Mary C. could be your client, or the parent or grandparent of one of your clients. She’s a 70-year-old widow whose late husband was an alcoholic. She has raised eight children, and has recently survived a bout with cancer. One of her sons, like many children of alcoholics, married a young woman who had problems with alcohol and drugs, thinking he could rescue her. Unfortunately, her daughter-in-law’s condition continued to deteriorate, and Mary has cared for her 4 1/2 year-old grandson in her home since his infancy.

Mary has much wisdom to impart to others in her situation. She walks a precarious line. In order not to harm her relationship with her son and daughter-in-law, she has refrained from going to court to obtain custody of her grandchild. She respects and nurtures the bond of love between her grandchild and his mother. She says she “takes one day at a time,” drawing emotional support from her Al-Anon support group.

As an addiction counselor, especially if your client is the individual with the alcohol or drug problem, you may not initially think that Mary’s interactions with her grandchild are relevant to your therapeutic responsibilities. Your primary focus is on your client’s needs — as indeed it should be. Hopefully, though, you know that the impact of your client’s relationships with their spouses, parents, siblings, children, and friends can be substantial. You also know that these relationships can be part of the addiction problem or part of the solution, and that often they are both.

Although you may tend to think primarily about the relationship each of these individuals has with your client, their relationships with one another can be equally important. If these “outer links” in your addicted client’s personal network are strong, there’s a greater chance that everyone in the network, your client included, will overcome the harmful effects of the addiction.

The relationship of grandparent to grandchild is one such potentially supportive link. After all, grandparents naturally love their grandchildren, desire their well-being, and feel deeply distressed when a parent’s alcohol or drug use puts them at risk. The bonds among the members of all three generations are complex, and there are boundaries that must be respected. As a therapist you will want to encourage healthy development of the grandparent-grandchild connection whenever you can, and help your client derive support from the relationship.

If your client is the grandparent or the grandchild, your focus naturally shifts. But the underlying principles remain true. Each healthy family relationship can be a source of strength in the fight against addiction, just as each co-dependent, enabling relationship can undermine the battle. You want to help grandparent and grandchild build healthy relationships and break unhealthy entanglements.

A grandparent’s perspective
Millions of grandparents in the U.S. today are concerned about how their children’s drinking or drug use is affecting their grandchildren. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that about one in four children, or more than 19 million, are exposed to problem drinking in the home at some time during their childhood (Grant, 2000). Many more children live in families where drug use is a problem. No segment of society is immune. Chemical addictions occur among the very wealthy and the very poor, in the inner city, the suburbs, and out in the country, and among all ethnic and religious groups.

The U.S. Census (2000) counted some 4 million children, or about 5 percent of all U.S. children, living in the home of a grandparent. Of these, some 35 percent, or about 1.4 million, did not have a parent living in the household. While there are many reasons for such arrangements — poverty, divorce, illness, death, a parent’s incarceration, for example — alcohol and drug problems are high on the list, according to Census Department officials.

No one knows how many more grandparents there are who provide day care, weekend care, or general back-up support to parents under stress. And then there are the grandparents who are not yet actively involved in caregiving, but who are worried because they see an alcohol or drug problem developing and are uncertain about whether or how to intervene.

Their ambivalence is warranted. Grandparents are indeed in an awkward position in our society, where the nuclear family is the dominant model. They have no automatic legal rights with respect to their grandchildren. And their problem is compounded by geographic mobility. Grandparents who live hundreds or thousands of miles away from their grandchildren cannot step in as surrogate parents.

Grandparents also face personal limitations on what they can do. They may be experiencing the dwindling energy, health problems, and diminished financial resources that often come with age. They may not have planned for the burden of grandchild care at this time in their lives. Very likely, they have been looking forward to the freedom of the “golden years.” Equally likely, they are still caring for their own parents or older relatives. And their children’s alcohol or drug problem may have been thrust upon them suddenly, an unwelcome surprise.

