Effects of Drugs & Alcohol on Children & Families · Effects of Drugs & Alcohol on...
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Effects of Drugs & Alcohol on Children & Families Kierstin Thornhill, MS, LPC-Intern Coordinator of Children’s Clinical Services Under Supervision of Gabrielle Seekely, M.Ed., LPC-S, BCPC
Effects of Drugs & Alcohol on Children & Families · Effects of Drugs & Alcohol on Children & Families ... 漀昀 琀栀攀 氀椀猀琀 琀漀 琀栀攀 琀漀瀀⸀ 屲Those at
Kierstin Thornhill, MS, LPC-InternCoordinator of Children’s Clinical Services
Under Supervision of Gabrielle Seekely, M.Ed., LPC-S, BCPC
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Presentation Notes
Prenatal exposure Parental substance abuse Teen substance abuse I am going to share some client letters and drawings with you today. I just want to make sure that you know that each family gave permission to use these to educate the community about what it feels like to grow up in a family with addiction.
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Addiction does not discriminate against people based on color or gender, race or religion, creed or ethnicity and it surely does not care how much money is in your bank account. It hurts families from the oldest to the most innocent.
Approximately 1 in 4
The National Institute of Health (NIH), 2012
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1 in 4 children in the US is growing up in a family with substance abuse – addiction to drugs and/or alcohol. That means that when you visit an elementary school and you see 600 children pouring out of the doors, 150 of them have stories that just might be like these two stories.
Cycle of AddictionCOAs are four times likelier than non-COAs
to use alcohol or develop alcohol-related problems.
COAs tend to initiate alcohol use earlier and engage in problem drinking at a younger age than non-COAs.
The National Center on Addiction and Substance Abuse at Columbia University. (2005). Family matters: Substance abuse and The American Family. New York: The National Center on Addiction and Substance Abuse at Columbia University.
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Presentation Notes
COA – Children of Alcoholics. Ask the audience: What is the average age of first use of alcohol in the U. S.? 9! Marijuana? 10! Prevention must start early. There are other things COAddicts are more likely to experience as well..(next slide)
The National Center on Addiction and Substance Abuse at Columbia University. (1999b). No safe haven: Children of substance- abusing parents. New York: The National Center on Addiction and Substance Abuse at Columbia University.
#1 risk factor for a child being abused is alcoholism/addiction in the home.
COA’s are 4 times more likely to suffer neglect.
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Presentation Notes
Child abuse is correlated with addiction. So what does that do to a child? It changes the way the brain is formed.
www.childtrauma.org
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Presentation Notes
We are big fans of Dr. Bruce Perry at the Child Trauma Institute here in Houston and these two graphics are from his website www.childtrauma.org On the right you will see how we can conceptualize the brain and its four parts. (read out the four) Brain grows from the bottom to the top and from the inside out. Not a linear process, but somewhat sequential. So, the brain stem controls all of the stuff a baby must do in order to be released from the hospital the first time. What are those? Body temp, heart rate, blood pressure, respiration, etc. Those are the most essential functions and they are the functions that are compromised if a fetus is exposed to trauma. Such as with Fetal Alcohol Spectrum Disorders, which is permanent damage to the brain that is 100% preventable. Early childhood is the time when the next two, the midbrain and the limbic system form The cortex does most of its organizing between the ages of 11 – 12 and 24 – 25. On the left you can see many of the functions of the brain, increasing in complexity as you move from the bottom of the list to the top. Those at the bottom of the list are the most essential and therefore they develop first and those at the top of the list are the least essential to live, but they are quite important in adult life.
FAS FASD
Texas Office for Prevention of Developmental Disabilities
Wattendorf, D. MAJ, MC, USAF, and Muenke, M, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland. Am Fam Physician. 2005 Jul 15;72(2):279-285.
