Monday, March 1, 2010

Substance Abuse and Parenting

Typically the underlying feelings of this type of personality and substance abuse disorder are feelings of shame, humiliation, depression, and mania (Westen, 1985).

Interesting enough, research shows if one person in a family or couple is suffering from alcoholism or substance abuse there is a strong probability another person in the family is suffering from the same disease.

Because this family now more than likely has two people suffering from alcoholism or substance abuse the children in this family are at risk for neglect and/or abusive parenting. To date there are no research studies known which address three crucial factors for families with alcoholism and substance abuse, alcoholism, personality and parenting. These three variables need to be the focus of research which determines the impact upon the children in families who suffer from alcoholism.


Substance abuse has long been known to be indicated in neglect and or abuse cases. According to the United States Department of Health and Human Services more than 80 percent of substantiated cases of child abuse and neglect indicate poverty and substance abuse as the two primary contributing factors to abuse and neglect of children (C.S.A.T., 1997).

Children, whose parents abuse substances, are almost three times more likely to be abused and four times more likely to be neglected than other children (National Center on Addiction and Substance Abuse at Columbia University [CASA], 1999).

Substance abuse is considered the responsible culprit for at least one third of all child welfare cases currently in the child welfare system across the nation (C.S.A.T., 1997).
Research conducted with parents who were involved in aftercare programs discovered,

Inappropriate parental expectations of the child, lack of empathy towards the child's needs, parental value of physical punishment and parent child role reversal (Gallant, 1998).

Parents who did not suffer from addiction did not show these same indications of parenting problems. The longer the parent was in residential treatment the stronger the predictability of a lower parental role reversal.

Parent educators need to be aware of the characteristics and parenting patterns among adults in recovery from substance abuse.

Working with parents in recovery to educate them on realistic expectations, how to discipline in a positive manner, assist them in building up their child's self-esteem and learning problem solving skills seems to increase their chance of experiencing more balanced or appropriate parenting from parents endeavoring to empathetically understand their needs and lower the chance of abusive parenting (Gallant, 1998).
Developing nurturing, positive, empathetic supportive communication with problem solving skills increases the possibility of recovery and of a family system building resiliency factors to prevent other in the family from developing a substance abuse.

What if the tears of an infant are totally ignored, if his signals for help are consistently misread or disregarded, if his mother punishes his persistent crying by striking him, slapping him with a belt, or burning him with a cigarette. If his cries of pain and rage are ignored or precipitate more punishment, the child will learn not to cry (Pincus, 2001).
In a Neurological approach to understanding anger, rage, trauma and addiction, Dr. Cardwell Nuckols discussed the poor development of infants who are exposed to neglect and abuse. According to Dr. Nuckols, these infants will not develop a predictable sense of self and a sense of separateness. They will develop a disturbed body image, poorly modulated affect and impulse control including aggression against self and others as well as an uncertainty as to the reliability of others (Nuckols, 2003).

A young brain is so susceptible to the affects of alcoholism in the family because the posterior cortex and the frontal cortex are still developing at birth and are not fully developed until the infant is approximately twenty years of age. Twenty toddlers, ten without an abuse/neglect history and 10 with an abuse/neglect history showed the following developmental characteristics. The ten toddlers with no abuse/neglect history showed the ability to empathize with other toddlers by responding to crying with empathic crying, behavioral showed concern and tried to help other toddlers who were distressed. The ten toddlers who had a history of abuse/neglect responded to other toddlers cries of distress with anger, physically aggressive and threatening behavior (Nuckols, 2003). Without intervention children from homes with a history of addiction will show behaviors which look like conduct disorders, ADHD, affective disorders, schizophrenia and obsessive-compulsive disorders (Nuckols, 2003).

The absolute strongest argument for parenting intervention in families with substance abuse disorders are how children are raised is how they will ultimately raise their own children. Children learn best from the example set by their caregivers not by what they are told to do (Bavolek, 2000).
The nurturing parenting program for families in substance abuse treatment and recover is a new psycho educational, group-based program which assists parents in strengthening their own recovery, facilitating recovery within their families, and building a nurturing family lifestyle. A core goal of this program is to nurture parents, thereby enhancing their ability to nurture their children. To enhance the richness of the experiences of nurturing and recovery, the program focuses on parenting as a relationship characterized by mutually (building attachments with their children), authentically (being worthy of their children's trust), and empathy. Parents develop self-awareness and build nurturing skills by using a variety of techniques and activities that accommodate different learning styles. Parents explore their childhood experiences, their fears and their strengths, and the effects of substance abuse on them and on their families. They build skills that strengthen their recover, explore their own development as adults in recovery, and examine similarities and differences in the development of their children. This program is also useful for partners of parenting adults in treatment and recovery and for extended family members who may be parenting children of substance-abusing adults as well as examines similarities and differences in the development of their children (Bavolek, 2000).

