time to listen and talk with their children. By encouraging strong adult and child relationships, parents can guide their children toward more positive activities. For more information about this campaign, please visit the Web site at http://mentalhealth.samhsa.gov/15plus/default.asp.

Other resources are available for families who have a close relative with a substance use disorder. The Child Welfare League of America (CWLA) provides programs, publications, research, conferences, professional development, and consultation to address the needs of American children, young people, and families.³³ For more information, contact the CWLA at 202-638-4918 or visit its Web site at www.cwla.org. Also, the American Public Human Services Association provides a list of each state's social services agencies, which help improve the health and well-being of adults, children, and families in their respective states. For more information, contact 202-682-0100 or visit its Web site at www.aphsa.org/home/news.asp.

Another organization that may help children and family members of people with substance use disorders is the National Association for Children of Alcoholics (NACoA). The NACoA is a national non-profit organization that works on behalf of children of alcohol- and drug-dependent parents and all family members. For more information, call 888-55-4COAS or visit its Web site at www.nacoa.org. Additionally, Al-Anon and Alateen (www.al-anon.alateen.org) provide support for families and friends of those who suffer from alcohol use disorders.

In addition, a 30-minute documentary titled Lost Childhood: Growing Up in an Alcoholic Family is a resource for treatment professionals and others who are close to a child whose family is affected by a substance use disorder. The film presents a message of hope through a visits to a summer camp program specifically designed for these children. The film can be ordered for a small charge through SAMHSA's NCADI. To order, call 800-729-6686 and request VHS201 or DVD191.

Making a Difference:  What Can I Do?

1. Participate in a family support group such as Al-Anon/Alateen or Families Anonymous, where you can find others who have family members or close friends with substance use disorders. Listening to stories can help some people overcome negative perceptions about substance use disorders.
2. Become involved in your family member's treatment and recovery and understand that substance use disorders can be treated just as other diseases can be.
3. Volunteer to be a mentor for a child who has a parent or close relative with a substance use disorder. Mentors may serve as crucial educators and support figures, promoting learning and capability, providing exposure to positive influences, and helping youth realize their full potential.^{34, 35, 36}
4. Encourage pediatricians, schools, and other people who routinely interact with children to identify those with parents who have substance use disorders and intervene to provide support.³⁷
5. Consult helpful organizations to learn more about overcoming stigma. For example, Join Together, a national resource for communities working to reduce substance use disorders, offers an action kit titled Strengthening Families:  What Communities Can Do to Support Families with Addictions (see contact information provided at the end of this document). You can use it to work with families who are affected by substance use disorders.

Making a Difference:  How Can I Contribute to Recovery Month?

We encourage every community member to participate in National Alcohol and Drug Addiction Recovery Month (Recovery Month) this September. The theme for this year's Recovery Month is "Join the Voices for Recovery:  Build a Stronger, Healthier Community." Your participation is essential to the success of the 17^th annual celebration of Recovery Month. Here are some ideas you may consider:

I came from a very successful family and had every opportunity to do well in life, and for years I did. However, as a kid, I never was quite able to truly be comfortable with my life and I always felt like something was missing. This lack of fulfillment eventually led me to the path and lifestyle of drug addiction. My family watched me become helpless and in despair as an alcohol and marijuana addiction led to a cocaine addiction, which then led to a raging heroin addiction. The years of success that I had built my life on were wasted on nine years on hard drugs as I ended up in jail. My family helped me locate a rehabilitation center and I wanted to pick up the pieces of my life. I started my recovery process with an arrest record, multiple debts, burned bridges, distrust and mistrust, and little hope. After receiving treatment, I recognized that there was hope for me and that I was done with my old lifestyle. Since then, I have made the most of my three years being clean. Today , I am accomplished, successful, and I have made my family proud! I no longer feel I am missing something in life. There is always hope and I am indeed living proof. Ryan Thorpe Admissions Counselor		Raise awareness among parents, caregivers, and young people in your community by educating them about substance use disorders and recovery, and how to help overcome stigma. You can do this by setting up educational tables or booths at shopping centers, grocery stores, libraries, county or state fairs, movie theaters, or other areas that are frequented by families. Create a task force or community coalition to educate others about substance use disorders and to dispel myths and misconceptions. To develop a community coalition, consult the "Resources" section of this planning toolkit. Education is the best tool to help reduce stigma and discrimination associated with substance use disorders and recovery. Support existing community efforts by collaborating with a local treatment facility. Volunteer time, money (if donations are accepted), and/or other resources. You also may consider collaborating with a treatment organization on a Recovery Month press event to raise public awareness about substance use disorders, treatment, and recovery. For example, reporters could be invited to a press briefing honoring recent drug court graduates or families reunited through the child welfare system (who agree to appear publicly), as well as members of the drug court team and others who have dedicated themselves to helping those who need treatment. You can identify organizations working on Recovery Month initiatives in your state at the Recovery Month Web site at www.recoverymonth.gov. Speak out about your experiences with substance use disorders and recovery. Use Recovery Month as an opportunity to share how you supported a family member through treatment and recovery or how you worked on your own recovery. Talk to friends, extended family, and other community members during everyday conversation about the reality of substance use disorders to help rise above societal stigma.

For additional National Alcohol and Drug Addiction Recovery Month (Recovery Month) materials, visit the Recovery Month Web site at www.recoverymonth.gov or call 1-800-662-HELP.

For additional information about substance use disorders, treatment, and recovery, please visit SAMHSA's Web site at www.samhsa.gov.

Affected Families and Children Resources

This list is not exhaustive of all available resources. Inclusion does not constitute endorsement by the U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration, or its Center for Substance Abuse Treatment.