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Presentation Notes
How many of you have heard of Fetal Alcohol Spectrum Disorders before today? (encourage them to raise their hands by raising yours as well as you say these questions.) Okay, how many of you have heard of Fetal Alcohol Syndrome or FAS before today (again raise your hand to encourage them to raise theirs.) Many people have heard of FAS but not of FASD (reflect on what you just say.) Prenatal alcohol exposure causes a spectrum of impacts, but science did not always know this. FAS (Fetal Alcohol Syndrome) is only one of the diagnoses under the umbrella term Fetal Alcohol Spectrum Disorders (FASD.) The children pictured here each have FAS and you may be able to visually see some of their common facial features (thin upper lip, flat philtrum – the space between the bottom of the nose and the mouth.) To receive a diagnosis of FAS, a child must have 3 things: growth deficiency, a specific set of facial features, and Brain/Central nervous System (CNS) damage. The majority of people who were impacted by prenatal exposure to alcohol and who have a diagnosis under the FASD umbrella do not have FAS*, so they have typical features and you can not necessarily SEE their diagnosis. It is also important not to go out and “diagnose” the people that you work with because they may have some of these features. A diagnostic assessment can only be done by trained medical professionals. *(May and Gossage, 2009 - http://www.ncbi.nlm.nih.gov/pubmed/19731384) New research shows us that binge drinking may be more damaging than occasional drinking when it comes to the impact on a fetus. Binge drinking as defined by CDC is 4 or more drinks at one time for a woman. 2013 research from the CDC indicates that 1 in 5 high school girls binge drink, and 1 in 8 women binge drink at least once per month (http://www.cdc.gov/vitalsigns/bingedrinkingfemale/.) Combined with the fact that almost ½ of all pregnancies are unplanned*, and that alcohol consumption even before a woman knows that she is pregnant can be harmful, we have a serious issue here. *Source: Unintended pregnancy in the United States: incidence and disparities, 2006.Contraception. 2011;84(5):478–485. We want you to remember that FASD is an umbrella term, with multiple diagnoses underneath it, similar to autism and that the majority of people impacted by prenatal alcohol exposure look completely normal. (ask the audience,) So is FASD a diagnostic term? NO! (wait for them to respond then point to or look and nod towards someone who said no when you repeat the correct answer to the group.)
Photo courtesy of Sterling Clarren, MD – Brain at 6 wks
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This image is of two infant brains, both were 6 weeks old at the time of their death. Can you all guess which of these two brains represents the brain of a child who had FAS? (let them guess, they’ll probably guess the brain on the right.) Yes, the brain on the right is from a child whose mother drank heavily throughout pregnancy. (ask audience) What are the differences that you see? (people will likely shout out – size, shape, hemisphere separation or “gap between the two sides,” color, texture or surface area.) Yes, let’s talk about some of those differences that can be caused by prenatal alcohol exposure and the potential impacts. -Less folds (or “one is smoother”): Brain space /surface area is directly tied to intellectual capacity. The brain on the right has less folds, so there is less brain surface area and therefore less intellectual ability. -Reduced overall brain size. -Division: If you went straight down through the center of the brain between the hemispheres, you would come to a band of nerve fibers that connects the two halves of the brain, which is called the corpus callosum. The primary job of the corpus callosum is to integrate (“organize”) motor, sensory, and cognitive performances. While some people who were prenatally exposed to alcohol have intellectual disabilities or low IQ, many have completely normal IQ. They just may have diminished (or be totally missing,) the circuitry or hardware to use their “normal,” IQ. One of the most common brain based impairments that results from prenatal alcohol exposure occurs in the frontal lobe.* (Ask audience) And who knows what occurs in the frontal lobe? Executive Functioning! (If no one knows, say it outloud yourself.) Executive functioning allows people to be organized, self-regulated, and engage in goal-directed behavior. It involves cognitive abilities such as reasoning, language, visual perception and memory processes and allows people with the ability to shift strategies, adapt, use inhibition, abstract reasoning, sequencing and organizing processes. Alcohol can impair multiple parts of the brain including areas associated with memory, sensory issues, self regulation, impulsivity, judgment, and inhibition. (http://www.come-over.to/FAS/FASbrain.htm) * J Child Psychol Psychiatry. 2009 Jun;50(6):688-97. doi: 10.1111/j.1469-7610.2008.01990.x. Epub 2008 Oct 23. Executive function deficits in children with fetal alcohol spectrum disorders (FASD) measured using the Cambridge Neuropsychological Tests Automated Battery (CANTAB). Green CR, Mihic AM, Nikkel SM, Stade BC, Rasmussen C, Munoz DP, Reynolds JN.
There is also no safe time during pregnancy to drink and no safe kind of alcohol. We urge
pregnant women not to drink alcohol atany time during pregnancy.”
