ERIC ED335623: Young Children of Substance Abusers. Prevention Research Update No. 8.

76 Pages·1991·2.8 MB·English

by  ERIC

DOCUMENT RESUME
CG 023 616
ED 335 623
Austin, Gregory; Prendergast, Michael
AUTHOR
Young Children of Substance Abusers. Prevention
TITLE
Research Update No. 8.
Western Center for Drug-Free Schools and
INSTITUTION
Communities.
Department of Education, Washington, DC.
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*Adolescents; Alcoholism; *At Risk Persons; Children;
DESCRIPTORS
Drug Abuse; Elementary Secondary Education; Parent
Child Relationship; School Role; *Substance Abuse
*Children of Alcoholics; *Children of Substance
IDENTIFIERS
Abusers
ABSTRACT
The stated objectives of this document are: to
increase awareness of and clarify the risks facing children of
substance abusers (COSAs) through a review of recent empirical
research literature; and to examine the prevention and intervention
issues involved in providing services to these youth in the schools.
The literature review deals mainly with children of alcoholics
because of the longer history and greater prevalence of alcoholism in
this country and the relative lack of research on children of other
drug abusers. The similarities and differences between children
affected by parents who use different drugs are clarified as much as
possible, particularly as much less is known about the effects of
their illicit drug use. The focus is specifically on adolescents.
(COAs),
Terminology issues centering on COSAs, Children of Alcoholics
and Children of Other Drug Abusers (CODAs) are discussed. Specific
topics discussed include: (1) prevalence; (2) characteristics and
problems of COAs and CODAs; and (3) prevention and intervention,
including id3ntification and assessment, labeling, program goals and
techniques, parental involvement, and program evaluations.
Twenty-seven abstracts of research studies involving COSAs are
included. An extensive list of references is included, as well as a
selected list of some of the main sources on services for children of
substance abusers. (ABL)
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Reproductions supplied by EDRS are the best that can be made
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from the original document.
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OERI position or policy
Update
Prevention Research
No. 8
Winter 1991
SUBSTANCE ABUSERS
YOUNG CHILDREN OF
Northwest Regional Educational Laboratory
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Educational Laboratory
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2
REST CoPY AVAILABLE
Prevention Reset-vet Update
Gregory A. Austin, Eilitor
Southwest Regional Laboratory
Communities
Drug-Free Schools and
Western Center for
Judith A. Johnson, Director
Northwest Regional Educational Laboratory
101 SW Main Strett, Suite 500
Portland, OR 97204
[phone]
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Southwest Regional Laboratory
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© 1991 NWREL, Portland, Oregon
that the Western
is granted with the stipulation
Permission to reproduce in whole or in part
Educational
Communities, Northwest Regional
Regional Center for Drug-Free Sciaools and
all copies.
Laboratory, be acknowledged as the source on
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developed under Cooperative
The contents of this publication were
necessarily
Eclucation. However, the contents do not
S188A00001 with the U.S. Department of
of the contents by the
Department of Education, and endorsement
represent the policy of the
federal government should not be assumed.
Plow Gannon 12(1)Yth VpcIe2t;i
no. 8 / Winter 1991
YOUNG CHILDREN OF SUBSTANCE ABUSERS
Gregory Austin, Ph.D.
Michael Prendergast, Ph.D.
Western Center for Dmg-Free Schools and Communities
Southwest Regional Laboratory
4
Prevention Research Update is a quarterly current awareness service, pre-
pared by the Western Center for Drug-Free Schools and Communities,
which summarizes recent research on adolescent drug abuse and its preven-
tion. Each issue abstracts and reviews the prevention implications of new
research dealing with a major topic of concern in the field, placing the new
information in the context of past findings. The goal is tu help bridge the
communications gap between the researcher, the practitioner, and the gen-
eral population, by disseminating research fmdings in an accessible manner
and providing an introductory review of their significance. Abstracts are
arranged alphabetically by first author's last name. Preceding the abstracts
is an overview discussion in which references to abstracted studies are
identified by an asterisk (*). References to all documents cited are located
following the abstracts. Copies of the Updates are available from all the
Western Center sites, listed on the last page of this issue.