Then too, grandparents may find the situation embarrassing, and a negative reflection on their own parenting. These feelings of shame can make them reluctant to seek the help they need. There’s also the possibility that one or more of the grandparents have an unacknowledged problem with alcohol or other drugs. Alcohol abuse and alcoholism are common but under-recognized problems among older adults (Rigler, 2000).

Nevertheless, grandparents are indeed stepping in to help their grandchildren. Therapists in treatment centers are finding this out. As more treatment programs begin to offer support services to their clients’ children, they are meeting the grandparents, who are often the ones who bring the child to the sessions (see below). Says Betty Conger, ACSW, Director of the Henry Ford Health System’s Maplegrove Children’s Program in West Bloomfield, Michigan, “the grandparents and other family members tended to wait around, wanting to talk to us. Eventually we created a support group for them” (Personal Interview, December 2002).

Grandparents’ support groups
Such grandparents’ groups are springing up around the country, not only in addiction treatment centers but also in senior centers, churches, and other community organizations. Some are true grass-roots organizations, created by the grandparents themselves. Typically, a program will offer monthly educational meetings, referrals to social services, and support services. But some groups also offer extensive social programs. For example, the “No Empty Nest” program operated by the Volunteers of America of Alaska offers a “grandfamilies camp” — an annual three-day weekend for grandparents and their grandkids, complete with crafts and workshops for adults and youth. AARP® operates a Grandparent Information Center that includes a directory of such programs by zip code.

In the grandchild’s eyes
A grandparent can at least analyze the grief, shame, and uncertainty that the alcohol or drug problem generates. A young child growing up in an alcoholic home has not yet developed this ability. Says Sis Wenger, Executive Director of the National Association for Children of Alcoholics (NACoA), “Such a child is often deeply confused. Adults’ behavior makes no sense. The child’s parents are unpredictable, irrational, out of control. The way they are when drunk is the opposite of what they are when sober. The child often feels both at fault and hopeless, unable to change the situation” (Personal interview, October 1, 2003). NACoA educates professionals and the general public about these children’s needs.

Claudia Black, PhD, MSW (2001) describes the intellectual and emotional climate of such a home. She explains that an alcoholic family typically lives by a set of rules designed to preserve the status quo, even though following the rules inflicts enormous suffering on each member of the family. The rules are:

• Don’t talk. This rule allows a regime of silence and rationalization to be maintained, preventing a family member’s alcoholism from being addressed.
• Don’t trust. Because alcoholic parents are not consistently available to them, children learn early that their needs are unimportant and that adults are unreliable.
• Don’t feel. Children in alcoholic families learn to block out their feelings of fear, worry, embarrassment, guilt, anger, and loneliness. If they are not taught otherwise, they will take this counterproductive skill with them into adult life.

To a child, a grandparent can offer an oasis of sanity, dependability, and emotional support — another reference point from which to see the world.

But, Wenger cautions, this is possible only if the grandparent has developed a degree of clarity about how addiction is affecting the family. She notes, however, that “since alcoholism tends to run in families, the grandparent may also need to unlearn the ‘don’t talk . . . . don’t trust . . . don’t feel’ rules.”

The children need to hear clear and positive messages that will help them understand the reality of their situation, and at the same time show them that they can live happy and healthy lives despite their parent’s addiction, adds Wenger. NACoA teaches a set of simple principles that even young children can understand. They are summed up as “Seven Cs”:

• I didn’t cause it.
• I can’t cure it.
• I can’t control it.
• I can help take care of myself by: communicating my feelings, making healthy choices, and celebrating me.

These Seven Cs are among the core messages of the educational support programs that NACoA espouses. Wenger urges grandparents to use them in their conversations with their grandchildren.

Basic advice to grandparents
There is no “one size fits all” solution to family alcoholism. Nevertheless, grandparents around the country who are facing or have faced the problem have much hard-earned wisdom to share. They are conveying a message of encouragement and hope: that much can be accomplished if one is “savvy” about establishing and maintaining the grandparent relationship. Their advice to other grandparents, in a nutshell is:

• Arm yourself with information. Get the facts about your child’s condition and its impact on your grandchild. You won’t feel so helpless. Visit the bookstore, get on the Web, contact AARP’s Grandparent Information Center.
• Strive for emotional clarity. Know your own mind and heart, prioritize, and get the emotional support you need.
• Move forward. Take action. Do what you can, knowing it will never be enough.

