1. Substance Abuse & the Family
Tara Shepherd, MA, CAS
Deputy Director, Behavioral Health
Modoc County Health Services
Alcohol & Drug Services

2. Substance Abuse & Babies
 When a pregnant woman drinks alcohol, the
blood vessels going from the mother to the
baby get smaller.
 So, the baby doesn’t get enough food, water
& oxygen.
 This can slow the baby’s growth &
development.

3. What Can Alcohol Do to the
Unborn Baby?
 Miscarriage – the baby dies before it can live
outside the mother’s womb
 Stillbirth -- the baby is born dead
 Birth defects – alcohol use during pregnancy
is the leading cause of preventable birth
defects

4. Drinking During Pregnancy
May Cause the Baby to have:
 Low birth weight; increased risk for SIDS
 Facial problems – thin upper lip, short nose,
flattened or missing bridge of the nose
 Eye problems – small eyes, short eye-
openings, drooping eyelids
 Vision problems – cross-eyed or near-sighted

5. More Harm to Baby from
Drinking During Pregnancy
 Liver, kidney, heart problems
 Brain damage
 Learning & reasoning problems
 Feeding & sleeping problems
 Restlessness & irritability
 Long-term behavior problems

6. Effects of Mother’s Use of
Marijuana During Pregnancy
 Effects on baby of mother’s marijuana use –
• Altered responses to visual stimuli,
tremulousness & high pitched crying
(possible neurological problems)
• Increased risk of infection
• Low birth weight
• Increased risk of SIDS

7. More Effects of Mother’s Use of
Marijuana During Pregnancy
 Effects on toddlers and older children
• Increased nighttime arousal & more awake time
(3 year olds)
• Difficulties with problem solving, attention span,
memory, abstract & visual reasoning & impulsivity
in school-age children
• Psychological problems, including depression
symptoms at age 10

8. Effects on Baby When Mother
Uses Speed While Pregnant
 Low birth weight
 Increased risk of SIDS
 Small head and brain
 Heart defects
 Behavior problems

9. Effects on Baby When Mother
Uses Tobacco While Pregnant
 Stillbirth
 Low birth weight
 Increased risk of SIDS
 Small body

10. What Else Happens
to These Children?
 Children who are prenatally exposed to
alcohol or other drugs are 2 to 3 times more
likely to be abused than are other children.
WHY ???

11. Children in Homes With
Parental Substance Abuse
 Nearly 30 million children in the U.S. live in
alcoholic households
 14 million children in the U.S. live with a
parent who has used illegal drugs in the past
year

12. When Parents Abuse Substances…
 Interferes with the development of that
special bond between mother and baby
 Interferes with a parent’s mental functioning,
judgment, and capacity to protect the child
 Interferes with a parent’s ability to respond
consistently & sensitively to a child

13. Parental Substance Abuse
 Leaves the parent emotionally and physically
unavailable to a child
 Lowers a parent’s threshold of aggression
toward children
 Lowers a parent’s ability to set and maintain
clear and appropriate boundaries with
children

14. Parental Substance Abuse,
cont.
 Parent may spend household money needed
for food, clothing, and other needs on
alcohol and other drugs
 May result in being associated with criminal
activity that might jeopardize a child’s health
and safety
 Leads to neglect of a child’s routine health
care needs

15. Help is Available
 If you, or someone you know needs help,
contact Modoc County Behavioral Health
(233-6312) and ask to schedule an alcohol
and drug assessment appointment with a
counselor (2 hour appointment).
 If it is the parent of a child 0-5, services are
free with enrollment in Health Beginnings,
otherwise fees on a sliding scale.

16. Addiction
 Addiction is a chronic brain disease.
 Treatment is available.
 Treatment works.
 Treatment compliance and relapse rates are
similar for addiction and other chronic
diseases (like diabetes, asthma, hypertension).

17. Children …
Parental Substance Abuse
Children raised in homes with parental
substance abuse are more likely to:
• Develop anxiety and depression
• Have problems in school
• Act out aggressively
• Become addicted to alcohol & other drugs

18. Substance Abuse & Violence
in the Home
 72% of women surveyed in women’s shelters
reported partners with drinking problems
 Sibling physical abuse is more common in
families with parental substance abuse
 Daughters of alcoholics are twice as likely as
other girls to be victims of incest

19. GROWING UP with
Parental Substance Abuse
Children experience trauma & pain from their
parents’ words and attitudes, which results in:
* children miss important parenting designed to
prepare them for adulthood.
* children miss parts of their childhood when
forced (by the absence of parenting) to adopt
certain roles which help them survive in the
family.