Topical Literature Review
Developing empathy in parents who are in recovery from substance abuse is the main challenge of parenting education. As already established in previous paragraphs people who suffer from addictions exhibit narcisstic personalities which means they focus only on themselves and seek out undue attention. This need for undue attention keeps the focus off of meeting their child(ren)'s needs. Developing empathy is of paramount importance to supporting the bonding, attachment and nurturing capacity of parent's in recovery.

The construct of empathy defined
Empathy first suggested by E. B. Titchner a psychologist in the 1920's was used to describe the behavior of infants who cried out when they hear the cry of other babies. The psychologist believed hearing or perceiving distress in another created distress in the person who had perceived the distress thereby allowing them to understand the inner experience of another person. By the 80's empathy was described as, an empathic response is one which contains both a cognitive and an affective dimension - the term empathy is used in at least two ways; to mean a predominantly cognitive response, understanding how another feels, or to mean an affective communication with the other - (Galio, 1989). Carl Rogers described empathy as, - the state of empathy or being empathetic is to perceive the internal frame of reference of another with accuracy and with the emotional components and means which pertain as if one were the person, but without ever losing the as if condition" (Rogers, 1989).

Today, empathy is defined as, the affective capacity to share in another's feelings and the cognitive ability to understand another's feelings and perspective. Definitions sometimes also include the ability to communicate one's empathic feelings and understanding to another by verbal and/or nonverbal means (Bavolek, 2000).

There are four defining attributes of empathy, awareness of the state of being of another, understanding of the condition of empathy, personal identification with the situation and appropriate affective response to another's condition (Bavolek, 2000).

According to Stephen Bavolek, Developing empathy in families, general research indicated:
- Females exhibit higher levels of empathy than males; however, there is some evidence empathy training reduces this difference.
- Empathy and prosocial behavior increase with age, however, empathy training has been shown to reduce the differential in empathy between very young children and older ones.
- Along with knowledge, self-determination, and strategy utilization, empathy is coming to be regarded by more and more educators as a key attribute of a successful learner.
- In general, the higher people score on measures of empathy and prosocial behavior, the higher their scores on measure of critical, higher-order thinking. Role-taking, in particular, enhances open mindedness and reasoning capabilities.
- Classroom strategies and program designs which are positively related to empathy and prosocial interactions are cooperative learning structures involving learning teams made up of representatives of different racial/ethnic groups, academic ability levels, both genders, the differently abled, socioeconomic groups and cross-age and peer tutoring.
- Emotionally disturbed children exhibit greater empathy and prosocial behavior when taught in learning environments featuring components known to promote these qualities - focus on one's behavior affects others, role-taking, etc. Learning environments characterized by extrinsic rewards or punishments, and behavioral charting are negatively related to the development of empathy/prosocial behavior in emotionally disturbed children.

Road blocks to empathy are reported to include:
1. Emotional neglect;
2. Stress acts as a roadblock to empathy;
3. Emotional abuse results in hyper vigilance. This preoccupation with feelings of others as children often result in adults who suffer intense emotional ups and downs;
4. Some research indicates an absence of empathy may stem from neural deficits.
Empathy in parenting manifests as responsive, non-punitive, non-authoritarian behavior of mothers and father towards their preschool children.

Parents can:
1. explain to children the effects of their behavior on others,
2. point out to children the power of being kind and generous to others makes them happy,
3. explain to children who have hurt or distressed others why their behavior is harmful,
4. and give them suggestions for making amends to those who they hurt.

Parents can model empathetic, caring behavior and encourage school-age children to discuss their feelings and problems with parents (Bavolek, 2000)

The lack of empathy in parenting interactions show up as controlling, inconsistent, punitive and manipulative behavior which may also include the physical punishment of the mothers. All of these interactions discussed earlier as part of the cycle of neglect and abuse is found in families with substance disorders (Bavolek, 2000).

So how can parent educators effectively teach empathy to parents in recovery from substance abuse? Suggestions include using visual cues to teach recognition of feelings in other and how to respond to these feelings with communication, recognition of the needs of others, appropriate identification of one's own feelings and methods for communicating these feelings to others effectively.

Teaching empathy links one person to another by showing concern or caring for another human being. This process is widely accepted as attunement to another by letting them know their, emotions are met with empathy, acceptance and are reciprocated, (Bavolek, 2000).