Here are some specific suggestions from NACoA’s members based on pieces of advice a counselor can offer grandparents to help them carry out this agenda:

1. Grandparents can learn about the biological aspects of alcoholism and other drug addiction. Counselors may need to teach that addiction is a disease with a distinct physiological pattern.

2. They can learn about the psychological manifestations of the illness. Counselors can help grandparents understand the defense mechanisms the typical alcoholic uses, by teaching them that they do not want to be taken in by their child’s denial, or their attempts to blame your client for what is occurring.

3. They can read up on the family dynamics of alcoholism. Grandparents are part of a complex family system. Help them discover how they could be reacting to some of the signals their adult child is sending out.

4. They can learn their rights and entitlements. Counselors can suggest that clients become knowledgeable about the child protection laws and regulations in their jurisdiction, so that if the time comes when they need to seek custody, or find some other way to have their grandchild removed from the home, they will know their options. Encourage your clients to find out what social service benefits might be available to them.

5. Your clients can clear away their own emotional cobwebs. Grandparents also need to be working on their own personal responses to their family’s situation.

6. They can get support for themselves. Concerned grandparents are especially in need of moral support and the more detached perspective of others to help them from being overcome by negative emotions. Help them look to all possible sources — their spouse, other family members, close friends, or pastor. Remind them that some may be better listeners than others; some may offer concrete advice or refer them to additional sources of help.

Counselors also can recommend a more organized source of ongoing support. Al-Anon/Alateen is a worldwide organization that serves individuals affected by the alcoholism of a family member or loved one. Al-Anon meetings follow the 12 Step principles of Alcoholics Anonymous. To find out whether there is an Al-Anon group in your area, visit http://www.al-anon.alateen.org/.

7. They can find out about alcoholism treatment programs in their area. In the ideal scenario, a grandparent’s adult child will recognize the problem, enroll in treatment, and get on the road to recovery. To maximize the chances that this will happen, help your client learn about the programs that are available, and if the programs offer support for family members, including age-appropriate education and support for the children.

8. They can consider how to intervene. Getting someone to accept treatment is not an easy task, but it is possible if approached right. Suggest that your client find out who has leverage with their child — anyone who touches his or her life and cares about what happens. Encourage them to see whether one or more of these individuals can help you make headway against the typical denial of the addict.

If this doesn’t work, help them consider a planned intervention. (Editor’s note: To help your clients understand intervention options, see “Strategies for Increasing Client Motivation” in the December 2003 issue of Counselor).

9. If possible, they can offer their grandchild a safe haven. Even if your client’s grandchildren live at home, there may be times when they should not be there. Pat Cochran, Director of Prevention Services at the Volunteers of America (VOA) of Alaska in Anchorage, was such a child. She remembers her grandparents’ home as a sanctuary. The VOA of Alaska runs an active support program for children of addicted parents. Children are taught to list three “safe people” whom they can call on in an emergency. Only one of these three people can be a teacher. According to Cochran, the children list their grandparents very frequently (personal interview, May 8, 2003).

“Grandparents should take every opportunity to teach their grandchildren how to connect regularly with the safe people in their life,” says NACoA’s Wenger. “They need to know the basics of self-protection; for example, how to avoid getting into a car with someone who is inebriated, and how to protect themselves to the extent possible if they have no choice.”

10. They can keep the lines of communication open. The members of the VOA of Alaska’s grandparents’ group have developed a list of suggestions of ways to keep in touch:

• Give the child a phone card and show him or her how to use it.
• Teach the child how to use a pay phone, and give him or her money to make a call. (Of course, this advice may be obsolete if the family is cell-phone savvy; however, many grandparents and their grandchildren still rely on older technology.)
• Give the child stamped, self-addressed envelopes, and start a journaling or storytelling project. Or perhaps use e-mail, a faster, easier method of grandparent-grandchild communication.

