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Section 26
Children of Addicts: When Should Reunification Occur?

Question 26 | Test | Table of Contents

The enormous impact on children of parental drug and alcohol abuse has been well-documented in the literature. Substance abusing mothers tend to be unaware of their children's developmental status and tend to expect too much maturity from their children [Fiks et al. 1985]. Mothers may have poor attachment histories themselves and as a result, have poor attachment with their children [Davis 1994]. Children may respond with emotional outbursts that addicted mothers may take personally [Kaplan-Sanoff & Rice 1993].

Few studies have investigated the impact of recovery on parenting skills and relationships, and most information tends to be anecdotal in nature. Mothers in early recovery may initially experience a great deal of guilt and shame over their past behaviors [Eliason & Skinstad 1995; Kane-Cavaiola & Rullo-Cooney 1991]. They may notice their children's misbehavior for the first Melinda M. Hohman / Rick L. Butt 59 time and may see this as a reflection of past neglect while they were under the influence of alcohol or drugs [Hohman 1995]. Because of this, mothers in early recovery may feel a need to "make up for lost time" by becoming the "perfect" mother. They may have high expectations for themselves and their children and may react harshly when their children won't listen [Finkelstein 1994; Hohman 1995]. Behavioral or cognitive problems in the child, perhaps due to prenatal alcohol or drug exposure, may compound the mothers' feelings of guilt, making mothers in recovery prone to relapse [Finkelstein 1994].

Recovering mothers may overidentify with their children and see normal developmental milestones as threatening. A child born during the addiction period may be seen as a "child of my addiction," whereas children born while in recovery may be viewed more positively [Watkins & Durant 1996]. As mothers move toward ongoing recovery and work through personal growth issues, they may be better able to use support systems such as parenting classes. Establishment by the mothers of identities as recovering people may allow them to give their children the freedom to develop their identities as well [Watkins & Durant 1996].

Case One
Patricia is a 42-year-old mother who is presently separated from her abusive husband, Michael. She has one child, Zachary, age 3. Zachary was removed from his parents' care due to allegations of his parents abusing drugs and exposing him to domestic violence. A petition was filed by the child welfare social worker with the juvenile court, and Zachary was placed in out-of-home care. The parents initially minimized their drug use as well as the domestic violence issues in the family. The matter was taken to trial in juvenile court, and Zachary was declared a dependent of the court. A reunification plan was ordered for both parents. The reunification plan called for the parents to submit to drug tests regularly, participate in and complete a drug rehabilitation program, complete a parenting program, and participate in a domestic violence counseling program.

Patricia took her reunification plan very seriously. She wanted to reunify with her son. She had never been without her son and this separation was devastating for her. She contacted her social worker and obtained the necessary referrals to begin her reunification. She started her random drug testing, began attending Cocaine Anonymous (C.A.) meetings daily, enrolled in a drug rehabilitation day treatment program, and finally enrolled in a domestic violence support group. Although this treatment program required total commitment from Patricia, she was determined to "stay clean" and regain custody of Zachary. Michael, her husband from whom she was separated, refused to participate in any of the treatment interventions.

Patricia attended her various programs daily and started to gain insight into the effects of drug use on both herself and her child. She initially had a difficult time admitting to the severity of her drug problem, but with her continued determination and with support from all programs, she began to understand her loss of control over her cocaine use and how this impacted Zachary. Patricia discussed this with her social worker, who was encouraged that she recognized the severity of her problem. Patricia began to suffer bouts of depression and feelings of hopelessness and was at high risk for relapse about a month or so into sobriety. The social worker realized that Patricia was up against "the wall" in her recovery. She gave her encouragement by indicating that it was natural to feel this way, that she would get through it, and that her determination to stay clean was the best present she could give herself and her son. Patricia often attended several C.A. meetings a day to obtain the continued support she needed to keep herself from returning to the drug scene and her drug-using friends. The social worker often asked her about these meetings, particularly regarding female friendships she was making there to make sure she wasn't feeling isolated.

