AT RISK YOUTH: DRUG

ADDICTED PARENTS
Kristin Caroza, Tonya DeDera, Edith Feld,
Davis Legaspi-David, Jared Hansen, Leslie
Ramos, & Sara Silverberg

Breaking Night
Liz Murray grew up in the Bronx with
her older sister and two drug
addicted parents
Her need to care for her parents, lack
of supervision and love of the streets
as a young child superseded her
desire to attend school, eventually
leading to homelessness
While living on the streets it became
clear to Liz that only she was in
control of her own future and needed
to make changes, if she wanted to
survive
While still homeless, Liz obtained her

Retrieved from: http://www.amazon.com/BreakingNight-Forgiveness-Survival-Homeless/dp/1401310591

(Murray, 2010

Effect of Substance Abuse on Children

https://www.youtube.com/watch?v=Kf1zNyKoREA
Video

Definitions
Children of substance abusers are a population without a clear
definition
COA/COSA is any child whose parent (or parental caregiver) uses
alcohol or other drugs in such a way that is causes problems in the
childs life

The parent does not have to still be actively drinking or using for the
child to continue to feel the impact of the abuse.

Alcoholism and other drug addictions have genetic and

environmental causes

Both have serious consequences for children who live in homes where
parents are involved with drugs and/or alcohol

(American Academy of Experts in Traumatic Stre

Statistics
More than 28 million Americans are children of alcoholics

Nearly 11 million Americans are children of alcoholics

More than 8 million children live with at least one parent addicted to
alcohol or drugs (drugrehab.us, n.d.)

14% are younger than 2 years

12% are 6 and 11 years old
10% are between ages 12 and 17 years

(Children of Addicted Parents, n.d; drugrehab.us

Statistics of Homeless Children in Part Due to

Drug Addicted Parents
23,790 : Number of homeless children in Nevada in 2012 2013
11,253 : Number of homeless youth enrolled in Clark County schools in
2014 2015
2,232 : Number of unaccompanied homeless children and youth living on
the streets or in homeless shelters in Southern Nevada on an average day in
2015
4th : State of Nevadas nationwide ranking for the prevalence of
unaccompanied homeless children and youth residing in our state in 2014
1st : State of Nevadas nationwide ranking for the rate of unaccompanied
homeless children and youth living unsheltered on our streets in 2014

(Nevada Partnership for Homeless Youth, 2

Parents Path Towards Addiction

(Generalized)
Background of chronic abusers:
Product of dysfunctional parents who were substance abusers

Felt neglected
Abused: Physically and sexually

Mental illness or genetic disorder

Drug use progression:
Social/Experimental (Use)
Coping or avoiding (Abuse)
Becomes primary need (Dependence)

(Martin, Smith, Rogers, Wallen, & Boisvert,

Parental Substance Abuse and Its

Child abuse and neglect: Between and of all maltreatment
Impact
cases involve some type of substance abuse

Children with addicted parents are 3 times more likely to be abused, and
4 times more likely to be neglected when compared to peers
According to my grandparents, my mom was such a lively, smart,
vivacious and respectable woman. She was generous and would give
the shirt off her back to someone in need. However, as soon as she
would use drugs she would lie, cheat and steal. She would go missing for
weeks at a time (R. M., personal communication, February 15, 2016).

Developmental and mental health issues

More likely to exhibit behavioral problems at home and school and at a

higher risk of developing anxiety or depression

Foster care or other placement

More likely to live in foster care or with caregiver

(Drugrehab.us, n.d

(Brook, Brook, Rubenstone, Zhang, Castro, &

Sociocultural
Role Reversal

Child becomes a young carer

Place adult burdens on childrens shoulders

Role Confusion

Acquired loss of respect of parent due to substance addiction

Forfeit of authority and power shift between child and parent
relationship
Assertive and parental behavior of child
Sneaky behavior of parent
Strong feelings of disgust and hatred toward parent

(Kroll, 2004)

Socioeconomic
Youth from lower SES families are more likely to smoke
Youth from higher SES families are prone to alcohol use, heavy
episodic drinking, and marijuana use
Adults from higher occupational status are associated with more
alcohol and substance use disorders

(Patrick, Wrightman, Schoeni, & Schulenberg

Neglect
Food, clothing, school supplies, and other necessities that a child
needs is disregarded because parents focus on their addiction,
mostly out of fear of withdrawal from their substance abuse
Parents spend money to support their drug habit instead of
financially supporting the childs basic needs
Parents are entangled within their addiction, which consumes their
parenting responsibilities
I was five years old but I remember vividly the times when my mom would be
extremely high. She was also addicted to men who were verbally and physically
abusive. She would get beat and dragged down the hall by her hair. As a five
year old, I couldnt wrap my brain around the fact that this behavior was
substance induced. It was very frightening to live with her (R. M., personal communication,
February 15, 2016).

