It is well recognized that having a parent with a substance use disorder (SUD) can have adverse effects on a child (Fisher & Wampler, 1994; Rogosch, Chassin & Sher, 1990), but research is scarce on how the family environment changes when one or both parents are in recovery; and few studies have evaluated the impact of recovery on child functioning. A prevailing notion, based on a very small group of studies with clinical samples, is that prolonged remission can positively impact child functioning and family functioning (Moos & Billings, 1982; Callan & Jackson, 1986; Andreas & O’Farrell, 2007; Andreas, O’Farrell & Fals-Stewart, 2006). The purpose of this article is to describe the parenting challenges associated with various stages of recovery and how children might benefit from their parents’ recovery process. Through discussion of these issues, addiction professionals can help facilitate such positive effects.  

Intergenerational recovery
The large number of parents undergoing addiction treatment and the larger pool of parents in long-term recovery underscores the need to better understand the impact of a parent’s recovery process on his or her children. The well-documented transmission of alcohol and drug problems across family generations reinforces the potentially important role parents in recovery can play in breaking these intergenerational cycles. There is great potential in targeting parents in addiction treatment for prevention and early intervention initiatives that seek to mitigate the intergenerational transmission of alcohol and other drug problems by modifying parenting practices. This area of research is promising for the design of new prevention strategies to reduce adolescent substance use and new clinical practices that can enhance the quality of life of parents and families in long-term recovery.   

Because of addiction’s often chronic course, its impact on family members and the family as a whole ebbs and flows over a prolonged period of time. A useful model to describe the impact of addiction on a family is to conceptualize addiction as something that causes disruption in normal family processes and dynamics and eventually results in an imbalance that can be corrected as recovery begins and is sustained. Clinicians have noted that each family’s response to addiction over time is different, and is influenced by factors such as: family composition; the degree of closeness in the spousal relationship; the presence of extended family members; family history; socioeconomic status; and a whole host of other cultural and environmental circumstances. However, the high degree of heterogeneity in the impact of addiction should not be a stumbling block to identifying common “culprits of imbalance” among families so affected. Identifying these commonalities is important because they become the targets of intervention strategies to improve the health of family members and family relationships.

It is critical to keep in mind that parental addiction and recovery has different effects on children based on several factors, including the child’s developmental stage. Adolescence is considered to be a highly vulnerable period for exposure to parental addiction (Biederman, 2000; Latendresse, 2008).  The adolescent brain is still developing, which may heighten vulnerability (Dahl & Spear, 2004). The issue of developmental context must be woven through any strategy to modify parenting practices of parents in recovery. Children who experience trauma as a result of their parents’ alcohol or drug use at an early age will most likely have a much different perception of the experience and react much differently in the long-term as compared to a child whose parent’s alcohol or drug problems developed during the child’s teenage or young adult years. However, to date, empirical studies are not available that focus on the developmental differences related to the experience of having a parent in recovery.

The Family Recovery Project, led by Brown and Lewis (1999), administered qualitative interviews and ­various quantitative assessment instruments to 54 families with varying lengths of recovery ranging from two months to 20 years. The aim of this work was to describe the underlying developmental process of family recovery. White and Savage (2005) state that the work of Drs. Brown and Lewis:
“. . . challenge the prevailing expectation that families can rapidly move toward health the initiation of alcoholism recovery. They found in their research that the emotional turbulence within the family produced by addiction continues well into the first three to five years of recovery. Family recovery begins with what are, in essence, individual recoveries of its members. Without ‘holding environments’ to sustain these individual recoveries until couple and family relationships can be reconstructed, the risk of collapse and disintegration of the family is quite high” (White & Savage, 2005).  

The following discussion presents four developmental stages of family recovery described by Brown and Lewis, and describes for each stage, the possible impact of the family environment—in particular, parenting practices on child development. These different stages of recovery appear to correspond to unique parenting challenges. The following is based on a compilation of knowledge from the limited body of scientific literature as well as discussions with clinicians who are involved in the treatment of families affected by addiction.

