Recognizing and Stopping Teen Addiction: A Complete Guide for Responsible Parents

Community Health Improvement Transitioning Programs
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What are others doing about it? And what tools can we start using now to help our children develop healthier relationships with technology? Remember, back in the day, when our parents told us sitting too close to the TV would give us square eyes? Well, most of the issues lie with the number of stimuli our devices offer us. Because our devices give us the ability to process multiple actions at once, we are taking away the need for younger minds to process the information themselves.

Psychology Today summarises it nicely:. Unlike a mother reading a story to a child, for example, a smartphone-told story spoon-feeds images, words, and pictures all at once to a young reader. Most of the literature on interventions that involve parents has focused on externalizing behavior, given that internalizing behavior is less prevalent McKee et al.

Yet the trajectory of internalizing behavior across childhood is often persistent, serious, and linked to adult outcomes Dekker et al. DSM-5 American Psychiatric Association, includes diagnostic classification and criteria for both anxiety disorder and depression that extend to young children.

Some internalizing conditions have been inversely associated with certain parenting practices, such as those that are overinvolved and those that display low warmth Bayer et al. Empirically validated intervention approaches have been developed to address both anxiety disorder and depression in children. Anxiety disorder Anxiety in some situations is normal for young children, such as when very young children are anxious around strangers or in new places. However, severe and debilitating forms of anxiety may manifest in phobias, sleep terrors, posttraumatic stress disorder PTSD , and separation anxiety.

Recent systematic, critical reviews by Anticich and colleagues and Luby have identified empirically supported interventions for anxiety disorder in young children. Cognitive-behavioral therapy, once used primarily with older children and youth and in clinical settings, has. PCIT, described earlier as treatment for externalizing conditions, also has been adapted for anxiety in young children Comer et al. In addition, other supported treatments have employed psychoeducational approaches addressing anxiety disorders Rapee et al. All of these studies used experimental designs with active control, passive control, or wait list control groups.

Childhood depression The intervention studies discussed above for anxiety have at times included children with depression. Luby and colleagues adapted the PCIT intervention specifically for parents and their young children with depression. One of the most promising approaches for supporting these parents is problem-solving therapy.

Bright IDEAS is a problem-solving skills training program provided by a mental health professional over eight 1-hour individual sessions Sahler et al. Melnyk and colleagues developed an educational-behavioral intervention called Creating Opportunities for Parent Empowerment COPE for mothers of critically ill children in pediatric intensive care units. In two randomized controlled studies Melnyk et al. Researchers also found that treatment effects were mediated by parent beliefs and inversely negative maternal mood state.

A number of other programs have tested cognitive-behavioral approaches as well as training in communication and social support for parents of children with illnesses ranging from cancer to diabetes to other chronic diseases. Unfortunately, most of these studies have either been underpowered or shown no significant benefits. Very low birthweight is defined as less than 1, grams at birth and extremely low birthweight as less than 1, grams.

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The terms are most commonly used to designate an infant as being born prematurely. Very-low-birth weight infants are admitted to neonatal intensive care units NICUs , may reside in those units for weeks to months, and at times sustain chronic health or developmental conditions. Because these infants do not come home immediately after birth, a concern is that the normal formation of attachment and transition to parenthood especially for first-time parents may be disrupted Odom and Chandler, In addition, the children may have ongoing and significant medical needs e.

Some have evaluated parenting training designed to support effective early parenting skills, while others have looked at psychosocial support for parents to prevent or address posttraumatic stress or depressive symptoms. In a Cochrane-like quantitative review, Athanasopoulou and Fox evaluated 13 experimental and quasi-experimental studies of KMC. They found that, although the outcomes of these studies were mixed, mothers in the KMC groups experienced significantly less negative mood and more positive interactions with their infant relative to mothers in the control groups.

To examine the effects of the COPE model, described previously, applied with mothers with very low-birth weight infants in the NICU, Melnyk and colleagues conducted a secondary analysis of a larger randomized controlled study. They found that mothers experiencing COPE had less anxiety and depression and higher parent-child interaction scores compared with the control group. Segre and colleagues used the Listening Visits intervention, consisting of six to minute individual sessions provided by a trained neonatal nurse practitioner.

