Preschoolers and Substance Abuse

Strategies for Prevention and Intervention

Bruce Carruth, Pedro J Lecca, Thomas D Watts

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317823001
• Topic: Psychologie
• Subtopic: Addiction en psychologie

Find remarkable prevention and treatment strategies for preschool-age children of substance abusers in this informative volume. It provides an overview of the various problems exposure to substance abuse can cause for preschool children. Because of the strong influences parents have on their children, early childhood is a critical time for intervention to counteract the damaging effects of alcohol and drug abusing parents. Research shows that attitudes about alcohol and other drugs are already formed by junior high school level, and senior high school is too late for significant attitude change. Preschoolers and Substance Abuse promotes preschool age as the ideal time to apply strategies that will aid the family in building the self-esteem, trust, autonomy, and initiative necessary to protect the child from further problems caused by addictive parents. Intervention strategies are presented in a succinct manner, making them easy for practitioners, health officials, government officials, and family members to put into immediate practice.This book offers a unique approach to substance abuse, treating it as a community and societal problem rather than an individual problem. Intervention and treatment strategies are geared toward the substance abuse problem itself as well as how it impacts children and family systems. The harmful impact of alcohol or drug abusive parents is evaluated for all stages of childhood development, from pre-natal influences through infancy and the preschool years. Some of the harmful results of alcohol and drug abuse affecting preschool children addressed in this volume include violence, sexual abuse, Fetal Alcohol Syndrome, and intra-uterine exposure to drugs. The authors outline a comprehensive list of imperatives for a future agenda to protect preschool children from suffering the consequences of their parents'substance abuse. Public health officials, decision makers, practitioners, and legislators will find a series of policy recommendations including increased research, substance abuse training for child care workers, increased outreach and education for expectant mothers, and community-based outreach programs to insure ethnic or socioeconomic sensitivity and appropriateness.

Chapter I
Introduction

This issue is not easy to research or write about. While there is growing research on children of alcoholics and on substance abusers in general, little research exists on substance abuse among families of preschool children. Preschool children are uniquely dependent in almost every respect on their parents. If one or both parents is a substance abuser, then the problem is immense for all concerned. It is possible that teen-age sons or daughters of substance abusing parents could manage to cope in some way, even to move to the home of a relative or friend. Preschool children, on the other hand, are totally dependent on their parents. We do not see many runaway preschoolers, but we do see many runaway teens. To "run away" is a fiercely independent action. Preschool children are not old enough to cope with even thinking about such exigencies. They are rooted in one place, their parents' home, and dependent on them for emotional nurturance, physical support—support of all kinds.

Our discussion of prevention and intervention strategies includes no magic elixirs, nor do the studies that we examined contain instant solutions. Indeed, "even the best of studies have limitations that confound interpretation of the results" (Battjes and Bell, 1985). The complexity of the problem dwarfs the efforts of researchers and writers attempting to make sense of it. Hence, we have no pretensions that solutions will be easily seen or implemented. Substance abuse is so deeply interwoven into U.S. and other societies, that long-term solutions will be difficult, badly needed — but at the same time attainable.

Several years ago six babies in Washington, DC, were abandoned after being born to mothers addicted to crack, a particularly dangerous form of cocaine. Hospital officials say boarder babies such as these at Howard University Hospital are taking up space that could be used for treating older children. While the material cost for dealing with these children is high, from $750 to $1,768 a day (Fort Worth Star Telegram, July 2, 1989), the physical and psychological price is immeasurable.

Statistics gathered by the House Select Committee on Children, Youth, and Families suggest that 375,000 newborns a year may be harmed by drug exposure and that last year 11 percent of pregnant women used drugs (Fort Worth Star Telegram, July 2, 1989). Although hospital officials say the number of boarder babies is growing, the problem is so recent that nationwide statistics are not available. There is not even a standard definition for boarder babies.

Poverty and deprivation are not the only contributing factors in substance abuse, but they are nevertheless seminal factors that too often have been ignored. Many low-income people seek a "way out" of their situation. Substance abuse often is this way out. Unfortunately, services to low-income substance abusers are sparse, and the ones that are present are sometimes inadequate. With no national health program in place, many low-income substance abusers are left out of the picture. Particularly affected are many of the "working poor," who are ineligible for many health (and other) programs.

