I. Introduction:
    SUBSTANCE ABUSE AMONG FAMILIES

In order to better assist families where parental abuse of alcohol or other drugs is present, it is helpful for program staff to have a basic understanding of:
 Substance abuse and its impact on family functioning

ALCOHOL AND OTHER DRUG ABUSE:
A BASIC OVERVIEW OF THE PROBLEM

    No specific cause of addiction has been identified. However, there are factors that seem to influence this behavior. Certain patterns of experiences, for example, seem to be common among those who abuse alcohol and/or other drugs. Substance-abusing parents often have other serious issues which have affected their lives, especially if they grew up in families where substances were abused. For example, many women who enter substance abuse treatment programs report that they suffered physical, sexual, and/or emotional abuse as children. Other studies have shown that substance-abusing women also indicate that they have fewer friends and more intense feelings of loneliness than non-drug-abusing women. Additional factors that may influence an individual's use of alcohol and/or other drugs include pressure from peer groups during middle childhood, adolescence, and/or early adulthood; academic and/or learning difficulties; low self-esteem; and a cycle of adverse circumstances that brings about feelings of hopelessness.

    It is important to remember that not all persons who have experienced the events described above go on to develop problems with alcohol and/or other drug abuse. Regardless of their backgrounds, though, individuals who do become substance abusers share a common disorder that interferes with almost every aspect of their lives.

    Substance abuse is a problem that generally can be characterized by overriding need: the alcoholism or addiction becomes the most important ongoing element of the addicted individual's life. Alcohol dependency, for example, has been described as compulsion, loss of control, and a continued consumption of alcohol despite adverse consequences. The same applies for addiction to other drugs. A key feature of the disorder of addiction is denial. As a result, personal health, financial security, safety, and relationships with others all may be neglected as the substance abuser focuses on sustaining his or her habit.

The Prevalence of Substance Abuse in Families

    The prevalence of substance abuse among men and women of child-rearing age is very difficult to determine with any real accuracy. One reason for this is the fact that self-report by an individual who abuses alcohol and/or other drugs may be unreliable, for a variety of reasons. Users may be embarrassed about their substance abuse, in denial about the problem, and/or simply unable to remember the quantity or types of substances consumed during periods of intoxication. A further complicating factor is the fact that most persons who abuse drugs are polysubstance abusers (i.e., they use more than one drug), and the majority of drug abusers today include alcohol among the range of substances they use.

    However, some information has been collected. For instance, one study conducted between 1985 and 1988 indicated that approximately 25% of pregnant women and 55% of non-pregnant women surveyed reported some use of alcohol, with an average of 4.2 drinks per month for pregnant women and 8.7 for non-pregnant women. This report noted that women who were smokers, single, less educated, and younger reported the heaviest consumption of alcohol. With respect to other drugs, in 1990 it was estimated that five million women of childbearing age within the United States used cocaine. Again, exact figures are difficult to obtain.

    Figures regarding the number of alcohol- and other drug-affected infants who are born annually have presented even more challenges. One study estimated that over 7,000 children are born with Fetal Alcohol Syndrome each year, but this report did not address the numbers born with less pronounced effects related to their mothers' alcohol consumption during pregnancy. Reports of the number of infants born prenatally exposed to cocaine have ranged from 91,500 to 240,000 annually. However, these figures do not address prenatal exposure to heroin, methamphetamine, phencyclidine (PCP), and other substances of abuse.

The Impact of Substances of Abuse on Mental Status

    In addition to the background experiences that substance-abusing parents bring into the family environment, the various substances of abuse have an impact on the user's mental state. The following paragraphs provide a brief explanation of the more general effects of alcohol and other drugs.

    Given the behavioral effects of the commonly abused substances described above, it is clear that addiction to any of these drugs, either alone or in combination, is likely to affect an individual's ability to function in a responsible and thoughtful manner, especially as it may relate to the complexities of day-to-day responsive parenting.
 
