Hi XXXXXXX

Preventive strategies for childrenare indeed a key aspect of the systems approach, when a parent starts treatment for alcohol dependence. Like I had mentioned earlier, there can be various factors like “modelling” or other dysfunctional family dynamics which may put the children of alcoholic parents at risk of developing substance abuse problems in the future.

The number of children at risk that we are talking about is astounding. There are 18 million alcoholics in the U.S. according to the National Council on Alcoholism and Drug Dependence (2005). As a result, an estimated 26.8 million children are exposed, at varying degrees, to alcoholism in the immediate or extended family. These children are more likely to marry an alcoholic as well, thereby leading to the formation of a truly vicious cycle of addiction involving many generations.

So, a significant proportion of time and effort in therapy has to be spent with these children. Identifying these dysfunctional family dynamics and breaking the vicious cycle will not only prevent children from developing addictive behaviours, but will also prevent many generations to come, from this problem of addiction.

The treatment approach will involve the following principles:

1)     Identify parental risk factors, family situations and dysfunctional family dynamics early on so that appropriate preventive interventions for children can be planned accordingly.

2)     Aim to engage the children in therapy as early as possible and keep them actively involved in therapy (Therapists often tend to underestimate the early negative impact of an alcoholic parent or tend to keep this agenda towards the end of therapy).

3)     In younger children, interventions should also be targeted at minimizing the developmental impact of an alcoholic father and creating a therapeutic environment where the child is able to feel safe, secure and supported.

4)     In older children, a psycho-educative and supportive approach should be the crux of therapy involving children. They should be empowered and encouraged to freely seek help whenever necessary.

5)     Promptly identifying safety risks (like physical abuse, sexual abuse) and intervening accordingly is also an important priority.

6)     Identifying and strengthening protective factors in the family help in minimizing the risk of psychological problems as well as the risk of addiction.

7)     Rebuilding self-esteem and re-learning to communicate and trust and love should be the ultimate focus of a systems approach involving children of alcoholics.

Firstly, it is important to be aware of and correctly identify what potential parental factors may be putting the children of an alcoholic father at risk of becoming addicted. Only then, appropriate strategies can be planned. Some of the well-known contributing factors for developing addictive behaviours in children are:

-     The developmental impact of parental addiction on children’s attachment and identity formation – leading to development of emotional insecurity, identity diffusion and anti-social traits (in turn leading to addiction). Research shows that earlier the age children are exposed to living with an alcoholic parent, greater are the risks of them developing alcohol problems in the future.

-     Disorderly family structure leading to improper parenting. For example, poor limit setting limit setting, poor inculcation of moral and ethical values, family schisms - such as too much of a punitive approach or too much of an overindulgent approach by one parent (usually the non-alcoholic parent).

-     Family violence, child abuse and neglect.

-     The psychological trauma inflicted by an alcoholic father, leading to depression, anxiety and a variety of stress-related disorders.

-     Social isolation, shame, stigmatization, etc. – all of which lead to poor social functioning and lack of social support (in turn leading to addiction).


The second important step which I have mentioned is to engage children early in therapy. This is probably the most difficult step in therapy - for the child to openly identify the problem and begin to talk about his or her sadness and anger. Out of love or fear, most children try to keep family problems a secret. Because addiction in the family is embarrassing, children are taught by word and example not to talk about it. Therefore one of the tasks of the therapist is to encourage discussion. Children with drinking parents often hide behind a wall of denial, defensiveness and guilt. So a therapeutic environment should be created so that the child is able to feel safe and supported enough to come out with his / her problems and needs.


Treatment approaches will vary slightly between young children and adult children.

In younger children, the aim would be to minimize the negative developmental impact of living with an alcoholic father. Providing a corrective environment through family-based approaches, strengthening attachment and emotional support with the other non-alcoholic parent or relatives can help a great deal in preventing emotional difficulties and psychological problems. A corrective and therapeutic environment means clear rules, consistency and predictability, and a place where children can learn about alcoholism and its effects on all the family. Since young children believe their thoughts and feelings are all-powerful, they imagine that they cause bad things. They may even assume their parents drink because of them. Such guilt feelings should be promptly identified and addressed. In very young children, experiential learning involving drawing, play and games can help establish a good communication and therapeutic relationship.

In older children the approach is predominantly psycho-educative. Research has shown that children of alcoholics who are educated about their risk factors drink significantly less than children of alcoholics unaware of their risk status. Teaching coping skills and encouraging positive social relationships can prevent social isolation, guilt, stress and depression (all of which can put the child at risk for addiction).


Another important focus of family-based interventions is the assessment is physical safety. Is the child in danger? Is there evidence of physical or sexual abuse? If yes, then the therapist must follow intervention guidelines for providing immediate interruption of the XXXXXXX situation and ensuring safety for the child. This intervention may involve notifying CPS, the police, or altering living arrangements temporarily or long term.
(Note: This is an important area which many therapists tend to ignore inadvertently, assuming that it is not part of therapy. But no doubt, this is an integral part of therapist’s duty.)


Finally, the therapist should aim to identify all possible protective factors available in the family system, so that these can be utilised to the fullest potential. Re-establishing the broken family structure and correcting the faulty dynamics will ultimately help build back communication, trust and love between the child and the parent.

It is very important that therapists should be sensitive and pro-active about the special problems and needs of children of alcoholics and consider them as an integral part of therapy.


Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

---