For parents with substance use disorders, the search for recovery usually comes at the end of a very rough and painful road. By the time a mother or father seeks help, the trust of children and other family members may be lost. Emotional bonds in the household have been severely damaged, if not destroyed. Parents with drug or alcohol addiction are likely to be experiencing guilt, shame, and remorse over the harm done to their families. Yet in spite of all these obstacles, many parents have recovered from substance abuse and managed to rebuild their lives and reestablish trust with their children.
Facing the Consequences of Addiction
Nearly all parents who are challenged with addiction will experience guilt and regret for their actions. Even if they know that addiction is considered a chronic, progressive disease rather than a moral failure, they may blame themselves for the consequences of their substance abuse and torment themselves over the impact that their actions have had on their children. They may wonder whether they can continue to serve as role models for their kids, and whether their children will respect or trust them again. They may even wonder if their children still love them.
There is no doubt that parental substance abuse can have a devastating impact on the youngest members of a household. According to the Substance Abuse and Mental Health Services Administration, between 2002 and 2007, nearly 12 percent of American children, or over 8 million kids, lived with at least one parent or guardian who was dependent on drugs or alcohol or who had abused drugs or alcohol in the past 12 months. Substance abuse can harm children in numerous ways, including increased risks of injuries, neglect, and accidents. Living with a substance-using parent also increases the risk that a child will develop alcohol or drug addiction later in life.
How can parents face the consequences of addiction and move on to restore their lives and the lives of their children? Self-acceptance isn’t easy, but it can be accomplished with the help of an intensive treatment program that includes the following core components:
- Talk therapy with an experienced addiction counselor or therapist
- Family and couples therapy
- Participation in 12-Step fellowships
- Participation in peer support group meetings
- Behavioral modification therapy
In order to rebuild broken relationships and reestablish trust, all members of the family will need to learn more effective communication skills. Parents may need to learn how to set boundaries for their children, while children and teenagers will need to learn how to respond to those boundaries in a respectful manner. Marriage or couples counseling is typically required to restore relationships that have been damaged by drug or alcohol addiction.
How Rehab Affects Children
When a parent goes to rehab, children go through a wide range of emotions. They may feel happy and relieved that their mother or father is finally getting help. On the other hand, suppressed feelings of anger, resentment, and fear of abandonment can come to the surface when the children go through counseling. If a parent is attending a residential rehab program, children might feel abandoned again, especially if they are young and insecure about their attachment to the parent. All of these issues must be addressed in therapy, both with the family and with the child alone, so that children can recover from their own experiences.
Issues of Abuse, Neglect, and Domestic Violence
In addition to coping with the emotional repercussions of addiction, parents may need to face the legal consequences of child abuse and domestic violence. If verbal, physical, or sexual abuse occurred while the parent was intoxicated, the parent may face loss of custody and criminal prosecution. In this case, legal counseling will be required, so that all of the family members are aware of their rights and potential outcomes. Parents should be aware that if therapists or clinicians suspect the possibility of child abuse, they have an obligation to protect the child against further harm.
CASAColumbia estimates that the children of parents who are addicted to drugs and alcohol are four times more likely to be the victims of neglect and three times more likely to experience physical or sexual abuse. Alcohol Research & Health confirms that one of the most common forms of child abuse perpetrated by parents who abuse drugs or alcohol is neglect. Neglect occurs when the needs of the child — for food, shelter, emotional comfort, clothing, sleep, or security — are not met, either because the guardian is not present or is unable to provide for those needs.
To some degree, substance abuse distances all parents from their children, imposing barriers to emotional bonding and communication. Overcoming those barriers in sobriety is one of the greatest challenges of recovery. Many parents state that they feel like addiction made them strangers to their children and spouses.
Meeting the Needs of Parents in Treatment
Parents in rehab require support from multiple sources. In addition to counseling, peer support, and other therapeutic modalities, they may need psychosocial services such as access to affordable housing, transportation, and occupational training. They may also need physical protection or legal representation, especially if there have been reports of abuse or domestic violence.