Improvements were detected in primary outcomes of maternal depressive and anxiety symptoms, as well as quality-of-life measures in a single group pre-post test trial Segre et al. Much of the research in this area has focused on low-birth weight infants in the NICU, and there is a set of well-articulated programs that can be beneficial to these parents. Given the stress created by a premature birth, the psychological trauma associated with prolonged stays in the NICU, and the possible chronic health and developmental conditions that may emerge in these infants, these programs may produce ongoing benefits.

It is also important to note the long-standing finding that low-birth weight children born to families living in poverty often have poorer outcomes relative to those born to families not living in poverty Sameroff and Chandler, , even when interventions are implemented to support their early development Brooks-Gunn et al. Parents with limited financial resources or social supports who have premature and low-birth weight children may well need more assistance than their better-off counterparts.

This section reviews programs addressing the needs of parents facing special adversities related to mental illness, substance abuse disorders,. It is important to emphasize that approaches for intimate partner violence differ from those applied, for example, with parents with mental illness in that concerns about the safety of the child—even removing the child from the home—must be the priority rather than providing treatment for parents and supporting them in their parental role. Certainly, concerns about the safety of the child are part of the evaluation in the latter cases, but they are not the central focus.

Breadcrumb

Learning gives incentive value to arbitrary cues such as a Pavlovian conditioned stimulus CS that is associated with a reward unconditioned stimulus or UCS. Parents may be more willing to seek health care for their children than for themselves, but during pediatric visits, health care providers may identify a parent who would benefit from mental health treatment Nicholson and Clayfield, S ocial media channels are designed to keep us engaged, to fight for our attention in a crowded media landscape. The defining feature of addiction is compulsive, out-of-control drug use, despite negative consequences. Unfortunately, interventions to support and strengthen parenting for parents with severe mental illness have typically not been rigorously evaluated using the types of well-designed randomized controlled trials used to test other parenting interventions described in this report, and this is an identified area of need Schrank et al. While ASFA is designed to protect children, it also includes provisions pertaining to parental rights.

It should also be noted that, because of the lack of definitive research on support for parents facing other adversities, such as homelessness or incarceration, the discussion does not address these adversities, even though they affect the lives of millions of children.

The fact that parents are experiencing one or more of these adversities does not necessarily mean that they need help with parenting.

Identifying Enabling Behavior and Thoughts

Many parents facing such problems are able to provide adequate parenting. As discussed below, it is well established that children living with parents facing these adversities are less likely to attain the desired outcomes identified in Chapter 2 relative to children whose parents are of similar socioeconomic status but do not face these adversities. Providing effective interventions for these parents to support and strengthen their parenting is therefore critical for both them and their children.

At present, the majority of parents experiencing one or more of these adversities are receiving no services for their condition. For higher-risk families most in need of effective treatment programs, engagement rates may be even lower Ingoldsby, Although not specific to parents, one study estimates the percentage of persons who needed but did not receive substance abuse treatment to be about 90 percent Batts et al. With respect to mental health, a national study of low-income women found that just one-quarter of those with any mental health disorder had sought treatment in the past month Rosen et al.

Again, even when individuals do receive services, the services generally focus on the presenting problem but do not address parenting issues; in fact, individuals receiving treatment for mental health or substance abuse disorders frequently are not asked whether they are parents. Three interrelated factors are particularly common barriers to seeking and receiving support among the parent populations discussed in this section: stigma e. Parents facing adversities may have an internalized sense of stigma about their condition that affects their sense of self-worth and competence Borba et al.

The widespread stigma associated with mental illness often increases parental and family stress and poses a barrier to seeking any parenting support, even basic health care Blegen et al. This appears to be particularly true for parents with severe mental illnesses. Similarly, societal stigma may increase the self-blame, remorse, and shame already felt by mothers with substance abuse disorders, pushing them further away from seeking help and contributing to the denial that is a hallmark of the disease of addiction. Mothers report feeling significant vulnerability based on fear of not being perceived as a good mother.

