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1
Children of Substance Abusers
in the Child Welfare System
Naomi Weinstein, MPH, Director, Phoenix House Children of Alcoholics
Foundation646-505-2061
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
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Critical Factors Parent’s use of drugs Child’s experience Family dynamics Relational issues Protective factors Systems involvement Environment
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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
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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
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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
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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
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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
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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
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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
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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
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Dependence/Addiction
Separation/Removal
Loss and abandonment Fearful re: parent May live with AOD caregiver/family
member Possibility of multiple placements No pause button
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Behavior
Resiliency
Successful adaptation despite challenges Personality traits + environment Contextual Dynamic process Enhanced by protective factors
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Behavior: Resiliency
Wolins’ 7 Areas of Resiliency
Insight Independence Relationships Initiative Morality Creativity Humor
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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
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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
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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
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Recovery
New homeostasis Recovery the parent’s #1 priority Fantasies – unrealized Denial of family issues No AOD as a buffer Relapse potential Reunification issues
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Reunification
When Families Reunify
Honeymoon period Testing behavior = parental surprise
Tantrums Defiance Jealousy Nightmares Clinging behavior Hypervigilence
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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
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Relapse
Dashed hopes Child may re-enter care Renewed separation – erodes attachment Pre-recovery state for child Further cements lack of trust
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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
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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