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Children of alcoholics and
other substance abusers are a population without
a clear definition. Because the concept of
COA/COSA is focused on the child rather than
the parent, the definition of a COA/COSA is
any child whose parent (or parental caregiver)
uses alcohol or other drugs in such a way
that it causes problems in the child's life.
The child may no longer be living with the
substance abusing parent because of separation,
divorce, abandonment, incarceration or death.
And the parent does not have to be still actively
drinking or using for the child to continue
to feel the impact of the abuse.
In families
where alcohol or other drugs are being abused,
behavior is frequently unpredictable and communication
is unclear. Family life is characterized by
chaos and unpredictability. Behavior can range
from loving to withdrawn to crazy. Structure
and rules may be either nonexistent or inconsistent.
Children, who may not understand that their
parent’s behavior and mood is determined
by the amount of alcohol or other drugs in
their bloodstream, can feel confused and insecure.
They love their parents and worry about them,
and yet feel angry and hurt that their parents
do not love them enough to stop using.
Despite the
suffering these children endure, many blame
themselves for their parent’s substance
abuse. They believe it when their parents
scream that they wouldn’t drink so much
or use other drugs if the children didn’t
fight, or rooms were kept clean or grades
were better. Some children try to control
the drinking or drug use by getting all A’s,
or keeping the house spic and span, or getting
along perfectly with their siblings. Others
withdraw, hoping not to create any disturbance
that might cause a parent to drink or use.
Few realize that children cannot cause a parent
to drink or use drugs, nor can they cure a
parent’s substance problem.
Many times,
children of substance abusers are frightened.
They may be the victims of physical violence
or incest. They may also witness violence
– frequently alcohol and other drug
abuse goes hand in hand with domestic violence.
And as a result, these youngsters may suffer
from post-traumatic stress syndrome, with
the same kinds of sleep disturbances, flashbacks,
anxiety, and depression that are associated
with victims of war crimes. These children
are not only frightened for their own well-being
– they also harbor the all-too-real
concern that their parent may get sick or
die as a result of the drinking or drug use.
They know that their parent may drive intoxicated,
or get into fights on the street.
Despite the
fact that friends can be a buffer for the
problems at home, some COAs/COSAs have a limited
social life. They may avoid bringing home
friends, or going out in public with their
parents. They may even shy away from making
friends, because they lack basic social skills
or out of a profound fear that someone will
find out the truth. They may also find it
difficult to make friends because other parents
have warned their children to stay away from
these youngsters from troubled families. On
the other hand, some young people use friends
as buffers, relying on their leadership skills
to take on key positions in school and extracurricular
activities. These young people are often among
the most difficult to identify as COAs/COSAs
because their achievements make them seem
so "well-adjusted."
Not every
family is affected identically. Research has
shown that families that maintain certain
"rituals," such as holiday traditions
or a Friday night pizza and movie can help
mediate the chaos of addiction. Sober parents
who are able to provide stability, support
and nurturing also help minimize confusion
and strengthen children. Sometimes family
life is less damaging because children rely
on "adaptive distancing," a technique
in which the child separates from the "centrifugal
pull" of family problems in order to
maintain pursuits and seek fulfillment in
life, school and friendships.
Consequences
Read through
the links below to learn more specifics about
the consequences of parental substance abuse.
BEHAVIORAL
CONSEQUENCES
Parental substance
abuse interrupts a child’s normal development,
which places these youngsters at higher risk
for emotional, physical and mental health
problems. Because parents who abuse alcohol
or other drugs are more likely to be involved
with domestic violence, divorce, unemployment,
mental illness and legal problems, their ability
to parent effectively is severely compromised.
There is a higher prevalence of depression,
anxiety, eating disorders and suicide attempts
among COAs than among their peers. In addition,
COAs are 3-4 times more likely than others
to become addicted to alcohol or other drugs
themselves.
In homes where
a parent is abusing substances, physical and
sexual abuse of children is more likely. Sexual
abuse is more frequent in chaotic and dysfunctional
families where communication has broken down
and roles have been blurred. Children who
live in high conflict homes are more likely
to have lower self-esteem and less internal
locus of control. This puts COAs/COSAs at
higher risk for being re-victimized in the
future. For instance, female COAs are more
likely to be involved with men who abuse substances,
which leaves them open to even more abuse.
Even if the
children themselves are not themselves victimized
by family violence, simply witnessing violence
can have emotionally destructive consequences.
COAs are six times more likely to witness
spousal abuse than are other children.
As a result
of these stressors, COAs/COSAs often have
difficulty in school. They may be unable to
focus on their school work due to the conflicts
and tensions at home. They are also more likely
than their peers to have learning disabilities,
be truant, repeat more grades, transfer schools
and be expelled.
