Parental Abuse of alcohol and other drugs

1. Parental Abuse of alcohol and other drugs The relationship between substance abuse and child maltreatment By Beth Mayers and Kelly Thomas

2. Fetal Alcohol Spectrum disorder Facts and Statistics • The estimated rate of alcohol use among pregnant women is approximately 12% (Pruett, Hubbard, Waterman, & Caughey, 2013). • Approximately 53 % of women drink alcohol (Pruett, Hubbard, Waterman, & Caughey, 2013). • Many women drink alcohol when they are unknowingly pregnant, exposing the fetus to alcohol (Pruett, Hubbard, Waterman, & Caughey, 2013).

3. Fetal Alcohol Spectrum disorder Facts and Statistics (cont.) • Alcohol use at any time during pregnancy can negatively impact the fetus’s development. Development of the central nervous system takes place throughout pregnancy. The CNS is most vulnerable to teratogens (a substance that causes birth defects) during the first two thirds of pregnancy (Southern New Jersey Perinatal Cooperative, 2013).

4. The Effects of Alcohol on the human fetus • Fetal exposure to alcohol can result in facial deformities, abnormal development of the central nervous system, abnormal growth and development, and learning disabilities (Pruett, Hubbard, Waterman, & Caughey, 2013). • These problems result in lifelong complications in cognitive, social, behavioral, and physical development (Pruett, Hubbard, Waterman, & Caughey, 2013; Whitehurst, 2011).

5. Physical Abnormalities of FASD • Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum) • Small head size • Shorter-than-average height • Low body weight • Poor coordination • Sleep and sucking problems as a baby • Vision or hearing problems • Problems with the heart, kidney, or bones

6. Fetal Alcohol Spectrum disorder Facial Features Did you know…Fetal Alcohol Spectrum Disorder is the ONLY 100% preventable birth defect? Did you know…Causing FASD in an infant is a form of child abuse? Did you know…It is a myth that one or two drinks per day are safe during pregnancy? There is no safe amount(Southern New Jersey Perinatal Cooperative, 2013).

7. Cognitive Effects of FASD • Inconsistent memory and recall • Inability to filter out environmental or emotional distractions and sensory stimuli • Slower, inconsistent cognitive and auditory processing • Decreased mental stamina • Difficulty interpreting, and applying abstract concepts (i.e. managing money & time) • Inability to control impulses • Inability to predict outcomes (as a result of their own or others' actions) • Difficulty changing modalities (i.e. shifting from one context to another) • Rigidity (unable to move on prior to completion) • Inability to see another person's perspective • Inability to recognize indirect social cues

8. Social impact of fasd • Mental Health Disorders • Homelessness • Alcohol and Drug Addictions • Disrupted School Experience • Trouble with the Law, Incarceration • Inappropriate Sexual Behavior • Problems with Employment • Dependent Living • Early Death

9. But… using drugs while pregnant is worse than using Alcohol, Right? • Wrong. Prenatal use of alcohol is the only substance that has been proven to have irreversible effects (Kelley, 2002).

10. How can fathers help prevent FASD? • About 75% of children born with FASD have biological fathers who are heavy drinkers and alcoholics.(Gearing, McNeill, & Lozier, 2005) • Mothers are not the only ones who can prevent FASD. The father’s role is also important in helping the woman abstain from drinking alcohol during pregnancy. He can encourage her abstinence from alcohol by avoiding social situations that involve drinking and by abstaining from alcohol himself.

11. The relationship between alcohol and child abuse • Child maltreatment can be defined as “the physical and emotional mistreatment, sexual abuse, neglect and negligent treatment of children, as well as their commercial or other exploitation” (World Health Organization, 2006, p.7). • 8.4 % of adults meet criteria for alcohol use disorders. Alcohol use is strongly linked to child maltreatment (Goldstein, Henriksen, Davidov, Kimber, Pitre, & Afifi, 2012). • Substance abuse is one of the leading problems in reported cases of child maltreatment, second only to poverty, and alcohol is cited as the leading substance of abuse (Kelley, 2002).

12. How does substance use lead to an increased risk of child abuse? • Substance use can result in lower tolerance levels for frustration and an increase in the likelihood that a person will react with frustration in an angry manner. • Substance use results in lowering of inhibitions and impulsive behaviors.

13. How does substance use lead to an increased risk of child abuse?(Cont.) • Substance use can interfere with good judgment and parenting skills. • Using substances can cause a parent to focus primarily on getting the substance rather than focus on their children. (Kelley, 2002).

14. Implications for Children of Substance Abusers (COSA) • Alcoholism and drug abuse affects the entire family • Difficulty concentrating in school • Learning deficits • Increased physical and mental health problems • Increased risk of violence and all forms of abuse • COSAs learn to: • Not feel • Not talk about what happens in their home • Not trust

15. School • Children of addicts score lower on tests measuring verbal ability. Their ability to express themselves may be impaired, which can impede their school performance, peer relationships, ability to develop and sustain intimate relationships, and hamper performance on job interviews. • Children of addicts have greater difficulty with abstract and conceptual reasoning. • COSAs are more likely to be truant, drop out of school, repeat grades, or be referred to a school counselor, or psychologist.

16. Health • Parental alcoholism and other drug dependencies have an impact on children's early learning about alcohol and other drugs. • Children of alcoholics (COAs)are four times more likely than non-COAs to develop alcoholism. • Inpatient substance abuse treatment admission rates for COSAs are triple that of other children. • Inpatient admission rates for mental disorders are almost double that of other children.

