COAs and Adolescence

This issue of Counselor focuses on adolescents, young adults, and their alcohol and drug use. The focus of the National Association for Children of Alcoholics (NACoA) is on young people who are living with parental alcoholism and/or drug addiction (COAs), or have lived with and are still impacted by it. From birth forward, these young people have been negatively impacted by various levels of chaos and chronic emotional stress that tend to characterize the addicted family’s home environment. 

When substance use disorders enter the family system, no matter when that happens or who is the primary patient, the children are the first hurt and the last helped. Without a supportive intervening adult in their lives while their parents’ lives are spinning out of control at multiple levels, they learn to freeze their feelings, to placate, to cover up, to achieve, and to succeed in an effort to survive and to hide the pain and confusion in their homes—while they often suffer in fear and silence—with a smile that deceives.

Collaborating with leaders in the major pediatric and family practice organizations, NACoA facilitated the development of the Core Competencies for Involvement of Health Care Providers in the Care of Children and Adolescents in Families Affected by Substance Abuse fourteen years ago. From Level One competencies for all primary care providers who regularly see children and youth in their general medicine or specialty practice, to Level Three where they have become trained to identify, address, and find appropriate referral for support of the impacted young people they see, these competencies outline the knowledge and skills primary care providers need to serve this population effectively.  A supplement to Pediatrics was published and distributed with the journal introducing the competencies, the science supporting them, and the report of their development.

Over subsequent years, education and strategies to serve these at-risk COAs have been developed by various medical associations and offered in symposiums, Grand Rounds, and workshops at national medical conferences.  Most recently, The American Board of Addiction Medicine (ABAM), featured an article titled “The Role of Child/Adolescent Health Practitioners in Addiction Medicine” by Hoover Adger, Jr., MD, MPH, MBA, in the ABAM Diplomate News. It included a more comprehensive approach to addressing adolescence and alcohol and drug issues and imperatives to address their prevention, intervention, and treatment needs in primary medicine and in addiction medicine. It included a focus on COAs to complete the discussion and offered solutions that grew out of the Core Competency work which Dr. Adger, a member of the NACoA Board, spearheaded for NACoA in the early days of the initiative.

Recognizing that addiction is a disease that often begins during adolescence or even in childhood, addiction can be visualized as a developmental or pediatric disease that has the potential to escalate in adulthood. Certainly, as previous issues of Counselor have demonstrated, along with the growing findings of the CDC’s Adverse Childhood Experiences (ACE) study, mental health problems that germinate in the chaotic environment of the alcoholic family begin to develop by adolescence and, without preventive interventions, can often trigger early use of substances leading to adolescent addiction with the possibility of co-occurring mental health disorders whose roots were in their early childhood. 

Health practitioners who see children, adolescents, young adults, and families are in an ideal position to intervene at key points early in the evolution of this important health problem by providing prevention, early intervention, referral, and/or treatment services. Certainly, those who are providing care to this population and have acquired the basic knowledge and skills needed, can recognize the need and potentially prevent the mental health and substance use disorders from ever occurring. In addition, practitioners should be aware of community services for evaluation, referral, and treatment of substance use disorders and be available to provide aftercare for adolescent and young adult patients completing substance use treatment programs as well as assist in their reintegration into the community. 

For over three decades, student assistance programs were bedrocks of recovery support for students who had slipped into substance use disorders. Although the drug free schools funds that supported these effective prevention and intervention programs were zeroed out in the President’s budget in recent years, it is still effective when school and community-based clinicians partner with the primary care practitioner to prevent, to intervene when needed, and to support recovery for students and their family members who are troubled or in trouble. 

There is wide support for the primary care provider caring for children and adolescents to routinely screen for substance-related concerns both in the pediatric patient and in the family. It is also increasingly recommended that they be knowledgeable about all aspects of screening, brief intervention, and referral to treatment (SBIRT). Health risk appraisal and preventive counseling throughout childhood preadolescence, adolescence, and young adulthood is a well-established principle in primary care. In addition, these visits represent multiple opportunities for screening, early identification, and intervention for children and adolescents affected by substance related problems, including parental alcohol and other drug use disorders.

For health practitioners, discussions about prevention of alcohol and other drug use related problems, including prescription misuse, should begin with the prenatal visit by focusing on the responsibility of parents, parental lifestyle, and effects of parental alcohol or other drug use on the fetus, infant, child, and adolescent. Parents serve as important role models for their children. The mental health and addiction professional can increase the likelihood of preventing adolescent substance use disorders by providing the same cautions to their adult clients who are parents.  

Children’s attitudes and beliefs regarding alcohol and drugs develop early in life, often by age seven or eight. All parents need to be aware that their attitudes, beliefs, and behavior can strongly influence and play a major role in shaping their child’s behavior. Hence, it is important for both health providers and clinicians to explore the attitude of the family toward alcohol and illicit drug use and provide basic education appropriate to the age and development of the children in that family. Guidance about alcohol and drug use should begin early in childhood when family standards and values are being assimilated. The community, the school, and places of worship can all play a role in effective prevention in early childhood. They can support the difficult role of parents to protect their children from alcohol and drug use and their often devastating consequences. All families and the community at large benefit. Addiction professionals could help lead the way.

Many of NACoA’s affiliate organizations offer preventive intervention programs to help adolescents in their communities, schools, and treatment programs. Others offer educational support programs for COAs as a component of their family treatment efforts. The following are a few examples of these creative efforts to help COAs. Links to all these programs and many more provided by NACoA affiliates are accessible at www.nacoa.org. 

This organization in Tarrytown, NY provides an evidence-based program called Project SUCCESS (Using Coordinated Community Efforts to Strengthen Students). The program’s components include an eight-session alcohol, tobacco, and other drugs prevention program; individual and group counseling; parent programs; and when needed, referral of students and parents to treatment.

Lines for Life in Portland, OR provides a peer-to-peer crisis line for teens every day. For more information on this award-winning suicide prevention program that has helped to save and redirect thousands of teen lives, including COAs who had called believing there was no way out, visit OregonYouthline.org. 

This organization offers support programs for children aged seven to twelve from families hurt by addiction. All children’s programs are open to the public and scholarships are available; no child is turned away for lack of funds. Continuing care is also offered to the children and adolescents of parents who have been in treatment.

A program of The Moyer Foundation, Camp Mariposa offers weekend camps for adolescent COAs. Campers participate in traditional camp activities as well as groups providing supportive education for the COAs. The number of camps is growing and it is now in several cities across the country.

The Rainbow of Hope Children and Youth Program at Father Martin’s Ashley offers a supportive educative program for young and adolescent children on the second Saturday of each month. The program runs from 8:45 am to 3:00 pm and is designed to help both the children and their parents.     

This section of NACoA was founded in 2004 and is run primarily by volunteers. In ten short years it has become well established across Germany, hosting over eighty events and activities across the country for COA Week 2014. NACoA Deutschland has also translated and printed several thousand copies of many NACoA products and distributed them to pediatricians, teachers, early child professionals, and others, and has provided programs for COAs in the schools as well as trained teachers in drug prevention. The organization also advocates for children and families at the German Federal Parliament (Bundestag).  

Familial Trust is the only organization of its kind in New Zealand. It provides counseling, group therapy, children and youth programs for COAs, and intensive outpatient programs and interventions to support impacted families.