The United States "is the only major industrialized nation in the world that does not have a plan or system for delivery of health care. Consequently, we provide less health care coverage to our population than any other major industrialized nation in the world. In addition, we are paying more for our health care than most other nations" (U.S. House of Representatives, 1984). The ones most affected are poor families and poor children. The Children's Defense Fund (1988) states:

• More than 35 million Americans — a third of them are children — lack any type of health insurance, public or private, and are one catastrophic illness away from financial disaster.
• The United States has fallen to a tie for last place among 20 industrialized nations in preventing its babies from dying in the first year of life. . . . Prenatal care utilization by poor mothers—which can reduce low-birthweight births, birth defects, and infant mortality—is eroding.
• The number of working families without private health insurance has been growing rapidly, and most public health programs are overburdened and underfunded.
• Children are at particular risk. One in three uninsured Americans is a child, and the majority of these children are from low-income families that cannot afford care without insurance.

Poor, substance-abusing parents of preschool children are more likely to be uninsured and hence unable to afford expensive substance abuse treatment. Also, treatment for this population may be even more expensive because of the need for child care.

According to the National Institute on Drug Abuse (1986), 2.5 million adolescents 12 to 17 years old were using marijuana and hashish regularly and 7 million were using alcohol regularly. Often these children live in an environment where there is a family history of substance abuse. It is estimated that 7 million children below the age of 18 live in homes with active alcoholism (National Institute on Alcohol Abuse and Alcoholism, 1987).

Children of substance abusers continue to be the most underserved population in the continuum of care in the recovery field. Most treatment centers do not include these children in family programs, most therapists are not qualified to counsel the total family, and schools do not have community approaches to prevention (Naiditch, 1986).

Marijuana is among the most widely used psychoactive substances in the Western world, although in the United States its use has declined somewhat in recent years. "The decline for young adults (18 to 25) was from 64.1 percent in 1982 to 60.5 percent in 1985. Nevertheless, a total of 18 million Americans used marijuana in the past 30 days; 2.7 million were 12 to 17 years old, 7.1 million were 18 to 25 years old, and 8.4 million were 26 years old or over" (National Institute on Drug Abuse, 1987; U.S. Department of Health, Education and Welfare, 1980). Considerable marijuana use also appears to be occurring among pregnant women, with serious health consequences to themselves and their offspring (Sokol et al., 1980; Hingson et al., 1982; Linn et al., 1983; Fried et al., 1984; Gibson et al., 1983). It is only in the last few years, however, that critical attention has been focused on the possibility that these substances can cause birth defects and postnatal behavioral aberrations. The National Institute on Drug Abuse (1987) states:

Drug abuse (with the exception of alcohol abuse) became uncommon following the passage of the Harrison Narcotic Act of 1914. However, during the past twenty years it has emerged as a dominant public health and social concern. In 1960 less than 7 percent of college-age young adults had ever used marijuana; by 1982, a majority (64 percent) of young adults 18-25, nearly two out of three, had done so. Cocaine use for most of this century was restricted to a tiny population. But by 1985, more than one in six (17.3 percent) high school seniors had tried cocaine; nearly a third of our young adults had done so.

Fetal alcohol syndrome has been widely researched and mentioned in the literature, and alcohol remains the most widely used drug among American youth. The early age of first use appears to be the best demographic predictor of alcohol and other drug abuse. Further, alcohol appears to be a gateway leading to other drug use (U.S. Department of Health and Human Services, 1987).

Methadone maintenance has been the heroin addiction treatment of choice for several years. The prenatal and early neonatal effects of methadone have been described in several reports (Kandall et al., 1979; Finnegan, 1983). However, there have been few reports on the long-term effects of methadone maintenance during pregnancy on the child's somatic and neurobehavioral development. Some investigators have described mild neurobehavioral abnormalities, while others have found none (Finnegan, 1983; Wilson et al., 1981; Lifschitz et al., 1983).