They recognize that as a result of their condition, they can be at risk for involvement of child protective services and loss of child custody, a perception that is based in fact Berger et al. For example, using Medicaid and child welfare system data, a large study of Medicaid-eligible mothers with severe mental illness found almost three times higher odds of being involved with child welfare services and a four-fold higher risk of losing custody at some point compared with mothers without psychiatric diagnoses Park et al. In the case of mothers with substance abuse, caseworkers may be more likely to perceive that children have experienced severe risk and harm Berger et al.

And the law in many states requires that reports of domestic violence be investigated by child welfare agencies Blegen et al. Ambivalent feelings about parenting support programs may come from past experiences, as well as familial or social histories or perceptions McCurdy and Daro, Some parents report stigmatizing remarks or comments from health care or social service providers. Parents with substance use problems, for example, frequently report that they experience anger and blame from medical and other treatment professionals instead of being viewed as suffering from an illness and treated as such Camp and Finkelstein, ; Nicholson et al.

In the case of parents with mental illness, the distrust may be part of the general attitudes associated with paranoia or delusions Healy et al. Although generating participation can be challenging, a wide range of programs are available that are designed to meet the needs of these populations, both by addressing the underlying problems and with respect to supporting and strengthening parenting.

High-quality trials of such interventions are limited, however. Although there have been randomized controlled trials, many smaller studies, observational research, and case-control studies provide some guidance on best practices. This section reviews the available evidence on interventions designed specifically to support parents facing adversities related to mental illness, substance abuse disorders, intimate partner violence, and parental developmental disabilities, since each has unique needs that should be considered in offering services to strengthen and support parenting.

As noted, many parents face two or more of these challenges, and some face nearly all of them. There has been almost no rigorous evaluation of interventions for these very complex cases, and many of these families are referred to child welfare agencies. Later in this chapter, the committee assesses parenting interventions offered through the child welfare system.

Many parents struggle with mental illness at the same time they are trying to provide a safe, nurturing environment for their family. It is estimated that Research indicates that one-half of all lifetime cases of diagnosable mental illness occur by age 14 and three-fourths by age 24 Institute of Medicine and National Research Council, ; Kessler et al.

Determining the prevalence of mental illness specifically among parents is more challenging. Depression is the most common mental illness. But many parents who experience mental illness have not been formally diagnosed, and patients with a diagnosis of mental illness often are not identified as being parents. It is particularly challenging to estimate the number of parents with severe mental illness often defined as schizophrenia, psychosis, and bipolar disorder.

The relevant research typically has assessed individuals in community settings community service agencies, mental health clinics, child welfare agencies, prisons, or hospitals , who likely do not represent the broader population Nicholson et al. Analysis of data from the National Co-Morbidity Survey suggests that approximately one-half of mothers In another study, among adults identified with severe persistent mental illness, approximately two-thirds of women and three-quarters of men were also parents Gearing et al.

Mental health disorders encompass a wide spectrum of illnesses and levels of severity, and symptoms may wax and wane over time; thus their impact on parenting and the supports these parents need can be quite variable. As with prevalence, far more is known about the impact of depression on parenting Institute of Medicine and National Research Council, than about the impact of severe mental illness Bee et al.

The IOM and NRC report describes research showing that parental depression is associated with more negative and withdrawn parenting and with worse physical health and well-being of children. But the same report describes a number of promising two-generational programs focused on prevention and emphasizes the potential for helping parents with treatment and parenting programs. For individuals with mental illness, being a parent is not only a challenge but also often one of the most rewarding parts of their lives Dolman et al.

However, mental illness also can interfere with the quality of parenting. A cross-sectional study using video observation of depressed mothers with their toddlers demonstrated that those with more severe depressive symptoms engaged in fewer positive interactions and more negative interactions with. Children of parents with mental illness also have a higher risk of developing their own mental health issues, developmental delays, and behavioral problems Beardslee et al.

