Opinion
To break cycles of trauma, we need family-friendly addiction treatment
When public health experts talk about the American opioid epidemic, they rarely acknowledge its impact on children.
I worked at a community health center in the South Bronx for a year, often counseling patients who struggled with addiction. I talked them through treatment options, trying to connect them to the right resources. These already difficult conversations were even harder if children were involved.
Once, I worked with a young woman who had been dealing with severe opioid use disorder for a few years. She had tried multiple times to quit, including through an outpatient addiction medicine clinic, but none of it stuck. She was also a single mother to an eight-year-old boy. No one else in her family could take care of him.
When I suggested that she check into a residential drug treatment program, her eyes widened with anxiety.
“What’s gonna happen to my kid?” she asked.
The truth was, I didn’t know. I wanted her to get the help she needed, and I wanted to help her find a way to keep custody of her son. But I knew this would be very difficult.
“That’s my baby,” she said. “I’m not leaving him.”
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This young woman’s situation was far from unusual. In 2017, more than 2 million children had at least one parent affected by opioid use disorder. The figure includes children whose parents died from an opioid overdose as well as children removed from their homes because of their parents’ opioid use. Experts expect that number to rise to 4.3 million children by 2030.
These children are at increased risk for developmental disorders, behavioral issues, poor parental attachment, abuse and neglect, and substance use disorders. Their challenges have ripple effects, from health care and special education spending to child welfare and criminal justice. Yet there is little research on the long-term effects of parental opioid use on children.
I’m part of a research team examining the health outcomes of children experiencing parents’ opioid use disorder. Our research shows that the number of children who are placed in foster care because their parents used opioids increased by 213 percent between 2014 and 2020. Those children in foster care experienced developmental, substance use, and mental health disorders at higher rates than children who remained with their parents. We need to better understand why these children in foster care have poorer health outcomes, and how we can identify and better meet the needs of their nuclear families.
We should also rethink how we treat opioid use disorder among parents. The child welfare system and substance abuse treatment centers have often worked independently. But if we want to break cycles of trauma, we need to increase access to family-friendly treatment for opioid use disorder. Opioid treatment programs should offer counseling on parenting skills and preventing youth substance use. Recent programs targeting parents that combine addiction treatment with parenting therapy have improved both parents’ recovery rates and parent-child attachment.
Treatment should also accommodate childcare. Family-based residential recovery programs that allow mothers and children to remain together during the mothers’ treatment produce more women completing the programs and fewer children removed from their homes by the child welfare system.
The success rate at the Los Angeles SHIELDS for Families’ Exodus program over five years—81 percent—was four times the national average. (The program no longer offers residential treatment.) At Minnesota’s Wayside House, 70 percent of participants’ children remained at home—and 94 percent were free from abuse and neglect—12 months after their parents completed the program, a vast improvement in child welfare outcomes. Earlier this year, New York City Mayor Eric Adams announced similar plans to open an $8 million substance use disorder clinic for pregnant people and new parents, aiming to treat affected families as a unit.
We also need to identify these children as early as possible. The American Academy of Pediatrics recommends that pediatricians learn how to screen for family member substance use and then partner with appropriate mental health, child welfare, and other professionals.
To move this forward, federal and state governments must increase funding for child welfare agencies, addiction treatment programs, youth development programs, and other organizations. The funding needed may seem high, but these efforts will help reduce unnecessary foster care placements, create long-lasting support networks for affected families, and improve these children’s health outcomes.
Finally, we must reduce the stigma around opioid use disorder, including when childcare is involved. We need to shift language from blame to support, to combat misinformation about addiction, and to work to build trust with affected families.
The young mother I counseled ended up joining the waitlist for a family-based residential treatment program where she could bring her son. In the meantime, her son was placed in foster care. Five months later, by the time I stopped working at the health center, she was still waiting.
