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Addictions: Treating Family Manipulation, Mistrust, & Misdirection
Substance Abuse Addiction: Treating Family Manipulation, Mistrust, and Misdirection - 10 CEUs

Section 18
Addiction Concealment and Taboo: The Lives of Children of Addicts

CEU Question 18 | CEU Answer Booklet | Table of Contents | Addictions
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Remarkably little research has been conducted on the parenting practices of drug-dependent parents and the limited empirical research available has produced inconclusive findings. In contrast to the substantial literaturedrug-dependent Substance Abuse Addiction mft CEU course on how individuals adjust to substance abuse, historically there has been little work that examines drug dependence as it directly and uniquely affects parental or family functioning. In a review of research on the well-being of children of opiate- and cocaine-addicted parents, Hogan pointed to the need for empirical studies of the processes by which parenting is affected by dependence on illicit substances. The present article reports findings of a study conducted in Dublin on the social and psychological development of school-aged children of opiate-dependent parents. The particular focus of this article is on opiate-dependent parents’ perspectives on the risks to which their children may be exposed as a result of parents’ drug dependence and associated lifestyle, and their reports of the strategies they employ to protect their children from the potentially negative effects of these perceived risks. These strategies centre around efforts to conceal their use of illicit opiate substances and the lifestyle with which their drug dependence is associated, such as buying and selling drugs and other crimes.

Drug Taking: Location and Method
All but 2 parents said that that their homes were the main venue for drug taking. This may be because the study participants were parents with children in their care and it is not clear whether the same patterns would be found for other drugs users. Most of the drug-using parents (74%) currently, or had previously, injected heroin intravenously as their primary route of drug taking.

Concealment of Drug Taking
The most common strategy used by parents to conceal their drug taking was to retreat to another room in the house to take drugs. Parents mostly said that they injected heroin in the kitchen, bathroom, or bedroom. Different tactics were used to keep children away while taking drugs, ranging from keeping the door of the room locked, to warning the child to stay out. For example: ‘I would use upstairs while she was outside playing. That was one thing I always kept away from her’ (mother of a 4-year-old girl). ‘I always got everything upstairs in one of the rooms. She [children’s mother] would watch them ... sometimes I locked the bedroom door while I used’ (father of an 8-year-old child).

A large proportion of parents also said that they tried to restrict their drug taking to times when the children were out of the home, such as school hours. Many also reported devising strategies to get children out of the house, mostly by sending them out to play or to a friend’s house, but also in some cases resorting to bribing their children by giving them money to stay away for certain periods. Most drug-using parents reported that their children had not been exposed directly to their drug-related activities. A sizeable minority, however, reported that their children had seen them taking drugs. A small proportion of parents said that their children had been regularly present in the same room while they injected heroin. Most parents, however, found it difficult to indicate the frequency of their children’s exposure to injecting.

Factors Associated with Children’s Exposure to Parental Drug Ingestion
Parents’ reports suggest that four factors were associated with children’s likelihood of having direct exposure to their parents’ drug taking. First, children were more likely to have witnessed their parents’ drug taking if they were very young children, especially of preschool age. Parents tended to believe that younger children would not have the competence to make sense of such behaviors at a young age, and that the risk was less than that of injecting in the presence of older children. For example, the mother of a 9-year-old girl said that her daughter, when younger, had seen her injecting heroin, ‘Not very often, but often enough. I tried to hide it, she wouldn’t know what I was doing but she knew it wasn’t right and knew it was wrong’ (mother of a 9-year-old girl). Secondly, children were more likely to witness parental drug taking if the parent was a chronic drug user during the lifetime of the child. The mother of a 12-year-old girl said: ‘She knows everything about me. She grew up with it ... I explained things to her ... She always knew about drugs, knew we were taking heroin, from growing up with it. She knows mostly everything.’