CONTENTS
OVERVIEW
1
Introduction
1
Terminulogy Issues
2
Methodology Issues
3
4
Prevalence
4
Alcohol
Other Drugs
5
Conclusion
5
Characteristics and Problems
6
Children of Alcoholics and Alcohol Abusers
6
Risk of AOD Use and Abuse
8
Health Effects
8
The Alcoholic Family
9
Psychosocial and Psychiatric Problems
11
Resiliency Factors
14
Conclusion
16
Children of Other Drug Abusers
17
The Drug-Abming Family
17
Risk of Drug Abuse
18
Psychosocial Problems
19
Health Problems
19
Conclusion
.21
Prevention and Intervention
'?,1
22
Identification and Assessment
Labeling
23
Goals, Strategies, and Techniques
24
Regular Classroom Techniques
24
.
Generic AOD Education Programs
24
COSA Programs
24
.
Student Assistance Programs
25
Programs for Drug-Exposed Children
26
Parental Involvement
26
Programs Evaluations
28
CASPAR
28
SMAAP
28
Conclusion
29
Issues in Research and Practice
29
Conclusions
31
ABSTRACTS
33
REFERENCES
51
Author Addresses
66
Organizations, Programs, and Resource Materials
68
OVERVIEW
gle, homeless male--the skid-row drunkard--
INTRODUCTION
cut off from all ties to the family. Margaret
One of the most discussed special
Cork's 1969 book, The Forgotten Child,
populations at risk of alcohol and other drug
heralded a new awareness that the most com-
mon environmental setting in which to find an
(AOD) abuse and related problems is children
alcoholic is "a stnicturally intact, and by and
of substance abusers (COSAs); that is, people
completely functioning, family"
large
who are raised by parents addicted to or heavy
abusers of alcohol and other drugs.
This
(Steinglass 1987:21). The problems faced by
population has long been characterized as at the children of alcoholics (COAs) were dis-
exceptionally high risk of becoming AOD
cussed in terms of a neglected, hidden tragedy
involving numerous unseen casualties.
abusers themselves as well as of developing a
In
wide range of social, behavioral, and
1974, the National Council on Alcoholism
emotional problems stemming from the
created a Department of Prevention and Educa-
dysfunctional family life that results from
tion, which decided to focus on COAs as the
parental AOD abuse. Much of this discussion
population most at risk of becoming al-oholics
themselves, and in the same year the National
has focused around adult children of alcoholics
In this Update we focus on the
Institute on Alcohol Abuse and Alcoholism
(COAs).
contracted for a study on the needs and re-
current state of knowledge about school-age
children of both alcoholics and other drug
sources for COAs (O'Gorman 1982:37-38).
As in the 19th-century temperance tracts,
abusers.1
concerns were not limited to the risk COAs
Concerns over the effects of parental AOD
faced of becoming alcoholics themselves. By
abuse on children run throughout history. In
the late 1970s, clinicians began describing
the West, these concerns have focused on al-
clients who did not have alcoholism problems
cohol, the drug of choice. In particular, the
spread of gin consumption among poor
themselves but who came from alcoholic fami-
women in 18th-century London sparked
lies and seemed to be manifesting a particular
set of other adverse characteristics (e.g., low
(Austin et al. 1985).
widespread concern
self-esteem, inability to achieve intimacy). Al-
Temperance tracts beginning in the 1830s de-
coholism came to be recognized as a "family
scribed the many negative effects of male
disease" on the premise "that the sharing of the
drunkenness on families, emphasizing that it
dysfunctional behavior of the alcoholic by the
led to subsequent alcohol problems in children
other family members through the adoption of
and even hereditary degeneration, as well as to
individual dysfunctional behaviors is like
numerous economic and social hardships and
sharing the disease of alcoholism" (NIAAA
other detrimental impacts on family life. The
1985:4).
child as victim was an especially strong theme
Responding to, and in many ways fueling,
within the Woman's Christian Temperance
these changing perceptions, a vigorous grass-
Union.