11. They can help their grandchild build a positive relationship with his or her parents, while acknowledging the reality of addiction. Grandparents are clearly in a powerful position. Sandy Powers, a grandmother who runs the “Kinship Navigator” Program at Children’s Hospital in Columbus, Ohio, believes that it is crucial for them to give the grandchild a balanced view of the parent’s condition. “You have to avoid both extremes,” she says. “If you cover up for the parent, you encourage the child to adopt the parent’s lifestyle as a model. On the other hand, if you poison the child’s relationship with the parent, you run the risk of angering the parent and losing contact with the child” (personal interview, May 21, 2003).

12. They can alert their grandchild’s teachers to the situation. Especially if you are providing informal caregiving, it is important that your grandchild’s teacher be aware that you are in the picture. Teachers can communicate informally. Ask your grandchild’s parent to provide your name and phone number to the school as an additional emergency contact.

13. They can try to get their grandchild into an educational support group. Programs like the one Pat Cochran runs at the VOA of Alaska can be enormously helpful. Some schools offer such programs as part of their counseling or student assistance programs. Or you may be able to locate one operated by an alcohol treatment center.

Each of these suggestions is intended as the starting point of a conversation between counselor and grandparent. But a counselor’s task in pursuing the conversation is extremely complex. The subject is sensitive, and the grandparent may be reluctant to begin the conversation. There may be a history of family alcoholism, or an unresolved personal addiction, that is causing shame or embarrassment. In addition, there are numerous decision points, where the grandparent must strike a delicate balance between intrusion and passive detachment. And the stakes are extremely high — both family relationships and the child’s well-being are at risk. The counselor will need to draw upon the full range of professional skills to guide the conversation.

“Fortunately,” says Wenger, “support is out there — an entire new body of literature on the subject of grandparenting, kinship care, and related subjects; numerous child-serving organizations focusing on helping grandparents; and new networks of grandparent support groups. NACoA’s work on behalf of COAs fits into this larger picture; we are eager to hear from counselors, and to help them find the resources they need to help their clients.” (Editor’s note: For additional guidance on starting a conversation with concerned grandpaernts, please see the “Parents of Substance-Abusing Children Interview” assessment tool on page 78.)

A companion “Resource List for Grandparents” is available online at www.counselormagazine.com for counselors to retrieve, print out, and share with your clients.

Marion Torchia, PhD, is director of communications for the National Association for Children of Alcoholics. She has 20 years of experience as an analyst and writer for Washington, DC-based healthcare associations.

References
Black, C. (2001). It will never happen to me. Second edition. Denver, CO: MAC Publishing Inc.
Grant, B.F. (2000). Estimates of U.S. children exposed to alcohol abuse and dependence in the family. American Journal of Public Health 90(1):112-114.
Rigler, S. (2000, March 15). Alcoholism in the elderly. American Family Physician, 61:1710-16.
U.S. Census Bureau. (2000). Population Profile of the United States (Internet Release), Chapter 6 “From Birth to Seventeen: The Living Arrangements of Children, 2000.”

New Children's Program Kit Available

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) has joined with the National Association for Children of Alcoholics (NACoA) to create a new Children’s Program Kit. The Kit contains all the materials an alcohol or drug treatment center or a community organization needs to create a support program for school-age children affected by family addiction.

The Kit can help treatment providers ensure that the children:

• Hear the messages that they are not alone and that they are not to blame for their parent’s addiction.
• Learn skills such as problem solving, staying safe, and seeking supportive services.
• Be put on a path to build on their existing strengths and develop resilience.

The Children’s Program Kit can be ordered from SAMHSA’s National Clearinghouse on Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847-2345, or by fax to 301-468-6433. For more information call 1-800-729-6686 or consult the clearinghouse Web site at http://ncadi.samhsa.gov. (Ordering name: CPKIT).

This article is published in Counselor,The Magazine for Addiction Professionals, February 2004, v.5, n.1, pp. 53-58.

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