Children of Addiction (COA) Awareness Week is an annual celebration near and dear to my heart for many reasons, not the least of which are my personal experiences as a child of an alcoholic and as a child with four ACEs - three of which were the result of secondhand drinking (explained below).
NACoA’s mission is to eliminate the adverse impact of alcohol and other drug use on children and families, and the theme for this year’s celebration is “Empowering Children to Heal.”
Images From the National Association for Children of Addiction, https://nacoa.org/about-us/press-room/
Bringing ACEs Into COA Week Conversations and Celebrations
I can only imagine what my life and the lives of the millions of other children, teens and adults, whose parent(s) have/has/had the brain disease of addiction, would have been (could be) like had there been an understanding of the disease and of ACEs.
As I wrote in my April 24, 2017, post, “The Legacy of Untreated Secondhand Drinking-Related ACEs,”
I am the child of an alcoholic. My mom didn’t stop drinking until age 79. She died at 84. There was no warning, no lingering illness. She died two days after an unsuccessful emergency surgery. But we had five years during which she did not drink, after forty-five years during which she did.
You see, my mom knew she had a drinking problem. So did we, the rest of her family. There were times when she fought mightily to stop or control it. There were times when the rest of us fought mightily to help her. She even succeeded in cutting back or not drinking for periods of time, which convinced her and us that she really wasn’t an alcoholic(1) . None of us knew alcoholism(1) was a developmental brain disease; a chronic, often relapsing brain disease. None of us knew one of the key risk factors for developing the disease is childhood trauma. None of her primary care doctors who saw her over the four+ decades her disease marched on ever diagnosed it.
Ironically, my mom was also a 17-year cancer survivor when she died. She knew to do (and did) self-breast exams. She found a lump and immediately contacted her doctor; her doctor immediately ordered a biopsy; and she was diagnosed with breast cancer in 2000. She had a mastectomy, went through chemotherapy, lost her hair, and showed such courage and grace in her battle to recover. (If you’ve ever witnessed someone recovering from cancer, you know what I mean by “battle.”)
But cancer was a disease people and their doctors understood. Symptoms and having the disease were openly talked about and medical protocols were routine. There was no denial, secrecy, lying or self-judgment.
This was not the case with my mom’s other disease – alcoholism.
It wasn’t until my mom’s third alcohol-related collapse and ambulance ride to the ER within a one-week period in the summer of 2011 that she was finally diagnosed with acute alcoholism. The ER doctor said she was too sick to go home and referred her to a skilled nursing facility.
In her first weeks at the facility, she couldn’t walk but a few shuffling steps with someone on both sides holding her up. She had difficultly recognizing her family, didn’t know how to sequence washing her hands or going to the bathroom without help, and ate like a toddler – mostly shoveling food into her mouth with her hands – the idea of using a napkin and utensils didn’t register.
Her treatment included intensive occupational therapy, physical therapy, speech therapy, and eating nutrient rich foods and vitamins. By the end of her stay, as her clarity returned, she felt great shame, guilt, and remorse. She wanted desperately to go home and promised never to drink again. She never did.
As you can imagine, there are many directions this story could take at this point, but I’m going to focus on…
The Legacy of Untreated Second Drinking-Related ACEs
During the last years of her life, my mom and I talked a great deal about the work I’d been doing since 2003. She’d known the gist of it. I had offered my expertise and help over the years and couched it in terms of the other alcohol misusers(2) in my life’s experiences and my own secondhand drinking experiences and eating disorders. She’d get uncomfortable and gloss over my giving a presentation or completing a book on an addiction-related topic with a vague, “That’s nice dear. I’m happy for you.” There were times after a particularly bad bout or a disastrous consequence of drinking that she’d express a willingness to get help, but she never wanted to go to rehab, nor back to AA, something she’d tried early on.
But after she stopped drinking in 2011 and had some months of clarity, she didn’t cut me off as I shared a new talk or blog post topic.