17. Health (continued) • COSAs are at higher risk for disruptive behavioral problems and are more likely than non-COSAs to be sensation seeking, aggressive, and impulsive. • In general, COSAs appear to have lower self-esteem than non-COSAs in childhood, adolescence and young adulthood. • COSAs exhibit elevated rates of psychopathology. Anxiety, depression, and externalizing behavior disorders are more common among COSAs than among children of non-addicts.

18. Relationships • Children of addicts are more likely than non-COSAs to marry into families in which alcoholism and/or drug use is prevalent. • Compared with non-addicted families, addicted families demonstrate poorer problem-solving abilities, both among the parents and within the family as a whole. These poor communication and problem-solving skills can lead to increased conflict which can quickly escalate into violence in addicted families.

19. Typical Child “roles” in a dsyfunctional family • The Hero – typically the oldest child • The Scapegoat – may be the second child • The Lost Child – may be the third child • The Family Mascot (or clown) – may be youngest child

20. The HEro • Does well in school • Involved in many activities • Seems very mature/responsible for their age • Helpful at home • Teacher’s pet • Inwardly, the hero feels: • Inadequate/Never good enough  • Scared, guilty, lonely

21. The Scapegoat • Often fails in school • Angry/Puts on a tough front • Always getting into trouble • Early substance abuse • If female, may become pregnant • Inwardly, the scapegoat feels: • Left out of family  • Like a misfit • Needs attention but can't ask for it  • Lonely, guilty, hurt

22. The lost child • Quiet, shy, often goes unnoticed • Loner/ill at ease with others • Often retreats into books, music or tv • Often an animal lover • Inwardly, the lost child feels: • Different • Like an outsider • Low self worth  • Forgotten

23. Family Mascot • Typically a class clown/Disruptive in school • Happy-go-lucky • Energetic • Keeps focus on self • Inwardly, the mascot feels: • Fearful/Anxious (sees something is wrong but no one acknowledges it) • Confused/In the dark  • May feel crazy

24. You can help Cosa to: • Develop autonomy and independence • Develop a strong social orientation and social skills • Engage in acts of "required helpfulness" • Develop a close bond with a care-giver • Cope successfully with emotionally hazardous experiences • Perceive their experiences constructively, even if those experiences cause pain or suffering, and gain, early in life, other people's positive attention • Develop day-to-day coping strategies

25. Teach children The 7 cs

26. Help stop the cycle of child abuse • Experiencing a history of child abuse increases the risk of a person abusing substances into adulthood for both males and females (Kelley, 2002). • Parental healthy choices now can lessen the likelihood our children will abuse substances as they get older. • Less substance use = less child abuse = less substance abuse.

27. Resources • Alcoholics Anonymous - www.aasj.org or call 856-486-4444 • 211- www.nj211.org or call 211 211 is a resource for callers to find varying types of assistance, including alcohol and drug treatment. • National Institute on Alcohol Abuse and Alcoholism (NIAAA) - www.nida.nih.gov • National Institute on Drug Abuse (NIDA) - www.nida.nih.gov • Southern New Jersey Perinatal Cooperative - www.snjpc.org 856-665-6000 • Substance Abuse and Mental Health Services Administration (SAMHSA) - www.samhas.gov • National Association of Children of Alcoholics - www.nacoa.org A support group for children of alcoholics. Parents Anonymous - www.pa-of-nj.org A support group for parents.  • Women for Sobriety - www.womenforsobriety.org or call (215) 536-8026 A support group for women looking to get sober.

28. References • Goldstein, A.L., Henriksen, C.A., Davidov, D.M., Kimber, M., Pitre, N.Y., & Afifi, T.O. (2013). Childhood maltreatment, alcohol use disorders, and treatment utilization in a national sample of emerging adults. Journal of Studies on Alcohol and Drugs, 74(2), 185-194. • Kelley, S.J. (2002). Chapter 5 Child maltreatment in the context of substance abuse. In J.E.B. Myers, L. Berliner, J. Briere, C.T. Hendrix, C. Jenny & T.A. Reid (Eds.), The APSAC handbook on child mistreatment (2nd ed.) (pp. 105-117) Thousand Oaks, CA: Sage Publications Inc. • National Institute on Drug Abuse. (2013). Statistics and trends. Retrieved from http://www.drugabuse.gov/drugs-abuse/alcohol • Pruett, D., Hubbard Waterman, E., & Caughey, A.B. (2013). Fetal alcohol exposure: Consequences, diagnosis, and treatment. Obstetrical and Gynecological Survey, 68(1), 62-69.

29. References Continued • Southern New Jersey Perinatal Cooperative. (2013). Substance use during pregnancy: FAS/FASD [PowerPoint Slides]. • Whitehurst, T. (2011). Raising a child with fetal alcohol syndrome: Hearing the parent voice. British Journal of Learning Disabilities, 40, 187-193. doi: 10.1111/j.1468-3156.2011.00692.x • World Health Organization. (2006). Preventing child maltreatment: A guide to taking action and generating evidence. Geneva, Switzerland: Author. Retrieved from http://whqlibdoc.who.int/publications/2006/9241594365_eng.pdf • Gearing, R., McNeill, T. & Lozier, F. (2005). Father involvement and fetal alcohol spectrum disorder: Developing best practices. The hospital for sick children, department of social work. 1-11. Toronto, Ontario

30. Contact information • Beth Mayers, BA, CPS, SAC • Prevention Plus • BethMayers@prevplus.org • For more information on substance abuse prevention and education, please contact the Burlington County Healthy Communities Coalition at: 609-261-0001. • April, 2014