Abstract
When a family member suffers from a substance abuse disorder, the entire family is impacted. To help the affected persons, the practitioners have to learn about SUDs from one’s family history, including how the condition develops, how it is sustained, and what treatment options are available. Family systems theory and attachment theory provide a theoretical framework for examining the impact of SUDs on families. Furthermore, knowing a family’s current stage of development aids in the evaluation of impairment and the selection of appropriate therapies. In children and adults, SUDs can profoundly affect their emotional and behavioral patterns from the time they are born.
Substance use Disorder
Substance use disorder (SUD) is the inability to regulate an individual’s use of alcohol or drugs (or both), which can cause problems such as health problems and a lack of capacity to fulfill duties at home, school, or work. Children can suffer due to their parents’ substance misuse and SUD situations. It is more common for the children of SUD parents to have a lower socioeconomic status and greater difficulties in academic and social contexts, and difficulties in their families’ functioning. When one or both parents have a substance use disorder, their children are at risk for both direct and indirect effects, including abuse or neglect by the parent(s) and reduced financial resources in the home (Lander et al., 2013). The negative effects of a parent’s SUD can differ depending on the type of SUD the parent has, as shown in prior studies. Policymakers can use data on the number of children whose parents suffer from a substance use disorder to develop focused prevention and outreach programs. According to the Surveys on Drug Use and Health, a growing proportion of children under the age of 17 who have a parent who has a substance use disorder, alcoholism, or an illicit drug problem, according to the Surveys on Drug Use and Health, are at greater risk of developing a substance themselves.
Theories
Some theories are critical in understanding how SUDs affect families, including attachment and family system theories.
Attachment Theory
Attachment theory involves the study of quality and family relationships. According to John Bowlby, the fundamental bond developed at a baby’s birth is a template for all subsequent interactions throughout the life cycle. Through the interaction, infants develop paralanguage skills such as communicating and relating to their environment (Lander et al., 2013). This can be accomplished through various methods, including crying, cooing, rooting, and grasping. The primary caregiver’s response to these cues will affect the degree of the child’s attachment. If the caregiver is seen as responsive and caring, a strong link is developed between the child and the caregiver. An insecure attachment may form if the child perceives the primary caregiver as inattentive or inconsistently responding, which can cause anxiety, depression, and other problems. Parents with SUD, Depressed, high, or recuperating from the effects of drugs or alcohol may lose the potential to develop healthy bonds with their children. Eye contact, tone, volume, the rhythm of the voice, calming touch, and the capacity to interpret the baby’s needs are the building blocks of attachment. People with healthy attachments are like a body’s natural defense mechanism. Just as individuals require a physical immune system to fight disease and illness, the relational attachment system protects against mental diseases. Trauma, anxiety, and depression are more common in children and adolescents who don’t have a solid social support network. According to the attachment theory, a parent’s childhood attachment system influences their ability to form healthy relationships with their children and other individuals.
Family System Theory
General system theory served as a foundation for developing Family System theory. In general systems theory, it is important to understand how the components of a system work together. Two of the most important concepts in both theories are feedback, homeostasis, and boundary conditions. Every family therapy approach is founded on the basic tenet of family systems theory, which holds that a person cannot be fully understood or effectively treated without first understanding their family system. Family members’ ability to maintain a stable state of homeostasis is critical to understanding how SUDs affect their families, even when it is detrimental to specific individuals. It is common for children to try to hide that their parents are drinking by cleaning up after them, getting them into bed after they pass out, and keeping their drinking to themselves. SUD is allowed to continue as long as there are no conflicts between mother and father, which keeps the family system in balance. As beneficial as it may be to the family, this adaptation serves to amplify the problem. Feedback is a term used to describe the circular process in which parts of a system communicate with each other. Attachment between a parent and kid is formed due to both parties receiving and giving feedback. Boundaries define internal and external limitations, which are protective barriers to conserving energy. With a SUD parent, the boundaries between the parental and kid systems are typically porous, making it difficult to maintain a stable family environment. Boundaries around the family are stringent to keep the substance abuse secret. A family’s and a child’s growth can only be maximized with well-defined boundaries.
Impact of parental substance misuse
Neglect
SUD parents struggle to stay organized and support their children and keep their home and family clean and attend to the physical requirements of both the parent and their children. The children’s health and safety are jeopardized as they might not be able to cater to their basic needs like food and clothing and protect them against dangerous things like needles and syringes (NSPCC, 2021). In the event of a parent’s incapacitation due to drug or alcohol abuse, their children may be left alone with no other responsible adult to provide for their needs and ensure their safety.
Emotional abuse
Parents who abuse alcohol or drugs may become emotionally unavailable to their children. A mother addicted to drugs may be less attentive to her children, less keen to participate in meaningful play, and less able to respond in ways that encourage more interaction with their children. Children may be scared by their parents’ irrationality, unpredictability, or seclusion if they have parents abusing drugs or alcohol.
Physical abuse
It might be difficult for parents to control their emotions when they are under the influence. Children are physically abused by their parents because of excessive and dangerous drinking or substance use.
