Children of addicted parents need their own form of recovery

“Sherilynn” — a 5-year-old Baltimore City girl I met after her mother was released from jail and referred to a treatment facility — like all children about to enter kindergarten, is wide-eyed about her hopes for the future. But for Sherilynn, the odds are against her.  Her mother is addicted to heroin and unable to provide a stable and safe home life for her children. In addition to being food insecure, her children are exposed to harsh conditions — economic instability, a mother who is emotionally unavailable, strangers in their presence, left home alone and unsanitary surroundings — that threaten their safety, healthy development and academic success. At her tender age, Sherilynn is unaware of the potentially long standing impact of these adversities on her developing brain, body and mind.

This last decade has witnessed an historic rise in opioid drug addiction and overdoses, with a 200 percent increase in opioid related deaths since 2000. And now, in the context of a pandemic, these rates have soared. In an effort to counter this trend, policy initiatives tend to focus on relapse and recovery support for individuals with opioid use disorder. But the children of caregivers with opioid use disorder and other substance use disorders have been largely left out of the equation. The reality is that the impact of the opioid epidemic on the safety, mental and physical health and school readiness of the nation’s children can reasonably be predicted to exceed the impact of today’s morbidity and mortality.

The psychological and physical trauma experienced by children exposed to caregiver substance use disorders is profoundly impactful. Adverse childhood experiences, such as maltreatment, poverty, community violence and substandard housing conditions abound. In effect, their ability to meet developmental milestones and enter adulthood prepared with the requisite social competency and learning skills are in jeopardy.

Long-term caregiver substance use disorder exacts significant intergenerational impacts, placing children at heightened risk for academic failure, severe behavioral and mental health problems, inability to enter the workforce and increased likelihood of developing a substance use disorder. They more often become involved in the justice system due to their reactions to trauma (e.g., disruptive behavior) creating a dual issue of possible negative health and criminal outcomes, and endangering their future potential.

Although this scenario seems bleak, all is not lost. Over the last 40 years, the field of prevention science has emerged as a prominent branch of the human sciences. Research-backed programs and policies generated by prevention scientists are significantly improving the odds for children experiencing adverse childhood experiences from various sources, including fall-out from the opioid crisis. In fact, equitable and widespread implementation of prevention strategies can improve the lives of most people beyond anything we have achieved to date.  

Prevention science works to pinpoint risk factors that contribute to problems and protective factors that either counteract risk factors or boost young people’s ability to successfully navigate challenges. By providing support for patient and skilled parenting, we can prevent the most common and costly problems in childhood that stem from caregiver addiction. At least 17 family-based programs have been shown to produce these benefits. Evidence-based family interventions have been demonstrated to disrupt pathways to substance use disorders, leading to greater self-regulation and more positive outcomes in a number of aspects of functioning. And the coupling of substance use disorder treatment for the caregiver and family intervention substantially boosts the effects for both the children and the parent. 

So what can prevention science offer to Sherilynn that can override the risks and, in effect, foster a safe and nurturing family environment? One approach marries substance use disorder treatment and evidence-based family intervention infrastructures that exist in many communities. Currently, they do not typically intersect and children do not receive programming. Coordinating across these systems supports caregivers in recovery from substance use disorders to adopt evidence-based parenting techniques that cultivate healthy parent-child attachment, strengthen social emotional learning in children and effectively address misbehavior. Parenting and family interventions can be readily embedded into their routine substance use disorder treatment schedule for group-based delivery to adults with children. 

Consistent with the evidence, we anticipate that this approach will lead to significant improvements in parenting practices and reduce mental health and behavioral problems in children. In fact, the involvement of the entire family unit in substance use disorder treatment has been shown to significantly reinforce recovery in the caregiver.  So it’s a win-win!  

Waiting until people develop psychological or behavioral problems is, thus, no longer justifiable. Although not a panacea, best practices from the field of prevention science promise to help children like Sherilynn avoid a pathway to substance use disorder and find the way forward to a happy and healthy adulthood. 

Diana Fishbein, Ph.D. is the co-director of the National Prevention Science Coalition to Improve Lives. She is also a senior scientist in the Frank Porter Graham Child Development Institute at the University of North Carolina and part-time faculty at The Pennsylvania State University. Sharon Kingston, Ph.D. is an associate professor of Psychology at Dickinson College and the secretary of the National Prevention Science Coalition to Improve Lives.