Drug Abuse, Treatment Is Family Affair, Study Says : Health: A Tustin therapy center requires all household members to attend sessions, a rarity in state.

When Cheryl and her husband admitted their daughter to a Tustin drug treatment center, officials produced a form asking whether anyone in the family had a drinking problem.

“I thought, ‘How dare they?’ I was scared, hurt, embarrassed and ashamed.”

She was not eager to share the fact that her husband drank to excess, and that she, raised to be perfect, drank and overate to cover insecurities.

But after two years of required family therapy two evenings a week, she said, she has learned to live with imperfection. Her husband still drinks, and she and her daughter still argue. “But we are sober when we are talking to each other. It makes it a lot easier.”

Fortunately for this middle-class family, treatment at the private, for-profit Healthcare Medical Center of Tustin required participation by the entire family, and treatment was mostly paid for by insurance.

But their experience is the exception, not the rule. Despite growing perceptions that families are perhaps the most important element in causing and breaking the cycle of drug and alcohol abuse, family-focused treatment programs and public funding for them remain scarce, according to a report published this month by a statewide task force on the changing family.

“The problem is, it becomes more expensive if you deal with the whole family,” said Sherry Novick, who prepared the report for the task force, co-chaired by State Sen. Diane E. Watson and Assemblyman Tom Bates.

The report, called “Families and Substance Abuse: The Case for a Comprehensive Approach,” was derived from statewide testimony during the past three years and recent studies. It concludes that unless the state adopts a substance-abuse strategy that emphasizes the role of families, it will fail to confront the problems of the 2.1 million drug addicts and 2.2 million alcoholics clogging California’s courts and jails, and will fall short of easing such tragic problems as drug-addicted babies, drug-related violence, accidents and suicides.

The report also concludes that the influence of parents may even be stronger than peer pressure, heightening the need for counseling involving the whole family rather than simply focusing on young people in school.

Current state and federal programs allocate 70% of their budgets for enforcement and punishment, and 30% for all kinds of treatment and prevention.

As a consequence, those without money or insurance often wind up on long waiting lists for only a few publicly subsidized programs.

Chauncey Veatch, director of the state Department of Alcohol and Drug Programs, agreed that prevention efforts must be expanded and that family treatment is the best way to treat addiction. But state efforts are hampered by erratic funding that fluctuates from year to year, he said.

“Federal funds have come in great numbers, but it’s like a roller coaster. It’s difficult to realistically address treatment when the package is for an incredibly limited term.”

Earlier this year, the department reported young people are turning away from drugs, notably cocaine, as a result of education and prevention efforts, citing studies of high school seniors in Yolo and San Diego counties.

Others, however, note that the studies did not include those who drop out of school. They also point to an increase in the number of drug-related deaths and arrests among both youths and adults.

Citing state figures, the report says that 85% of youths committed to the California Youth Authority are involved in drug or alcohol abuse, and the majority of those who wind up in the already-overflowing prison system have substantial histories of substance abuse.

Veatch agreed with the report’s suggestion that family patterns may have more influence on children than peer groups--particularly among high-risk youth who have at least one parent who is a substance abuser.

“Peers are important at mid-age,” he said. “Parents are important from the very beginning.”

Studies show that 70% of children of alcoholics develop some compulsive behavior--alcoholism, drug abuse or eating disorders. For boys, the presence of an alcoholic family member nearly doubles the risk of developing substance abuse. If the alcoholic is the boy’s father, the likelihood increases ninefold.

In addition, the report cited research by J. David Hawkins, professor at the University of Washington’s School of Social Work, that “poor family management, inconsistent rules, lax supervision, excessive discipline, constant criticism and negative communication patterns are highly correlated with a child’s future drug use.”

Another study funded by the National Institute on Drug Abuse shows that families that rarely or never use drugs or alcohol are better at problem solving and communication. They also tend to be less authoritarian than families beset by addiction. The study concludes that “a troubled, disorganized or fragmented family life is an undisputed factor in placing youths at risk of substance abuse.”

Many researchers have been saying the same thing for years.