Image: LightFieldStudios / iStock
Republish this article
<p>The surging number of children of opioid users in foster care is leading to worse health outcomes.</p>
<p>Written by Nisha Chandra</p>
<p>This <a rel="canonical" href="https://harvardpublichealth.org/policy-practice/children-of-addicts-with-opioid-use-disorder-need-more-support/">article</a> originally appeared in<a href="https://harvardpublichealth.org/">Harvard Public Health magazine</a>. Subscribe to their <a href="https://harvardpublichealth.org/subscribe/">newsletter</a>.</p>
<p class="has-drop-cap">When public health experts talk about the American opioid epidemic, they rarely acknowledge its impact on children.</p>
<p>I worked at a community health center in the South Bronx for a year, often counseling patients who struggled with addiction. I talked them through treatment options, trying to connect them to the right resources. These already difficult conversations were even harder if children were involved.</p>
<p>Once, I worked with a young woman who had been dealing with severe opioid use disorder for a few years. She had tried multiple times to quit, including through an outpatient addiction medicine clinic, but none of it stuck. She was also a single mother to an eight-year-old boy. No one else in her family could take care of him.</p>
<p>When I suggested that she check into a residential drug treatment program, her eyes widened with anxiety.</p>
<p>“What’s gonna happen to my kid?” she asked.</p>
<p>The truth was, I didn’t know. I wanted her to get the help she needed, and I wanted to help her find a way to keep custody of her son. But I knew this would be very difficult.</p>
<p>“That’s my baby,” she said. “I’m not leaving him.”</p>
<p>This young woman’s situation was far from unusual. In 2017, more than <a href="https://media.uhfnyc.org/filer_public/6e/80/6e80760f-d579-46a3-998d-1aa816ab06f6/uhf_ripple_effect_national_and_state_estimates_chartbook.pdf" target="_blank" rel="noreferrer noopener">2 million children</a> had at least one parent affected by opioid use disorder. The figure includes children whose parents died from an opioid overdose as well as children removed from their homes because of their parents’ opioid use. Experts expect that number to rise to <a href="https://media.uhfnyc.org/filer_public/6e/80/6e80760f-d579-46a3-998d-1aa816ab06f6/uhf_ripple_effect_national_and_state_estimates_chartbook.pdf" target="_blank" rel="noreferrer noopener">4.3 million children</a> by 2030.</p>
<p>These children <a href="https://capmh.biomedcentral.com/articles/10.1186/s13034-019-0266-3" target="_blank" rel="noreferrer noopener">are at increased risk</a> for developmental disorders, behavioral issues, poor parental attachment, abuse and neglect, and substance use disorders. Their challenges have ripple effects, from health care and special education spending to child welfare and criminal justice. Yet there <a href="https://link.springer.com/article/10.1007/s10826-018-1061-0#Sec19" target="_blank" rel="noreferrer noopener">is little research</a> on the long-term effects of parental opioid use on children.</p>
<p>I’m part of a research team examining the health outcomes of children experiencing parents’ opioid use disorder. <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818408" target="_blank" rel="noreferrer noopener">Our research</a> shows that the number of children who are placed in foster care because their parents used opioids increased by 213 percent between 2014 and 2020. Those children in foster care experienced developmental, substance use, and mental health disorders at higher rates than children who remained with their parents. We need to better understand why these children in foster care have poorer health outcomes, and how we can identify and better meet the needs of their nuclear families.</p>
<p>We should also rethink how we treat opioid use disorder among parents. The child welfare system and substance abuse treatment centers have often worked independently. But if we want to break cycles of trauma, we need to increase access to family-friendly treatment for opioid use disorder. Opioid treatment programs should offer counseling on parenting skills and preventing youth substance use. <a href="https://pubmed.ncbi.nlm.nih.gov/28401850/" target="_blank" rel="noreferrer noopener">Recent programs</a> targeting parents that combine addiction treatment with parenting therapy have improved both parents’ recovery rates and parent-child attachment.</p>
<p>Treatment should also accommodate childcare. <a href="https://www.casey.org/family-based-residential-treatment/" target="_blank" rel="noreferrer noopener">Family-based residential recovery programs</a> that allow mothers and children to remain together during the mothers’ treatment produce more women completing the programs and fewer children removed from their homes by the child welfare system.</p>
<p>The success rate at the Los Angeles SHIELDS for Families’ Exodus program over five years—<a href="https://www.casey.org/family-based-residential-treatment/" target="_blank" rel="noreferrer noopener">81 percent</a>—was four times the national average. (The program no longer offers residential treatment.) At Minnesota’s Wayside House, <a href="https://www.casey.org/family-based-residential-treatment/" target="_blank" rel="noreferrer noopener">70 percent of participants’ children remained at home</a>—and 94 percent were free from abuse and neglect—12 months after their parents completed the program, a vast improvement in child welfare outcomes. Earlier this year, New York City Mayor Eric Adams announced similar plans to open an <a href="https://www.nychealthandhospitals.org/pressrelease/mayor-adams-announces-plans-to-open-substance-use-disorder-clinic-for-expecting-and-parenting-families/" target="_blank" rel="noreferrer noopener">$8 million substance use disorder clinic</a> for pregnant people and new parents, aiming to treat affected families as a unit.</p>
<p>We also need to identify these children as early as possible. The <a href="https://publications.aap.org/pediatrics/article/138/2/e20161575/52464/Families-Affected-by-Parental-Substance-Use?autologincheck=redirected" target="_blank" rel="noreferrer noopener">American Academy of Pediatrics recommends</a> that pediatricians learn how to screen for family member substance use and then partner with appropriate mental health, child welfare, and other professionals.</p>
<p>To move this forward, federal and state governments must increase funding for child welfare agencies, addiction treatment programs, youth development programs, and other organizations. The funding needed may seem high, but these <a href="https://www.urban.org/sites/default/files/publication/103249/supporting-children-and-families-affected-by-the-opioid-epidemic_0.pdf" target="_blank" rel="noreferrer noopener">efforts</a> will help reduce unnecessary foster care placements, create long-lasting support networks for affected families, and improve these children’s health outcomes.</p>
<p>Finally, we must reduce the stigma around opioid use disorder, including when childcare is involved. We need to shift language from blame to support, to combat misinformation about addiction, and to work to build trust with affected families.</p>
<p class=" t-has-endmark t-has-endmark">The young mother I counseled ended up joining the waitlist for a family-based residential treatment program where she could bring her son. In the meantime, her son was placed in foster care. Five months later, by the time I stopped working at the health center, she was still waiting.</p>
<p class="is-style-t-caption">Image: LightFieldStudios / iStock</p>
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