– Centers for Disease Control and Prevention, 2011
Texas Office for Prevention of Developmental Disabilities
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Presentation Notes
You don’t have to take my word for it, the CDC and Surgeon General and ACOG all agree that no alcohol is the only safe amount of alcohol during pregnancy. A researcher named Sood in a 2001 study found that a child’s behavior was adversely affected even at levels of one drink per week. This study also found that children exposed to any level of prenatal alcohol exposure were found to have 3 times the odds of showing delinquent behavior as children and young adults. So even if your own OBGYN says a drink a week is ok, here is some other information for you and the people that you work with to consider.
www.childtrauma.org
Presenter
Presentation Notes
We are big fans of Dr. Bruce Perry at the Child Trauma Institute here in Houston and these two graphics are from his website www.childtrauma.org On the left you will see how we can conceptualize the brain and its four parts. (read out the four) The brain grows from the bottom to the top and from the inside out. It is not a linear process, but it is somewhat sequential. So, the brain stem controls all of the stuff a baby must do in order to be released from the hospital the first time. What are those? Body temp, heart rate, blood pressure, respiration, etc. Those are the most essential functions and they are the functions that are compromised if a fetus is exposed to trauma. In a moment we will talk about Fetal Alcohol Syndrome, which is permanent damage to the brain which is 100% preventable. Early childhood is the time when the next two, the midbrain and the limbic system form and then the cortex does most of its organized between the ages of 11 – 12 and 24 – 25. On the right you can see many of the functions of the brain, increasing in complexity as you move from the bottom of the list. Those at the bottom of the list are the most essential and therefore they develop first and those at the top of the list are the least essential to live, but they are quite important in adult life. Let’s talk about Fetal Alcohol Spectrum Disorders. We cannot talk about addiction and children without talking about it.
Characteristic Concerns of COAs
Children feel responsible for parent’s drinking or
drug use.
Characteristic Concerns
Children fear the person who uses alcohol or drug will get sick or die.
Characteristic Concerns
Children feel angry with
non-using parent
Characteristic Concerns
Children are embarrassed by
parent’s behavior.
Characteristic Concerns
Children never knowwhat to expect.
Characteristic Concerns
Children are confused by the
difference between “dry” and
“drunk” behavior.
Characteristic Concerns
Children sometimes want their
parent to drink or use drugs.
Characteristic Concerns
Family Dynamics
Presenter
Presentation Notes
Any family living with or “drowning in” addiction is likely to be functioning in emotional extremes. Feelings can explode-get big fast or implode-disappear altogether just as fast Things that don’t matter get a lot of attention while things that do get ignored Routines are thrown off, feelings get hurt, doors get slammed, and families can be torn apart. Take a look at how one child viewed their family dynamics…
Common Beliefs in Families with Addiction
Presenter
Presentation Notes
I was talking with a coworker about this family disease of addiction. He grew up in a family with people who drank too much. He said, “You know, I thought my family was crazy. I began to speak up and was told that our family was normal. It didn’t feel right to me, so I decided I was crazy. If only I had learned as a little kid that addiction – addiction is what makes families feel crazy. Maybe I wouldn’t have had to go to rehab so many times.”-Beliefs and opinions of “normal” and “healthy” shift. As kids, we develop templates for how to hold relationships and view others and we grow up to use those templates as adults
Don’t rock the boat.
It’s not okay to play or be playful.
Do as I say, not as I do.
Don’t be selfish.
Unrealistic expectations.
It’s not okay to express feelings freely.
Indirect communication is best
It’s not okay to talk about feelings.
Important Messages
• Children need to hear:• “You are not at fault.”• “You didn’t cause me to drink, use drugs, or engage in any
addictive behavior”• “Nothing you said, thought, or did could have changed my
choices or actions when I was using.”• “All your feelings are OK”• “I love you. Always have, always will.”• “You are not alone”• “You get to be a kid!”
Breaking the RulesTALK about it:Let kids know in an age-appropriate way what happened when/if they ask.If they don’t ask or don’t know about your addiction, let them know before they are adolescents.Work on communication skills as a family and one on one.
Build TRUST:Make promises you can keep.Be where you are supposed to be, when you are supposed to be there.Be consistent and fair with rules and consequences.Trust yourself to make decisions for your children.Trust others and seek help when you don’t know what to do.
Start FEELING:ALL FEELINGS ARE OK!Be aware of your own feelings and let them out.Do model your feelings appropriately .Avoid yelling and other displays of violence.
Child’s View of Recovery
Child’s View of RecoveryChange is scary-even if it’s what they have hoped for.
What is my role now?
Kids are confused about the “meetings” parents go to.
Kids sometimes feel resentful about all of the slogans &
terminology.
Children expect everything to be all better now. Sometimes
parents relationship worsens after recovery.
Children react to limits being set when there might have been
none or inconsistently set ones be
ResourcesLiterature
• How to Raise a Drug Free Kid by Joseph A. Califano, Jr.