Other
effects
A parent’s substance abuse can have
other effects on children besides parent-child
interactions. For example, if a parent loses
a job because of drinking or drug use, the
child suffers the economic consequences, especially
if this is the household’s only income.
Without employment, a family might lose their
home, car or other valuable possessions.
A child’s
health might also be compromised by a parent’s
drinking or drug problem. The child might
develop stress-related health problems like
gastrointestinal disorders, headaches, migraines,
or asthma, causing them to miss school. And
a child whose parent’s substance abuse
causes neglect might become injured because
of failure to adequately child-proof the house
or because of inadequate supervision, or even
lack immunization and other routine well-child
care.
However, the
fact remains that the majority of COAs/COSAs
do not end up in horrible circumstances. Only
one in four COAs will become alcoholic themselves,
three in four will not. Most children and
teens are able to draw upon their inner strengths
to cope with their circumstances and succeed
in life. COAs and COSAs can be helped in many
ways - both formal and informal - to call
on their resiliency.
MEDICAL
AND PSYCHIATRIC CONSEQUENCES
Medical
problems
health care utilization:
Studies of COAs in childhood have documented
increased rates of several physical illnesses
generally believed to be stress-related, including
enteritis, colitis, and asthma. A 1990 COAF
study of hospital admissions compared 595
minor children of Independence Blue Cross
subscribers who had received treatment for
alcoholism with children of subscribers never
treated for alcoholism. The study revealed
a 24% higher overall inpatient admission rate,
a 29% greater average length of stay, and
36% greater average hospital charges for the
COAs. Admissions for injuries and poisonings,
substance abuse, mental disorders, and diseases
of the gastrointestinal and respiratory systems
were also greater for the COAs. In addition,
children of alcoholic mothers had more admissions
and greater lengths of stays for birth defects.
child
abuse and neglect: Child abuse
and neglect have been linked to parental alcohol
abuse, as has incest. Although studies are
not conclusive, between 12% and 70% of child
abusers have been identified as alcoholics
using various data. Such abuse may be the
cause of physical as well as emotional trauma
and may bring the COA to medical attention.
birth
defects: Significant alcohol
intake by the mother during pregnancy has
been linked to a variety of birth defects,
the most serious of which is the Fetal Alcohol
Syndrome (FAS). FAS consists of a combination
of facial dysmorphia, severe and persistent
growth deficiency, central nervous system
dysfunction with mental retardation, and other
defects. Lesser degrees of alcohol-related
birth defects are referred to as Fetal Alcohol
Effects (FAE). Both FAS and FAE are persistent,
lifelong organic dysfunctions requiring specific
rehabilitation.
alcoholism
and other drug dependence: The
familial nature of alcoholism has been documented
in many studies over the years, with both
genetic and environmental factors implicated
in the transmission process. COAs are at approximately
3 to 4 times greater risk for developing alcoholism
compared to children of non-alcoholic parents.
In addition, COAs are at increased risk for
other drug dependence, which in conjunction
with alcoholism, accounts for much of the
increased incidence of hospitalization for
poisoning and accidental trauma in COAs discussed
above.
Psychiatric
disorders
disorders of childhood:
As mentioned before, mental retardation and
other organic mental dysfunctions have been
linked to maternal drinking during pregnancy.
Attention deficit/hyperactivity disorder has
also been linked to parental alcoholism, as
have other anxiety and childhood depressive
disorders, and conduct disorders in childhood.
eating
disorders: Recent studies have
shown that a disproportionate number of patients
suffering from bulimia nervosa are COAs.
anxiety
and depressive disorders: As
in childhood, anxiety and depressive disorders
have been reported to be more common in adolescent
and adult COAs than in the general population,
particularly among females.
pathological
gambling: Adult alcoholics and
addicts who had alcoholic fathers show an
increased risk of pathological gambling.
sociopathy:
The relationship between antisocial personality
disorder (ASP) and parental alcoholism is
well-established, as is the strong association
between ASP and adult alcoholism and other
drug dependence.
EDUCATIONAL
CONSEQUENCES
Children from
substance abusing families are more likely
to have learning disabilities; repeat more
grades; attend more schools; and are more
likely to be truant, delinquent and drop out
of school because of pregnancy, expulsion
or institutionalization.
Children whose
parents drink too much or use other drugs
may:
- be preoccupied or tired
because of home events and unable to concentrate
in school or other activities
- work below their potential
because their energy is focused on the
substance abuser;
- be reluctant to bring
friends home due to embarrassment about
the addicted parent's behavior;
- witness physical or emotional
abuse between family members, or experience
it themselves; and
- be unable to focus on
homework because of fighting, tension
or worry at home;
- take on developmentally
inappropriate responsibility for household,
siblings or parents.
EMOTIONAL
CONSEQUENCES
Mistrust
Parents with an alcohol or drug problem often
exhibit unpredictable behavior. For the child,
the rules may be constantly changing, according
to the amount of alcohol or drugs in the parent’s
blood. This lack of consistency can lead to
a mistrust of parents (and often other adults).