There have been few high-quality large-scale evaluations of interventions designed for parents with mental illness and even fewer of those for parents with severe mental illness. However, many universal interventions have the potential to prevent or mitigate mental illness before it has serious impacts on parenting, and a number of smaller studies have shown positive or promising results of such interventions. For example, the MOMS Partnership, operated by Yale University, interviewed more than 1, low-income urban mothers of young children to create a set of developmental and community-based mental health and workforce supports Smith, Early results based on a participant questionnaire reveal an increase in positive parenting and reduction in depression Smith, A number of programs are designed to prevent adverse child outcomes among families with known parental mental illness.

The evidence for treating maternal depression for mothers of infants, however, is mixed. Several reviews found that while sustained interventions may improve the cognitive development of the child, additional research is needed to determine the success of these treatments over time, particularly with regard to the benefits for the child as well as the mother Nylen et al. Forman and colleagues.

Nonetheless, most studies have demonstrated that interventions combining mental health treatment and parenting support, or at least including a component focused on parenting, often lead to better outcomes relative to programs that focus solely on the illness. A systematic review of the impact of maternal-infant dyadic interventions on postpartum depression included 19 single group pre-post and randomized controlled studies.

The author concluded that strategies focused on the dyad and maternal coaching were most effective at reducing psychiatric symptoms and demonstrated modest improvements in the mother-child relationship and maternal responsiveness Tsivos et al. Not all such approaches are successful, however. A Cochrane review assessing the impact specifically of parent-infant psychotherapy versus control or an alternative intervention found no significant effects of the psychotherapy on maternal depression or the mother-child dyad Barlow et al. With the advent of primary care medical homes and the resultant integration of physical, mental, and behavioral health care, there has been growing interest in incorporating parenting interventions and support into primary care settings.

This may be a particularly effective way of diagnosing and addressing parental mental health issues. Parents may be more willing to seek health care for their children than for themselves, but during pediatric visits, health care providers may identify a parent who would benefit from mental health treatment Nicholson and Clayfield, Screening adults for depression in primary care settings with the capacity to provide accurate diagnosis, effective treatment, and follow-up is endorsed by the U.

Preventive Services Task Force Models of stepped collaborative care entail screening for and identifying depression in primary care settings and providing straightforward care in those locations while referring patients with more severe or resistant illness to mental health specialists Dennis, Additional primary prevention programs for parental depression have focused on the period from conception through age 5, although most address parents with infants rather than those with toddlers Bee et al. Selective primary prevention of depression among parents has been tested most frequently in the perinatal period, with most programs targeting high-risk groups, such as mothers with preterm infants or those at increased risk for postpartum depression Ammerman et al.

Lessons from the Child of an Addict - Emily Smith - TEDxErie

The perinatal period appears to be an effective time to reach a broad population of parents. Home visiting programs discussed in detail in Chapter 4 serve parents with high rates of depression, interpersonal trauma, and PTSD, yet less than. Early studies examining the mental health benefits of home visiting interventions for parents had mixed results, but the results of more recent studies have been positive. In recent studies, for example, home visiting that includes psychotherapy for mothers has been found to improve depression, and as depression improves, so do many measures of parenting Ammerman et al.

A randomized controlled trial enrolled women in home visiting programs who were identified as being at risk for perinatal depression Tandon et al. The intervention consisted of six 2-hour group sessions focused on cognitive-behavioral therapy, with skills being reinforced during regular home visits. At 6-month follow-up, 15 percent of mothers in the intervention group versus 32 percent of the control mothers had experienced an episode of major depression Tandon et al. In a randomized trial of the Building Healthy Children Collaborative, there was no difference in rate of referral to child protective services for mothers who received mental health services as part of home visits and women in a comparison group who did not receive such services; in both groups, almost all mothers avoided referral to child protective services Paradis et al.

There also have been efforts to help parents with children in center-based care. In a randomized controlled trial of depressed mothers who had infants and toddlers in Early Head Start, investigators tested interpersonal therapy combined with parenting enhancement training versus just treatment for the depression Beeber et al. Both groups had a significant improvement in depression scores, but only the group with parent training showed enhanced parent-child interaction skills.