Four stages of recovery and their impact on family dynamics and parenting
Stage 1: Active Alcohol or Other Drug Use. It is important to include this active stage of alcohol and drug use in our framework for describing recovery because, as mentioned earlier, impaired parenting is most likely to occur at this stage. Consideration must be given to the fact that impaired parenting during active drug use may have adverse long-term effects (e.g., trauma, neglect) and that the study of the effect of recovery on child functioning must take into account these earlier experiences. Several mechanisms have been proposed that describe how addiction of a parent affects family functioning and child development (Kumpfer, 1986; McMahon, 2002; 2007). First, children are likely to witness parents’ drinking, drug use or are adversely impacted by the after-effects of use (e.g., the parent might not be able to wake up on time to take children to school).

Second, parental impairment from excessive alcohol or drug use is often associated with high levels of family conflict—fighting, family violence and verbal abuse. However, the literature is highly inconsistent with respect to the direct effect of family conflict on child functioning—while almost all agree that there is a link between family violence and poor child outcomes, some studies suggest that the effects are mediated through spousal conflict (Keller, 2008).  

Third, poor home management (e.g., not paying bills, chores like laundry and general household tasks piling up) are likely to occur in a household where one or both parents have a substance use disorder. Certainly, these sorts of problems are not specific to parental substance use, and can occur in a variety of family situations, but might contribute to adverse child outcomes especially for some children. For example, some studies have shown that some children of alcoholics have academic difficulties that are linked to heightened distractibility and impaired motivation and organization skills (McGrath, 1999). These children might be more sensitive than others to disorganized household environments.

Fourth, parental absence is an issue. In some cases, temporary parental abandonment, periods of unemployment or parental incarceration followed by correctional supervision (e.g., probation and parole) can take a toll on families directly through loss of family income (McMahon, 2007), and also indirectly through emotional abandonment and unpredictability. Sporadic parental absence arguably decreases parent-child at­tach­ment and decreases the frequency with which the child is en­couraged or praised by their parent, all of which can influence psychological adjustment.

Fifth, family rituals (e.g., from family dinners to holiday celebrations), which many feel are important for child functioning and adjustment, may have failed to develop or be disrupted in the face of a substance use disorder of a parent.  

Sixth, parental monitoring and supervision are impaired in substance-dependent parents, which may have negative short- and long-term effects on child development. For example, parents with a substance use disorder might not assist with schoolwork when needed, or might not be aware of psychological issues that may need intervention. This sort of reduced parental involvement might increase the risk underage drinking, and other forms of unhealthy adolescent risk-taking. Appropriate parental monitoring and supervision is considered to be one of the most important aspects of effective parenting that can decrease the risk of substance involvement in children and adolescents.

Seventh, increased family isolation may occur in families in which one or both parents have a substance use disorder. This may occur because of the shame or stigma associated with that parent’s behavior, or because that parent has experienced the loss of friends and acquaintances due to his/her behavior (e.g., poor supervision of children or fighting with neighbors). There may be abandonment of relationships between the alcohol or drug dependent parent and his/her extended family members, thereby limiting the potentially helpful influences of these individuals on the child’s development and basic needs. This correlate of parental addiction has not been adequately explored in the literature, but could be very influential on child development because social connectedness may be very protective. If a family is able to sustain connections to one’s extended family, neighbors and the larger community, the likelihood of involvement with alternative healthy role models is increased, and the child may benefit. Moreover, having strong connections to the community or school provides an “out” for a child trying to escape a chaotic home (e.g., community sporting events, extracurricular activities, YMCA, camps, etc.). Through these community activities, children may find opportunities to learn social and communication skills that they otherwise would not be learning in their own homes during critical stages of adolescent development. Lastly, active parental addiction co-occurs with a high degree of denial, which has a long-lasting impact on the child’s view of what is normal, and can also have a negative effect on learning how to communicate openly and honestly with others.  

For all of these aspects of family functioning, one must keep mindful of the following caveats: a) not all of these situations may be true for all families; and b) a non-using spouse (or sometimes even an older sibling) may compensate for the substance-dependent parent so that the true impact on the entire family system
of having one addicted parent is ­minimized.