The number of women using and abusing non-narcotic drugs exceeds the number addicted to narcotics (Chambers and Hart, 1977). Current data show that 63 percent to 93.5 percent of women use analgesics during pregnancy and that sedative drug use ranges from 22 percent to 28 percent (Doering and Stewart, 1978; Forfar and Nelson, 1973; Hill, 1973).

Public concern over substance abuse in families with preschool children has stimulated a major effort to identify effective ways of deterring onset of this behavior. Traditional health education approaches have proven largely unsuccessful. New approaches, strategies, and interventions hopefully will provide insight and avenues for programs to meet this challenge.

Current Impact of Substance Abuse on Families of Preschool Children and Models

In examining the impact of substance abuse on families of preschool children, one encounters a variety of issues that will require diverse, creative, and persistent effort to impact. These range from the relatively clear-cut prevention efforts directed to fetal alcohol syndrome — the mother abstaining from alcohol and other unnecessary drugs during pregnancy (NIAAA, 1987) —to the elusive issue of preventing intergenerationa! transmission of alcoholism and the spread of substance abuse, which would include treatment of the active alcoholic or substance abuser as well as working with all family members to prevent future problems (Kenward and Rissover, 1980).

The changing drug abuse pattern in society has caused researchers to move prevention efforts to preadolescents (Greenspan, 1985), to accept adolescent drug use as normative statistically (Baumrind, 1985), and to realize that a distinction must be made between use, abuse, and addiction. These adolescents often report being introduced to drugs by a parent or older sibling (Bush and Iannotti, 1985), which implies the significant role played by the family in the onset of drug use.

Federal policy has focused on reducing the supply of illicit drugs through border control, confiscation, and arrest, but it is obvious to anyone who reads a newspaper that this approach is at best ineffective and at worst criminalizes a large segment of the population. This shortsighted, narrow, legalistic focus has been accompanied by a prevention campaign using "scare tactics" that utilized questionable data to support its case and actually may have worsened the problem (Lindesmith, 1982).

The complexity of these issues insists that they be investigated in the context in which they occur and that prevention and intervention must take place in the same context. Certain social problems in the community often are investigated as correlated with substance abuse, and most researchers generally accept that the family has a role in initiating, maintaining, and perpetuating a substance abuse problem (Adler and Raphael, 1983). The debate concerns which social and family problems create substance abuse and vice versa.

These substance abuse problems will be viewed here in the context of the community and the family, and the broader term "substance abuse" will be used to subsume other categories including drug abuse, alcoholism, alcohol abuse, chemical dependency, and addiction. Other terms will be used regarding particular research or programs when they are specified. The intent of this book will be to:

1. briefly state the nature of the substance abuse problem identified by the literature as it affects the child and the family system,
2. discuss the social problems (e.g., violence, crime, sexual abuse, FAS, etc.) often correlated with familial substance abuse,
3. review and analyze the effectiveness of demonstration programs mentioned in the literature on familial substance abuse and related problems, and
4. make policy and research recommendations for future advances and understanding of this important issue.

Although no definitive pattern of deficits, traits, or interactions has emerged that explains the intergenerational transmission of alcoholism or the spread of substance abuse In families, prevention and intervention strategies have been pursued with whatever theoretical foundation was current at the time. Bacon (1987) takes a historical view and suggests that everything done in the past 200 years has been ineffective and plagued by factional beliefs that have hindered progress. He calls for a "common sense" approach.

"Common sense" dictates that some basic questions must be answered before proceeding. What are we trying to prevent? Who or what is the target of this effort? What is the difference between prevention and intervention? To oversimplify the answers, attempts are made to prevent the spread of alcoholism and substance abuse within families and communities and the secondary negative effects such as fetal alcohol syndrome, minimal brain dysfunction, and emotional and behavioral problems in children of substance abusers.

Primary prevention provides information or services that promote healthy attitudes and reduce the occurrence of substance abuse. Secondary prevention, or early intervention, identifies and intervenes with high-risk individuals exhibiting early warning signs before they experience additional problems. Tertiary prevention is intervention with those who are already experiencing problems (Sweti, 1984). In the case of alcoholism and drug abuse, this can be considered prevention due to its prevalence in the community and the unexplained transmission of substance abuse and other problems to family members. Moos and Billings (1982) showed that children with alcoholic fathers who had recovered were less depressed and anxious than those whose alcoholic fathers had relapsed and were hospitalized. This implies that the recovery of one family member may reduce risk factors in other members.