IDENTIFYING ALCOHOL AND/OR OTHER DRUG USE

    The first step in determining a substance-abusing family's need for services is to identify the problem. Through careful observation of parents and children, Head Start staff can learn to better recognize a substance abuse problem within a family. Such opportunities for identification may occur throughout the family's involvement with the Head Start program and may take place during any of the following activities:

Observations of Parents:
Physical and Behavioral Indicators of Adult Substance Abuse

    The physical and behavioral indicators for specific substances of abuse have been described previously within this chapter. To summarize, physical signs and symptoms that are highiy suggestive of adult abuse of alcohol or other drugs include:

    In addition, there are more indirect indicators that may or may not be due to substance abuse but that should be evaluated because they may be associated with a wide variety of family problems, including substance abuse. These more general signs and symptoms include:     In assessing these more indirect indicators, Head Start staff need to identify the reasons why they are occurring in order to make appropriate referrals for needed services.

Observations of Children:
Physical and Behavioral Signs That May Indicate Parental Substance Abuse

    The first indication of parental substance abuse may be seen in the behavior or appearance of children. It is often the case that children whose parents abuse alcohol or other drugs may demonstrate a number of behaviors which indicate that they are under stress or may not be receiving the adequate nurturing. Such indicators include:

    Again, although these characteristics may be associated with parental substance abuse, they also may be related to a wide variety of other family problems. Each individual situation must be evaluated in order to determine how Head Start staff can best help the child and family.
 

SPECIAL SERVICES THAT HELP ADDRESS PARENTAL SUBSTANCE ABUSE

    Parents who abuse alcohol and/or other drugs may approach treatment with what appears to be a great deal of ambivalence. It is important to recognize that not all substance abusers are ready or willing to accept treatment even after they acknowledge their addiction. However, there may be many reasons for a parent's seeming resistance to seeking treatment. In some cases, a substance-abusing spouse or significant other may discourage a parent from pursuing sobriety. Some parents may be afraid of the consequences of this major lifestyle change (e.g., developing new, sober friendships; possibly moving to a different neighborhood; giving up the pleasurable aspects of intoxication; and facing life's challenges without that "crutch"). Other parents may fear failure after having made previous unsuccessful attempts at treatment.

    A critical reason why many women choose not to participate in treatment is the fear that they will have their children removed from the home. Frequently, treatment programs available may not be appropriate for the individual parent- for instance, many programs are set up to accommodate men and do not even accept women who have young children. They may not provide adequate and nurturing care for young children while the woman is in treatment. Finally, some communities lack substance abuse treatment programs altogether.

Pre-Treatment/Early Intervention

    Whatever a substance-abusing parent's situation may be, the pre-treatment phase is a significant one. During this time, many individuals may benefit from educational services that address the disorder of addiction. The effects of alcohol and other drugs on parental health, the fetus, and the family are described. Supportive and motivational group sessions can give substance abusers an opportunity to learn about their problem, discuss their feelings and fears regarding treatment in a non-threatening atmosphere, and learn that they are not alone. Pre-treatment discussions often help substance abusers more readily decide that they cannot deal with their problem alone and that they need a formal alcohol and/or other drug treatment program. Such pre-treatment services are increasingly being recognized by professionals as a sensitive means of encouraging substance-abusing parents to enter treatment voluntarily.

    Head Start programs offer activities and interactional opportunities with parents which are characteristic of a pre-treatment environment. Head Start staff have the kind of relationships with parents which encourage them to discuss their problems and needs. Head Start staff need training in how to encourage and support those specific interactional opportunities which will assist parents with substance abuse problems.

Treatment and Relapse

    Enrollment in a substance abuse treatment program is the next important step in recovery. However, it is important for Head Start staff to understand that relapse is a significant element of the recovery process. Further, the formal treatment program, even when it proceeds relatively smoothly, may take as many as nine to eighteen months. It may be useful for Head Start staff to discuss the recovery process with substance abuse treatment specialists in order to learn about the usual course of treatment, strategies that can help to prevent relapse, and signs and symptoms of relapse.