roots movement with evangelical overtones
Such concerns subsided in the aftermath of
emerged encompassing clinicians and coun-
Prohibition, when alcoholism was primarily
selors, 12-step programs, national organiza-
viewed as an individual problem of a small
tions, and popular media (Williams 1990:210-
segment of the population. Indeed, the pri-
211; Seilhamer and Jacob 1990:168). This
mary image of the alcoholic was that of a sin-
movement has sought to address the concerns
of COAs and improve public understanding of
1We are grateful for the comments and criticism of this
their problems. Formal advocacy organiza-
review provided by Margret Dugan, of the National
tions have been created (notably the Children
Association for Children of Alcoholics; Michael
of Alcoholics Foundation, founded in 1982,
Fitzgerald, drug education consultant in the Nevada
and the National Association for Children of
Department of Education; Jeannette Johnson of the
Alcoholics, founded in 1983), and a cottage
University of Baltimore, Maryland; and Richard Yoast,
industry has evolved for the counseling and
of the Wisconsin Clearinghouse. In addition, we would
treatment of COAs.
like to acknowledge the ar3istance provided by Ann
Furthermore, as a result of the normaliza-
Bickel, Karen Fie land, and Melinda Jones of the
tion of illicit drug use over the same period,
Western Regional Center for Drug-Free Schools and
Communities.
awareness of the problems of children whose
Prevention Research Update 8
supports the characteristics of COSAs as
parents are dependent on other drugs has also
grown. The rise of cocaine and crack addic-
described in the clinical literature.
tion among women has produced a sense of
It will be shown that youthful COSAs are a
urgency over the need to develop programs to
population at high risk of substance abuse and
deal with a new generation of youth adversely
other problems and that prevention and inter-
affected by maternal drug use during preg-
vention efforts in both schools and communi-
ties need to be expanded to address their
nancy.
needs. However, many of the assumptions
Despite these efforts, considerable uncer-
tainty surrounds the scope and nature of the
and assertions made in the clinical and popular
literature about the scope and nature of this
problem as well as the most effective means to
deal with h. The public remains only vaguely
problem, much of it based on observations of
aware of the risks faced by COSAs. This
adult patients, is not supported by existing
research dealing with youth. Although much
Update aim:, first, to increase awareness of,
of the popular and clinical literature describes
and clarify, the risks facing COSAs through a
COSAs, and particularly COAs, as
review of recent empirical research literature
a
population almost universally at risk of a
and, second, to examine the prevention and
clearly defined syndrome, the research
intervention issues involved in providing
suggests considerable variability.
services to these youth in the schools.2 This
Before pmceeding to the review of the re-
review deals mainly with children of alcoholics
search itself, two general issues need to be dis-
because of the longer history and greater
cussed: the confusion surrounding terminol-
prevalence of alcoholism in this country and
ogy and the limitations of the research.
the relative lack of research on children of
other drug abusers. At the same time, we have
Terminology Issues
sought to clarify as much as possible the
similarities and differences between children
The substance abuse field is plagued by
affected by parents who use different drugs,
many definitional problems, and this is particu-
particularly as much less is known about the
larly the case in regard to COAs (children of
affects of their illicit drug use. Whereas much
alcoholics) and COSAs (children of substance
of the literature deals with adult COAs or the
population as a whole, we are specifically
abusers). There is a pronounced lack of claity
in the use of these term that needs to be ad-
concerned with adolescents.
dressed. Although COSA is the most com-
The focus is also on research rather than on
monly used term to refer to the "illicit drug"
the large and growing body of clinically based
equivalent of COA, conceptually the terms are
COA literature directed at practidoners and the
not equivalent since an alcoholic is not the
general public. The concepts and techniques
of this literature are essential to anyone
same as a substance abuser, who may or may
not be drug dependent.
Furthermore,
providing help to COSAs. Attention should
"substance abuse" is a generic term that refers
especially be directed to the early books on
to alcohol as well as other drugs.
children of alcoholics that have influenced all
(e.g., Black 1981;
subsequent writers
A more appropriate equivalent to COA
would be "children of drug addicts" or
Wegscheider 1981; Ackerman 1983; Woititz
1983). But there are numerous practitioner
"children of drug dependent parents." There
handbooks and self-help guides, whereas
are several problems with the use of the latter
findings from the research literature are less
terms, however. The defining characteristic of
a COA or a COSA is not always parental de-
familiar. We are concerned, however, with the
In common usage, COA and
connection between research and practice;
pendency.
specifically, the extent to 'which research
COSA do not just refer to children of parents
who are clinically defined as alcoholics or ad-
In fact, many of the estimates of the
dicts.