The familial environment of active addiction described above can potentially impact child functioning in a variety of ways. Poor and inconsistent discipline may lead to affiliation with deviant peer groups and early involvement with alcohol and drugs in the children, depending on the age of the child and his/her drug exposure opportunities. Psychologically, children are commonly observed to be not able to trust adults in their environment and many feel like their home is not a safe place.  A child’s sense of normal becomes distorted, and if they are not able to seek out and discover other types of support structures (e.g., academically-achieving youth might search out school as a safe place), children can feel abandoned and unsafe. Another important effect of this stage is that children sometimes take on a role as a “hero-child” in a process known as “parentification” to deal with the parents’ addiction, especially when younger siblings are present. This may serve as a temporary coping mechanism, but may be hard to switch out of later as the recovery process ensues.

Stage 2: Transition to Recovery. This stage can last several years and relapses may be common. Typically, the substance user is out of control and the family system is in chaos. Brown and Lewis (1999) identified this as the “trauma of recovery stage.” Children are left confused and frightened with the major changes, as parent(s) typically focus on how best to make a transition to their own individual recovery. Often a major life event (e.g., the non-addicted spouse threatens to leave, the parent gets arrested or is hospitalized for an overdose, or the parent becomes the victim of a drug-related crime) may be the impetus for the transition to recovery. All of these events can have significant traumatic effects on a child. In addition, at this stage, there may be major legal and financial issues facing the family. Clinicians describe this stage as a “period of collapse” that prompts the family system to transition toward addiction. How a parent decides to sustain their recovery (e.g., through behavioral or pharmacological and/or spiritual support) will have different impacts on the family.  

Brown and Lewis (1999) found that for pre-teens and adolescents, the early years of recovery were often worse than the drinking years, as the family experienced the “trauma of recovery” when all of the alcoholic’s energy was focused on maintaining abstinence and recovery. Children may be particularly vulnerable during this stage, and it is often said that life for children of alcoholics does not automatically improve when the alcoholic parent stops drinking or using drugs. Parental absence as a result of removal of the parent from the home to attend a residential program, or even participation in outpatient treatment and recovery support groups can pose logistical complications for a family with children, even if there is another spouse living in the household. Depending on their age and level of understanding regarding the meaning of treatment, children may feel emotionally distraught due to prolonged parental absence.
Stage 3: Early Recovery. At this stage, parents learn that recovery is possible and begin to acquire or resume the use of non-addictive lifestyle skills. Parents begin to build their own separate identities. Early recovery is signaled by decreases in impulses to use. Clinicians characterize this stage as having a “calming, quiet effect” on the family. In the optimal case, family members will show a capacity for self-reflection. The environment may become calm and less chaotic. There will be more order as the family stabilizes. In early recovery there is more expectancy that abstinence is now the norm. Because there is still an underlying fear of relapse, tension and anxiety can still be present, even in many of the family’s most “normal” daily ­routines.

During this stage, children still risk being neglected as their parent may be spending more time out of the house attending 12 Step meetings and trying to regain a sense of normalcy in their social relationships. Children may act out, withdraw, ‘adopt a friend’s family’, or in some cases, attend 12 Step meetings with their parents. Very little information is available regarding the impact of this stage on child and family functioning. Optimally, the child might benefit from increased stability in the home, but hypervigilance and anticipatory anxiety about relapse might be expressed in some children.

Stage 4: Ongoing Recovery. At this stage, the recovery process becomes internalized for the parent. With prolonged abstinence, the possibility of relapse lessens and the family can begin to re-build their routines and perhaps adopt new family rituals such as family dinners and outings. The parent in ongoing recovery might attempt to involve themselves more in the day-to-day activities of his or her child, and begin the process of renovating a relationship with the child. It might be necessary for a parent to learn about their child’s most basic interests and activities, depending on the severity of their SUD, and how extensively it affected their relationships with their children. Spousal resentment may be a critical issue at this stage. Parents might be able to now ‘tolerate’ hearing from their children about the pain they caused and the process of healing with the now adolescent or adult children can begin.