Impact on brain development
Childhood trauma, including abuse and neglect, can hurt a child’s brain development. Affective childhood experiences encompass these types of experiences. Children’s brains are permanently altered by abuse and neglect, and these consequences can endure well into adulthood. There are a variety of negative outcomes that could occur as a result of a weakened immune system, including impaired cognitive development, such as a loss of self-control and learning disabilities.
Involvement in illegal conduct
Parents and caregivers who abuse drugs or alcohol may turn to criminal behavior to fund their habit. This may entail bringing their children into contact with potentially harmful individuals or forcing them to participate in criminal activity (NSPCC, 2021).
Other effects.
The impact of a parent’s substance abuse depends on the child’s health, stage of development, character, and family relationship, which is different for each child.
A child being taken into care by welfare, parental imprisonment, or parental hospitalization due to drug abuse or excessive consumption of alcohol can cause children to be isolated from them for short or long periods. As a result of their situation, they may find themselves taking on the role of the family caregiver, cleaning the house, preparing meals, and taking care of younger siblings.
Psychological effects
ChildLine is frequently contacted by young people concerned or psychologically affected by their parents’ drug misuse.
Some other psychological effects include preoccupation with their parent’s substance abuse, taking the blame for their parents’ conduct, inability to attend school regularly and poor academic performance, challenges forming and maintaining positive relationships, and the development of behavioral, emotional, and cognitive problems.
Risk and vulnerability factors
Every now and then, a family runs into problems. This does not indicate, however, that children are more prone to abuse. To make matters worse, parents may find it more difficult to cope, especially when they are on their own or have no help. Families with a history of adversity tend to have more vulnerable children. Children who have one or both of their parents engaged in domestic violence, addictions, mental illness, or learning difficulties are at risk of experiencing abuse and neglect.
Ethical Issues
Beneficence
Therapeutic intent, or beneficence, is the foundation of medical knowledge, training, and practice. A patient’s ability to understand the connections between physiologic dysfunction and behavior and the physical and psychological ramifications of each is a key factor in fostering behavioral change in the patient-physician interaction. The Centers for Disease Control and Prevention recommends that all patients are asked about their alcohol and substance use regularly and in plain language (OCOG Clinical, 2015). Routine screening for substance misuse can be accomplished by using validated questionnaires or one-on-one interviews with patients. Testing of biological samples in the laboratory is not required regularly. Alcohol and substance addiction disorders can be assessed using evidence-based screening approaches. For the most efficient and effective screening, non-physician members of the health care team should be taught about screening and how to treat women who have positive screening results.
Nonmaleficence
Individuals suffering from substance abuse problems should be treated with nonmaleficence, the commitment to preventing or not imposing damage, especially harms of omission in mind. Uninformed doctors may miss diagnoses, prescribe harmful prescription combinations, or have psychological effects when unaware of a patient’s drug use. When substance usage is seen as more personal failing than a health issue, patients may suffer the consequences. Female addicts are more likely to be stigmatized and branded hopeless than male addicts. Forcing change by humiliating people is immoral and unprofessional, and it serves as a stumbling block to rehabilitation. In their role as team leaders, physicians should show compassion and understanding rather than condemnation when caring for patients with substance use disorders.
Justice
In the medical profession, the concept of justice drives equal access to care, equitable allocation of resources, and nondiscriminatory medical practices. Regardless of their age, gender or ethnicity, all people should be checked for substance abuse regularly (OCOG Clinical, 2015). Since women are less likely to be tested or referred for substance use disorder treatment, their impairment, and health status burden increase. If you’ve ever been punished for a substance abuse disorder, you’ll know that punishment isn’t applied equitably across the board.
Preventive education and treatment referrals are required by law for all patients with a substance use disorder. In the absence of evidence-based methods for diagnosing and treating substance use disorder, a patient’s access to health care services and resources is limited. As with any chronic medical condition, physicians should counsel their patients with substance use disorder and refer them to an appropriate treatment option when available, even if the likelihood of response to treatment is low. To properly educate and refer patients, obstetricians and gynecologists must be well-versed in the available community resources.
Recommendations
Individuals with SUDs can’t be understood or treated correctly unless the entire family is considered. Everyone influences and is influenced by their social environment. One of the most important aspects of long-term treatment for SUDs is how it is developed and maintained within a family context. Everyone in the family benefits when we can intervene early in developing a SUD.
References
Lander, L., Howsare, J., & Byrne, M. (2013). The Impact of Substance Use Disorders on Families and Children: From Theory to Practice. Social Work in Public Health, 28(3-4), 194–205. https://doi.org/10.1080/19371918.2013.759005
NSPCC. (2021, June 3). Parental substance misuse. NSPCC Learning. https://learning.nspcc.org.uk/children-and-families-at-risk/parental-substance-misuse#article-top
OCOG Clinical. (2015). Alcohol Abuse and Other Substance Use Disorders. Acog.org. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/06/alcohol-abuse-and-other-substance-use-disorders-ethical-issues-in-obstetric-and-gynecologic-practice
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