Enhancing Positive Outcomes for Children of Substance-Abusing Parents

Introduction

Adolescent behavioral health problems are on the rise worldwide, particularly for impulse control disorders (ICDs) including substance abuse, delinquency, obesity, and HIV/sexually transmitted diseases (STDs) for genetic and environmental reasons. Contributing to these developmental issues are children growing up in families of substance abusing, depressed, highly stressed, and dysfunctional parents. Even simple things such as the diminishing number of family meals eaten together has been found to have a negative impact on adolescent’s risk for substance use and negative youth development.fn1

Substance abuse has been a concern for many years, but recently there have been alarming rates of increasing adolescent tobacco, alcohol, and drug use worldwide, particularly in girls and women. In many developed countries, adolescent legal and illegal substance use has been rising for the past 5 years. along with concerns about youth risky consumption patterns in Europe and the United States. In the United States, 2014 resulted in nonsignificant decreases in adolescent substance use mostly because of a decrease in marijuana use. The biggest recent increase in substance use in adolescents has been in the use of party drugs—prescription drugs, binging on alcohol, and prescription drug misuse and e-cigarettes. The use of e-cigarettes is now higher than use of regular cigarettes, the use of which has decreased since 1992. Of course, teen alcohol misuse and accidents is the major cause of teen mortality. Traditional gender differences have narrowed in the United States and most countries. Girls have higher rates of tobacco and alcohol use in the 8th grade; however, by 10th grade, boys generally catch up.

The misuse of alcohol and other drugs has a significant impact on the global health and economy as well as the well-being of children and families. It is estimated that around 48% of adults worldwide use alcohol and 4.5% use illicit drugs, although only about 15% misuse alcohol and drugs. The greater the consumption of alcohol, the greater the harm done. It is of interest that Europeans have the highest amount of yearly alcohol consumption in the world: 2.5 times that of the world average. Despite lower overall consumption levels in Northern European countries compared with Southern European countries, where drinking small amounts of wine with meals is common, when Northern Europeans in Nordic counties drink they display more detrimental patterns of excessive use. Alcohol and other drug misuse has a wide impact on all strata of society, not just in terms of illness and disease, but also related to violence and crime rates, workplace injuries and performance, and family stability and relationship breakdown. The cost of addictions in the United States is very high and is estimated at about $2000 per person in economic costs related to lost revenue, taxes, treatment costs, criminal justice costs, fires, accidents, and other related costs.

Higher Risk for Addictions

Research suggests that children of addicted parents are at 2–9 times greater risk of becoming substance abusers as adolescents or adults depending on genetic risk, despite the positive and adaptive behavioral outcomes of many of these children. Among adolescents, children of substance abusers misuse substances more than children whose parents are not substance abusers and escalate their use more steeply. As young adults they are more likely to be diagnosed with alcohol and drug abuse/dependence. The risk for later substance misuse depends on their degree of risk factors compared with protective factors including risk factors associated with the extent of their family history of alcoholism, which includes whether one or both parents are abusers and the addiction severity, the type of alcoholism that runs in the family, and the extent of their parents’ antisocial behavior, health, and mental health problems. Gender differences also exist; for example, girls have increased vulnerability to the negative impact on later drug use from family environmental risks, which are high in families with substance-abusing parents.

Living with a parent who abuses alcohol or other drugs can have severe effects on every aspect of a child’s life, including social acceptance, mental and physical health, and school performance. Most studies find that children of substance abusers have elevated rates of psychological symptoms. Beyond risk for addictive behaviors, children of substance abusers are also at higher risk for developing emotional, behavioral, academic, criminal, and other social problems, particularly if both parents are substance abusers, have type II alcoholism, or genetic risks such as short alleles of the serotonin transporter (5- HTTLPR ) gene, and there is high stress and conflict in the family. They tend to be lower on protective factors and higher on risk factors, thereby increasing their risk for depression, anxiety, suicide, eating disorders, chemical dependency, teen pregnancy, and HIV.