(Manly, Oshri, Lynch, Herzog, & Wortel,

Emotional and Behavioral

Consequences
Neglected children of substance abuse parents may
experience as a result the following:

Erratic attendance
Repeating a grade
Truancy
Stress from conflicts at home
Suspension

(Manly et al., 2013

Emotional and Behavioral

Consequences
cont.
Hostile home environment are at risk for multiple emotional and
behavioral problems.
Displays angry, antisocial, hyperactive, physically aggressive,
delinquent behavior,and even violent behavior.
Associated with panic attacks, compulsiveness, personality disorder,
dissociation, depression, and dangerous play.

This one time I punched my boyfriend in the head and it made him
cry because he was an abused child too. I have this relationship with
this person that I care about and Im doing the same things my father
did to me. Realizing Im following in my fathers footsteps and thats
something I never what I wanted to do. (Q. N., personal communication, Februrary 12,
2016)
(Hser, Evans, Li, Metchik-Graddis, &

Long-Term Consequences
The concentration of drug addiction, criminal activity, and HIV/AIDS
in urban low-income communities may constitute a stressful
environment for adolescents, and increase their likelihood of
engaging in substance use
Ecological factors, such as drug trafficking, gangs and less
neighborhood cohesion, may impact adolescents through a lack of
community norms against drug use or the absence of informal
social controls
Children growing up with substance abuse parents, include
increased mortality, self-destructive behaviors, which include
suicide or drug addiction

(Brook et al.,

Long-Term Consequences
Adolescents who live in underserved, low-income environments with
high levels of drug use, drug trafficking, and gang activity, are at
increased risk of psychological maladjustment and problem
behaviors, including substance abuse (Brook et al., 2008)
I always told myself I would do better than my parents. It wasnt until
I broke my foot in 2007 that I discover the euphoric effects of vicodin
and I started stealing vicodin from my grandpa. My lower self
confidence in school heightened my use exponentially. It was my way
out! It relieved my stress and made me feel extremely confident. No
longer could I drink just one drink or take just one hit (R. M., personal
communication, February 15, 2016)

Diversity Factors: Non-Discriminatory

Impacts all races, genders, and socioeconomic status
However, in one 10 year study behavioral problems were higher in
Whites (52.76) compared to Blacks (50.05), Hispanic (49.11), and
Asian/other (47.35)
Hispanics demonstrated better family and social outcomes than
Whites, due to more family support during recovery process
A comparative study on White and Black adolescents found that
Whites wanting to be in the in crowd were more susceptible to
negative role modeling than Black individuals
Asian culture putting emphasis on ethnic identity, conformity, and
collectivism discouraged them from deviant behaviors

Gender did not play a significant difference among ethnic groups

(Hser at al., 2013

Lifestyle Choices
Instead, what I was beginning to understand was that however
things unfolded from here on, whatever the next chapter was, my
life could never be the sum of one circumstance. It would be
determined as it had always been, by my willingness to put one foot
in front of the other, moving forward, come what may (p. 191).
Sleeping in a hallway around Bedford Park later that week, I took
out my blank transcripts and filled in the grades I wanted, making
neat little columns of As. If I could picture it If I could take out
these transcripts and look at them then it was almost as if the As
had already happened. Day by day, I was catching up with what
was already real. My future As in my heart, had already occurred.
Now I just had to get them (p. 157).

(Murray,

Population: Common Characteristics

Family life characterized by chaos and unpredictability

Role Reversal
Fear
Blame
Mistrust
Guilt
Shame
Stress
Confusion
Ambivalence
Insecurity
Secrecy and Denial
Conflicts about sexuality
(American Academy of Experts in Traumatic

Occupational Injustice
1.
2.
3.
4.
5.