Beardslee and colleagues describe a nonrandomized, multiyear, multicomponent pilot intervention with parents, staff, and administration in an Early Head Start program serving up to children a year. The intervention, Family Connections, was intended to help staff with strategies for addressing mental health problems in the families they served. The program, which was provided to all the families, not just those identified as suffering from depression, utilized widespread education of staff and parents and a parent support group.

It resulted in improved parent self-reported parenting knowledge and social support and increased parent engagement with the center. Other approaches have been tried in public health settings. Both interventions improved child mental health symptoms and behaviors. Family Talk utilizes manual-based psychoeducation prevention strategies. One study of 93 families with. While parents with brief or time-limited mental health problems can benefit from brief interventions, those with severe mental illness or more complex mental health disorders are likely to need ongoing support and crisis intervention services.

Is Your Teenager a Master of Parental Manipulation?

Unfortunately, interventions to support and strengthen parenting for parents with severe mental illness have typically not been rigorously evaluated using the types of well-designed randomized controlled trials used to test other parenting interventions described in this report, and this is an identified area of need Schrank et al. Shrank and colleagues conducted a systematic review of parenting studies involving parents who had severe mental illness psychosis or bipolar disorder and at least one child between the ages of The review included a heterogeneous range of interventions, and child outcomes were evaluated.

Four of six randomized controlled trials included in the review showed significant benefits from the interventions, which included intensive home visits, parenting lectures, clinician counseling, and Online Triple P; the lower-quality studies showed mixed results. A 3-year observational study of mothers with severe mental illness with children ages demonstrated that over time, as serious symptoms remitted, parents became more nurturing, raising the hope that treatment could lead to improved child outcomes Kahng et al.

A meta-analysis of a variety of parenting interventions found a medium to large effect size in improving short-term parent mental health but noted that these benefits may wane over time, again emphasizing the need for longer and more enduring programs Bee et al. One approach for parents with severe mental illness that appears to be promising is to provide parenting interventions during intensive outpatient treatment or inpatient treatment for mental health crises Krumm et al. A few hospitals in the United States many more in Europe and Australia have mother-baby mental health units where the baby can stay with the mother while she is hospitalized.

A newer observational study in the United Kingdom using a video feedback intervention found that between the time of admission and discharge, mothers with schizophrenia, severe depression, and mania became more sensitive and less unresponsive, and their infants became more cooperative and less passive Kenny et al. Notably, mothers at discharge had better outcomes on all parenting measures than both a comparison group of nonhospitalized mothers with mental illness of comparable severity and a group of mothers without mental illness in the community.

Interventions and treatment for parents with mental illness have been found to significantly reduce the risk of children developing the same mental health problems as well as behavior challenges. A meta-analysis included 1, children in 13 randomized controlled trials of interventions with cognitive, behavioral, or psychoeducational elements for parents with a variety of mental illnesses and substance use problems Siegenthaler et al.

Given the enormous complexity of comorbidities and varieties of presentation in mental illness, sorting out which risks to children derive from parental mental illness and which should be attributed to other stressors is challenging. Doing so is critical, however, for identifying the best strategies for helping families and in considering interventions at both the micro and macro levels. For example, many parents living with severe mental illness will need support in learning parenting knowledge, attitudes, and practices, specifically in understanding normal child development and milestones and how to provide emotional support for their children.

They, like all parents, may also benefit from training in such skills as getting children to have a consistent bedtime routine, feeding them, administering nonphysical discipline, and providing emotional support Nicholson and Henry, ; Stepp et al.

Recognizing and Stopping Teen Addiction: A Complete Guide for Responsible Parents

Mothers living with severe mental illness themselves have identified generic parenting issues for which they may need help—both in accessing essential resources and in developing critical parenting skills Nicholson and Henry, Mental illnesses include a wide range of conditions. One mother may have severe depression and struggle with lifelong, recurrent episodes, while another may have a single episode of mild postpartum depression. One disorder may cause symptoms that make it difficult to recognize the emo-. Even a single diagnosis can manifest with different symptoms and severity at different stages of the illness, and the illness itself can lead to complications.