The social worker did not push Patricia to attend parenting classes during the first two months; from the struggles Patricia was having, the worker felt that it was in her best interest to delay classes until her recovery gains were further consolidated. After four months, Zachary was returned to his mother's care (but not his father's, as his father had not participated in any part of his reunification plan). Patricia had been clean the entire time, as indicated by her random drug tests and had fully participated in a parenting program, drug rehabilitation program, and weekly domestic violence class. Patricia was now on the road to recovery and was doing extremely well. The social worker realized that Patricia might now be entering the "adjustment stage," and might think that she wouldn't have to do any more recovery work. Even though the social worker thought it was necessary that Zachary be returned home (as his mother's progress was excellent and she had been complying with the terms of the reunification), she encouraged Patricia to continue to attend C.A. meetings and counseling. The social worker thought it was particularly important that Patricia continue with parenting classes and therapy as she attempted to rebuild a new sober life with her son. Supervision by the court was recommended for at least another two months. In this case, risk should continually be assessed during the recovery process. Zachary's risk appeared to be low, and Patricia should be able to adequately care for him.

Case Two
Mary is a 32-year-old single mother of two children. She has a two-year-old daughter. Sherry, who is being cared for by Mary's mother. Mary's mother has had custody of Sherry since her birth. This placement was done voluntarily by Mary due to her continued drug use. Mary recently gave birth to her second child, Tanya, who was born exposed to crystal methamphetamine. Although Mary and her baby both tested positive at birth, she denied her drug use and initially refused services. Mary had no prenatal care and was not prepared for this baby. She had no diapers, formula, crib, clothing, etc. Mary was also homeless. A petition was filed by the social worker with the juvenile court, and Tanya was declared a dependent of the court. A reunification plan was drawn up and discussed with Mary, and she was court-ordered to comply The reunification plan comprised a parenting program, a drug rehabilitation program, random drug testing, and attendance at N.A. meetings. Mary's social worker gave her a referral for a county-funded recovery home that would provide her with housing and drug treatment. This home met all the requirements of the reunification plan and even permitted the placement of Tanya with her, once Mary was in full compliance, and staff felt she was ready to parent.

Mary entered the recovery home but participated only minimally in the group sessions. She told her social worker that she really didn't see herself as being like "those women" and that drugs weren't a problem, because she had been able to quit so easily. Mary denied having any craving to use, although she eventually left the recovery home after several weeks to meet a male friend and failed to return. Her drug testing came up positive after that, resulting in her discharge from the recovery home.

Mary moved in with the male friend and continued to attend her drug testing sporadically. Several more of her drug tests were positive. She never enrolled in any other drug treatment program, nor in any parenting program. Mary, however, always kept her weekly visits with Tanya, was always appropriate with her, and did not appear to be under the influence during her visits. Mary seemed to be bonding with her child. Mary told her social worker that she was looking for housing for herself and would be moving out of the friend's apartment soon. This continued for several months.

Since Mary continued to test positive and failed to enroll in any type of drug rehabilitation program, the court felt that it was not appropriate to reunify Tanya with her, although she had  established the beginnings of a relationship with the infant. Despite the bonding Mary had with her daughter, the social worker felt that she also needed to recognize her drug addiction and take the necessary steps to engage in recovery. It would be possible for Tanya to return home if Mary had all clean drug tests and was enrolled and actively participating in a drug rehabilitation program. At the time, however, there had been minimal change in Mary's recovery process.