A third factor was the stage of addiction of the parent. Parents whose opiate use was more frequent and more chaotic were more likely to take drugs in the presence of their children, because they were less successful in their attempts at concealing their drug taking and contact with other drug users as they experienced increased drug needs. The father of an 8-year-old boy described the decrease in his vigilance when his heroin addiction increased: ‘He [my son] might have spotted me [injecting] once or twice ... I used upstairs in the house, mainly when they were outside. When you’re on drugs, you always slip up ... I might have been neglectful and forgot to lock the door. If you’re using five times daily, of course you drop your guard.’

A fourth factor affecting children’s exposure to drugs was their age at the onset of parental drug use and treatment. More than half of the children were born to parents who were already using opiates and approximately half to parents who had received treatment for opiate dependence prior to their birth, suggesting that the majority of children were born to parents already engaged in the lifestyle surrounding opiate addiction. The range of experiences differed widely however; the parents’ first opiate use had occurred from up to 22 years before the birth of their child to 8 years afterwards. Furthermore, parents’ first drug treatment occurred in time periods ranging from 13 years before children were born to 8 years after the birth.

Finally, it is important to note that a small minority of parents used exposure of children to elements of their lifestyle as a means of deterring their children from future drug use, believing that this was an effective protective measure. One father’s description of his behavior illustrates this approach: ‘I let him know as much as possible. I even showed him me ‘dying sick’ [in withdrawal] ... I locked myself in my room for 3 weeks. I came out of it 3 times, I let him see me like this ... in the horrors. It gave him a fright’ (father of a 10-year-old boy).

Concealment of Involvement in Drug Trading
Parents had fewer concerns about children’s exposure to drug trading than drug taking. Twenty-one parents (42%) said that their child had been with them when they purchased drugs, and 9 (18%) when they sold drugs. Most, however, said that they had made efforts to conceal the nature of these activities in order to protect their children. They stated that their children were probably aware that drugs were being bought and sold on these occasions, but were reluctant to concede that children definitely knew that they were drug users.

Concealment of Drug Treatment
Most parents reported concealing their methadone treatment from their children. By way of explanation for their attendance at drug treatment clinics, the majority said they told their children that they were receiving treatment for a non-drugs-related illness. ‘She has seen me taking it [Physeptone] in the mornings, the takeaways. She calls them “mammy’s takeaways”. She just says, “that’s mammy’s medicine”. Sometimes she asks what it’s for. I say it’s for my stomach. I’ve been in and out of hospital with my liver and stomach, the kids know that. ... She doesn’t know anything about me using drugs’ (mother of a 10-year-old girl).

However, not all parents gave explanations to their children, particularly when their treatment began when children were very young. In these cases children discovered their parents’ drug dependence through gradual exposure to a range of drug-related activities. ‘They were very young, only babies when I started. They didn’t ask, they just started knowing that ma was getting medicine. When they were older they knew that people stopped coming to the house, that I stopped using it and buying it’ (mother of a 12-year-old girl).

Maintenance of a Taboo
The second strategy used by the majority of parents to distance their family life from their drug-related lifestyle was the construction of a strict taboo within the family about their drug dependence. Two thirds of drug-using parents said that they had not told their children anything about their drug use and therefore it was not a topic that was ever discussed. Even within these families where parents had disclosed their drug dependence to their children, the usual practice of parents was to discourage communication about the issue. Although the majority of parents maintained silence within the family about their drug dependence, it is interesting to note that most (70%) also believed that their children probably knew they were drug users, but were hesitant to conclude that children knew with certainty that they were dependent on opiates, even when children had witnessed their drug taking.

Functions of Maintaining the Taboo
For most parents, the silence about their drug dependence within the family was part of a protective strategy. It protected them from admitting their problem to their children and facing their children’s disappointment, distress and worry. They also saw it as protecting their children from distress upon learning that their parents were ‘junkies’ in a social and cultural context in which drug dependence, especially among parents, is socially condemned. Furthermore, parents believed that concealment and silence about their drug dependence protected the family, as they worried that children might disclose their parents’ drug problem outside the family, leading to social censure and possibly eviction from their homes, as most rented in the public housing sector. Many parents, particularly mothers, also feared that they would be judged to be unfit parents by child protection services. It appeared that some parents believed that if children learned that the subject was taboo, this would prevent their disclosure to others of any suspicions they might have that their parents used drugs.

