When a parent struggles with drug addiction.

Parental Substance Abuse: Family Assessment & Treatment

Brandon Bruce Dellario LMSW LASAC

The issue of substance abuse disorders within a family, and its effect on family systems, is a testament to the usefulness of ecological theory in social work practice.  “An ecological model of causation, which seeks to understand the transactions between the person and the environment, offers a more robust model for describing the addictive process and its effects

(Rhodes, 1996).”  When a parent is a problem user, their self-destruction can no longer be called a victimless situation.  Parental substance abuse can become toxic to the family as a whole.  Children are often victims of abuse or neglect.  Additionally, children have an increased risk of being prenatally exposed to alcohol and other drugs (Young, 2007).  Spouses, significant others and other adult family members of the using parent may also become candidates for physical and mental abuse. 

When a parent, caregiver or guardian is substance abusing, it can be devastating to a family’s health.  Some of the consequences are damaged relationships related to areas of imprisonment, institutionalization, abuse and neglect, injury, illness, disease, death… as well as lack of trust, care, commitment, responsibility, respect…  Addiction and other substance abuse disorders erode at the place where supportive families stand and grow.

When an individual is assessed and treated for a substance abuse disorder, there is normally little or no attention paid to their family.  Family therapy is normally used for substance abusing adolescents but not for adults.  Thus, another way the family of a substance abusing parent is left to fend for itself, yet again.  There may be an assessment or treatment referral for family members if the courts or human service agencies are involved and deem a situation worthy of investigation.  However, individuals who go inpatient at treatment facilities are treated with the medical disease model of addiction, which helps patients to primarily focus on their own behavior.  Some treatment centers have family days for education, support and family involvement, but it is actually only a small percentage of the activity involved in a treatment program.

Assessment

Social Workers have an opportunity to assess a using parent and the family as a whole in everyday practice, although not as much work is usually done with the family unit.  The National Study on Child and Adolescent Well-Being (NSCAW) has child welfare workers who use the Composite International Diagnostic Interview-Short Form (CIDI-SF) to assess substance dependence of caregivers.  It is used for both open and closed cases for the year prior to data collection.  The CIDI-SF is used to find statistics of caregivers in America who fit into the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis for substance abuse disorders.  “It was found that child welfare workers failed to identify a substance abuse problem in 61% of the caregivers who actually met DSM criteria for alcohol or drug dependence (Young, 2007).”  Moreover, the courts and the addiction treatment system do not report on the needs of the family when serving the client. 

Social workers are in an integral and personal position to the client and family.  Additionally, social workers need to stay aware of issues that may be resulting in harm to anyone.  The Child Welfare System (CWS) identifies parental substance abuse issues only when they lead neglect or abuse of children.  Early screening and assessment is extremely important to intervention.  It can lead to programs like family drug treatment courts, and programs that have services for children of problem users (Young, 2007). 

Social workers can orchestrate initial sessions with families through:  Establishing a personal relationship and confidentiality; defining the presenting problem as a family problem; asking open-ended questions which support clarification of family and individual needs, wants, perceptions, choices, hopes, expectations, concerns, reservations and roles; explanation of the nature of the helping process; role-modeling open communication; appropriate self-disclosure; establishing an empathetic relationship; and active, effective listening (Way, 2009)

Workers can gain awareness of client and family issues by asking themselves questions like the following:  How was this client referred?  What is the impact of this problem on the family?  How does it affect family dynamics?  How do they manage pressures?  What are this client’s and family’s strengths?  How have they dealt with similar situations in the past?  What are the family boundaries and maintenance of those boundaries?  To what degree do individual family members exhibit differentiation?  Does everyone in the family feel free to be themselves?  How are decisions and disagreements managed?  Who is the disciplinarian?  What are this client’s and other family member’s goals?  Are these goals connected to the presenting problem or other problems?  To what degree are these goals connected to a crisis?  What do this client and family anticipate in working on those goals?  What are the established supports and barriers (Way, 2009).

Biegel, D.E., Ishler, K.J., Katz, S., Johnson, P. (2007). Predictors of burden of family caregivers of women with substance use disorders or co-occurring substance and mental disorders. Journal of Social Work Practice in the Addictions, 7(1/2)

Gruber, K.J. (2001). In-home continuing care services for substance-affected families:  the bridges program. Social Work, 46, 3, 267-278

Rhodes, R., Johnson, A.D. (1996). Social work and substance abuse treatment: a challenge for the profession. Families in Society, 77, 3, 182-186.

Springer, D.W. (2002). Families helping families: implementing a multifamily therapy group with substance abusing adolescents. Health & Social Work, 24, 3, 204-208

Young, N. K., Boles, S.M., Otero, C. (2007). Parental substance use disorders and child maltreatment: overlap, gaps, and opportunities. Child Maltreatment, 12, 2, 137-149.

Way, I. (2009). SWRK 6610: social work practice with individuals and families. Western Michigan University School of Social Work, Fall 2009, Thursdays 10am-12:20pm, 1087 CHHS, Kalamazoo, MI.