What prevention methods will we use? This question will be answered for each problem area discussed. Why do we think that a particular program will work? The answer will be to identify the theoretical perspective or to cite significant findings in those programs with strong evaluations in place.

Most prevention program designs emphasize empowering the individual, the family, and/or the community in order to have a longlasting impact on any public health problem whether it be targeted toward minorities (Mason and Baker, 1978), low-income communities (Resnick. 1980), adolescents, or families (Ellis. 1980).

A panel convened by the National Institute of Drug Abuse's Office of Program Development and Analysis in June 1978 (Ellis, 1980) was assigned to develop models of practice for family-centered primary prevention that can be demonstrated and evaluated. The results were conceptualized into three models:

1. Ecological Systems or Systems Linkage Model. This model suggests that the vertical organization of many agencies can contribute to dysfunction and suggests a broad goal should be the realignment of societal units in which groups of individuals called families link with groups of families called communities or neighborhoods, which then link with organizations that help individuals, families, and communities. The model would emphasize process and context in a horizontal interactive network rather than a from-the-top-down approach. The task would be to create new links in the community and then step back to monitor and evaluate. This has been described by Bartunek (1982) as a "minimal intervention designed to generate structural systemic change."
2. Family Intervention Model. This model attempts to empower the family's sense of competency and reduce the sense of isolation by providing skills training with psychodynamic group techniques in informal family groups. The emphasis again is the return to traditional family networks developed within these groups to provide the sense of community and social support that has rapidly and spontaneously disappeared in the current culture. The agency role is to facilitate this process rather than to control interaction or provide a service delivery model of treatment.
3. Media Model. The last model addresses the unrealistic image of the family as presented on television and advertising and the power that the media have to change attitudes and opinions. The strategy is to provide models of functional families and how they cope and seek support within the family and community. This could be done through public service announcements and cable television and network entertainment shows that represent family life. There were no strategies discussed to achieve this model or how to motivate those with decisionmaking power to commit to it (Ellis, 1980).

These models compare current strategies with what was considered effective based on prevention research at the time and to reflect the change in emphasis from treating the individual to realigning the community, the helping agency, and the family in order to help the individual not use drugs or alcohol in a health-compromising way. It is this focus on changing social norms, strengthening the family, and making agencies more responsive to needs that differentiates prevention from intervention.

Community Perspectives

America has become a chemically dependent society that offers its children mixed messages regarding the use of mood-changing chemicals. We have "bad drugs" (heroin, cocaine) and "bad users" (alcoholics, addicts). Some drugs like opiates are "bad" on the street but "good" if prescribed by a doctor (Swett, 1984). Other drugs like tobacco are considered "bad" but are sold in machines on the street. The trends in social thought about alcohol have been traced by Watts (1982) as the

1. moral perspective that views alcohol as evil and those who drink it as weak-willed;
2. the disease concept that views alcohol as neutral and those who drink it to excess as sick with a disease called alcoholism;
3. the new public health view that alcohol is not entirely neutral, that availability has social consequences and that social control and reduction of overall consumption are worthwhile goals.

All three of these perspectives and others exist today in varying degrees in religious, social, and ethnic communities. The result: contradictory social policy. The Supreme Court decision (McKelvey v. Turnage, 1988) ruling in favor of the Veterans Administration used a moralistic view of alcoholism to deny benefits to many veterans, and yet the Hughes Act of 1970 institutionalizes the disease concept in most other federal arenas. From a s...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• About the Authors
• Contents
• Foreword
• Acknowledgements
• Chapter I. Introduction
• Chapter II. Prenatal and Postnatal Consequences of Maternal Substance Abuse
• Chapter III. Prevention Strategies and Programs
• Chapter IV. Children of Minority Groups and Substance Abuse
• Chapter V. Summary and Recommendations
• Chapter VI. References
• Appendix
• Index