Parents with severe or recurrent illness also may face separation from their children due to hospitalization or temporary or permanent loss of custody, which can impact parental self-efficacy as well as attachment Gearing et al. Thus it is important for programs to tailor services to the individual needs of parents.

Programs that offer service coordination are likely to be effective for parents with mental illness who face other adversities as well, such as poverty, family violence, housing instability, and substance abuse. Providers and policy makers also need to be mindful of the multiple layers of risk these co-occurring conditions pose to families, since childhood outcomes will be affected by far more than the parenting behaviors or knowledge targeted by many programs. Like mental health conditions, substance use and abuse can affect parenting attitudes and practices, as well as engagement and retention in parenting programs.

It has been estimated that nearly 22 million Americans have a substance use disorder Center for Behavioral Health Statistics and Quality, Yet in , only 4. Moreover, both research and clinical practice have seen little integration of child development and parenting with addiction prevention and treatment. Most studies on substance abuse to date have measured mainly retention in treatment and reduction in maternal substance use as the primary outcomes, with less attention to parenting and work with children Finkelstein, , ; Nicholson et al. Abuse of alcohol and drugs can impact parenting in multiple ways.

Potential neonatal effects include prematurity and low birth weight; greater reactivity to stress; increased arousal; higher irritability and restlessness; disordered sleep and feeding; tremulousness, high-pitched cry, and startled response; difficulties with sensory integration, such as abnormal responses to light, visual stimuli, and sounds; and hyperactivity Iqbal et al. Department of Health and Human Services, a.

An infant who cannot regulate sleep, wakefulness, or stress is therefore often partnered with a mother who has. Research has recently combined the neurobiology of addiction with the neurobiology of parenting, and has examined how the disregulation of the stress-reward neural circuits in addiction may impact the capacity to parent Rutherford et al.

Red Flags of Manipulation

It is well documented that increases in stress result in increases in cravings and substance use Sinha, More specifically, the rewarding value of drugs for a substance-dependent individual comes from ameliorating withdrawal and other stressful situations, and this value may diminish biochemically the rewarding and pleasurable aspects of parenting Rutherford et al. Oxytocin motivates social behavior by stimulating a reward response to proximity and social interaction and has been shown to increase significantly in both mother and infant during periods of close contact and breastfeeding Strathearn et al.

Substance abuse interferes with this process. For example, cocaine specifically coopts this neuropathway by decreasing the production of oxytocin and thereby making maternal care less rewarding for a cocaine user Elliott et al. Dopamine operates similarly: it rewards social behavior and regulates the production of stress-response chemicals. From a neurobiological perspective, therefore, the motivation to engage with and respond to infants may be compromised in the presence of addiction, and this diminished motivation may result in part from infant signals holding less reward value Rutherford et al.

In addition, the increased stress inherent in the parenting role may increase cravings, drug-seeking behaviors, and relapse to substance use Rutherford et al. From this limited sample, studies have described a range of parenting deficits and consequences, sometimes associated with specific drugs including alcohol , as well as the amount, frequency and duration of use. Parents may become preoccupied by drug cravings and drug-seeking behaviors, which in turn may lead to physical absences and multiple disruptions in parenting.

Further complicating this picture is that all too frequently, the substance-dependent mother has herself been a victim of violence and abuse. High levels of trauma history and moderate to high levels of PTSD diagnosis co-occur among both men and women with substance abuse disorders Back et al.

Women whose childhood history includes sexual abuse are significantly more likely than women without such a history to report substance use and abuse, as well as depression, anxiety, and other mental health problems Camp and Finkelstein, Although prenatal substance exposure and early mother-child interactions characterized by intoxication and withdrawal have independent affects, it is the cumulative risk of chemical, psychological, and environmental disturbances related to substance abuse disorders that interferes with parenting and child development Huxley and Foulger, ; Mayes and Truman, These secondary risk factors are amenable to early intervention, identification, and comprehensive treatment modalities, offering an avenue for improved outcomes for both mother and child Barnard and McKeganey, Indeed, childrearing conditions appear to greatly outweigh substance abuse in predicting adolescent outcomes for drug-exposed children Fisher et al.