They tend to have heightened levels of conduct problems in preschool and elementary school and delinquency in adolescence, particularly if their parents also show antisocial behaviour. Children of substance abusers also demonstrate elevations in impulsivity and activity level as well as behavioral disinhibition, leading some researchers to view them as behaviorally undercontrolled. Children of alcoholics have been found in a longitudinal study to age 23 years to employ more of a cognitive coping style and less of a decision-making coping style than children of nonalcoholic parents. Similarly, children of two parents with substance use disorders tend to use aggression as a major coping style, compared with children of only one or no parents with substance abuse disorders, who use a more problem-solving, decision-making style of coping. Earlier studies described children of substance abusers as higher in “difficult temperament,” meaning a relatively stable trait, likely genetically linked, that led to increased emotional and behavioral liability and difficulty with behavioral control. Parental alcoholism has also been linked to anxiety and depression in children, and West and Prinz have noted that children of alcoholics had higher levels of anxiety and depression than did controls in 10 of 11 published studies. Longitudinal studies up to three decades, found that children of alcoholics consistently reported greater risk for stressors in the family domain of 11 life areas. In addition, they report repeated and more severe stressors into adulthood in their family.

In addition, children of substance abusers show lower academic achievement than do children whose parents are not substance abusers, even in comparison with depressed children or children of divorce, and they have poorer cognitive functioning in the preschool years than do children whose parents are not substance abusers. Casas-Gil and Navarro-Guzman have identified five variables in which school performance by children of alcoholics was poorer: intelligence, repeating a grade, low academic performance, skipping school days, and dropping out of school. Sons of male alcoholics who have many alcoholic relatives across generations have been reported to show deficits in verbal and abstract reasoning and verbal learning. For this subgroup, Pihl and associates suggested that cognitive deficits may be caused by heritable dysfunctions of the prefrontal cortex and limbic systems. However, cognitive impairments may also stem from fetal alcohol exposure, high stress levels in pregnant mothers or a lack of environmental stimulation or conversely a chaotic home environment. Studies find that in the absence of family stress and conflict, the academic performance of boys who are children of alcoholics is similar to that of boys who are not until high school. As more thoroughly explained below, high family stress and elevated cortisol levels has been found to be related to triggering the phenotypic expression of genetic risks according to Brody and associates. Hence, for both environmental and genetic reasons, children of alcoholics living with high family conflict would likely have more trouble with their academic performance.

Genetic Risks

Family, adoption, and twin studies support the heritability of addictions, which is estimated to contribute to about 40%–60% of the overall risk. This heritable influence appears not to be substance specific. For instance, children of alcoholics today are also becoming abusers of illegal and prescription drugs. Children in families with many early onset alcoholics (beginning use before 15 years of age) are at highest risk for later substance abuse or addiction because this is an indicator of type II alcoholism. Type II alcoholism is the highly heritable type of alcoholism that appears to have a heavy genetic loading as compared with type I alcoholism, which is more environmentally caused. Research suggests that about 60% of the variance in risk for an alcohol use disorder is related to genetic factors and the remaining 40% is due to environmental factors in this type of alcoholism in males. However, twin and adoption studies suggest that girls are not at such a high risk. In females, only about 40% of the variance in risk for an alcohol use disorder is related to genetic factors and the remaining 60% is due to environmental factors. However, this risk increases if both biological parents are alcoholics from type II alcoholism families. Luthar and associates found that similar adverse circumstances are present for children whose parents abuse illegal drugs. They concluded, however, that maternal drug abuse per se is not as damaging to children’s resilience as maternal stress, depression, and anxiety disorders.

Fetal Alcohol and Drug Exposure

Of interest is that exposure to toxins like alcohol, tobacco, and other drugs in utero, appears to lead to similar neurodevelopmental deficits (e.g., prefrontal cognitive deficits and poor emotional regulation) as the genetic risks listed above. Unfortunately substance abuse by girls has been increasing dramatically since 1992; hence, young women are attracting attention as more enter drug treatment and are mothers. They become addicted more quickly and for different reasons. They appear to be influenced more by pressures to use or by observing the use of substances by friends, peers, and family members.

The economic cost of fetal alcohol syndrome and fetal alcohol effect (FAS and FAE) is very high. Popova et al. estimated that the lifetime economic costs of just one baby born with FAS in 2002 was estimated at $2 million. Chasnoff’s research suggests that the damage to the brain is mostly in the last 3 months when the brain is developing rapidly. Hence, if a pregnant woman stops substance use in the last trimester, much of the brain damage can be prevented. If not, children with FAS generally have significantly reduced general intelligence, executive functioning, language-based memory, and functional communication skills, which can result in more aggression and behavioral disorders. Unfortunately, more than 80% are not diagnosed appropriately when adopted or put into foster care, so they are not getting the services they need.