• Understanding Addiction and Recovery Through a Child’s Eyes by Jerry Moe
• The Truth About Children and Divorce by Robert E. Emery
• Straight Talk from Claudia Black: What Recovering Parents Should Tell Their Kids about Drugs and Alcohol by Claudia Black
• Bonding and Attachment in Maltreated Children by Bruce Perry
ReferencesBlack, Claudia (2003). Straight Talk from Claudia Black. Hazelden, Center City, MN.J Child Psychol Psychiatry. 2009 Jun;50(6):688-97. doi: 10.1111/j.1469-7610.2008.01990.x. Epub
2008 Oct 23. Executive function deficits in children with fetal alcohol spectrum disorders (FASD) measured using the Cambridge Neuropsychological Tests Automated Battery (CANTAB).
Wattendorf, D. MAJ, MC, USAF, and Muenke, M, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland. Am Fam Physician. 2005 Jul 15;72(2):279-285.Werner, E.E. & Smith, R.S. (2001). Journeys from childhood to midlife: Risk, resilience, and
The National Center on Addiction and Substance Abuse at Columbia University. (2005). Family matters: Substance abuse and The American Family. New York: The National Center on Addiction and Substance Abuse at Columbia University.
The National Center on Addiction and Substance Abuse at Columbia University. (1999b). No safe haven: Children of substance- abusing parents. New York: The National Center on Addiction and Substance Abuse at Columbia University.
•Brown, S.A., Tapert, S.F., Granholm, E., & Delis, D.C. (2000). Neurocognitive functioning of adolescents: Effects of protracted alcohol use. Alcoholism: Clinical and Experimental Research, 242, 164-171.•Califano Jr., Joseph (2009),How to Raise a Drug-Free Kid, The Straight Dope for Parents.•Dahl, R.E. & Spear, L.P. (Eds.) (2004). Adolescent brain development: vulnerabilities and opportunities. New York: Annals of the New York Academy of Sciences, Volume 1021. •Dubuc, B. (n.d.).The brain from top to bottom. McGill University web site:http://www.thebrain.mcgill.ca/flash/index_d.html•Giedd. J. N. (2004).Structural magnetic resonance imaging of the adolescent brain. Annals of the New York Academy of Sciences, 1021, 77-85.•Gogtay, N., Giedd, J.N., et al. (2004). Dynamic mapping of human cortical development during childhood through early adulthood. Proceedings of the National Academy of Sciences, 101 (21), 8174 – 8179.•Grant, B.F., Dawson, D., et al. (2004). The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug and Alcohol Dependence, 74, 223-234.•Johnston, L. D., O’Malley, P. M., & Bachman, J. G. (2006). Monitoring the Future national survey results on drug use, 1975-2005. Bethesda, MD: National Institute on Drug Abuse.•Nestler, E. J., & Malenka, R. C. (2004, March). The addicted brain. Scientific American, 290 (3), 78-85.•Spear, L. P. (2002). Alcohol’s effects on adolescents. Alcohol Health and Research World, 26 (4), 287-291.•Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking. Developmental Review, 28, 78-106.•Tomkins, D. M., & Sellers, E. M. (2001). Addiction and the brain: the role of neurotransmitters in the cause and treatment of drug dependence. Canadian Medical Association Journal, 164 (6). p.817-821.Underwood, N. (2009). The teenage brain: Why adolescents sleep in, take risks, and won’t listen to reason. The Walrus Magazine.•Walsh, D. (2004). Why do they act that way? A survival guide to the adolescent brain for you and your teen. New York: Free Press.
Bebarta, V. S., Ramirez, S., Varney, S. M. (2012). Spice: A new “legal” herbal mixture abused by young active duty military personnel. Substance Abuse, 33(2), 191-194.Borek, H. A., & Holstege, C. P. (2012). Hyperthermia and multiorgan failure after abuse of “bath salts” containing 3,4-methylenedioxypyrovalerone. Annals of Emergency Medicine, Epub ahead of print.Fass, J. A., Fass, A. D., Garcia, A. S. (2012). Synthetic cathinones (bath salts): Legal status and patterns of abuse. Annals of Pharmacotherapy, 46(3), 436-441.Hu, X., Primack, B., Barnett, T., Cook, R. (2011). College students and use of K2: An emerging drug of abuse in young persons. Substance Abuse Treatment, Prevention, and Policy, 6, 16.Jerry, J., Collins, G., Streem, D. (2012). Synthetic legal intoxicating drugs: The emerging ‘incense’ and ‘bath salt’ phenomenon. Cleveland Clinic Journal of Medicine, 79(4), 258-264.
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