As the parents begin to spend vast amounts of time and energy on recovery and working a recovery program, children may be somewhat neglected and left without a parental figure to guide them through the intense process of change that is happening in the family. As will be described in the next section, some addiction treatment programs address parenting issues thoroughly, others in a more cursory fashion. Addressing parenting skills during treatment can make adults better parents, and lead to enhanced quality of the parent-child relationship and ultimately decrease the risk for adolescent substance use. Moreover, it is often the case that relationship issues lead people to relapse. Unresolved issues with children and a paucity of skills to deal with these issues can put individuals with addiction at high-risk for relapse. Following are issues that appear to be unique parenting challenges faced by parents in ongoing recovery.    

Discipline issues. Parents in recovery may experience difficulty with knowing how to discipline their children. First, they might not have had good role models if their own parents were active drug users, or if they experienced childhood trauma or witnessed domestic violence. The intergenerational transmission of alcohol and drug problems as well as child abuse has long been recognized, but the intergenerational transmission of parenting skills and more subtle parenting behaviors has not been thoroughly studied. Parents in recovery should examine their parenting skills “3-generationally”—that is, to place their own knowledge of parenting skills in the context of what their own parents taught them and how their grandparents behaved toward their parents. Parents must learn how difficult is it to provide discipline to different types of children and how discipline practices should take into account stages of child development. It is common that a parent in recovery does not want to hold a child responsible for his or her behavior, but must learn that rule-setting and positive discipline is necessary and will most likely lead to better child outcomes in the long-term.

Overindulgence as a coping mechanism for guilt. Parents in recovery might try to “spoil” their children to overcome the guilt and shame associated with their past lifestyle and inadequate parenting. Often what is seen clinically is that parents in recovery will go from one extreme (i.e., overly controlling and hostile) during their active drug use to the other (i.e., overly lenient). Parents in recovery, just like other types of parents, should clearly be encouraged to set limits; monitor and supervise activities and friends; and provide a structured environment that encourages responsible behavior. Parents in recovery should expect that their children might be more likely than other children to react negatively to parent’s attempts to set limits, and might even call attention to the purported hypocrisy of having to follow rules when the parent themselves had broken rules during periods where they were actively addicted. A useful strategy is to encourage parents in recovery to see that what they have to offer the child is a great gift—the gift of experience—to acknowledge their own drug-using behavior as something that took them off-course in a serious way, and that more than anything, they want their own child not to have to repeat these negative experiences. All parents, including parents in recovery, should encourage children “to walk their own journey” towards capitalizing on their own unique strengths and talents, so that they can fulfill their own potential.
Preoccupation with maintaining recovery. Parents in recovery can become preoccupied with their recovery process. Going to meetings, seeking out new friends, starting new lines of employment or making geographic moves all are examples of transitions that while might be positive and needed changes for the parent, may place children under stress due to the changes. It is important to ensure that any major family life events are handled with care, and monitored to make sure that the children are adjusting well. Second, parents’ attendance at nightly recovery support meetings or involvement in social activities with a new network of non-drug using friends can result in unwanted parental absence. Also, it is possible that a parent in recovery might be trying to re-establish an employment routine after getting fired from a job, and might have to work odd hours or multiple jobs to compensate for the lack of job opportunities available to individuals with criminal or drug use histories.

Parental absence. It is important that parents realize the possible negative impact of parental absence. Not
only can the impact be emotionally ­disturbing (e.g., loneliness), but in a practical sense, the parent’s absence may result in less vigilance to: monitor homework; play a part in their child’s extracurricular activities; and monitor their child’s peer networks and social activities. The optimal strategy is to be open with the child about the parent’s needs to sustain their recovery, but strike a balance between the child’s needs and the parent’s needs. One should not assume that as a child gets older, the effects of parental absence lessen. On the contrary, the teenage years can be more demanding in terms of the need for parental supervision and monitoring. It is also possible to draw assistance from trusted neighbors, extended family members and community support networks to “fill in” for parents during times when it is essential for parents to be separated from their children.