2Although the literaturt
on this subject spans the
prevalence of COAs are based on respondent
period from the 1960s to the present, the discussion
perreptions that alcohol use was a problem
emphasizes studies that have appeared since 1985. For
within a family.
For example, to identify
reviews of the earlier literature, see el-Guebaly and
Offord 1977, 1979; Giglio and Kaufman 1990; Jacob,
COAs DiCicco, Davis, and Orenstein (1984)
Favorini, et al. 1978; Watters and Theimer 1978; West
argue that drinking behavior that results in a
and Prinz 1987; Woilitz 1978; Woodside 1983, 1988,
child wishing that his or her parent would
1988a).
drink less should be considered "alcoholic,"
2
Young Children of Substance Abusers
and analyses that avoid many of them. These
even though this might not conform to a strict
methodological problems will be discussed
clinical defutition of alcoholism.
further in the text as relevant, but they include
In addition, the concerns about these chil-
dren are not simply rooted in their risk of al-
the following:3
coholism or addiction per se, but more broadly
Use of unrepresentative samples. Most re-
on the adverse effects that the child experiences
search has been conducted on children
as a result of the parent's excessive AOD abuse
whose parents are in treatment and who am
and on the accompanying chaotic and stressful
family life. From the perspective of school
therefore likely to be from families that are
prevention and intervention efforts, whether a
more dysfunctional than those in which the
parents are not in treatment, thereby ren-
parent meets the clinical criteria of alcoholism
dering the results unrepresentative of the
or addiction may be less important than that the
child exhibits problems related to parental
general population of COSAs. Also, many
alcohol abuse, or feels troubled by it, to the
adolescent samples are unrepresentative of
the general youth population (e.g., delin-
extent that his or her development is impaired.
quents) or combine children of different
In this context, it is important to remember that
any parental AOD use does not in iteself
developmental stages.
Study samples that are confined to sons
warrant classification of a child as a COSA.
and fathers or to parents and children.
Thus, for purposes of this Update, COA
Relatively little research is available on
should be understood to mean "children of al-
mothers or daughters.
coholics and alcohol abusers," although spe-
Failure to control for confounding vari-
cific studies of this population are confined to
ables, such as psychiatric diagnoses in par-
Similarly,
clinically diagnosed alcoholics.
ents other than alcoholism (e.g., antisocial
COSA is used to refer to any child who experi-
personality disorder, schizophrenia) and
ences a dysfunctional family and personal life
drinking or drug use by the mother during
il-
as the result of parental abuse of any licit or
pregnancy. Thus, problems among chil-
licit drug. The acronym CODA is used to refer
dren attributed to parental alcoholism may
specifically to "children of other drug
actually be rooted in other parental disor-
abusers."
ders.
Distinguishing between children of sub-
Failure to control for substance use vari-
stance abusers, alcohol abusers, and other
ables (e.g., duration of use, severity of de-
drug abusers is conceptually important. On the
pendence) and for demographic and family
one hand, there are many similarities in the
variables.
experiences and problems faced by all children
Interviewing or other data collection that is
of substance abusers, as well as in the
not blind to the status of the subjects.
prevention and intervention strategies recom-
Use of correlational rather than longitudinal
Furthermore, with the
mended for them.
designs, making it difficult to determine
spread of multiple drug use, the number of
causal or developmental factors.
Alcoholics are often
COSAs is increasing.
Inconsistent or imprecise definitions and
abusers of other substances, although alcohol
measures of alcoholism, drug dependence,
is probably the drug that is most visible in the
and ether variables.
family. On the other hand, children of parents
Failure to consider the clinical significance
who are predcminantly other drug abusers face
of differences found between groups in re-
problems stemming from the illegality of their
search studies, so that the practical implica-
parents' drug use that are not faced by children
tions of the research are unexplored.
of alcoholics. Becwise of these differences, as
Reliance on a single source or instniment,
well as the lop-sided nature of the literature,
raising questions about the validity of the
we will discuss children of alcoholics and chil-
assessment or diagnosis.
dren of other drug abusers separately.