She eventually started asking questions and was especially taken with the ACE Study and adverse childhood experiences. As we talked over time, she came to understand and appreciate that adverse childhood experiences cause toxic stress and that toxic stress can actually change a child’s brain architecture, negatively affecting their lifetime physical and emotional health. She loved my concept of secondhand drinking:
Secondhand Drinking (SHD) refers to the negative impacts of a person’s drinking behaviors on others. Drinking behaviors include verbal, physical, emotional abuse; neglect; blackouts; unplanned/unwanted sex, sexual assault; breaking promises to stop or cut down; shaming, blaming, denying; unpredictable behaviors; and driving while impaired, to name a few. Drinking behaviors are caused by a number of drinking patterns, including: binge drinking, heavy social drinking, alcohol abuse, and alcoholism. People engaging in these drinking patterns are referred to as alcohol misusers. The negative impacts a person coping with SHD experiences are related to toxic stress. [Note: this concept equally applies to secondhand drugging - the negative impacts of a person's drug misuse behaviors on others.]
But it was the connection between ACEs and SHD and how they set up the key risk factors for developing addiction (of which alcoholism is one) - see image below - that rocked her world the way it had rocked mine. It was this connection and finally understanding that alcoholism (addiction) is a brain disease that set her free. She didn’t “choose” to become an alcoholic just as she didn’t “choose” to have breast cancer; nor was she weak-willed, immoral, uncaring or any of the other adjectives used to label persons with this particular disease.
Often a parent’s alcohol misuse and the resulting drinking behaviors cause secondhand drinking for children in the family. Secondhand drinking creates many of the adverse childhood experiences measured in the ACE Study. Both SHD and ACEs are two of the key risk factors for developing addiction (of which alcoholism is one). The two key risk factors are childhood trauma and social environment. Given SHD’s genetic connection, a person experiencing SHD-related ACEs then has three of the five key risk factors for developing the brain disease of addiction (alcoholism).
And, of course, it's not just SHD-related ACEs that can contribute to a child developing addiction. But generally, if a child's parent has a substance use disorder / addiction, which is one of the 10 ACEs measured in the ACE Study, there are others. And, typically those "others" are related to the behaviors the parent exhibits towards the child while under the influence or the behaviors that take hold in a family as a result.
By Incorporating ACEs Into Our COA Week Conversations and Celebrations, We Build on This Year’s Theme, “Empowering Children to Heal”
As I wrote in my February 2, 2018, post, "Children of Addiction Awareness Week | February 11-17, 2018,"
“Healing” is three-fold. The first is to facilitate the emotional healing that can come when a child understands addiction and that the child is not the cause nor can the child “make” a parent stop (the NCAoA “Just 4 Kids” and “Just 4 Teens” sections, for example).
The second is putting children in contact with adults who can help them. These include other family members, primary care providers, social workers, teachers, faith community leaders, and the like, and these are the adults who can learn a great deal from the NACoA website on how best help a child in this situation.
And third is to help these same adults understand the crushing impacts of a parent’s drinking or drug misuse-related behaviors | addiction-related behaviors on a child (e.g., secondhand drinking / secondhand drugging).
These impacts are related to the physical and mental health consequences of toxic stress, toxic stress that results from the trauma of Adverse Childhood Experiences (ACEs). They include: anxiety, depression, stomach ailments, skin disorders, sleep problems, neck/back/shoulder pain, and inflammatory diseases, to name a few.
Now imagine if parents, communities, families, teachers, church leaders, and medical professionals — anyone and everyone who comes in contact with a child of addiction — understood ACEs and the ACE Study. They would understand that a child of addiction needs to not only be able to identify, cope with, and stop the trauma of a parent’s addiction-related behaviors but to heal from the toxic stress-related physical and emotional health consequences of their ACEs.
For more on ACEs and their impacts, I urge you to check out:
- the American Academy of Pediatrics, “Adverse Childhood Experiences and the Lifelong Consequences of Trauma,”
- the Harvard University Center on the Developing Child’s “Excessive Stress Disrupts the Architecture of the Developing Brain,”
- Nadine Burke Harris, MD’s TedMed Talk > How Childhood Trauma Affects Health Across a Lifetime],
- Robert Anda, MD, MS, member of the Board of Scientific Advisors of NACoA and co-principal investigator of the original ACE Study, in his paper, “The Health and Social Impact of Growing Up With Alcohol Abuse and Related Adverse Childhood Experiences: The Human and Economic Costs of the Status Quo," and
- Jane Stevens’ “ACEs 101 > ACEs Science FAQs.”
To close this post, I invite you to do what you can to spread the word about Children of Addiction Awareness Week and to do what you can to incorporate ACEs into your conversations and celebrations. Click here for NACoA's information, tools and resources to help with your efforts.