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young child superseded her desire to attend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 high
school diploma, won a New York Times
scholarship and was accepted, and
graduated, from Harvard University

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

(Murray, 2010)

Effect of Substance Abuse on Children Video

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

Definitions
Children of substance abusers are a population without a clear definition
Children of Addicts/Children of Substance Abusers 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 Stress, n.d.)

Statistics
More than 28 million Americans are children of alcoholics
More than 8 million children live with at least one parent addicted to alcohol or
drugs

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; Drug Rehab, n.d.)

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

Youth aged 12 17 are at higher risk for homelessness than adults nation-wide
(Nevada Partnership for Homeless Youth, 2015)

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, 2011)

Parental Substance Abuse and Its Impact

Child abuse and neglect: Between and of all maltreatment 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

Increased likelihood of being next generation substance abusers
(Drug Rehab, n.d.)

(Brook, Brook, Rubenstone, Zhang, Castro, & Tiburico, 2008)

Sociocultural
Role Reversal

Child becomes a young carer

Place adult burdens on childrens shoulders

Role Confusion

Forfeit of authority and power shift between child and parent relationship
Acquired loss of respect of parent due to substance addiction
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, 2012)

Neglect and Abuse

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, 2013)

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 increases risk for multiple emotional and behavioral
problems

Displays anger, antisocial, hyperactive, physical aggression, and delinquent 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 wanted to do (Q. N., personal communication,
Februrary 12, 2016).

(Hser, Evans, Li, Metchik-Graddis, & Messina, 2013)

Long-Term Consequences
The concentration of drug addiction, criminal activity, and HIV/AIDS in urban lowincome 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., 2008)

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 discovered 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 with Caucasians
(52.76) compared to African Americans (50.05), Hispanics (49.11), and
Asians/other (47.35)
Hispanics demonstrated better family and social outcomes than Caucasians, due
to more family support during recovery process
A comparative study on Caucasian and African American adolescents found that
Caucasians wanting to be in the in crowd were more susceptible to negative role
modeling than African Americans
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, 2010)

Population: Common Characteristics

Values
Loyalty
Security
Predictability
Comfort
Beliefs
Guilt
Shame
Blame
Mistrust
Fear

Customary Practices
Family life characterized
by chaos and
unpredictability
Role Reversal
Secrecy and Denial
Stress
Confusion
Ambivalence

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

Occupational apartheid
Occupational deprivation
Occupational marginalization
Occupational alienation
Occupational imbalance

(Durocher, Gibson, & Rappolt, 2013)

Occupational Apartheid
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 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).
A couple nights later when our stomachs finally ached from hunger, and it
became too awkward to knock on 1A and ask for leftovers again, Lisa and I
split a tube of toothpaste and a Cherry-flavored ChapStick when we got
hungry (p. 51).

(Murray, 2010)

Occupational Marginalization
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, 2010)

Occupational Alienation
As a child, I hated 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 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 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, 2004)

Health and Well-Being

Substance abuse interrupts normal development

Higher risk for emotional, physical and mental health problems

Higher prevalence of depression, anxiety, eating disorders and attempted suicide
compared to peers
Increased rates of anxiety, depression, oppositional behavior, conduct problems, and
aggressive behavior
Decreased rates of self-esteem and social competence

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).

Substance abuse impacts attachment, family dynamics, relationships and

functioning, and increases risk of violence
(American Academy of Experts in Traumatic Stress, n.d.; Kroll, 2004; Solis, Shadur, Burns, & Hussong, 2012)

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 al., n.d.)

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, 2004)

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%3A
1020768011128#page-1

(Peleg-Oren, 2002)

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
Drug Rehab. (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), 129140. 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

Group Activity
Adapted from: Substance Abuse Awareness Activity: Time of Truth

In this activity, we are going to look at the story of Liz Murray from Breaking Night.
We are asking that you put yourself in the position of a child living with a
substance abusive parent.
With your provided cards write down the following:

Write or symbolize 1 person or relationship that is important to you.

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

(Regional ATTC Products & Resources, n.d.)

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/StopSign-nofont.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 hygiene by
classmates and exhaustion, Liz often misses school.

Retrieved from https://openclipart.org/image/800px/svg_to_png/167093/StopSign-nofont.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/StopSign-nofont.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
streets of New York City with her best friend, Sam and older
drug-dealing boyfriend, Carlos.

Retrieved from https://openclipart.org/image/800px/svg_to_png/167093/StopSign-nofont.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 loves, is the reality check she has
feared, but needs in order to take a different path in life.

Discussion

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