After-Care

    Following a parent's completion of an alcohol and/or other drug treatment program, they begin a period of after-care. Head Start staff should be aware that after-care is an important element of the recovery process, one that helps facilitate and support ongoing sobriety. Typically, after-care may involve attendance at self-help meetings (e.g., Alcoholics Anonymous, Narcotics Anonymous, or Cocaine Anonymous), as well as periodic individual, family, or group counseling. On a long-term basis, relapse prevention during the after-care phase also may include mental health counseling to help parents address underlying issues, such as sexual assault and/or incest, domestic violence, self-concept, sexual identity, behavior disturbances, and co-occurring mental health disorders.

    During the treatment and after-care phases of intervention, Head Start programs can work with treatment programs to provide a supportive and nurturing environment for parents and children at various stages of recovery.
 

SUMMARY: THE ROLE OF HEAD START STAFF

    Head Start staff can play a significant role in supporting substance-abusing families. As a community-based effort that is sensitive to cultural differences and has a family-centered focus, Head Start often is able to reach these families in a way that other programs cannot. By providing a consistent, safe, and nurturing environment for young children, Head Start staff make one of the most important contributions to substance-abusing families' overall well-being. The support network that Head Start staff offer to all families, including those affected by alcohol and/or other drug abuse, has been shown to have a positive impact on family health and child development.

II. Substance-Abusing Parents:
    CHARACTERISTICS OF PARENTS
    INVOLVED WITH ADDICTION

While many Head Start families are under stress and face a variety of problems which make them more vulnerable to substance abuse, the majority of Head Start families do not have problems with addiction. These families can best be supported by the basic Head Start strategies to strengthen families in their capacity to nurture their children, to help parents develop economic self sufficiency, and to assist parents with opportunities for personal development.

    However, it is likely that all Head Start programs have some families who are involved with addiction to alcohol or other drugs. Some Head Start programs may have significant numbers of families affected by this problem, as well as large numbers of families who live in neighborhoods where the economics of buying and selling drugs increases the violence and instability of these communities. Therefore all Head Start staff need to know about the problem of addiction, how to identify it, and how to support families in ways that help them to address it.

    Many substance-abusing parents are sincere in their desire to meet their children's needs, but they are limited in their ability to do so. Substance abuse can profoundly impact a parent's capacity to provide the consistent nurturing and hands-on care that children require in order to thrive. Head Start staff need to be aware of the nature of substance abuse and the unique characteristics and problems of parents who abuse alcohol and/or other drugs, so they can support services for families which are appropriate and adequate.

    Addiction is a problem that affects all aspects of an individual's personal and family life. Strategies for intervention, therefore, generally acknowledge three basic assumptions:

THE NATURE OF ADDICTION

    The impact of alcohol and other drug abuse varies widely from individual to individual. However, the following characteristics seem to be fairly universal, regardless of the drug or drugs of choice, and can help us to understand the nature of most chemical dependencies. By building upon this understanding, professionals will be better equipped to design realistic service plans that are more likely to be effective.

    Addiction is progressive. People do not set out to become addicts or alcoholics. First-time users universally resist the notion that they could ever become dependent on any chemical. It is with an accumulation of time and experience that the casual user becomes chemically dependent and that life can no longer be endured "clean and sober."

    Experimental Use. Early use is described as experimental. The user generally is motivated by curiosity or social pressure to try substances reputed to alter ways of thinking and feeling. Use during this phase is occasional, frequently unplanned, and involves little, if any, reorganization of lifestyle to accommodate it. Similarly, there may be no detectable deterioration in health, relationships, or ability to function as expected.