Wide mood
swings within the family also contribute to
additional lack of trust. When the parent
gives up drinking alcohol, or using drugs
there is often a feeling of hope that the
problem has been "solved." However,
if the parent relapses the disappointment
is intense. These experiences often lead children
to a distrust of authority figures or adults
in general, with an expectation that they
will eventually be let down.
Guilt
Instead of understanding the parent’s
substance abuse as a disease, the child sees
the drinking or drug use as a reaction to
bad behavior. Family members may blame each
other for "setting off" a drinking
episode or angry outburst. Examples of this
kind of thought are "If I were a better
student, my mother wouldn’t drink"
or "If I didn’t make my Dad angry,
he would stop using drugs."
Shame
The COA or COSA is often deeply ashamed of
the "family secret." She may avoid
friendships with other children and feel she
cannot invite them to her house, because her
parent might be at home drunk or high and
embarrass her. Sometimes there is a hierarchy
among children of substance abusers which
places children of alcoholics above children
of drug users, who are above children of IV
drug users, who are above children of IV drug
users with HIV/AIDS.
Confusion
Substance abuse in the family creates confusion
in the child when the family fails to validate
either his external or internal reality. For
example, a child may observe his mother drinking,
becoming intoxicated, and passing out on the
kitchen floor, but be told by his father that
she is "sick" or "tired."
A parent may suffer from alcoholic blackouts
(Lapses of memory for events that take place
while the individual is intoxicated), and
make promises or reveal inappropriate personal
information while drinking. Later that same
parent is genuinely unaware of what transpired
and denies the conversation ever took place.
Ambivalence
Strong positive and negative feelings towards
the parent may coexist in the child. For example,
a girl may long for approval and love her
substance abusing, and simultaneously feel
angry and resentful.
Fear
Some children of substance abusers fear that
their anger towards the parent could cause
him to die, or more realistically, that the
parent could die as the result of drinking
and driving, other drug-related trauma, or
illness.
Insecurity
Low self-esteem, tension, anxiety, depressed
feelings, and acting out behavior are often
reflections of insecurity due to a difficult
home environment.
Conflicts
about sexuality
Disruption of normal sexual development can
occur if substance abuse interferes with the
parent’s ability to nurture and educate
the child. For example, the child may be exposed
inappropriately to sexual behavior, including
in some cases, sexual abuse.
Parental substance
abuse interrupts a child’s normal development,
which places these youngsters at higher risk
for emotional, physical and mental health
problems. Because parents who abuse alcohol
or other drugs are more likely to be involved
with domestic violence, divorce, unemployment,
mental illness and legal problems, their ability
to parent effectively is severely compromised.
There is a higher prevalence of depression,
anxiety, eating disorders and suicide attempts
among COAs than among their peers. In addition,
COAs are 3-4 times more likely than others
to become addicted to alcohol or other drugs
themselves.
In homes where
a parent is abusing substances, physical and
sexual abuse of children is more likely. Sexual
abuse is more frequent in chaotic and dysfunctional
families where communication has broken down
and roles have been blurred. Children who
live in high conflict homes are more likely
to have lower self-esteem and less internal
locus of control. This puts COAs/COSAs at
higher risk for being re-victimized in the
future. For instance, female COAs are more
likely to be involved with men who abuse substances,
which leaves them open to even more abuse.
Even if the
children themselves are not themselves victimized
by family violence, simply witnessing violence
can have emotionally destructive consequences.
COAs are six times more likely to witness
spousal abuse than are other children.
As a result
of these stressors, COAs/COSAs often have
difficulty in school. They may be unable to
focus on their school work due to the conflicts
and tensions at home. They are also more likely
than their peers to have learning disabilities,
be truant, repeat more grades, transfer schools
and be expelled.
Other
effects
A parent’s substance abuse can have
other effects on children besides parent-child
interactions. For example, if a parent loses
a job because of drinking or drug use, the
child suffers the economic consequences, especially
if this is the household’s only income.
Without employment, a family might lose their
home, car or other valuable possessions.
A child’s
health might also be compromised by a parent’s
drinking or drug problem. The child might
develop stress-related health problems like
gastrointestinal disorders, headaches, migraines,
or asthma, causing them to miss school. And
a child whose parent’s substance abuse
causes neglect might become injured because
of failure to adequately child-proof the house
or because of inadequate supervision, or even
lack immunization and other routine well-child
care.
However, the
fact remains that the majority of COAs/COSAs
do not end up in horrible circumstances. Only
one in four COAs will become alcoholic themselves,
three in four will not. Most children and
teens are able to draw upon their inner strengths
to cope with their circumstances and succeed
in life. COAs and COSAs can be helped in many
ways - both formal and informal - to call
on their resiliency.
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