3This summary of the limits of COSA research was
Methodology Issues
drawn from Drake and Vaillant 1988; el-Guebaly and
Offord 1977, 1979; Jacob 1987; Jacob and Leonard
Assessing the scope and nature of the
1986; Kumpfer and DeMarsh 1986; Roosa, Sandler, et
COSA population is made difficult by several
al. 1988; Tarter, Jazob, and Bremer 1989; and West and
limitations in the research itself, although mom
Prinz 1987.
recent studies have managed to use designs
3
9
Prevention Research Update 8
Strictly speaking, therefore, the 28-
Use of control groups that are not compa-
scores.
million figure refers to children of problem
rable to the treatment group.
drinkers rather than to children of alcoholics.
Also, the figure may be an underestimate
These limitations make it difficult to gen-
because the 1979 survey did not include people
eralize the results of a particular study to the
who were in the military or in institutions or
entire population of COSAs, to infer causal
who were homeless (Woodside 1988:643;
pathways between parental AOD abuse and
Kumpfer and De Marsh 1986:50).
problems in offspring, or to determine whether
Only a few surveys have attempted to de-
problems observed among COSAs are unique
termine more precisely the number of COAs in
to them or whether they are typical of children
the youth population, and these have tended to
from families that are generally dysfunctional
be based on small samples. Some have re-
(Burk and Sher 1988:287; see especially West
ported rates close to the 10% estimate given
and Prinz 1987 for recommended methodolog-
In a survey of 18-year-olds from
above.
ical improvements in COA research). As fu-
Kauai, Werner (1986*) was able to identify
ture research addresses these methodological
7% of them as children from alcoholic fami-
limitations, the validity and generalizability of
our knowledge of children of substance
lies. A survey of 1,300 adolescents (ages 12-
21) in New Jersey found that 10.6% had at
abusers will improve. In the meantime, these
least one alcoholic parent and 9% had a grand-
limitations need to be kept in mind while read-
parent who was alcoholic (Pandina and John-
ing this review.
son 1989*).
Other studies, using more liberal criteria,
have found higher prevalence rates.
Re-
PREVALENCE
searchers at Arizona State University asked a
sample of high school students to complete the
In terms of numbers a people affected, we
Children of Alcoholics Screening Test
know much more about children from alco-
(CAST); 18% of the students met the COA
holic homes than from homes in which other
criterion. Since the CAST measures concern
drugs are abused. The exact number of either
about parental thinking, not whether the parent
population is uncertain, however, in large part
meets clinical criteria for alcoholism, the stu-
because of the methodological difficulties in
dents are more properly labelled "self-identi-
identifying this population, including the
fied children of alcoholics," which may ac-
tendency of children from alcoholic or drug-
count for the high percentage (Rcosa, Sandler,
dependent families to deny their status and lack
of clarity and consistency in how the
et al. 1988*). Similarly, in Lillis' (1987) sur-
vey in New York, 17% of respondents stated
population is defined.
that one or both parents were alcoholic.
An even higher estimate of from 27% to
Alcohol
30% was found by the CASPAR Alcohol Edu-
cation program in Somerville, Massachusetts
Estimates of the number of COAs vary
(DiCicco, Davis, and Orenstein 1984:5).
greatly, and figures are often cited without
These estimates were based on the number of
providing any evidence as to their source. For
saidents in junior and senior high schools who
example, on the high end, Allen (1983:165)
mponded "yes" when asked, "Have you ever
simply states as fact that COAs comprise ap-
wishel that either one or both of your parents
proximately 25% of the school population.
would drink less?" The authors argue that
The generally accepted estimate of the number
drinking behavior that results in a child wish-
of COAs in the United States is 12.5% of the
ing that his or her parent would drink less
general population (28.6 million) and 10% of
should be considered "alcoholic." However, a
the under 18 population (6.6 million) (Russell,
such perceptions are also influenced by what
Henderson, and Blume 1985:1-2). This esti-
The high
youths are taught in school.
mate was derived by the Children of Alco-
percentage may also be related to the high rate
holics Foundation in the early 1980s on the
of alcoholism in Somerville (its cirrhosis mor-
basis of data from the 1979 National Drinking
tality rate is 65% above the national average).
Practices Survey (Clark and Midanik 1982), in
In the absence of more reliable data, the
which 15% of men and 6% of women were
figure of 10% for preadolescents and adoles-
classified as problem drinkers on the basis of
cents proposed by Russell, Henderson, and
loss-of-control and alcohol-dependency
4
I 0