The result too often is that individuals suffering from addiction are excluded from community programs, as well as research and evaluation studies Camp and Finkelstein, ; U. Department of Health and Human Services, This exclusion includes home visiting programs, which may screen out parents who use alcohol and drugs. Department of Health and Human Services, b. Substance abuse can be successfully treated.

However, while there is good reason to believe that decreased substance use should lead to improved parenting, there have been no experimental evaluations of whether successful treatment of substance abuse disorders, in and of itself, leads to better parenting. Described below are interventions for substance abuse that include a specific focus on parenting.

The literature describes a number of specific residential treatment programs for mothers with their children. The majority of studies report positive parent and child outcomes using pre-post evaluation designs Allen and Larson, ; Conners et al. Data on 1, women showed positive results, including an infant mortality rate 57 percent lower than that in the general population.

Seventy-five percent of 97 mothers at one site reported improved relationships with their children and learned better stress coping skills Clark, In response to high rates of nonviolent drug-related arrests in the early s, the United States began utilizing drug courts as an alternative to traditional sentencing procedures. These courts often mandate treatment for substance abuse disorders, frequent drug testing, and periodic court appearances for status hearings Mitchell et al.

I ran to the phone to call my mother, pleading with her between sobs to pick us up. When my mother got the call at work, she told me years later, it confirmed her growing fears that my father was using again. She was working long hours and, I suspect, hoping that ignoring the signs would make the problem go away.

You know when you have a gut feeling. But I felt it was important that you see him, so I was torn between protecting you and letting you and your brother have a relationship with him. The problem was now too big to avoid, so my mother obtained a restraining order against him. After that, my father disappeared from my life for close to eight years, from when I was six until I was But I remember, even at such a young age, feeling shame that he was so odd and unpredictable. He was too busy fighting wildfires in Yosemite or saving cats from trees to be around like other dads.

Fortunately, my mother had a successful career and was able to provide for us on her own. Once my father dropped out of the picture, she attempted to create an environment completely free of the chaos of my early years. I continued to attend private school, where I took gymnastics and joined the Brownies.

But there was one central fact that ensured our harmony. In my upper-middle-class enclave, it was embarrassing enough that I had a single mother, let alone a father who was banned from seeing us. Even into adulthood, I really thought my story was uniquely humiliating. Over 8. Called the Adverse Childhood Experiences ACE study , it asked over 17, patients to answer a host of questions about their physical health and childhood experiences. In almost 27 percent of the cases, the study found a history of household substance abuse. People who had experienced an ACE—like growing up with an addict—had an increased risk of STDs, obesity, heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

They also showed an elevated risk of alcoholism, drug abuse, depression, and suicide. Looking back at his research, Anda told me he is most proud not that it proved a link between childhood adversity and physical health issues, but that it inspired a greater conversation about the psychological impact of trauma. I became an extreme hypochondriac, seeing tumors in bug bites and seeking doctor visits—I was convinced and secretly hoping that I was dying. I was extremely quiet and overly sensitive, sometimes not talking for hours and then suddenly bursting into tears. My anxiety was palpable, and my teacher grew so concerned that I found myself in a therapy class for kids of divorced parents.

We sat in a circle reading Dinosaurs Divorce: A Guide for Changing Families , and one by one, we told the group our feelings. In fact, I was more disturbed by the therapy session itself. One boy told of his father throwing his mother into a wall and described going with her to the hospital. I thought our family code of silence seemed preferable to stirring up old horrors. Study after study shows that children of addicts develop anxiety, depression, issues with over-achievement and people-pleasing, and psychosomatic illnesses at a higher rate than others. I was astonished by how many of the symptoms applied to me.

In those days, a couple of sips of beer and a bong hit would render me temporarily soothed, but the effects never really lasted. The nervousness would always resurface in the form of an upset stomach or anxiety attack. In the midst of my emotional turmoil, my father called to let my mother know that he was clean after one last stint in Walden House, a rehabilitation facility formerly located in Haight-Ashbury. He wanted to rejoin family life and make up for lost time.

But while he got close to my mother and brother, who longed for a father figure in the family, I refused to engage.