    Recurrent Use. Many users believe they can sustain a level of use that they consider to be "recreational." However this term is misleading. Because this type of use is both planned and more frequent than experimental use, increased amounts of time, thought, energy, and money go into the acts of "scoring" and using. Users never really have control of their behavior, although they believe they do. One's social life may revolve around getting high, and peer relationships often change accordingly. The costs, both economic and personal, escalate as the ability to function at school or work declines and mood swings become more prominent. Tolerance to the original drug of choice may develop, a problem remedied either by using larger amounts of the same drug or recourse to "harder" drugs that will produce a more intense experience. As solitary use tends to increase, an increased emphasis is placed on simply getting high, rather than on the social experience of "partying" with one's peers. The user becomes increasingly preoccupied with drug use and may turn to dealing or other criminal activity to support a growing dependency on more potent and expensive drugs. Deterioration in all significant areas of functioning occurs.

    Dependency. Dependency, or addiction, is said to exist when the user can no longer manage life without getting high. Use may occur continuously or in binges, but the substance plays such a central role in the individual's life that everything else tends to revolve around it. Whether the dependency is psychological or physiological, the effects that it has on health, finances, relationships, and emotional stability are profound. The user finds it increasingly difficult to perform even ordinary tasks, and judgement at this stage can be severely impaired.

    The onset of addiction is insidious. Chemical dependency sneaks up on the individual, and he or she is often not the best judge of his or her own addiction. The lines drawn by professionals to note phases of alcohol and other drug use are, in reality, blurred. Precisely when the user moves from one phase to the next depends upon many factors, including:

    A dependency can evolve over a long period of time (months, or even years) or, as many crack addicts report, it can occur over the course of a weekend.

    The ear!ier the person starts to use, the more likely that person is to become addicted. Although there certainly are exceptions to this rule, children who are introduced to alcohol or other drugs while still very young are generally more susceptible to heavier use and abuse than people whose experimentation begins at a later age.

    Anyone can become an addict. Addiction cuts across all racial, social, and economic lines. No one is immune. Although some individuals seem to have a higher threshold of addiction than others, exposure to the right substance of abuse under the right circum stances (times of stress, loss, pain, or boredom) has the potential to seduce anyone into a true addiction.

    Addiction is a family problem. Addiction is a problem which can be found across generations of families. Family behaviors and patterns of functioning are learned and passed on from parent to child. Children of drug-dependent and alcoholic parents may learn to cope with unpleasantness in their lives as their parents have done before them, by taking substances into the body to effect a change in mental status. In most cases, a seriously addicted family member profoundly affects the lives of all other family members, either because they suffer the consequences directly through lack of attention to basic needs, or indirectly through adjustments they make to endure the presence of the addicted family member.

    Denial is intrinsic to the problem of addiction. It is well known that the substance abuser generally denies that there is a problem or minimizes its extent, and that this denial can persist even unto death. It is less well known that the entire family, to protect its integrity and tenuous ability to function, often also denies the existence and impact of the addiction.

    Addiction is a systemic problem. Addiction affects every aspect of the user's physical, emotional, and social life. Health is affected, work and school are affected, and relationships are affected. With chronic abuse, no significant area of functioning remains untouched.

    Addiction often afflicts those who are already the most vulnerable and the least equipped to cope. Often those most severely impacted by substance abuse are persons who grew up in highiy vulnerable families who were not able to offer them the nurturing and protection they needed. Such individuals, who may already be struggling to cope with difficult stresses, are then even more vulnerable as a result of their drug use. Thus, they tend to come to treatment with many serious problems which require a wide range of services.

THE SUBSTANCE-ABUSING PARENT

    The preceding description of the nature of addiction provides a background for better understanding the characteristics and needs of substance-abusing parents. The following portrayal of characteristics of the "typical" parent who is addicted to alcohol or other drugs is intended to sensitize staff to the issues with which many parents struggle. While not all addicted parents will have all these characteristics, it is important for Head Start staff to consider them as possible indicators and to be sensitive to their presence in the lives of Head Start families.