Parents can exhibit caring behaviors for infants and children with language expression known as 'parentese,' or matching the pitch of a child's emotional expression. Showing this validating behavior allows a child to continue in their emotional development and expression of their feelings (emotions are the behavioral expression of physiological biochemical responses in the brain we know as feelings).

Teaching infant massage classes to caregivers leaves a window of opportunity to discuss developmental appropriate expectations utilizing the Nurturing Parenting Curriculum which includes role playing, music and games to teach empathy to parents/caregivers for their children. This program effectively takes adults into the world of children.

The Nurturing Parenting Program provides an intervention strategy to increase the nurturing parenting skills of parents, caregivers and grandparents, enhances the positive self-esteem and feelings of care giving competence through self-awareness and success experiences. There are four constructs which are identified and proven successful over a twenty-year span of empirical research. These constructs are inappropriate parental expectations of children, lack of an empathic awareness of children’s needs, strong belief in the use of corporal punishment as a means of disciplining children and reversing parent-child family roles (Bavolek, 1987).

In the Florida Report, a multi-year evaluation study conducted on Parenting Program effectiveness, it was discovered a total of 86of parents who participated in the Nurturing Parenting programs completed the programs versus the 41of general curriculums provided in Florida. The reason this is important is because the completion of the programs shows a commitment to learning. Whereas incompletion obviously does not allow the participant to reap the full benefit of the parenting education (Bavolek, 2001).

Pre and post-test data gathered through the Adult Parenting Inventory shows significant change
- at alpha levels in age appropriate expectations of children,
- overall increase in empathic awareness of the needs of children,
- decrease in the belief of corporal punishment as a means of disciplining children, and
- significant decrease in reversing parent-child family roles (Bavolek, 2001).

Target audience
The Department of Children and Family Services Substance Abuse Program office is responsible for collecting SISAR data from all state funded substance abuse treatment providers in the state of Florida. Of the population of adults who receive stated funded substance abuse treatment is the subgroup of adult women who are pregnant. In the state of Florida during FY - 2002 there were 2,221 and during FY - 2002 there were 2,284 women who were pregnant at the time of admission into substance abuse treatment services.

The selection of participants is to be limited to pregnant women or women with infants less than one year of age. These mothers must have completed a minimum of six months of residential or day/night treatment and who meet the criteria in the Addiction Society of Addiction Medicine Patient Placement Criteria, Second edition revised, (ASAM-PPC II-R) Florida Supplement assessment as ready for integration into their family system.

Educational Plan
Teaching infant massage to parents in substance abuse recovery includes asking permission to touch the infant/child, matching their verbal expression to that of the infant/child, learning to read the infant/child's cues of engagement, positive eye contact, supportive environment for bonding and attachment through gentle touch, smell, hearing and inner experience of the infant/child. Many added benefits of learning infant massage include learning positive parenting interaction, education on brain development and appropriate behavioral expectations of the infant/child. Additionally many parents will open up and ask the parenting educator questions about child development thus a window of opportunity to provide further parenting education.

Utilization of the Nurturing Parenting Curriculum and introducing infant/child massage into the experiential classes for parents, grandparents and/or caregivers who are in substance abuse recovery and have children 0-18 years of age.

The Nurturing Program and the Infant Massage class curriculum require a certification to teach and have legal copy write requirements which do not allow inclusion into this paper. Certification training for the Nurturing Parenting Programs can be found online at www.nurturingparenting.com and certification for Infant Massage Instruction can be found at http://www.iaim-us.com.

Evaluation Plan
Administer a pre and post-test inventory to collect, analyze and interpret data results. The data gathering inventories are the Adult-adolescent parenting inventory (AAPI), the Nurturing quiz, the Family social history questionnaire (FSHQ) and program evaluation forms.

1. The AAPI is an instrument that assesses the attitudes toward child discipline practices of adults and adolescents. The inventory was designed to measure levels of acceptance of appropriate developmental expectations of children, empathy towards children's needs and belief in the use of violent discipline as well as the clarification of role development of the caregiver and the child.
2. The Nurturing quiz is an informal criteria-referenced inventory designed to measure knowledge of appropriate behavior management strategies.
3. The family Social History questionnaire is utilized to gather information about family member prior to treatment.
4. Parents and adolescents completed program evaluation forms at the completion of each weekly session and following the completion of the entire 12-week treatment program (Bavolek,1987).

A training survey is administered after each completion of the program to determine if any changes to solicit feedback on the infant massage classes

This feedback loop allows for the inclusion of education material requested by the parents/caregivers. Thus providing a parenting education class to meet the needs of the parents and caregivers as they learn to meet the needs of their infant/child.

