A kindergartner witnesses a violent argument between her mom and dad, fueled by their shared struggles with substance use. An 11-year-old boy misses his parents, angry that their addiction leaves them unable to care for him. And a teenager learns that her family’s history makes her more vulnerable to one day developing an addiction of her own.
When families live with addiction, children can be the first impacted and the last to get help. Joining Forces for Children, a collaborative project led by Penn Medicine Lancaster General Health, offers support for children of all ages who are affected by a family member’s substance use disorder. The program is part of Lancaster County Joining Forces, a coalition founded in 2017 to address the growing problem of opioid use disorder.
A family member’s addiction can have devastating impacts on even the youngest children. Joining Forces for Children program coordinator Chris Glover said that in addition to feelings of guilt, shame, and loneliness, many children show signs of anxiety and depression. They are also more likely to experience abuse or neglect.
“While adults might think that their substance use happens out of the child’s view, children still pick up on changes in behavior, moods or attitudes,” she said. “They sense the tension and stress, and many times, they blame themselves for it. One child told me they felt like they were disappearing in their own home.”
The need for support is significant, with an estimated one in four children across the United States impacted by a loved one’s addiction. In Lancaster County, that equates to nearly 32,000 children under the age of 18. In addition, overdose deaths, which had been declining in the county, increased by 44 percent in 2020, due in part to the COVID-19 pandemic.
Since its founding in 2020, Joining Forces for Children has served nearly 100 children with a family member who is in active addiction, in long-term recovery, or has died due to addiction. The program is funded by the U.S. Department of Justice Office for Victims of Crime, with confidential services provided in both English and Spanish, at no cost to families.
Through regular visits with a family advocate, as well as peer skill-building support groups, children come to understand that a family member’s addiction isn’t their fault, they can’t control it, and they aren’t alone. They also learn to tap into a powerful tool that’s already in their arsenal: hope.
Starting the conversation
Many adults are unsure of how to talk to their children about addiction. They might think that children don’t know what’s going on, or that they are protecting them by not talking about it. However, Glover said, avoiding the topic only reinforces the shame, guilt and isolation children may be feeling.
Family advocate Melanie Avila, MA, visits children at home or school, as often as needed. She connects the family with community resources, such as counseling or support groups, and works with children to build communication, coping, and problem-solving skills, such as learning where to go for help or healthy ways to manage stress.
“Children who are impacted by addiction learn not to trust people, talk about things, or feel things,” said Avila, who, like Glover, has experienced addiction within her own family. “We help them learn to identify and trust safe people, to talk about things even if it’s difficult, and that they can manage big feelings if they talk about them.”
Prevention is another key area of focus, as genetics significantly increase a child's risk for future addiction. Avila helps children practice how to respond if a peer offers them drugs, which can make the situation less scary if it actually happens.
Avila gently encourages children to talk about what’s on their minds, using books, toys, art projects, yoga, journals, or white boards to help children express their feelings. She’s found that a mancala game often works as a conversation starter with reluctant teenagers.
“We start by naming addiction for what it is,” she said. “A child might say, ‘When my mom drinks too much, she acts differently, and then I don’t feel safe.’ When we talk about those things, we find that it’s not quite the monster it is when it’s hidden.”
A tool called “The 7 Cs” can help children better understand what is within their control: I didn’t cause it. I can’t control it. I can’t cure it, but I can help take care of myself by communicating my feelings, making healthy choices, and celebrating me.
One teenager told Avila they keep a card imprinted with the “7 C’s” hidden inside their cell phone case. It serves as instant encouragement when they are having a bad day.
Harnessing the power of hope
To measure children’s progress, Joining Forces for Children uses hope theory, a research-based approach which has found that hope is one of the best predictors of overall well-being and success.
“Hope theory is the idea that the future can be better than today, and that anyone, even a child who is living with a very difficult situation, has a role in making it better,” Glover said. “Hope is accessible to everyone, and it can be nurtured in very concrete ways.”
Avila works with children to create a long-term vision for the future, which includes setting goals, as well as the steps to achieve them and who to ask for help when they get stuck. Children’s goals may be big or small, such as learning to tie their shoes, making the middle school honor roll, or even becoming the first in their family to go to college.
Avila regularly assesses a child’s progress with the Children’s Hope Scale, which consists of six statements, such as, “I think I am doing pretty well” and “When I have a problem, I can come up with lots of ways to solve it.” A child’s responses determine where they fall on the hope scale, from extremely low to extremely high.
So far, all children in the program have increased their hope score over time. One teenager lives in a very unstable home, where their mother and their mother’s partner use substances on a daily basis. Despite the chaos and unpredictability in their life, their hope score rose 10 points, from low hope to medium hope, in about six months.
“Hope lets children know that they have some control over the future,” Avila said. “It’s not something arbitrary that happens to them. Just one caring person helping them to nurture that hope can make all the difference.”
To learn more, visit lancasterjoiningforces.org/families or call 717-327-9451.