Effects of Parental Alcohol and Substance Use Disorder on Young Children
by Dr. Miguel Firpi, PHD
The ways in which parental substance and alcohol use disorder affect children are sometimes dramatic, sometimes subtle; sometimes instantaneous, sometimes chronic; sometimes they can be overcome, sometimes they are forever, but they are always powerful and enduring in the memories of children. They are typically scary and sad. They are often traumatic. Many times, they place children at risk as adults, for the very same situations they endured when they were younger.
In order to understand how these substances promote behaviors that affect children, it is important to understand how alcohol and other drugs (especially sedating drugs) affect the brain and behavior. In general, alcohol and other sedating substance such as benzodiazepines ( e.g., alprazolam, diazepam, lorazepam) and narcotics (e.g., opiates) exert a depressive effect on the brain’s functioning. The depressive effect on the central nervous system can lead to sedation, an overall slowing down of reaction times, difficulty thinking, confusion, speech problems, loss of coordination, and muscle weakness. Paradoxically CNS depressants will disinhibit feelings and behavior, causing people to react in ways they normally would not or exacerbating impulse control problems.
Why are these CNS effects so important to understanding the impact of alcohol and other substance use disorders on children? Parenting’s very essence is to provide children with the roadmap they will use to guide their decisions, their relationships and their ethics as adults. That guidance requires that parents and children form a healthy attachment bond which in turn requires that parents be physically present, that they are attuned to the needs of the child and that they reliably meet those needs. The attachment process is fundamental not only for healthy emotional development. It is also a significant factor in brain development, especially during the first few years of life. Disruption of the attachment process during those early years can affect the structural development of the brain and may be associated with emotional dysregulation into adulthood. There is some truth to the statement that securely attached children are tomorrow’s independent adults whereas insecurely attached children are tomorrows dependent adults (in more ways than one).
It follows that anything that disrupts the attachment process may have a potentially long-term negative impact on children. Disruption of the attachment process can be a traumatic event. Exposure to alcohol and other drug use disorders in the family is often a major source of trauma for children in multiple ways, sometimes dramatic and visible, sometimes subtle and profound, sometimes with immediate consequences, and sometimes smoldering and erupting later in childhood.
A particular child comes to mind who was in first grade when we met. Intellectually he was brilliant child with a vocabulary daunting for his age. He spoke like a little old man. Everyone thought he was mature beyond his years. He had a brother two years younger who was a sweet boy but rather introverted. Their mother was a depressed alcoholic and benzodiazepine user who had been in extended rehab multiple times but had relapsed. There was no father in their lives, although the mother had gotten into a couple of abusive relationships with substance using males. The paternal grandmother was present in their lives. The children had been exposed to episodes of severe conflict and aggression by these men against their mother. She came from a family with an alcoholic father who was times very affectionate and at others a raging angry lunatic. Her mother was submissive and ineffectual and worked tirelessly to keep the peace and protect the children. When I asked the child to tell me about his day there was no missing the impact of the mother’s substance abuse on this child. He got up early in the morning to dress his brother for Pre K and dress himself for school. Then he would open up a box of Lucky Charms and feed himself and his brother. Then he would try to wake up his mother who was typically profoundly passed out from a combination of alcohol and lorazepam, her drugs of choice. He commented that his mother worked hard and was always tired in the morning. He knew very well she was drinking but was protective of her because of past interventions by child protective services. One time he could not rouse his mother. He thought she was dead and pried her eyes open to make sure she was alive. He described the moment as very scary and told me his hands were shaking for fear of finding out that his mother was dead. Usually, she would wake up very groggy and stumble to the kitchen where the child would prepare instant coffee with milk in the microwave. The child stated that his mother was usually so sleepy that if she tried to prepare breakfast “it was very bad” and either she burned their eggs and one time even spilled boiling milk all over herself and the kitchen floor. He decided things would go more smoothly if he did them. Somewhat, abruptly he told me he did not want his mother to have a boyfriend because they were mean and scary. He narrated a couple of situations of violent behavior that terrified him and his brother and that still came up in his dreams.
Once breakfast was done, he would grab his younger brother by the hand and walk to school which was fortunately only a block and a half away. The mother watched them from the door or had them walk in the company of adult neighbors on the way to school with their own children. The child noted that by the time he came back from school the mother was up watching soap operas on TV. She would kiss and hug the children but she did not get up from in front of the TV. The child would go get some milks and Oreos for himself and his brother and then do his schoolwork. He knew not to interrupt the mother’s TV time because she would get irritated. He would call his grandmother on the phone if he had a question or if he needed something. She was always available. Finally, dinner was usually something canned and heated such as Vienna Sausages or Tuna sandwiches. The child was concerned because he had learned about food groups at school and he said their dinner usually had only one or two of the groups. By 7pm the mother was described as being very sleepy and usually nodding off. The child and his brother took the opportunity to switch the channels and watch their favorite cartoon until they fell asleep. The older boy eventually would wake up and put himself and his brother to bed after waking up their mother to say goodnight. Ultimately, the children were taken away from the Mother after she got involved in another abusive relationship which resulted in the younger child being bruised when the mother’s boyfriend hurled an object. The children were sent to live with their paternal grandmother who was quite nurturing and attentive to them but the loss of their home and the changes in the relationship with their mother affected them. The older boy, who was very protective of the mother, had some sense that the events were related to the mother’s drinking. He was also more engaging and articulate and was able to participate effectively in therapy. The younger boy who was introverted and overly dependent on his brother internalized his feelings, regressed to infantile behaviors and became severely depressed.