Rebuilding trust between parent and child. As mentioned earlier, it is not uncommon for parent-child trust to erode during the time when the parent is an active substance abuser. Some children may remember experiencing situations where the parent proved to be unreliable or negligent behavior and will require reassurance that this behavior was linked to the parent’s substance abuse. Rebuilding trust will most likely come when the parent is given the opportunity and is successful in demonstrating that they can be responsible and reliable when it comes to caring for the child. Even the smallest examples can make a difference to a child, like showing up on time to pick the child up from a friend’s house, or prompt attendance at an athletic or school event. This process should be anticipated to take time and energy on both the part of the parent and the child, with the encouragement of other family members and significant others.

Overcoming stigma. Many parents in recovery must overcome the challenge of directly experiencing stigma at their workplace, neighborhood, or sometimes, their children’s school. Children as well might be affected by stigma, especially in cases when their peers, their peers’ parents or their teachers, depending on the degree to which these individuals might have been aware of the parental substance abuse. From a clinical point of view, there do not appear to be clear or proven strategies to handling stigma, except to anticipate having to deal with the challenge; and focusing on the positive aspects of one’s own recovery; and establishing new behavior ­patterns.

Summary
Effective parenting includes a broad and dynamic set of behaviors, principles and attitudes that are simultaneously challenging and rewarding. Even in the absence of an SUD, parenting can be a daunting task, and becomes even more challenging for the parent when combined with maintaining one’s recovery (Nelsen, Intner & Lott, 1995). Developing appropriate parenting skills is necessary to enhance all phases of a child’s development—starting in infancy, through childhood and adolescence, and even through young adulthood, when the risk for developing a substance use disorder peaks. Figure 1 displays an example of a print resource that is provided to parents in the Betty Ford Center Children’s Program. Staff explain each item and get input from parents about various ways to incorporate these suggestions with their children. Staff asks the adults to commit to at least one item they will do regularly with their children after they complete the program. Online parenting resources have been developed by the Partnership for Drug Free America and are available at www.drugfree.org.  

Clinicians might find the information in this article as a useful starting point for discussing these issues with their clients. From there, they can facilitate problem-solving strategies based on the individual needs and circumstances of their clients. Parenting encompasses a complex set of behaviors that change in accordance to developmental stages and needs of a child; and it is essential for clinicians to inform their clients that parenting behaviors also can change as parents move through various stages of recovery. Parents can and should modify their parenting behaviors to benefit their child. Ultimately, modifying parenting behavior may help to reduce the intergenerational transmission of addiction.

There is a wide degree of heterogeneity in the extent to which parenting skill development is integrated into drug treatment programs. While parenting skills are sometimes taught for parents of the very young, it is less common to teach parenting skills to parents who have older children. This is unfortunate given the fact that the risk of adolescent health risk behaviors increases as children become older, and that research supports the important impact that effective parenting has in reducing this risk. Although some parenting interventions exist, there is a clear need for their enhancement and expansion as well as more research and evaluation of their long-term effectiveness. It is hoped that a shared understanding of these issues can lead to expanded resources for parents in long-term recovery. It is likely that becoming a better parent will both benefit the child as well as serve as a motivator in sustaining one’s own recovery.

Amelia M. Arria, PhD is the director of the Center on Young Adult Health and Development at
the University of Maryland School of Public Health, and a Senior Scientist at the Treatment Research Institute in Philadelphia, where she is the Scientific Director of the Parents Translational Research Center and a consultant on prevention issues for the Betty Ford Institute.

Jerry Moe, MA is the national director of Children’s Programs at the Betty Ford Center.  His latest book is Understanding Addiction and Recovery Through a Child’s Eyes.

Ken Winters, PhD is the director of the Center for Adolescent Substance Abuse Research, a Professor in the Department of Psychiatry at the University of Minnesota and a Senior Scientist with the Treatment Research Institute, Philadelphia, PA.  

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Clyde Sexton   |216.81.106.xxx |2011-01-22 05:07:23 This article is very informative and focuses on the parent as well as the child's impact from addiction.Clearly,addiction in itself creates havoc and chaos in both the addict's life and the child's,too.Hat's off!Continue the Good work! Reply 0   0

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