Occupational
Occupational
Occupational
Occupational
Occupational

apartheid
deprivation
marginalization
alienation
imbalance

(Durocher, Gibson, & Rappolt, 20

Occupational Apartheid
My whole life teachers had acted that way, like they felt sorry
for me. The Westchester-living, string-of-pearls-wearing ladies
that took one look at my life and it always made them sad (p.
246).
Professional adults had credibility and were my standard for
deciding what was legitimate or not, including myself.
Previously, when teachers like Ms. Nedgrin saw me as a victim despite her good intentions - thats what I believed about myself,
too (p. 286).

(Murray,

Occupational Deprivation
Many nights, I longed for a home. But it occurred to me as I
struggled for a feeling of comfort and safety: I have no idea
where home is (p. 145).
Maybe getting more sleep on school nights would have helped.
But I wasn't getting sleep; no one made me. Nearly seven days a
week, I bore witness to the endless traffic streaming through our
apartment. Ma and Daddy flowed in and out of the house like
tireless joggers, all night long (p. 31).

(Murray, 2010

Occupational Marginalization
It scared me that strangers had the power to give or take so
much of what we depended on (p. 33).
Mr. Doumbia had promised to put me in a home if I kept up my
truancy, and now I hadn't been to school in months. I was not
going back into the system. But being on the streets was not
working out either. I would go pack bags for tips again, but child
labor laws had become more strictly enforced over the last few
years (p. 119).

(Murray, 2010

Occupational Alienation
As a child I hate mothers and fathers day! I hated having to answer
the question: Why do you live with your grandparents? I hated
feeling like I was handicapped (R. M., personal communication, February 15, 2016).
I think it only got worse when I came out to my parents that I was
gay and he would try to make it like as bad as possible to do that.
My father would just get drink more often; he would burn me with
cigarettes as if it was a consequence for being who I am (Q. N., personal
communication, February 12, 2016).

Occupational Imbalance
I stayed away from the parties he started up again in the spare
hotel room. All throughout those nights, music blasted from the
part and cabs arrived, unloading person after person (Murray, 2010, p. 135).
I got through my fathers addiction by just being at school
realizing that if I was just a deadbeat, I would be at my fathers
house. I overloaded myself with a full AP class load and got tons of
extracurricular activities so I didnt have to be home. Where like if
I couldnt fix my home situation for me, at least I can control my
school situation (Q. N., personal communication, February 12, 2016).

Occupational Engagement
Academic and cognitive functioning

Lower GPA
Increased grade retention
Failure to pursue secondary education
Weaker performance in reading, spelling, and math during early
and middle childhood compared to peers

Earlier onset of substance use

Peer relationships

(Solis, Shadur, Burns, & Hussong, 2012; Kroll,

Health and Well-Being

Substance abuse interrupts normal development

Higher risk for emotional, physical and mental health problems

(American

Academy of Experts in Traumatic Stress, n.d.)

Higher prevalence of depression, anxiety, eating disorders and

attempted suicide compared to peers (American Academy of Experts in Traumatic Stress,
n.d.)

Increased rates of anxiety, depression, oppositional behavior, conduct

problems, and aggressive behavior (Solis, Shadur, Burns, & Hussong, 2012)
Decreased rates of self-esteem and social competence (Solis, Shadur, Burns, &
Hussong, 2012)

I was born prematurely due to my moms cocaine use during

pregnancy. I was not very verbal and my learning was hindered in
early childhood (R. M., personal communication, February 15, 2016).

Role of the Health Care Practitioner

Listen and ask questions
Provide support and validation for the patients concerns
Help educate patients and their families about substance use
disorders as a disease that affects the entire family
Take an active anticipatory role in guiding patients and families to
available resources
Help connect patients and their families to specialists and
consultants when needed
Use the acronym TEAR

Teach
Express empathy
Advise action
Reach agreement

(Adger, Blondell, Cooney, Finch, Graham, et a

Conspiracy of Silence
Family coping mechanism of silence

Problem is overlooked and/or minimized

Lack of affirmation leads to self doubt

The Hidden Group

Children who dont receive attention of welfare services

Children feel an innate sense of loyalty to their parents
Causes fear for seeking professional intervention

Once you tell an adult they start inspecting your family and theyre
gonna report it. And I felt that I was never safe, like what happens if I
tell an adult and then my father will be taken away from me (Q. N., personal
communication, February 12, 2016).

