supporting children of people with alcohol use disorder

for a child living with a parent experiencing alcoholism, being a kid may not feel like their main responsibility. 

“those children are living in a chronically emotionally stressful environment,” explained sis wenger, president and ceo of the national association for children of addiction (nacoa). even their home becomes an unknown environment they have to prepare for.

wenger said kids often feel pressured to make up excuses to avoid having their friends over. “what they’ve really got to do is go home and see if mom is drunk or sober,” she explained.

“approximately 28 million children in the united states have a parent with alcohol use disorder (aud), according to the american addiction centers.”

approximately 28 million children in the united states have a parent with alcohol use disorder (aud), according to the american addiction centers. aud is a chronic brain disorder that impairs a person’s ability to stop drinking, despite the negative physical or social repercussions they experience.

the national institute on alcohol abuse and alcoholism reports that aud can range from mild to severe and is characterized by a number of potential criteria, including experiencing cravings for alcohol or withdrawal symptoms when the effects of alcohol wear off.

but alcoholism does not just affect the individual. it interferes with a parent’s ability to safely care for their children, and it interferes with a child’s ability to experience childhood.

living with a parent experiencing alcohol use disorder is commonly accompanied by feelings of shame, guilt, anger, fear and sadness. as wenger said, these children (often referred to as coas or “children of alcoholics”) live under chronic stress.

that stress can manifest differently from family to family, even among children in the same family. for example, children of alcoholics are more likely to perform poorly in school. the american academy of child and adolescent psychiatry adds that children of alcoholics can be prone to risk-taking behaviors and aggression toward other children. 

however, some children can also feel an immense sense of responsibility—whether to play the role of the parent in the household or to maintain the family’s external image. wenger describes this as the “hero child,” one who gets good grades, participates in extracurricular activities and generally overachieves to compensate for the problems they know exist at home.

short-term

• feelings of shame, guilt, anger, fear and sadness
• chronic stress
• poor school performance
• risk-taking behavior and aggression
• sense of overwhelming responsibility

long-term

• higher rates of adverse health outcomes like obesity and cancer
• more likely to experience depression and alcohol use disorder
• more at risk of experiencing multiple other adverse childhood experiences

growing up with addiction in the household is an example of an adverse childhood experience (ace) that can lead to long-term health risk behaviors and diseases. aces, which also include divorce and abuse, were first studied by the centers for disease control and prevention and kaiser permanente in 1995. broadly, aces are associated with negative outcomes like obesity, diabetes, and smoking later in life. 

“in a 2002 study in psychiatric services, researchers found that children of alcoholic parents are significantly more at risk of experiencing nine particular aces than other children.”

in a 2002 study in psychiatric services, researchers found that children of alcoholic parents are significantly more at risk of experiencing nine particular aces than other children. the same research showed that experiencing more aces is associated with higher rates of depression and alcohol use disorder. there is also a hereditary component to alcoholism; research shows that genetics account for about half of an individual’s risk of developing alcohol use disorder.

additionally, daughters of people with alcohol use disorder are more than twice as likely to marry someone with aud, according to a 2009 paper in the american journal of drug and alcohol abuse.

despite the serious effects a parent’s aud can have on their families, much of their recovery is out of other people’s influence. “regardless of what our loved one is doing, we can’t control them. the only thing that we have control over is ourselves,” said cynthia galaviz-olivas, children’s program supervisor at the hazelden betty ford foundation.

if you are the child of someone with aud, you may be feeling…

who do you want to share your story with?

galaviz-olivas said it’s common to feel like other families or kids don’t have to deal with a parent’s drinking, or one who is away in recovery. but whether you see it or not, there are other kids experiencing the same problems.

there are people who work every day to help kids like you. there are also people who dedicate their lives to helping people like your parent overcome their disease.

it can be scary to talk about your thoughts with other people. sometimes, you can feel like you’re betraying your parent. but what’s happening is a part of your story, too. 

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look for someone to talk to.

think about people who make you feel safe. that might not be the same for everyone. wenger said it’s often a family member, like a parent, grandparent or aunt. but it could also be someone in your school, like a teacher or guidance counselor, or someone else like a coach or neighbor.

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ask for help.

a parent or teacher can connect you with a licensed therapist or help you find programs to spend time with other kids experiencing the same problems.

one of the things counselors teach kids at the children’s program is self-care—things you can do to focus on your own health and feelings. galaviz-olivas talks about five main areas of self-care.

take a look at the examples below and try and think of some ways you can practice self-care every day. they don’t have to be big or life-changing — just focus on small, achievable tasks.

parents, family members, educators and other loved ones may also be in a position to help coas. if you know a child in this situation, you may be feeling…

the temptation to hide information from children, as a means of protecting them, is common. but both wenger and galaviz-olivas said that it’s futile—children see what’s going on, even if they don’t have the context or the language to talk about it.

use the ‘backpack’ analogy.

galaviz-olivas compares the burden of secrecy to a backpack. we start filling it when we are young, with our feelings and problems, and carry it around. however, we’re rarely told what to do with it, and eventually the bag becomes too heavy. this is when people can turn to drugs and alcohol to help the backpack feel lighter.

when kids hear that analogy, they start to understand what’s in their own backpack, says galaviz-olivas. they realize, “‘wow, i’m carrying a bag around like that, too. i’m not using drugs and alcohol, but it is starting to get heavy because i’m not talking about it, or i don’t want to talk about it because i don’t want to get my parent in trouble,’” she said. 

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lead the conversation.

that’s why it can be beneficial to lead these conversations with kids. talking about a parent’s aud can not only reduce feelings of guilt, shame or confusion, but it can also provide children with an outlet to get the support they need. as galaviz-olivas explains, “you want to keep your bag light.”

when you do choose to talk to a child about parental alcoholism, understand that the way you describe it will affect their perception of not just the disease, but their parent. “the language needs to separate the disease from the person so that they can still hope and love that person even if the person is currently sick in the disease,” wenger said.

practice using language that the child can understand with terms they will recognize. experts also recommend emphasizing that the child’s role is not to help fix the parent.

instead of

“substance use disorder” or “alcohol use disorder”

“addicted”

“here’s how you can help.” or “what you need to do is…”

“it’s not other people’s business.” or “this is a family secret.”

“you’ll probably have the same thing happen to you.” or “alcoholism is unavoidable.”

“we don’t know why this happens.” or “it’s because mom or dad is stressed out.”

try

“disease”

“trapped” or “stuck”

“it’s not your responsibility.” or “your job is to be a kid.”

“i am here to talk about it.” or “i can help you find someone to talk to.”

“you can make different choices.” or “you have options.”

“this is never your fault.”

experts emphasized the importance of children having a safe place and person they can turn to. for many, it’s someone with prior knowledge of the situation at home, like a grandparent. but a safe space can also be a friend’s house, an after-school club or a teacher’s classroom.

what does a safe person look like? galaviz-olivas said there are a few commonalities when they ask children:

respect:  someone who doesn’t push the child to talk about things before they are comfortable or when they don’t want to.

privacy:  someone who does not share the child’s story with others and who they can build trust with.

validation:  someone who listens without correcting the details of the child’s experience or editing their feelings.

a parent or guardian may want to play that role instead of someone else, but galaviz-olivas recommends letting the child choose while continuing to practice the “rules” above.

this article is for informational purposes. if you or someone you know is struggling with addiction or struggling with mental health issues related to an addiction, reach out to a health or mental health care provider for assistance. and learn more about the role of social workers in helping families navigate these challenging issues. 

this article was published in september 2020.