Mary Haag is president and CEO of Cincinnati-based PreventionFIRST!
When we understand addiction as a disease, we understand that there are two key drivers in the development of the disorder: biologic or genetic factors and ecological factors, including early exposure.
A substance use disorder is a brain disease that is chronic, progressive, and relapsing, not unlike heart disease, cancer or diabetes. It has a pediatric onset, when the brain is not fully developed, and use and abuse peaks in early adulthood. It is also a family disease with multi-generational cycles.
The research tells us that those who begin to use substances before the age of 15 are five times more likely to develop a substance use disorder in adulthood. Children of addicts are four times more likely to develop the disease. Behaviors and symptoms that signal the development of a behavioral disorder often manifest two to four years before a disorder is present. If communities and families can intervene early, behavioral health disorders might be prevented, or symptoms can be mitigated.
Hospitals in our region began universal drug testing of expectant mothers in September 2013. Current data show that 1,549 drug-exposed infants have been born since tracking started. Of those, 839 were opioid exposed.
Family Drug Abuse
It’s estimated that 25 percent of youth under age 18 are exposed to family alcohol or drug abuse or dependence. Research shows that children in this environment are more likely to develop depression or anxiety in adolescence and use alcohol or other drugs early on. Having a parent who is addicted to drugs or alcohol can lead to lifelong problems if the child or teen doesn’t get help and support.
Children of all ages suffer when a parent abuses alcohol or drugs. Even if home physically, when a parent abuses drugs or alcohol, children experience a psychological or emotional absence Typically, children of all ages experience confusion, fear, worry, sadness, and anger—but children show and express their feelings differently.
Children who were neglected or abused might not have learned basic things like how to brush their teeth properly, how to groom themselves, table manners, and how to make and keep friends. They might have learned to hoard food or other items if there was not enough to eat, or if their things were taken away in order for a parent to get drugs or alcohol. Older children might have learned to take care of themselves, their younger siblings, or their parent. They might be used to playing the role of the caregiver and not be ready to give up that role when a parent enters in recovery.
Distrust of Authority
These children and teens may distrust authority figures because they have learned from experience to expect disappointment from parents. Others have an excessive need to be in control in order to balance out the chaos in their lives. Or they may constantly need approval to reassure themselves that they have value. Some become aggressive. The very secret nature of the substance abuse may have given a child little experience with making friends, so later these children and teens may have difficulty with intimate relationships.
To understand children’s feelings and behavior, remember that children learn to survive as best they can while living with a parent who abuses drugs. Even the most troubling behavior usually has its roots in the child trying to get a basic and healthy need met under difficult circumstances. If you want a child’s behavior to change, it’s necessary to understand how the child learned the behavior in the first place, and then to help the child get that healthy need met in a different and less troubling way.
What can we do? We can build resilience in children – draw upon inner strengths, skills, and support to prevent adversity from derailing one’s life.
“Kids don’t care about what we know, until they know how much we care.” Jerry Moe, national director of children’s programs, Betty Ford Center.
In small but consistent ways, sharing messages like “you are not alone,” “there are safe people who can help,” and “someone is on your side” can help bring clarity and hope to a child or teenager in need. When you talk with them, share your feelings, and explain (age appropriately) your own frustrations and how you resolve them. Model what healthy living – and healthy thinking – looks like. In this way, you can help raise awareness of feelings, thought processes, and life skills that may not exist at home. Inspire these children to believe that they can create a healthy life and family for themselves when they become adults.
Click here for a motivational calendar with daily inspirational phrases for kids.
Risk and protective factors can have influence throughout a person’s entire lifespan. Many factors influence a person’s chance of developing a mental and/or substance use disorder. Effective prevention focuses on reducing those risk factors, and strengthening protective factors that are most closely related to the problem being addressed. It is important to intervene early and to target multiple, not single, factors. Targeting only one context when addressing a person’s risk or protective factors is unlikely to be successful because people don’t exist in isolation.
Some prevention interventions are designed to help individuals develop the intentions and skills to act in a healthy manner. Others focus on creating environments that support healthy behavior. Effective parenting has been shown to mediate the effects of multiple risk factors. Research indicates that the most effective prevention interventions incorporate both individual and environmental approaches.
Health care providers need to collect family health histories and screen early for signs of substance abuse. This holiday season, parents and caregivers can discuss and record your family’s health history to better predict your risk for illness and keep you and your family healthy.
The vast, largely unaddressed problem of drug and alcohol use that is problematic but does not meet the criteria of an addiction must, going forward, be on the radar of all health care professionals when they see patients for annual checkups, in emergency rooms, and other contexts. Because of the impact of substance misuse and addiction on mental and physical health, as well as on compliance with medical treatment, proactively preventing and treating substance misuse at all levels has the power to improve health outcomes across the board.