So, what exactly were the effects of the mother’s alcohol and substance use disorder on the children?
1.The depressive effects of the substances numbed the mother’s ability to be responsive to the needs of the children. Kisses and hugs are fine but they are not equivalent to the nurturing and emotional responsiveness that children require. Children need the predictability of knowing that someone cares and addresses a wide variety of needs, ranging from love and affection to discipline and structure. The unresponsiveness of the mother left the children with a profound sense of insecurity and underlying anxiety. In fact, the older boy began as early as 4-5 years old to feel responsible for taking care of things trying to fill the void caused by the mother’s emotional absence.
2.Parentification essentially robs young children from being able to explore the world and feel that they have a secure, predictable base in their home. Instead, one of the children became responsible for the needs of the family taking over functions that the mother should have performed and even anxiously taking care of the mother. Along with taking on those responsibilities came anxiety and the learning to subject his feelings and his desires on behalf of the needs of other. Parentification in response to substance use disorders in a family results in an early assault on a child’s sense of appropriate boundaries which result in a long term and sometimes endless cycle of not knowing where one ends, and another person begins. The unresponsiveness induced by central nervous depressants and the consequent parentification with which some children react to that situation can become the foundation for highly dysfunctional relationships during adolescence and adulthood.
3.Exposure to aggression and violence is often exacerbated, if not more frequent in family situations where one or both parents are abusing depressants. Because of their disinhibiting effects CNS can lower the threshold for emotional hyper-reactivity and physical violence. There is a high incidence of physical aggression in families and couples with someone with a substance use disorder. This does not and mean that the disinhibiting effects of CNS use them to deal with social anxiety depressant always leads to increased likelihood of violence. Some people use them to deal with social anxiety. However, those individuals with proclivities toward poor impulse control or a tendency to rule breaking may show an increased level of physical aggression towards others.
Whatever the incidence, the impact of domestic violence on children is nothing short of traumatic. Young children in particular have little in the ways of mechanisms to interpret or cope with DV. Chaotic and intense rage often fed by CNS depressants often trigger existential threats to the child and may lead to severe attachment disruptions and post-traumatic stress disorders. These adverse childhood experiences (ACE) have the potential to induce toxic stress can impact brain development and bring on problems with emotional and behavioral dyscontrol, depression, personality disturbances and is associated with many causes of physical health problems. A specific problem for children in families with alcoholic or substance use disordered parents is that even if they receive expert trauma treatment they may be returning to a very unstable environment if the root causes of dysfunction are not addressed. This increases the chances of traumatization and promotes chronicity over the lifespan
4.Trauma begets trauma if not effectively addressed. Addressing alcohol and substance use disorders is an integral part of any effective treatment plan. The mother’s roots in an alcoholic family and her issues with an emotionally unstable father and a codependent mother were clearly reflected in her own interpersonal and familial relationships. When we talk about parenting in many ways involving giving children a roadmap for life and relationships, it is clear that the children in this story, at an early age, were already following a crooked and tortuous roadmap. Children of alcohol and substance use disorder parents are more likely to drink or use drugs themselves. Absent insight, a supportive environment, and an understanding of their vulnerability to this type of disorder, these children are likely to repeat their parent’s substance using and addictive behaviors.
The children in this case ultimately wound up living in a supportive environment, with predictable care and reasonable boundaries. Despite the constructive change in their environment and a significant amount of mental health services, the personality traits that developed while living in an alcohol and substance using home were deeply ingrained and resisted change. The older boy continued his parentified behavior toward his sibling and only the grandmother’s watchful and old-fashioned parenting model with strict boundaries eventually succeeded having the child pay attention to and validate his own needs or as the grandma said, “he needs to know he is a child and enjoy being a child”. The younger child experienced very significant difficulties and did not respond to treatment very well. He regressed and displayed baby like behavior (sucking his thumb, enuresis, age inappropriate fears). He did poorly in school and did not relate appropriately to his peers. At last contact he was deemed to be significantly depressed and a candidate for psychotropic medication.
The children’s mother went to several residential rehabilitation programs and was successfully abstinent for periods of time during which she saw the children. Her repeated relapses only added to the children’s confusion and their sense of abandonment
The effects of alcohol and other substance used disorder are varied and complex. They interact with an individual’s physiological and personality makeup in distinct ways. As evidenced by the case of these two young children, alcohol and substance use disorder in the family affected the children in multiple ways. There are many other potential effects to familial alcohol and other drug use. Young children appear to be very vulnerable to these effects in a physiological, emotional and behavioral way. It is unlikely that most substance using parents are aware or well informed regarding the serious and complex effect of their disorder on their children. It is unlikely that knowledge of those effects by itself will make anyone jump into sobriety. What is more realistic is to believe is that awareness of the impact of substance and alcohol disorders on others, and specifically on children, is an important part of the foundations for a sustained recovery.