Childhood Deprivation

    Many addicted or alcoholic parents report histories of significant childhood deprivation. Often, these histories include an early home life marked by family violence, parental substance abuse, or parental mental illness. Parents who grew up in such environments often report deprivation in many areas of their lives - economically, physically, socially, and emotionally.

    In families where early caregiving was inadequate, parents often were poorly nourished as children; they may not have been provided with necessary health care, and their educational and emotional needs may have been neglected. Thus, as adults and parents, such individuals often have numerous and chronic medical, dental, mental health, and educational problems that require attention. Developmental assessments, educational testing, and speech and other therapies that were needed and overlooked during childhood can result in serious deficits that last a lifetime.

    Many substance-abusing parents also describe growing up in households where there was a blurring of boundaries between parental and child roles. As young children, such parents often assumed primary responsibility for taking care of household and family needs. While this role reversal may have filled a void or need within the family, most likely it also seriously interfered with the timely acquisition of age-appropriate life skills and experiences. As adults, then, these individuals often have an impaired ability to form truly mutual adult relationships and a healthy self-concept, which are prerequisites to successful parenting.

    Parents who experienced childhood deprivation frequently also had emotional and safety needs that went unmet. Adults who grew up in such homes may have difficulty remembering occasions when warmth and affection were freely and consistently expressed. Parents often report feeling that their needs for comfort, reassurance, and support were met infrequently, if at all. During early childhood, their fears were often disregarded. When they were teenagers, their parents were often inattentive or incapable of maintaining the delicate balance between structure and freedom that adolescents need as they negotiate their way from childhood dependency to responsible adulthood.

    Finally, significant numbers of substance-abusing parents report histories of severe neglect, physical abuse, and/or sexual abuse during their childhood and teenage years. As adults, such parents are more likely to become involved in unhealthy and abusive relation ships. As one might predict, spousal abuse and domestic violence are, in fact, common occurrences in the lives of adults who seek treatment for alcohol and other drug dependency. Moreover, having grown up in homes where parenting was unpredictable and discipline often abusive, chemically dependent parents frequently are ill-equipped to provide effective parenting for their own children. The risk that they will perpetuate the cycle of abuse or neglect with their offspring is considerable.

Survival Needs

    Regardless of socioeconomic status, substance-abusing parents commonly have a range of basic unmet survival needs. While substance abuse among low-income parents often leads more quickly to impoverishment, even successfully employed parents may eventually find themselves homeless or on the brink of homelessness. As a result of their chemical dependency, many substance-abusing parents lack stable housing, food, clothing, and basic personal necessities for themselves and their children. They may live on the street, in temporary shelters, or in sub-standard housing. Furthermore, as noted above, chemically dependent parents also may have extensive and chronic medical problems that require immediate care and often long-term intervention. Often, such parents have little knowledge of how to locate and mobilize needed resources on their own behalf.

Mental Health Issues

    A significant percentage of adults who abuse alcohol and/or other drugs suffer from a psychiatric disorder of sufficient severity to require intervention. In some cases, this is an underlying condition - a depression, personality disorder, or psychotic illness that pre existed the chemical dependency and for which the drug and/or alcohol use was essentially an ill-advised attempt to self-medicate. In other cases, the psychiatric disorder may be the consequence of long-term addiction or alcoholism. In either case, it may profoundly impact the sufferer's ability to function, as well as to benefit from services offered to the family.

    As children, many substance-abusing parents experienced periods of parental absenteeism or even parental death. Many recall having been moved frequently from caregiver to caregiver. Such experiences of loss, inconsistency, and perceived abandonment can create feelings of anger, mistrust, low self-esteem, and confusion, which complicate relationships well into adulthood.

