A children’s mental health provider on the effects of parental addiction and how clinicians can unknowingly make things worse
When I first journeyed outside the hospital after spending five years working on a child inpatient psychiatric unit, I felt well prepared to deliver family-focused therapy in peoples’ homes. After all, I had witnessed and been exposed to the whole spectrum of childhood psychiatric disorders. I’d even headed up some support and parent training groups on the inpatient unit.
The transition from the hospital to the community was abrupt. Far from the sterile environment and whitewashed walls of an inpatient unit, I was now wandering the main streets of quaint small towns and distant municipalities all over Allegheny County. I found myself sitting inside the homes of clients—in their living rooms and at their kitchen tables—providing therapy and services to children and their families.
All the filters were removed. Working in the home allowed me to see the raw dynamics and uncensored interactions as they were lived, including the crises families went through as they struggled. They were all happening right before me in real time. I found it invigorating. Changes made in the home last longer and are more readily verifiable. Moreover, home-based therapy quickly showed me professional skills that I was lacking, areas I would need to develop and grow.
Addiction was a conundrum
I was a mental health therapist focused on children; treatment for the addicted parent existed in another realm.
Addiction was a foreign concept to me. It was rarely touched upon in any of my formal education in graduate school and only vaguely alluded to in the many conversations that I had with children back at the hospital. At times, addiction in the home was very subtle, maybe some beers cans that were always stacked out by the trash can. Others times, there was no skirting around the issue. Sometimes parents used drugs or alcohol openly in the home. Sometimes a frantic parent called to ask for a ride home from a local bar. Within the family system, parents who were struggling with addiction struck me as a real conundrum. It became a dominant discussion topic in clinical supervisions and also evolved into a mandatory training for the outpatient program I worked with.
But even with training and supervision, I struggled to find solutions to this problem. I was a mental health therapist focused on children; treatment for the addicted parent existed in another realm. There I was, right in the home, witnessing parental addiction with little understanding of its effects on the family system or what I could do to lessen them.
I needed to learn more about addiction. In addition to technical books and long lectures filled with statistical data, I was also being educated by some of my smallest clients. The cyclic nature of addiction and high rate of relapse was explained to me by a small 11-year-old girl whose mother would be absent from the home for days at a time. Parentified and very precocious, she not only managed the house, cleaned, and cooked the food, she was an academic standout at school and accepted full care of her two younger brothers. In hushed tones while sitting on the darkened stairs of their small apartment, she explained the futility of trying to help her family.
“You think you are the first person to try and help?” she asked, her voice filled with despair and sadness.
The effects of addiction on children
For many, relapse is a reality of addiction. Children become victims of the erratic ebb and flow of the relapsing parent. They are unwillingly pulled along for the ride. Statistically, children who have a parent struggling with addiction are four times more likely to struggle with addiction themselves as adults. I really wanted to believe that such children were in some way inoculated to addiction because their adverse exposure would teach them otherwise, but it turns out to be just the opposite. These children are at greater risk.
As I learned, clinicians themselves can unknowingly contribute to problems for these children. The dire wish to rescue children from such a difficult home life can lead us to be overly optimistic or say anything to make them feel better in the moment. Unrealistic promises can further a child’s feeling of hopelessness and mistrust of adults. Every circumstance is different and depending on the child, a better response might be helping them to find other mentors or social supports within the extended family, community or school system. It could be accurate, age-appropriate education on the effects of addiction and assistance with plans for the future so that children with addicted parents can envision a life beyond their present circumstance.
Alarms to the world
Within a family system, it is the children who are the most vulnerable to the effects of addiction and also the most visible sign of it. They become the red light, the alarm to the world that there is something awry within the home. We all know some of more popular psychiatric labels that children acquire: ADHD, depression, anxiety. All can be outward expressions of trauma taking place in the home. The child can easily be scapegoated as “the sick one” when in reality, the child may be the healthiest member of her family.
If a clinician does not notice or address a parent’s addiction, all efforts and services can be misdirected upon the child. This is a common occurrence because of the externalizing nature of addiction itself (that is, the tendency of a person with addiction to blame outside forces rather than acknowledge the substance use disorder) and how hard it can be to initiate such conversations with a struggling adult.
Working within a family with an addicted parent
Working with a child inside a family system requires a healthy knowledge of parenting, adult and childhood disorders, and both family and individual therapies. But working within a family with an addicted parent also requires an in-depth knowledge of addiction, the many stages and systems of recovery, and also a specialized knowledge of how to work with the children.
Addressing the parent is a necessity, but also addressing the effects of addiction with the child is also an absolute necessity. This is an important way to reduce the child’s risk of suffering from addiction herself, thus perpetuating a continuing cycle.
David Suda, M.Ed, is clinical educator who currently works with schools districts providing educational services and screening liaison services to students. For the past twenty years, he has worked in multiple settings with children and adolescents delivering a variety of services, including inpatient hospital programs, residential services, specialized summer camp programs, and community based mental health programs. In addition, he holds a black belt in Korean karate and in his spare time practices and teaches martial arts.