CoAs and Opioid Addiction
Thirty-five years ago, the Henry Ford Health System (HFHS) in Southeastern Michigan had an inpatient addiction treatment program at its main hospital in Detroit, and it included a family education program. That year HFHS decided to build a stand-alone treatment facility called Maplegrove, and include a family therapy component at the urging of the newly hired medical director, who had been a medical school professor sponsored by the NIAAA career teacher program to educate medical students about alcoholism. Across the country, treatment programs were including some form of family education and treatment, and insurance tended to cover it with the strong belief that the addict’s prognosis was much more positive if the family began to heal as well.
Shortly after that, Maplegrove established a very effective adolescent addiction treatment program. Because it was already well known that alcoholism and other drug addictions tended to run in families, and that addicted individuals—adolescent and adults alike—are at much greater risk of relapse when the family to which they return has not also begun its road to recovery, because patients do not recover in isolation, and because painful family relationships nurtured in the addictive family do not mend without their own recovery work, Maplegrove refused to accept any adolescent patients unless the parents agreed to participate in the related family program.
Today we have our latest addiction epidemic: opioids. This one has been made more important in the public eye as the children of the middle class and higher economic and social classes are being buried. The label “addict” has come home to those who couldn’t imagine that possibility. Parents who have lost a child to an overdose are speaking out and expect to be heard; those with substantial resources are investing them in supporting access to treatment and specialty recovery support programs; Congress has added large funds to multiple programs for the treatment of this dreadful disease and for medical education about it; the FDA has approved widespread availability of naloxone, the life-saving emergency antidote for use in the event of an overdose; and 2016 presidential candidates have “programs” to address it.
But there are several questions not brought up in all of this. What about the addict’s children? What about the family history of alcoholism and or other drug addictions? What is it about those young adults fortunate enough to get treatment that made it easy for them to take the first pill removed from a parent’s or grandparent’s medicine cabinet? Who is studying the family environment of the majority who refuse to try it from the very first versus those who succumb? Are we scrambling from emergency to emergency to treat what might have been prevented and forgetting that epidemics don’t die on by themselves? Where are the prevention efforts and funding, especially for the most vulnerable to being overtaken by addiction?
As I considered the theme of this issue of Counselor magazine, I thought back to the lesson of the Maplegrove youth treatment program and then, thinking back to the present, remembered that last year, Dr. Claudia Black, noted author and clinician well known to Counselor readers, has developed and is running a treatment program specifically for young adults at The Meadows in Arizona, and I wondered if she was seeing what I was guessing — that the victims of opioid addiction—for the most part—are from middle income with insurance or upper income families and are mostly white, helping to account for the strong media and public attention surrounding this tragedy (i.e., the impacted population gets attention when it is an empowered population). I was fortunate to reach Dr. Black, explained what I was thinking, and she answered the following questions.
Sis Wenger: In your new program, are you finding that the adage claiming that “addiction tends to run in families” still manifests itself and is a contributing factor in the addiction of young adults presenting for treatment? And do you see a predominance of relatively privileged young people involved? How is that manifested?
Dr. Black: Yes, we see this a lot. At the Claudia Black Young Adult Center, we work with young adults from a range of socioeconomic backgrounds. But many of our clients grew up with the privileges that come with being from upper-middle-income and high-income families.
Despite their advantages, children of affluence are experiencing disproportionately high levels of emotional problems today. These young adults experience the highest rates of depression, substance abuse, anxiety disorders, somatic complaints, and unhappiness of any group of children in the country. This is not meant to minimize the problems children from other economic backgrounds face, but we cannot ignore, dismiss or downplay what is happening to a very sizable portion of our young adult population.
Role of Depression, Anxiety, and Drugs
Dr. Black: Studies from public schools show that as many as 22 percent of adolescent girls from financially comfortable families suffer from clinical depression. That’s three times the national rate for adolescent girls. By the end of high school, one-third of the girls from these families exhibit clinical signs of anxiety. Boys from similar backgrounds also show elevated rates of anxiety and depression early in high school, though the difference is more pronounced with girls.
By late high school, many of these children may begin to use drugs and alcohol regularly to self-medicate their depression and anxiety.
In addition to depression, anxiety and substance use, rule breaking, and psychosomatic disorders are all elevated among affluent teens. They are also prone to eating disorders and cutting.
Dr. Black: Feelings of isolation seem to be especially common among children from wealthier families. Research is now beginning to tell us that there is an inverse relationship between closeness and high income. Children from lower income homes are far more likely to report feeling close to their parents than those from higher income homes. Material advantages do not lessen the sting of parents’ unavailability. Friends, nannies, housekeepers, au pairs, and older siblings cannot substitute for a concerned and involved parent.
In my current work, I see a lot of what I refer to as father hunger, meaning that Dad’s not involved in a manner that makes the child feel valued or supported. Many fathers are caught up in their highly demanding work schedules and often act as financial providers for the family but do not have an emotional connection with their kids. Or, in many cases, they are absent and only attempt to connect through messages about the child’s value being directly related to their performance in school, sports, etc.
Finally, and to the point of your questions, many parents end up absent in their own addictions. Many young adults, regardless of their socioeconomic background, have parents who are preoccupied with something other than parenting. They may have a father or mother who is rarely present not only because of work, but also because of a substance use disorder, gambling, sexually acting out or their many boyfriends or girlfriends. Many times these parents’ absence is due to their own untreated depression.
Healing the Family is Critical
Dr. Black: All of this simply reinforces the need for strong family programming in treatment programs, in drug court programs and in what we have traditionally called “aftercare.”
I have seen throughout the process of family treatment that family members share an abounding love for one another in spite of a history of challenging family dynamics. As the country is calling for ongoing recovery resources for the young adult, I strongly encourage it for other family members as well.
With the concepts of family history and parent child relationships so prevalent in Dr. Black’s comments, I propose an additional dimension to prevention for the population of individuals being sucked into the opioid epidemic. Dr. Donald Ian Macdonald, a pediatrician and former director of the United States Public Health Service, published a book entitled A Pediatrician’s Blueprint: Raising Happy, Healthy, Moral, and Successful Children (2014). An endorsement of the book by Hoover Adger, Jr., MD, MPH, MBA, professor of pediatrics at Johns Hopkins University Medical School and director of adolescent medicine at Johns Hopkins Hospital, states, “This book is must reading for parents who want their children to grow into healthy, productive, and caring adults who have a clear minded and principled perspective.”
Drug use prevention begins long before a child first goes to school. What we have learned over recent years is that parents matter greatly and that caring, nurturing parents are listened to by their children, especially if the parents have listened to them from early childhood. The greatest deterrents to taking the first drink, the first pill or the first puff is not wanting to disappoint one’s parents and having an honest and trusting relationship with them.
Dr. Black tells us that the eighteen- to twenty-six-year-old young adults she sees in her treatment program “so want to know they are valued by their parents in spite of the difficulty their addictions have caused the family; and these parents, in spite of whatever the family dynamics are, so love their kids.” A dynamic and in-depth family program can create transformation in individuals and whole family systems, and can begin intergenerational healing and help to halt the generational transmission of addiction.
If we are to arrest the scourge of opioid addiction, addressing the possibilities of preventing it through supportive parenting on the front end and through whole family recovery on the backend seems incredibly logical.
Macdonald, D. I. (2014). A pediatrician’s blueprint: Raising happy, healthy, moral, and successful children. Petaluma, CA: Roundtree Press.