Denial

    It is virtually a given in the field of chemical dependency treatment that most clients, particularly those who are involuntary, will deny the extent of their substance abuse problem. Thus, the chemically dependent parent usually minimizes the problem, denies its impact upon the family, and resists treatment.

    Often, parents also will emphatically deny any alcohol or other drug use whatsoever. In cases of prenatal substance abuse, parents may explain that positive toxicology reports are lab errors or reflect a one-time lapse that occurred, unfortunately, just prior to delivery. At the time of assessment and sometimes well into the course of treatment, it is common place for both clients and families to deny the reality of a parent's devastating, long-term, polydrug history.

    Often, this denial is tenaciously held and not readily relinquished. Denial and resistance, however, need not be insurmountable obstacles to treatment. Staff need to understand the important role that these defenses have played in the lives of parents. With this realization, it is often possible to work through them to form a supportive and mutually respectful treatment alliance with the parent and the family.

    In summary, addiction affects every area of individual and family functioning. It can seriously impair judgement and limits users' ability to take care of themselves and their children. Where substance-abusing parents have histories of deprivation, inconsistency, or loss experienced during childhood years, they will need interventions which help them to change the patterns of family behavior that they learned and that they may be predisposed to pass on to their children.

THE TASKS OF PARENTING AND SUBSTANCE ABUSE

    Different types of families (e.g., traditional two-parent families, grandparent/grandchild families, single-parent families, step-families, adoptive families, and foster care families) are capable of assisting children to become competent and self-assured adults, as long as the caregivers assume primary responsibility for both the life support and socialization needs of family members. This can be accomplished in a variety of ways, depending upon family configuration, culture, and subculture. However, when one or both caregivers abuse alcohol and/or other drugs, basic parental responsibilities can be profoundly affected.

    Caregivers need to bring in a sufficient income and must manage it so that the family's basic economic needs are met. Substance-abusing caregivers may expend money on drugs or alcohol and fail to provide for their children's basic needs. Thus, they may not meet their children's nutritional, housing, and medical requirements because their addiction is their first priority. Parents who abuse alcohol and/or other drugs often care deeply about their children, but the special relationship they have with their drug(s) of choice can dominate family finances in a way that is detrimental to all family members.

    Caregivers must provide appropriate and consistent discipline so that children understand and internalize the rules of the family and of the culture. Again, this can be accomplished in a variety of ways, but it must be done in a manner that builds trust, cooperation, and self-assurance. Caregivers who themselves grew up in multi-problem homes often have no model of appropriate discipline and may unconsciously emulate their own parents. Consequently, they may use methods of instructing and controlling their children that inspire fear, anger, and rebellion.

    This learned pattern of inappropriate discipline may be further compounded by the effects of a caregiver's own alcohol or other drug use. In substance-abusing families, parental decisions about what is or is not acceptable behavior may vary from one moment to the next, as may judgement about what constitutes an appropriate parental response to certain behaviors. The dramatic mood swings that accompany use and withdrawal, as well as the profound, often chronic, psychiatric disorders that result from long-term substance abuse, can make it virtually impossible for chemically dependent caregivers to exercise good judgement and respond appropriately and consistently to their children's behaviors.

    Caregivers are responsible for dealing with community agencies and major social systems, and for making the decisions that affect the well-being of all family members. Children lack the experience and the legal authority to interact successfully with school systems, housing authorities, health care providers, and other community agencies. It is the caregiver's responsibility to interact with these systems, deciding when and how they need to be accessed in order for family needs to be met. However, substance-abusing caregivers often may be absent, either physically or psychologically, when needs arise. Consequently, many caregivers fail to obtain medical care or needed educational services for their children. They also may forfeit eligibility for low-cost housing, public assistance, vocational rehabilitation, and a range of other services that, if accessed, could greatly enhance the quality of life for all family members. When caregivers fail to accomplish these tasks for their children, tasks that children cannot accomplish for themselves, basic needs go unmet.

