1. The Impact of Being Raised by a Caregiver with Substance Abuse and/or Mental Illness on Overall Health and the Implementation of Prevention and Intervention Methods through Social Work Practice to Improve Health Outcomes
Maddison M. Campbell
GRC Master of Social Work Program
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Abstract
Substance abuse and mental illness are prevalent conditions in the United States as one fourth of all U.S. adults experience some form of mental illness while one in twelve adults suffer from addiction. The behaviors and functioning of individuals living with mental illness or substance dependence can potentially impact the overall health of their children in both the short and long-term. This paper explores the health consequences of being raised by a caregiver with mental health and/or substance abuse issues, and identifies the risk and protective factors for various health outcomes. The effectiveness of social work prevention and intervention methods in improving health outcomes with this population are also examined and evaluated.
Introduction
Health Consequences
-Approximately one fourth or twenty-five percent of adults in the U.S. have a mental illness. (Reeves et al., 2011), and one in twelve adults currently have a substance use disorder (American Psychiatric Association, 2015).
-Mental illness involves significant changes in thinking, emotion, and/or behavior; and is associated with distress and problems functioning in social life, work, or family activities (American Psychiatric Association, 2015).
-Substance abuse changes the brain and is associated with health problems, failure to complete major tasks at work, school or home; discord with family members and friends; and social, work or leisure activities are given up or cut back because of substance use. It is the leading cause of preventable illnesses and premature death in the United States (American Psychiatric Association, 2017).
-Mental illness and substance abuse are often co-occurring, and the interaction between the conditions can worsen the course of both (National Institute on Drug Abuse, 2011).
-There are many children whose parents deal with these conditions. These children are often raised in households where they are exposed to discord, dysfunction, and negative environments due to parental mental illness and/or substance abuse, which can lead to significant negative health outcomes for the child.
-Risk for developing psychosocial development problems and poor psychosocial functioning. Approximately 33 to 40 percent of all children with a substance-using parent will develop a substance use disorder themselves (Broning et al., 2012; Conners-Burrow et al., 2015; Van Loon et al., 2015, p. 778; Wlodarczyk et al., 2017, p. 2).
-Risk of suicide attempts, sexually transmitted infections, and risky sexual behavior (Wlodarczyk et al., 2017, p. 2).
-Unfavorable family environment (strained relationships, family conflict, lack of communication, absence of supportive parenting and structure/discipline, poor home management, physical violence, emotional abuse, neglect, isolation, financial strain, frequent moves) are a risk to overall health for the child (Broning et al., 2012, p. 2; Johnson & Leff, 1999).
-Increased risk for externalizing and internalizing problems such as anxiety disorders and depression, social behavior disorders, or hyperactivity disorders (Broning et al., 2012).
-Deficits in interpersonal relationships and communication skills (Harrington & Metzler, 1997, p. 103).
-Higher rates of poor academic function, relationship problems, antisocial personality traits, susceptibility to illness (Johnson & Leff, 1999; Melchert, 2000, p. 64).
Prevention and Interventions Through Social Work Practice
Direct Treatment of Addiction and Mental Illness for the Effected Parent
-Comprehensive evidence-based behavioral therapies that treat addiction, mental illness, or both; which are to be run by qualified social workers or other trained professionals (National Institute of Drug Abuse, 2011).
-Medication assistance that alleviates mental illness/addiction symptoms, to be combined with behavior therapy.
-Behavioral health settings should implement screening tools and assessments that recognize the co-occurrence of the two disorders during the intake process and connect clients with the proper course of treatment that addresses both mental health and substance abuse if co-occurrence is found, either through the agency or through referral to other resources in the community.
Individual Interventions for the Effected Child
-Active coping strategies that deal with the stressor directly, such as confronting the problem, are typically related to positive outcomes. Prevention programs that educate children and adolescents about various active coping strategies and skills that they can use to deal with the problems and stressors in their lives.
-Enhancing self-esteem would be another important aim of a prevention program, as it has been shown that high levels of self-esteem have been associated with positive mental health (Van Loon et al., 2015, p. 779).
-There has been an association found between child access to another supportive caregiver and decreased levels of children’s internalizing and externalizing behaviors. Service providers should focus on accessing identified social supports in the child’s life in order to promote better child outcomes (Miller et al., 2014, p. 451).
-Peer group programs (mainly school-based) that draw on the effects of positive peer influence and mutual support (Broning et al., 2012, p. 2).
-A strengths-based empowerment approach that promotes resilience should be included in prevention and interventions that promote mental health in children (Van Loon et al., 2015, p. 778).
-Using psychoeducation to inform children of substance abusers of their potential tendency towards substance abuse and other addictive behaviors (National Institute of Drug Abuse, 2016).
Family Interventions for Parental Substance Abuse and/or Mental Illness
-Effective family interventions for this population would include a focus on parent-child communication, improving family dynamics, and increasing supportive parenting (Broning et al., 2012, p. 2; Van Loon et al., 2015, p. 795) through family therapy or general parenting programs.
Theoretical Orientation
Family Systems Theory (FST)
-Families are circular systems that may become dysfunctional, but can return to a healthier state of functioning (homeostasis). --Altering communication patterns and interactions, boundaries, and restructuring family roles and subsystems is the way in which family systems can return to homeostasis (Sutphin, Mcdonough, & Schrenkel, 2013, p. 502).
-Individuals are dependent on informal systems (families), formal systems (communities, neighborhoods), and societal systems (schools, government) (Sutphin, Mcdonough, & Schrenkel, 2013, p. 502).
-Families are influenced by the larger systems they are a part of (Sutphin, Mcdonough, & Schrenkel, 2013, p. 502).
-A whole family should be treated along with the family member who is experiencing difficulties.
Risk and Protective Factors
Risk Factors
-Environmental (socioeconomic status), biological (genetic predisposition), psychological (low self-esteem) (Johnson & Leff, 1999), lack of social support (Miller et al., 2014, p. 437), low family cohesion, lack of ability to express emotions, and high family conflict (Van Loon et al., 2015, p. 780).
Protective Factors
-Active coping skills, high self-esteem (Van Loon et al., 2015, p. 779), secure attachment, positive parent-child relationship, consistent parenting, parental support, emotional availability (Wlodarczyk et al., 2017, p. 2), and social supports (Miller et al., 2014, p. 437).