Product
- Skills and techniques appropriate for massaging newborn infants, toddlers and children.
- A parenting reference handout to review the strokes of infant massage.
- A website that includes the latest links for parenting education, (resource links), developmentally appropriate play, (which does not require extensive financial or material support), experiential exercises to continue to expand and support parenting education skills and competency.
-Telephone, email and web access to ongoing parenting and family educational support, www.allfamilysolutions.com.

References

American Society of Addiction Medicine Patient Placement Criteria 2nd Revision Florida Supplement. Department of Children and Family Services, Substance Abuse Program Office. 2002. 1-78.

Ainsworth, M. D.S., Elechar, M. Watern, E., and Wall, S. (1978) Patterns of attachment. Hillsdale, N.J:Erlbaum

Bowlby, J. (1969) Attachment and Loss. Vol. 1: Attachment. New York: Basic Books.

Bavolek, Stephen J. (1984) Adult-Adolescent Parenting Inventor, Family Development Association, Eau Claire, Wisconsin.

Bavolek, Stephen J. (1987) Building Nurturing Parenting Skills in Teenage Parents. Winter, Final Report. Family Development Resources, Inc., Family Nurturing Centers International, Inc. www.nurturingparenting.com

Bavolek, Stephen J. (2000). Developing empathy in families.
Family Development Resources, Inc., Family Nurturing Centers International, Inc 1-2.

Bavolek, Stephen J. (2000). The research and validation report the nurturing parenting programs. Family Development Resources, Inc., Family Nurturing Centers International, Inc. 1-20.

Bavolek, Stephen J. (2002). The Florida report: the impact of gender, race, income and education on parenting attitudes July 1999 to July 2001. State of Florida Department and Families of Children. 1-8.

Bavolek, Stephen J., and Dellinger-Bavolek, Juliana. (1999) Increasing the nurturing parenting skills of families in head start: validation of the nurturing program for parents and children birth to five years. Family Development Resources, Inc., Family Nurturing Centers International, Inc. 1-30.

Bennett, E.M., and Kemper, K.J. (1994) Is abuse during childhood a risk factor for developing substance abuse problems as an adult? Journal of Developmental and Behavioral Pediatrics, Vol. 15, 426-429.

Center for Early Education and Development. (1991, Winter). Attachment and bonding. Early Report. Vol. 18, Number 2. 4-8.

Center for Substance Abuse Treatment. (1996) Treatment drug courts: integrating substance abuse treatment with legal case processing. Treatment Improvement Protocol (TIP) Series, Vol. 23. DHHS Pub. No. (SMA) 96-3113. Washington, D.C.: U.S. Government Printing Office.17-25.

Center for Substance Abuse Treatment. (1997) Substance abuse treatment and domestic violence. Treatment Improvement Protocol (TIP) Series, Vol. 25. DHHS Pub. No. (SMA) 97-3163. Washington, D.C.: US Government Printing Office. 2-32.

Center for Substance Abuse Treatment. (2000) Substance abuse treatment for persons with child abuse and neglect issues. Treatment Improvement Protocol (TIP) Series, Vol. 36. DHHS Pub. No. (SMA) 97-3163. Washington, D.C.: US Government Printing Office. 1-61.

Gallant, William A. (1998, February). The association of personality characteristics with parenting problems among alcoholic couples. American Journal of Drug and Alcohol Abuse. 52.

Gale Encyclopedia of Childhood and Adolescence. (1998). Narcissism Gale Research, The Gale Group and Looksmart.

Keller, M. Kay (1998). Infant Massage- Loving Touch. International Association of Infant Massage~U.S. Chapter Annual Educational Conference. http://allfamilysolutions.com/massage.html.htm

Leavitt, Lewis A. (1998, November). Mothers' Sensitivity to Infant Signals. Pediatrics. Vol. 102 No. 5.

Masterson, James F. (1998) The emerging self: A developmental, self, and object relations approach to the treatment of the closet narcissistic disorder. New York: Brunner/Mazel.

National Center on Child Abuse and Neglect. (1997) Child maltreatment 1995: reports from the states to the National Center on Child Abuse and Neglect. Washington, D.C.: U.S. Government Printing Office. 22-28.

Nuckols, Cardwell C. (2003) A neurological approach to understanding anger, rage, trauma and addiction. Florida School of Addiction Studies. Handout. 1-3.

Pincus, Johathan. (2001) Base instincts. W.W. Norton, New York. 22.

Sandler, Joseph, Ethel S. Pearson, and Peter Fonagey, eds. (1991) On narcissism - an introduction. New Haven, Ct: Yale University Press. 32

Westen, Drew. (1985) Self and society: narcissism, collectivism, and the development of morals. New York: Cambridge University Press. 44.