Discussion
In the first case, Patricia did not want to deal with her cocaine addiction initially, but the loss of her son and the court order forced her to confront it. Patricia had a difficult time doing so, but her social worker used Rawson et al.'s [1991] model of recovery to provide appropriate and supportive feedback. The social worker also could see that Patricia recognized her loss of control of her use and had begun to build a supportive environment around herself and create a sober lifestyle and identity [Brown 1985; Landry 1994]. As Patricia reconstructed her view of herself from an addict to a sober mother, she was able to reconstruct her view of her marriage and the role of domestic violence in her life. After the first four months, the social worker felt that many of Patricia's treatment gains had had time to be consolidated; she realized, however, that Patricia would need some ongoing support and supervision after reunification, particularly to deal with parenting issues.

In the second case, Mary also did not want to deal with her addiction and was forced into treatment through a court order. Mary found herself in an environment that was supportive of recovery (the recovery home), yet her insistence that she could control her use distanced her from the other residents to the point where she left and returned to the environment that would support her habit. Because her identity still remained as someone who was in control of her drug use, Mary refused to comply with any counseling having to do with drugs or parenting. Mary's case was further complicated by her positive involvement with her infant and her compliance with that aspect of her reunification plan. The social worker recognized that although those with addiction problems can sometimes appear to have "pulled themselves together," such behavior is usually temporary. Mary had still failed to acknowledge she has a substance abuse problem. Unless she confronts her addiction and embarks on a recovery program, the risk for continued problems and the child remaining in the system is high.

While the social worker encourages clients as well as inquires about how the recovery program is working or not working, clients should reflect on the changes the recovery is making in their lives. Clients should openly acknowledge their addiction. Denial or minimization of the drug problem is an indicator that a client has not understood the seriousness of the addiction.

One crucial step in recovery is the relapse prevention plan. Although this plan is usually covered in a drug rehabilitation program, it is also something that a social worker should be familiar with and discuss with the client. Discussion of what safeguards the client has in place or what coping skills he or she will use when placed in an unsafe environment where there is pressure to use (relapse) is vital. Having a plan allows clients to know ahead of time what to do if urges or craving surface. It is also crucial for social workers to be aware that relapse can be part of the recovery process and that quick interventions can facilitate a return to recovery [Rawson et al. 1991].

Personal Reflection Exercise #12
The preceding section contained information about when reunification of a child and an addicted parent in recovery is possible.  Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Navigation for youth mental health and addictions: protocol for
a realist review and synthesis of approaches
and practices (The NavMAP standards project)

- Markoulakis, R., Arora, S. R. A., Kodeeswaran, S., Di Febo, M., Kuuter, L., Fleming, J., Walsh, C., Hauser, A., Cleverley, K., Hitzig, S. L., Kokorelias, K., Cheung, A., Willis, D., & Levitt, A. (2022). Navigation for youth mental health and addictions: protocol for a realist review and synthesis of approaches and practices (The NavMAP standards project). BMJ open, 12(11), e068211. https://doi.org/10.1136/bmjopen-2022-068211

Peer-Reviewed Journal Article References:
Joyner, K. J., Acuff, S. F., Meshesha, L. Z., Patrick, C. J., & Murphy, J. G. (2018). Alcohol family history moderates the association between evening substance-free reinforcement and alcohol problems. Experimental and Clinical Psychopharmacology, 26(6), 560–569.

Leathers, S. J., Falconnier, L., & Spielfogel, J. E. (2010). Predicting family reunification, adoption, and subsidized guardianship among adolescents in foster care. American Journal of Orthopsychiatry, 80(3), 422–431.

Peñas, S., Herrero-Fernández, D., Merino, L., Corral, S., & Martínez-Pampliega, A. (2020). Transnational links and family functioning in reunited Latin American families: Premigration variables’ impact. Cultural Diversity and Ethnic Minority Psychology, 26(3), 306–317.

Rusby, J. C., Light, J. M., Crowley, R., & Westling, E. (2018). Influence of parent–youth relationship, parental monitoring, and parent substance use on adolescent substance use onset. Journal of Family Psychology, 32(3), 310–320. 

QUESTION 26
Why are mothers in recovery prone to relapse? To select and enter your answer go to Test.