    Caregivers have the primary responsibility for home maintenance and house keeping. Although this is a responsibility that can and should be shared among family members, it ultimately falls to the caregivers to ensure that the home environment is both safe and clean. Substance-abusing caregivers often find it difficult to accomplish the tasks associated with running a household. Basic maintenance and housekeeping tasks are either neglected or left to young children who may lack the skills or motivation needed to accomplish them successfully. When bottles and dishes aren't washed, soiled diapers and garbage aren't disposed of properly, and plumbing isn't operable, then unsafe and unhealthy conditions exist for all family members. This may be further exacerbated by the housing conditions available to low-income families.

    Caregivers have the primary responsibility for child care. While this, again, is a task that can be shared, particularly within large families, the ultimate responsibility for seeing that children's needs are met resides with the caregivers. Although the "parentified" child in a substance-abusing family often does care for younger children, this child almost certainly lacks the judgement, experience, and maturity to care safely and properly for them over time. It is destructive for older children, as well as for younger siblings, if the responsi bility for child care is placed in children's hands.

    Caregivers must provide nurturing for one another and for their children. While loving and caring within families can and should flow freely in both directions between older and younger members, it is the responsibility of the caregivers to make sure that this nurturing is available. Sober and emotionally stable caregivers usually are able to defer their own emotional needs or surmount obstacles such as fatigue and ill health when their children need care and attention. However, substance-abusing parents often become so caught up in the cycle of addiction that they remain largely unaware of their children's basic needs. Children in such families often experience the pain, uncertainty, and loneliness that result from feeling a lack of caring and love.

    Caregivers are responsible for maintaining appropriate roles and boundaries within the family. In healthy families, it is clear to all members precisely who are the adults and who are the children, and who is in charge of whom. Unfortunately, in families where one or both caregivers is a substance abuser, roles and boundaries often are ill-defined. It is not at all unusual in such families to see a toddler ruling the roost with a heavy and tyranni cal hand. Sometimes, with boundaries so blurred and roles confused, it is possible to create family environments in which children become victims of incest.
 

IMPLICATIONS FOR INTERVENTION

    With an understanding of the nature of substance abuse, its impact on the life of the individual, and its effects on parenting, professionals are in a better position to develop comprehensive treatment strategies. The substance-abusing parent is a complex person with complex problems, not merely a drug addict or alcoholic who, if no longer using, can then be deemed a treatment success. In seeking to assist families involved with addiction, Head Start staff need to understand the intervention strategies with which they will be involved. Head Start programs cannot handle addiction problems alone, but must understand the larger picture of community services that are available.

    Returning to the three basic assumptions that underlie our understanding of addiction, we need to respect the power and tenacity of addiction, the central role that it plays in the substance-abusing parent's life, and the parent's attachment to it. It is unlikely that chemically dependent parents will be able to function effectively on behalf of themselves or their children unless they control their alcohol or other drug use. Intervention must address the parent's substance abuse problem with a full spectrum of appropriate services. We need to offer these services with optimism and with the encouragement that others, as severely impaired as they, have succeeded in becoming sober and drug-free.

    Remembering that addiction is not merely the problem of the individual, but that it affects the whole family, we need to involve the entire family in treatment to the fullest extent possible. Parents who abuse alcohol and/or other drugs, and who are often them selves the products of inter-generational substance abuse, present us with the opportunity to break a cycle of addiction, ineffective parenting, and abuse and neglect. By involving children as well as parents in treatment, we can offer children the opportunity to behave differently in their own lives and not repeat the mistakes their parents and grandparents have made.

    Bearing in mind that the substance-abusing parent has multiple, long-standing problems, it is critical that we offer a range of services that address needs which go far beyond substance abuse treatment. We must also respectfully take into consideration those problems that clients themselves feel are most urgently in need of remediation. This requires a comprehensive, cooperative, and creative use of an entire range of community resources. Treatment planning and subsequent intervention must be a collaborative effort.



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