“For a number of years, people were focusing on the peer group,” said New York Medical College psychiatry professor Judith S. Brook. “The real issue is, why do they pick certain friends?

“That goes back to what their (inborn) personality is like, and then, what is their family like,” said Brook, whose research on parents’ role in teen drug abuse has been funded by the National Institute on Drug Abuse for 10 years.

Drug-using parents directly influence their children to emulate their behavior. But they also tend to have relationships that lack warmth and are full of conflict, she said.

As a result, these children tend to be rebellious, aggressive and lacking in responsibility. They also tend to tolerate deviance. “That then leads to selecting friends who use drugs,” Brook said.

Siblings who use drugs may even have more influence than parents, she said.

However, even if only one parent is warm, affectionate and communicative toward the child, he or she can buffer the effect of the other parent, the sibling or of the peer group, she said.

Even single parents in high-risk environments can offset the risks if they develop a strong attachment with their children, providing reasonable expectations on how to behave, she said.

According to a 1989 report of the Office for Substance Abuse Prevention, “Various evaluations have found that even with drug-abusing parents, effective family skills training can lead to improved family communication, decreased behavior problems in the children and increased commitment to rejecting alcohol and cigarette use.”

Some publicly financed programs have recognized the growing evidence that families need to be included in treatment of addiction.

For instance, parents are targeted in two Orange County Department of Education community conferences to prevent drug, alcohol and tobacco use in children, one last week and one scheduled for Friday.

“Parents do a really good job when their children are babies. As soon as the child starts to walk, they’re harder to monitor,” said Vicki Walker, program specialist at the Orange County Department of Education.

“When a child begins to enter seventh grade, parents begin to lose a concept of what’s appropriate and it gets harder to monitor them.

“In this day and age, with both parents working, and a significant number of single parents who are raising children, that monitoring becomes far more difficult.”

Perhaps the most obvious and extreme examples of how the behavior of parents affects children are the substance-exposed newborns, 62,000 of whom were born in California during 1989.

According to the task force, the situation “illustrates a whole spectrum of failings: the lack of accessible treatment options; inadequate attention to needs of the family; the use of law enforcement procedures that criminalize rather than heal the family, and administrative and financial barriers that obstruct approaches that are known to work.”

In Los Angeles County, the report notes, nearly 16,000 women are referred by the courts to the county for treatment; however, the county has capacity for only 3,000 clients (including both men and women) in outpatient treatment and 700 in residential programs.

One innovative but short-lived federally funded program in Los Angeles was aimed at the highest-risk families, steeped in denial and especially unlikely to seek family training or other prevention help, the report said.

The program, Children of Drug Abusers and Alcoholics, treated 257 families of children ages 6 to 11 whose parents, grandparents or other relatives living at home had been identified as a drug abuser or alcoholic.

The families, mostly working class or poor, were referred by teachers and social workers who noticed behavioral problems in the children. Some parents in recovery, who had become worried about how they have affected their children, also volunteered for the program.

The three-month program, which brought the children to the center twice a week, once with their families, was designed to rid the children of their assumptions that “everything going on at home is their fault.” It was also designed to teach family communication skills, said Peggie Van Fleet, director of youth services and prevention for the nonprofit Southeast Council on Alcoholism and Drug Program in Downey.

Family night therapy featured exercises to demonstrate the effect of drugs and alcohol. In one, each family member painted a picture of their choice blindfolded, while the others helped. “The lesson is that poster painting blindfolded is like trying to do something under the influence,” Van Fleet said. “For the first time, children learn why mom and dad stumble around and spill everything. And it’s a real lesson for mom and dad.”

The families also watered two pots planted with seeds--one with water, another with wine--to demonstrate how damaging alcohol can be to living things.

The Office of Substance Abuse Prevention ranked it among the top 10% of demonstration projects it had funded, but dropped funding two months ago because it could only continue to underwrite the top 7%, Van Fleet said.

The program was free, but it has been cut back to a handful of families who now pay $10 or $15 a session.

“I couldn’t let it die,” Van Fleet said. “It deserves to live.”