SOURCES

¹  Rivlin, A., presentation at Community Anti-Drug Coalitions of America Science Writers' Briefing, Pittsburgh, PA, September 29, 2005, slide #4. Survey data collected August 2005 by Peter D. Hart Research Associates.
²  Ibid.
³  Pathways of Addiction: Opportunities in Drug Abuse Research. National Academy Press.Washington, D.C.: Institute of Medicine, 1996.
⁴  Results From the 2004 National Survey on Drug Use and Health: National Findings. DHHS Publication No. (SMA) 05-4062. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2005, pp. 155, 160.
⁵  No Safe Haven: Children of Substance-Abusing Parents. New York: The National Center on Addiction and Substance Abuse at Columbia University, January 1999, p. 1.
⁶  The NHSDA Report: Children Living with Substance-Abusing or Substance-Dependent Parents. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, June 2, 2003, p. 1.
⁷  Conners, Nicola A. "Children of mothers with serious substance abuse problems: an accumulation of risks." American Journal of Drug and Alcohol Abuse, 30(1), 2004, pp. 85-100.
⁸  Ibid.
⁹  "Children of Alcoholics." Center for Substance Abuse Prevention (CSAP). CSAP Web site: http://ncadi.samhsa.gov/govpubs/ms417/, September 28, 2000, para. 1.
¹⁰  Results From the 2004 National Survey on Drug Use and Health: National Findings, p. 31.
¹¹  The DASIS Report: Older Adults in Substance Abuse Treatment: Update. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, May 5, 2005, p. 2.
¹²   "Prescription Drugs Abuse and Addiction." National Institute on Drug Abuse Research Report Series. Publication Number: 01-4881. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, July 2001, p. 5.
¹³  Ibid.
¹⁴  Ibid, pp. 5-6.
¹⁵  As You Age...A Guide to Aging, Medicines, and Alcohol. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, May 2004, p. 5.
¹⁶  Treatment Improvement Protocol (TIP) Series 39. DHHS Publication No. (SMA) 04-3957. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2004, section entitled "Executive Summary: Impact of Substance Abuse on Families."
¹⁷  Kleber, H.D., O'Brien, C.P., Lewis, D.C., McLellan, A.T. "Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation." Journal of the American Medical Association, 284(13), Chicago, IL: American Medical Association, October 4, 2000, p. 1689.
¹⁸  Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Health Disorders. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2002, p. ix.
¹⁹  Conners, Nicola A. "Children of mothers with serious substance abuse problems: an accumulation of risks." American Journal of Drug and Alcohol Abuse, pp. 85-100.
²⁰  Adger, Hoover, M.D., M.P.H., Blondell, Richard, M.D., Cooney, Janice, P.A-C, Finch, James, M.D., Graham, Antonnette, R.N., M.S.W., Ph.D., Macdonald, Donald Ian, M.D., Pfeifer, Judie, M.Ed., Wenger, Sis, B.A., Werner, Mark, M.D. "Helping children in families hurt by substance use disorders." Contemporary Pediatrics, December 1, 2004, section entitled "Cover Article."
²¹  Treatment Improvement Protocol (TIP) Series 39, section entitled "Chapter 1: Family Therapy in Substance Abuse Treatment."
²²  Ibid, section entitled "Chapter 1: Family Therapy in Substance Abuse Treatment."
²³  Faces & Voices of Recovery Public Survey, p. 2.
²⁴  Results From the 2004 National Survey on Drug Use and Health: National Findings, pp. 78-79.
²⁵  Corrigan, Patrick W., Watson, Amy C., Miller, Frederick E. "Blame, Shame, and Contamination: The Impact of Mental Illness and Substance Abuse Stigma on Family Members." Evanston, IL: Evanston Northwestern Healthcare and Northwestern University. Manuscript Submitted to American Journal of Public Health, p. 14.
²⁶  Concurrent Disorders: Beyond the Label, An Educational Kit to Promote Awareness and Understanding of the Impact of Stigma on People Living with Concurrent Mental Health and Substance Use Problems. Toronto, ON: Centre for Addiction and Mental Health, 2005, slide #7.
²⁷  Results From the 2004 National Survey on Drug Use and Health: National Findings, pp. 67-72.
²⁸  Corrigan, Patrick W., Watson, Amy C., Miller, Frederick E. "Blame, Shame, and Contamination: The Impact of Mental Illness and Substance Abuse Stigma on Family Members." Manuscript Submitted to American Journal of Public Health, p. 18.
²⁹  Ibid.
³⁰  Lambert, Lisa. Substance Use in Children and Adolescents with Mental Health Needs. Parent/Professional Advocacy League. Boston, MA: September 2004, p. 2.
³¹  Ibid, p. 5.
³²  Piper, B., et al. State of the States: Drug Policy Reforms, 1996-2002. New York, NY: Drug Policy Alliance, September 2003, p. i.
³³  About CWLA: Fact Sheet. Child Welfare League of America Web site: www.cwla.org/whowhat/more.htm. Accessed September 20, 2005.
³⁴  Hamilton, S., Darling, N. "Mentors in adolescents' lives." The Social World of Adolescents: International Perspectives. New York: Aldine de Gruyter, 1989, pp. 121-209.
³⁵  Eccles, J. and Appleton Gootman J, eds. "Committee on Community-Level Programs for Youth." Community Programs to Promote Youth Development. Washington, D.C.: National Academy Press, 2001.
³⁶  Barrera, M Jr., Prelow, H. "Interventions to promote social support in children and adolescents." The Promotion of Wellness in Children and Adolescents. Washington, D.C.: CWLA Press, 2000, pp. 309-339.
³⁷  Strengthening Families: What Communities Can Do to Support Families with Addiction.Boston, MA: Join Together,
Fall 2000, p. 5.