Children raised in a household with one or more parents struggling with a substance use disorder often use compliance as a coping mechanism-a skill that often no longer serves them well in adulthood, according to an expert who spoke recently at the National Council Mental Health and Addictions Conference.
Teaching new skills to substitute for learned patterns can help break the intergenerational cycle of substance abuse, says Robert Neri, MA, LMHC, CAP, Senior Vice President/Chief Clinical Officer of the WestCare Foundation in St. Petersburg, Florida.
"We see a number of clients who have learned to be compliant because of how unpredictable the adults were in their life-they realized the best strategy was to blend into the woodwork, and not to make waves or test anyone," he says. "Most kids test the adults around them, to stretch and make their world bigger, but in children living in families with substance abuse, compliance is a survival tool."
Neri teaches his counseling staff that if a client does everything in treatment correctly, that can be a sign they are not internalizing, but rather simply adapting. "We see that with people who have been in treatment settings a lot-they learn not to make mistakes. But as the saying goes, 'If you make an A in treatment, you make an F in recovery.' We have to realize that mistakes are a wonderful opportunity to learn." He encourages his staff to tell clients that making mistakes allows them to learn how to tolerate frustration.
Compliance is one key reason so many people with substance use disorders do well while in the criminal justice system, but relapse, often only days after they are released. "They do well in a structured environment, but when that structure goes away, the person hasn't built any internal structure to rely on."
Learning how to play is another coping skill Neri teaches clients. "Children who grow up in a family with substance abuse become pseudo-adults, learning how to take care of their parents," Neri says. "They've missed their childhood. When we get them into treatment, they often avoid leisure-time activities. They are uncomfortable with these activities, because they never experienced them as children," Neri observes.
Knowing who to trust is also a vital coping skill, according to Neri. "First, we have to acknowledge that not trusting people has, in many cases, probably kept them alive, but now they need to expand their interpersonal tools to learn how to trust," he says. Clients learn how to evaluate who is trustworthy through exercises such as making a list of qualities they would want in a potential business partner, and interviewing members of their treatment group to see who matches the qualifications.
Clients who have spent years viewing themselves as victims can break the cycle of substance abuse by learning they are free to make choices, Neri states. "This gives them a model of empowerment, so they can take control and change the script."
By Celia Vimont