Some parents, however, did not speak with their children about their drug dependence because they were simply at a loss as to how to talk about this subject with their children. A number of parents also felt that, while they would prefer to be open with their children about the issue, the children themselves were ambivalent about having knowledge about their parents’ drug use. The reluctance of an 8-year-old boy to talk about the matter was described by his mother as follows: ‘I told him (drug use) was something I got into and I needed and that was why I was like that in the morning. I told him I needed it ... I don’t think he really understands much. It’s like he doesn’t want to know ... he doesn’t say much about drugs.’

Discussion
Interviews with opiate-dependent parents suggest that drug dependence and the lifestyle with which it is linked add considerable complexity to the task of parenting. One key challenge for parents was to create and sustain a balance between their responsibilities to their children and their engagement in a lifestyle that involved them in the use of illicit substances and engagement in illegal activities. The majority of parents dealt with these challenges by trying to conceal their drug use and dependence from their children. Maintaining a strict taboo within the family was of crucial importance in this, but was difficult given that many of the children had been exposed to their parents’ drug taking. The strategies parents employed created interpersonal mistrust and secrecy among family members.

This prohibited children from seeking reassurances about worries they might have about their parents’ health and well-being, either from parents or from others. As parents did not feel safe to disclose their vulnerabilities in any quarter, they did not receive support to help them to adopt and maintain more effective parenting practices in relation to their drug dependence.

These findings demonstrate that drug-dependent parents use a range of strategies to try to conceal a part of their life that they see as risky for their children and that could threaten the well-being of the family if it were publicly known. Their strategies for concealment were, however, linked to the level of their drug dependence and were often unsuccessful. The findings indicate that parents who effectively forbid communication within the family about their drug dependence are motivated by feelings of shame as well as by the desire to protect themselves, their children and their family, and resonate with the findings of Barnard and Barlow’s study. These parents also harbor fears that their children may feel embarrassed or let down, concerns about being a poor role model for their children, and anxiety that their children may tell others outside the home about their drug use, with all of the risks associated with public disclosure, including the possibility that children will be removed into care by social services. Children are placed in an impossible situation by their parents’ concealment and by the taboo of their drug dependence. They are bound to silence by loyalty to their parents and their desire to protect themselves, their parents, and their families from social censure and exclusion.

Parents’ descriptions of their beliefs and practices in relation to their drug dependence indicate that children’s fears and distress about parental drug dependence are carried alone. Barnard and Barlow found that children respond to both worries that their parents might be drug users and the discovery that parents are drug users in complex ways.

These findings suggest the need for intervention programs that are targeted at supporting drug-dependent parents in everyday life, recognizing that parents and children could benefit from a risk-reduction approach to parenting. Such programs should address parents’ beliefs about young children’s cognitive competencies as these influence their management of children’s exposure to their drug use. Parents need help to understand how children of different ages might respond to both concealment and disclosure. They need support in finding ways to communicate effectively with their children about their drug dependence, with sensitivity to a broad range of factors, including children’s age, social-emotional and cognitive competence, and an array of social and cultural factors.

It is also vital that intervention programs are put into place to provide support directly to children. At present, such programs may have low rates of uptake since parents’ fears of discovery would create a barrier to children’s attendance. Such programs will only be effective if both parents and children feel safe to disclose parental drug dependence without fear of placing the family at risk.

- Hogan, Diane M, “Parenting Beliefs and Practices of Opiate-Addicted Parents: Concealment and Taboo”; European Addiction Research, 2003 Vol, 9 Issue 3, p113-119

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Personal Reflection Exercise #4
The preceding section contained information about addiction concealment and taboo in the families of addicts.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 18
According to Hogan, how are children in the families of addicts placed into an “impossible situation”? Record the letter of the correct answer the CEU Answer Booklet.

 

CEU Answer Booklet for this course | Addictions
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