20. Roles Assumed by Children of
Parents Who Abuse Substances
Sometimes, Chief Enabler
Family Hero
Scapegoat
Lost Child
Mascot

21. A Parent Suffering from the
Disease of Addiction
 Experiences pain and shame, but may not see it
as a result of excessive alcohol or drug use
 Experiences feelings of guilt, inadequacy, fear
and loneliness
 Inappropriate defenses to hide shame & guilt:
irrational anger, hostility & depression
 Project blame onto others, including family who
take on unhealthy roles in order to survive

22. Chief Enabler
 Usually the spouse, but sometimes an older
child
 Enabling is anything that protects the
chemically dependent person from the
consequences of their behavior
 Becomes so obsessive about the addict’s
behavior, they lose perspective on own lives

23. Chief Enabler, continued
 If spouse, may try to stay connected to their
partner by drinking or using with them
 Usually a combination of controlling &
enabling behaviors
 Often have feelings of anger, depression, fear
and loneliness

24. The Family Hero
 Usually the oldest child
 Over-responsible & over-achiever
 Gets self-worth by being “special”
 Family reassured it is doing well by getting
pride and self-esteem from the achievements
of the hero

25. Hero, continued
 As things get worse, driven to higher and
higher levels of achievement in order to keep
the family together
 Achievement cannot remove the Hero’s
inner feelings of inadequacy, guilt, fear, pain
and confusion
 At risk of psychological abuse from playing
the role of parent to younger siblings

26. Heroes … as Adults
 When grown, heroes are often rigid,
controlling & judgmental (of self & others)
 Compulsive & driven; perfectionists
 “Outside” success, but cut off from their
inner emotional lives
 Deep inside still feel inadequate & insecure

27. Recommended Adult Behaviors
with Family Hero Children
 Give attention when not achieving
 Validate the child’s intrinsic worth & try to
separate feeling worthy from achievement
 Let the child know it is okay to make
mistakes
 Avoid letting the child take on parental
responsibilities

28. The Scapegoat
 Frequently the second-born child
 Acts out the tension and anger the family
ignores
 Gets attention negatively
 Provides distraction from the real issue of the
parent’s substance abuse

29. Scapegoat, continued
 Everyone can pretend the real issue is the
scapegoat
 Family is often ashamed of the scapegoat
 Poor school performance, use of alcohol and
other drugs, promiscuous sexuality, criminal
activity
 Makes strong peer alliances, but relationships
tend to be shallow

30. Scapegoat, continued
 The most emotionally honest child in the family
 Usually very sensitive & caring, so they feel
tremendous hurt
 Feelings of self-hatred; self-destructive
 May lose touch with inner potential & sense of
morality
 Often at risk of physical abuse

31. Recommended Adult Behaviors
with Scapegoat Children
 Let them know when behavior is not
appropriate
 Give positive attention when the child’s
behavior is appropriate & responsible
 Set limits
 Give clear explanations & choices

32. More for Adults with
Scapegoat Children
 Attempt to develop empathy and
understanding, rather than respond with
anger
 Avoid taking the child’s behavior personally,
as a sign of one’s own incompetence as a
parent, mentor, teacher, etc.

33. The Lost Child
 Receives reinforcement or reward for
causing no problems
 Often shy and isolated
 Inwardly, feels like an outsider in the family,
ignored by parents and siblings
 Feels lonely

34. Lost Child, continued
 Seeks privacy of his/her own company to be
away from the family chaos
 Hides their hurt & pain
 Attempts to self-nurture by losing themselves
in the solitary world of short-term pleasure,
like excessive TV, reading, music, drugs,
eating, and fantasy

35. Lost child, continued
 Prone to getting sick, asthma, allergies or
bedwetting – perhaps the only way to receive
attention
 At risk for sexual abuse – isolated, therefore
vulnerable
 Poor communication skills, difficulties with
intimacy or forming relationships

36. Recommended Adult Behaviors
with the Lost Child
 Point out and encourage the child’s
strengths, talents & creativity
 Try to pick out their particular interests, and
often they will talk
 Help the child to be in relationships with
other children

37. More for Adults with
Lost Child Children
 Do not let other children take care of the
child by talking or answering for him/her
 Avoid letting the child remain silent
 Call upon the child to join in
 Use touch slowly

38. The Mascot
 Often the last born child
 Each child has more difficulty getting the
parents’ attention because energy and
attention is taken by the addicted parent
 The mascot gets attention through humor,
charm, zaniness, and hyperactivity

39. Mascot, continued
 “Class clown”
 Takes responsibility for emotional well-
being of the family by relieving tension and
stress that everyone else ignores
 Provides distraction from real issues
 Works hard at getting attention and making
people laugh

40. Mascot, continued
 Humor hides inner painful feelings
 Feels lonely knowing no one knows the real
person behind the clown mask
 Anxiety, depression and fear
 Immature behavior patterns that may persist
into adulthood

41. Mascot, continued
 Difficulty concentrating
 May develop learning disabilities
 At risk of physical abuse
 Inability to cope with fear, depression &
anxiety may lead them to think they are
going crazy

42. Recommended Adult Behaviors
with Mascot Children
 Do not encourage inappropriate displays of humor
 Give appropriate chores with some importance and
responsibility
 Insist on eye contact
 Encourage appropriate humor
 Remember the underlying fear and depression
masked by the humor

43. The Only Child
 May take on parts of all roles
 May play all roles at the same time, or
alternately
 Pain and confusion intensified because of the
confusion of roles – “Who am I?”

44. Some thoughts about all roles…
 The longer a person plays a role, the more
rigidly fixed he or she becomes in it
 Eventually, family members see their roles as
necessary for survival
 Then, they play those roles with the same
compulsion, delusion and denial as the addict
plays the role of drinker or drug user

45. The Adult Child
 It is hoped that adults who assumed one or
more of these family survival roles as
children eventually realize they have a
choice
 They can remain victims of the past, or they
can make the decision to work through their
issues and free themselves to lead happier,
healthier lives

46. Remember . . .
Help is available.
Modoc County Behavioral Health
233-6312

47. Thank You!
Tara Shepherd
tarashepherd@co.modoc.ca.us