(Kroll,

Expressive-based Group Intervention

Case Study
Enable self-expression of fantasy and
conflict through play and art-based
activities.
Aim was to provide children with
tools to cope with emotional and
behavioral, and social difficulties
affecting their lives.

Retrieved from
http://link.springer.com/article/10.1023/
A%3A1020768011128#page-1

(Peleg-Oren, 2002

Group Activity
Adapted from: Substance Abuse Awareness Activity: Time of Truth
In this activity youre going to look at the story of Liz Murray from
Breaking Night and how she came to her time of truth.
With your provided cards write down the following:

Write or
Write or
security
Write or
Write or
Write or

symbolize 1 person or relationship that is important to you.

symbolize 1 item or resource that provides you with a sense of
symbolize 1 treasured memory from your past
symbolize 1 value/belief you live by
symbolize 1 part of you body or health you value

(Regional ATTC Products & Resources,

Liz is a five year old girl, living with her father,

mother and older sister. Both parents are
unemployed due to a serious addiction to heroin.
The family is dependent on government
assistance for food and shelter. Liz often
accompanies her father on trips down University
Avenue to scavenge for food and clothing in
garbage cans. Liz lives in an apartment in New
York City that wreaks of month old garbage and
crack cocaine, and wears the same clothing day
in and day out until it physically falls apart.

Retrieved from https://openclipart.org/image/800px/svg_to_png/167093/StopSignnofont.png

Her family is dependent on supplemental

security income (SSI), most of which is used to
obtain drugs. Liz and her sister are forced to
subside on egg and mayonnaise sandwiches
until the food runs out before the end of the
month at which point they resort to eating
toothpaste and chapstick. At a young age, Liz is
often responsible for looking after the house and
ensuring the safety of her parents. Liz often
stays awake late into the morning hours to
ensure her parents return safely from their drug
runs. Subsequently, due to taunting for poor

Retrieved from https://openclipart.org/image/800px/svg_to_png/167093/StopSignnofont.png

At eleven years old, Lizs mother shares some

devastating news. Lizzy, pumpkin, Im sick...Im
sick, I have AIDS. They diagnosed me at the
hospital. Daddy thought it would be better not to
say anything until I got sick They gave me a
blood test. I have AIDS, Lizzy. Liz remembers
someone telling her that anyone who has AIDS
eventually dies. Being around her mother forces
her to be around the disease, around the fact that
she is losing her mother fast, which is too painful
for Liz to handle.

Retrieved from https://openclipart.org/image/800px/svg_to_png/167093/StopSignnofont.png

With her mother sick and her dad in and out of

the picture, she begins to pump gas and bag
groceries for money since her parents would
always spend their minimal income on drugs and
alcohol. At thirteen, Liz is separated from her
family and taken into Child Protective Services
due to excessive truancy from school. Liz endured
abuse and maltreatment from peers and felt
belittled and blamed for her current situation by
administrators. After her unpleasant experience
at the residence, she makes her way out of the
system, drops out of school and takes to the

Retrieved from https://openclipart.org/image/800px/svg_to_png/167093/StopSignnofont.png

Carlos leads Liz and Sam on a tumultuous trek

throughout the city. Occasionally relying on her
friends homes, she often finds herself sleeping in
cheap motel rooms, subway stations, and
stairway landings. For sustenance, Liz begs,
steals and trades items. Although Liz experiences
many ups and downs while on the streets, it is not
until she hears the news about a 16-year-old girl
murdered by her drug dealer boyfriend in the
motel room down the hall from her that she
realizes change will be the only thing that will
save her. The thought of what this would do to
her dad, Lisa, and friends the few people she

Discussion

Retrieved from http://desire.eun.org/image/image_gallery?uuid=9318e060-d83c-4c6e-90c3861b1b66697f&groupId=12834&t=1340093966371

Local Resources
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Addiction Helpline: 1-877-478-5973
National Domestic Violence Hotline: 1-800-799-SAFE
National Domestic Violence Hotline (TDD): 1-800-787-3224
National Youth Crisis Hotline: 1-800-448-4663
NDMDA Depression Hotline Support Group: 1-800-826-3632
Poison Control Any Kind of Substance: 1-800-222-1222

Local Resources Cont.