Prescription drug abuse, especially of opioid pain medications, has become increasingly widespread in the US, and thousands of parents have been affected by this trend. Prescription drug misuse may seem socially acceptable and safe compared to heavy drinking or the use of street drugs like heroin or cocaine. In fact, prescription drug abuse has become a primary source of overdose fatalities in this country. The popularity of narcotic pain relievers like Vicodin, Percocet, and OxyContin has led to increased use and abuse of these medications, which has in turn resulted in an increased in opioid addiction and overdose. The Centers for Disease Control and Prevention state that 44 Americans die from overdosing on prescription pain medication every day — some of them intentionally, some accidentally. Other prescription drugs that are commonly abused include tranquilizers and sedatives, which may be used by parents to manage the stress of work and home life, or to facilitate sleep after a chaotic day.
Reunification with a child who has separated from a parent by the courts can be emotionally challenging as well as rewarding. A qualitative study published in the Journal of Drug Issues followed six mothers as they responded to the experience of being reunited with their children after substance abuse treatment. All the women found that the reunification process evoked intense and powerful emotional reactions, and that while reuniting with their children motivated them to continue with recovery, it also produced a certain amount of stress.
The primary substances of abuse among parents depend on their personal experience, living environment, availability of drugs, responses to substances, and other factors. Common drugs of abuse reported by adults in treatment include:
- Prescription drugs
In order to successfully reunite children with their parents after rehab, the journal proposes that the following support services are required:
- Therapeutic counseling
- Child care
- Parenting education
- Financial assistance
Parenting skills, such as setting limits, enforcing discipline, and expressing parental love, can be challenging for mothers or fathers, especially if they have been separated from their families for long periods of time. Treatment should offer the opportunity to relearn these skills, or to acquire them for the first time, with the help of a family therapist or child psychologist.
Therapeutic Approaches for Parents and Children
When a parent enters rehab, the whole family requires treatment. Family counseling is a critical component of rehab for mothers and fathers. In addition to treating the addicted parent, therapists will address the needs of his or her spouse and children. This involves one-on-one counseling with the client, therapy sessions with the entire family, and private counseling sessions with the children and spouse.
Family Systems Therapy is a popular approach to treating matters of addiction. This modality is based on the idea that addiction is not an individual disease, but a disease of the whole family unit. According to the Center for Substance Abuse Treatment, the systems perspective means that changing one part of the system, such as a parent’s addiction to alcohol or drugs, results in changes in other parts of the system, which may affect the whole unit positively or negatively. While Family Systems Therapy must focus on the parent’s substance abuse, it must also address the needs and concerns of other family members, including spouses or partners and children.
Twelve-Step fellowships can also play a vital role in a family’s recovery from substance abuse. In addition to groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), there are groups dedicated to supporting the relatives and friends of addicts and alcoholics, as well as the adult children of substance abusers. These groups include:
- Families Anonymous
- Adult Children of Alcoholics
Membership in these fellowships is free, and meetings of one or more of these groups are available in most major communities, as well as in rural areas, foreign countries, and online chat sessions.
Both parents and children can benefit from experiential therapies in rehab. Experiential therapy is founded on the premise that creative or recreational activities can be used as a form of therapy to facilitate emotional expression and reinforce the knowledge gained in treatment. Art and music therapy, in particular, have been applied successfully in the treatment of children and teens who have suffered from domestic violence and abuse. According to Psychology Today, art therapy allows children who have survived abuse, neglect, or violence a way to mediate their traumatic experiences and express their feelings in a safe, supportive environment.
Options for Substance Abuse Treatment
Once they have made the decision to get help for addiction, parents must choose the treatment option that is best for them and their families. A range of recovery services are available, from intensive detox programs to residential rehab centers, inpatient programs, and intensive outpatient treatment. Listed below are some of the most common treatment options, along with their advantages and disadvantages for parents:
- Inpatient treatment:
Inpatient detox takes place in a medically monitored clinical setting, such as a hospital or a dedicated treatment center. Patients stay fulltime at the facility while they go through detoxification and the initial stages of rehab. The pros of inpatient treatment include the structure and support of 24-hour clinical observation; the cons include more time away from family and higher costs of treatment.
