Breaking the Cycle of Addiction

… we know how to do it

Barry Rosen, MD, Med Director, The Sequoia Center

The Legacy Foundation and

The Children’s Place Program

September 1st, 2005

National Association of Children of Alcoholics (NACoA)

Objectives

To describe the personal & national impact of alcoholism & addiction on children, family and society

To underline the importance of your role as caregivers in recognizing, diagnosing, referring alcoholics/addicts and their children

National Picture

1 in 4 U.S. children

are exposed to alcohol abuse and alcoholism at home.

- Grant BF. Estimates of US children exposed to alcohol abuse and

dependence in the family. Am J Public Health 2000;90:112-115.

National Picture continued: Study Design

NIAAA’s Epidemiologic Longitudinal Alcoholism Survey – 42,862 households interviewed at random

– Definitions of alcohol abuse and alcohol dependence (alcoholism) based on DSM-IV criteria

– Assessed past-year and lifetime abuse and dependence on alcohol

– First direct estimate of the number of COAs

NIAAA Study Results continued:

43% (28 million) of children live in households with 1 adults who abused or were dependent on alcohol during their lifetime

15% (9.7 million) of U.S. children live in households with 1 adults who abused or were dependent on alcohol during the past year

NIAAA Study and Child Morbidity

Fetal Alcohol Syndrome Juvenile justice system 2-9 fold increased risk of addiction Non-accidental trauma Accidental trauma and ingestions

Morbidity continuedBetween 1985 and 1996: 5,555 children died, and 149,000 were injured in drinking related car

accidents 64% (3,556) of those who died, and 38.9% (58,000) of those who were injured

were passengers riding with the drunk driver.

– Quinlan KP et al. Characteristics of child passenger deaths and injuries involving drinking drivers. JAMA 2000;283(17):2249-52.

What does addiction look like in the family?

This is what the neighbors don’t see

Rules of an Alcoholic Family

Don’t Talk

Don’t Trust

Don’t Feel

Guessing at what is normal

Cannot identify feelings

Cannot express feelings

Do not trust themselves or others

Believe they are to blame

Children of alcoholic’s have difficulty …

– Making decisions

– Making friends

– Follow directions

– With change

– Completing projects – start to finish

Children of alcoholics …

Have poor self-esteem

Believe they do not fit in

Are rigid in their attitudes

Lie when it is easier to tell the truth

Have a constant need for approval

Typical Roles for these kids: Hero child Family clown Quiet or lost child Scapegoat

These behaviors will last a lifetime without intervention.

Areas of impact on children

Behavioral

Social

Academic

Health

Mental Health

Health Care Utilization

Child impact continued Behavioral

– Improper clothing for weather– Avoidance of conflicts– Overly aggressive play– Impulsive & disruptive– Thumb-sucking– Behavioral Disorders

Social– Infantile behavior with peers – Withdrawal & isolation– Manipulation & lying

Impact continued

Academic– Underachievement or compulsive

over-achieving– Morning tardiness– Absences & poor attendance– Inability to concentrate– Retention

Impact continued Mental Health

– Sudden changes: mood swings, tantrums

– Low self-esteem– Anxiety Disorders– Depression– Suicide– PTSD– Eating Disorders

Health– Frequent

complaints: stomachaches, headaches

– Fatigue– Insomnia– Frequent illness– Stress-related

illness: ulcers, colitis, tension

– Enuresis

Increased Health Care Utilization

More in-patient admissions & longer stays

More ER visits More office visits Higher health care costs

And!

These traits live on in adult life … you see them in your colleagues & friends

These kids are the alcoholics and addicts of tomorrow

The Children’s Place

A program for these kids Provides a safe environment They see they are not alone They learn about the disease They learn they didn’t cause it, can’t

control or cure it They learn it is not their fault

The Children’s Place continued

They learn their risk for the disease They play They learn how to care for themselves They learn who to call upon in need They get a chance to alter the

inevitability of these traits and behaviors

THEY LOVE IT!

The program

Community groups School groups Summer camp – one week Dedicated focus to COA’s Run by high quality, trained professional

staff

The Value

Testimonials– The children– School counselors– Parents

Summary

I. Over 1 in 4 children live alcohol or drug impaired homes.

II. It is an unidentified national priority.

III. Addiction is a family disease.

IV. Physical, emotional & fiscal costs are profound

VI. This vicious cycle can be interrupted

What can you do?

Learn about addiction & treat or refer Take an inventory of yourself & your

family Process any negative attitudes &

stereotypes

References Adger H Jr, Macdonald DI, Wenger S. Core competencies for involvement of

health care providers in the care of children and adolescents in families affected by substance abuse. Pediatrics 1999; 103(5)Suppl: 1083-4.

Abuse (RE9801). Pediatrics 1998; 101(1): 125-28. Belcher HME, Shinitzky HE. Substance abuse in children. Arch Pediatr

Adolesc Med 1998;152:952-60. Bijur PE et al. Parental alcohol use, problem drinking, and children’s injuries.

JAMA 1992; 267(23):3166-71. Duggan AK, Adger HJr McDonald EM, Stokes EJ, Moore R. Detection of

alcoholism in hospitalized children and their families. Am J Dis Child 1991; 145(6): 609-10.

Emshoff JG, Price AW. Prevention and intervention strategies with children of alcoholics. Pediatrics 1999;103(5)Suppl: 1112-1127.

Johnson JL, Leff M. Children of substance abusers: overview of research findings. Pediatrics 1999;103(5)Suppl: 1085-98.

Werner MJ, Joffe A, Graham A. Screening, early identification, and office-based intervention with children and youth living in substance-abusing families. Pediatrics 1999;103(5)Suppl: 1099-111.

Moe, J.J., Kid’s Power, Health Communications. Deerfield Beach, Fla. ‘89

Websites National: National Association for Children of Alcoholics (NACoA):

http://www.nacoa.net Children of Alcoholics Foundation: http://www.coaf.org/

– Opening and closing Pandora’s Box: discussing sensitive topics…

The National Clearinghouse for Alcohol and Drug Information (NCADI): a service of Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Dept. of HHS. http://www.health.org/govpubs/ph317

National Institute on Alcohol Abuse and Alcoholism (NIAAA). How does alcohol affect the world of a child: http://silk.nih.gov/silk/niaaa1/publication/yourself.htm

Local: LegacyKids@earthlinks.net

The Children’s Place…At the Heart of Recovery

-Jerry Moe, M.A. and Ross Ziegler, M.D.

You didn’t Cause it, You can’t Cure it, You can’t Control it, but you can learn to Cope with it.

-Kids Are Special; San Jose, CA