Big Brothers/Big Sisters of Southern Nevada, Inc. 702-731-2227
Youth mentoring program
Truancy program
Boys & Girls Clubs of Las Vegas 702-367-2582
Mentoring programs
After school, track break and summer recreation programs
Andre Agassi Unit: 702-651-4989
Gang Prevention Through Target Outreach Program (GPTTO)
Street Smart Program

Local Resources Cont.

Lied Memorial Unit 702-368-0317
Education & Career Development
Recreation
Health Education/Life skills Drug/alcohol prevention
Gang prevention
Teen suicide prevention

References
Adger, H. Blondell, R., Cooney, J., Finch, J., Graham, A. (n.d.) Helping children and adolescents in families
affected by substance abuse. Retrieved from http://www.nacoa.org/pdfs/guide%20for%20health.pdf
American Academy of Experts in Traumatic Stress (n.d.) Effects of parental substance abuse on children and
families. Retrieved from http://www.aaets.org/article230.htm
Brook, D. W., Brook, J. S., Rubenstone, E., Zhang, C., Castro, F. G., & Tiburcio, N. (2008). Risk factors for
distress in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers. AIDS care,
20(1), 93-100. doi: 10.1080/09540120701426557
Drugrehab.us. (n.d.). Parental drug addiction and its destructive impact on children. Retrieved from
http://www.drugrehab.us/news//parental-drug-addiction-children/
Durocher, E., Gibson, B. E., & Rappolt, S. (2014). Occupational justice: A conceptual review. Journal of
Occupational Science, 21(4), 418-430. doi: 10.1080/14427591.2013.775692
Hser, Y. I., Evans, E., Li, L., Metchik-Gaddis, A., & Messina, N. (2013). Children of treated substance-aabusing
mothers: A 10-year prospective study. Clinical Child Psychology and Psychiatry, 19(2), 217-232 16p.
doi:10.1177/1359104513486999

References Cont.
Holland Christian Psych. (2013, December 1). Substance Abuse Effects on Children. [Video File].
Kroll, B. (2004). Living with an elephant: growing up with parental substance misuse. Child & Family
Social Work, 9(2), 129-140. doi: 10.1111/j.1365-2206.2004.00325.x
Manly, J. T., Oshri, A., Lynch, M., Herzog, M., & Wortel, S. (2013). Child neglect and the development of
externalizing behavior problems associations with maternal drug dependence and neighborhood
crime. Child Maltreatment,18(1), 17-29. doi: 10.1177/1077559512464119
Martin, L. M., Smith, M., Rogers, J., Wallen, T., & Boisvert, R. (2011). Mothers in recovery: An
occupational perspective. Occupational Therapy International, 18(3), 152-161 10p.
doi:10.1002/oti.318
Murray, L. (2010). Breaking Night. New York, NY: Hyperion
Nevada Partnership for Homeless Youth. (2015). Problem with youth homelessness. Retrieved from
http://www.nphy.org/whatwe-do/problem-of-youth-homelessness/
Peleg-Oren, N. (2002). Group intervention for children of drug-addicted parents--using expressive
techniques. Clinical Social Work Journal, 30(4), 403-418. doi: 10.1023/A:1020768011128

References Cont.
Patrick, M. E., Wightman, P., Schoeni, R. F., & Schulenberg, J. E. (2012). Socioeconomic status and substance
use among young adults: a comparison across constructs and drugs. Journal of Studies on Alcohol and
Drugs, 73(5), 772-782. doi: http://dx.doi.org/10.15288/jsad.2012.73.772
Regional ATTC Products & Resources. (n.d.). Substance abuse awareness activity: Time of truth. Retrieved
from http://www.attcnetwork.org/regcenters/productdetails.asp?prodID=543&rcID=5
Solis, J. M., Shadur, J. M., Burns, A. R., & Hussong, A. M. (2012). Understanding the diverse needs of children
whose parents abuse substances. Current drug abuse reviews, 5(2), 135. doi:
10.2174/1874473711205020135