- Residential rehabilitation:
Residential rehab programs offer 24-hour monitoring and structure in a more home-like setting. These programs represent a step down from inpatient detox. At this stage of recovery, the client is ready to begin the therapeutic work of rehab. Advantages include distance from the stress of daily life, access to many amenities, and the opportunity to focus entirely on recovery. Disadvantages include separation from children and higher treatment costs.
- Partial hospitalization programs (PHPs):
PHPs represent a middle ground between inpatient and outpatient treatment. Clients attend recovery activities, such as counseling and support groups, at a hospital or treatment center during the day, while returning to their home or a transitional facility at night. PHPs offer more autonomy and the opportunity to maintain contact with family and keep up with personal obligations; on the negative side, the lack of 24-hour monitoring may increase the risk of a relapse, especially in an individual whose motivation to stay clean and sober is not very strong.
- Intensive outpatient programs (IOPs):
Outpatient treatment programs provide most of the therapeutic services of inpatient and residential treatment — including therapy, support groups, medication management, and psychosocial services — without the round-the-clock monitoring or clinical support of inpatient treatment. Clients meet with therapists or counselors, attend classes, and participate in group meetings during the day at an outpatient treatment center, clinic, or other facility. After hours, they stay at home or in a sober living environment. IOPs allow the client to remain part of the community and to fulfill parental responsibilities or stay in close contact with family. In addition, health insurance providers are often more willing to cover outpatient treatment than residential care. On the downside, the absence of a structured living environment exposes the client to more stressors and triggers that can lead to a relapse.
The choice of a treatment center should also be determined by the location of the facility, the cost of its services, and the therapeutic modalities that it offers. A rehab program for parents must have a strong family therapy component, so that all members of the household can experience a safer, healthier living environment after rehab.
Overcoming Barriers to Long-Term Recovery
In order to seek help and complete a rehab program, parents must be able to overcome barriers to recovery, such as the social stigma against addiction and the fear of public exposure or shame. Parents who abuse alcohol and drugs are often viewed in the public’s eye as irresponsible, abusive, and dangerous. One of the greatest needs of parents going through therapy is a motivational approach that encourages and empowers them to accept responsibility for their past actions while facing the challenges of recovery and looking forward to a more hopeful future. A comprehensive aftercare program provides the support and resources that parents need to cope with the challenges of parenting while maintaining their sobriety.
- American Association for Marriage and Family Therapy (AAMFT): The website of this professional organization provides information about family and marriage counseling for practitioners and the general public. Resources for the public include an online Therapist Locator, as well as information and news about advances in family therapy.
- Child Welfare Information Gateway: Sponsored by the U.S. Department of Health and Human Services, this portal site provides tools, learning resources, and news about the effects of parental substance abuse, domestic violence, and traumatic experiences on children.
- Families Anonymous (FA): This 12-Step fellowship is dedicated to providing hope and support for the family members of drug or alcohol abusers. Its website includes information on the 12 Steps of FA, a meeting locator, and access to FA literature.
- Family Matters: Substance Abuse and the American Family: This 2005 report from CASA Columbia discusses the causes and effects of substance abuse in families, with a special focus on the way parental substance abuse affects children.
- National Association for Children of Alcoholics (NACOA): The mission of this support organization is to relieve the harm done by alcohol and drug addiction to the children and adult children of substance abusers.
- org:Safe Horizon offers support and assistance to the victims of child abuse, domestic violence, stalking, human trafficking, and other crimes. This agency sponsors a 24-hour telephone helpline at 800-621-4673 (HOPE).
- Seeking Drug Abuse Treatment: Know What to Ask: This online resource, published by the National Institute on Drug Abuse, guides parents and other individuals through the process of choosing a drug rehab program. The goal of this publication is to teach people seeking treatment, as well as their loved ones, the right questions to ask a potential facility before committing to a rehab program.