Treatment: It’s All in the Family : Addictions: The relationship of user and parent is emerging as the most important element in breaking the cycle of drug and alcohol abuse, according to a statewide task force report.

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,” recalls Cheryl.

She was not eager to share the fact that her husband drank to excess, and that she drank and over-ate to cover insecurities.

But after two years of family therapy two evenings a week, she says, she has learned to live with imperfection. 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 evidence 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,” says Sherry Novick, who prepared the report for the task force, co-chaired by state Sen. Diane E. Watson (D-Los Angeles) and Assemblyman Tom Bates (D-Oakland).

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. 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.”

The report 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 be stronger than peer pressure, heightening the need for family counseling.

“For a number of years, people were focusing on the peer group,” says 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 tend to have relationships that lack warmth and are full of conflict, she said. As a result, their 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,” says Brook.

She also notes that siblings who use drugs may have more influence than parents.

Chauncey Veatch, director of the state’s Department of Alcohol and Drug Programs, agrees that prevention efforts must be expanded and that family treatment is the best way to treat addiction.

But state efforts are hampered by funding for programs that fluctuates from year to year, he says. In addition, state and federal programs now 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.

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 men and women) in outpatient treatment and 700 in residential programs.

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

“Peers are important at mid-age,” he says. “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.

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,” says Vicki Walker, program specialist 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.

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, CODA (Children of Drug Abusers and Alcoholics), treated 257 families of children ages 6 through 11 whose parents, grandparents, or other relatives living at home have been identified as drug abusers or alcoholics.

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 any subject blindfolded, while the others helped. “The lesson is that poster painting blindfolded is like trying to do something under the influence,” Van Fleet says. “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 has been cut back to a handful of families who now pay $10 or $15 a session. A 28-day non-hospital residential program costs $5,000 to $6,000, according to the report.

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

Another hallmark of Van Fleet’s program, called for by the task force, was cultural sensitivity. When working with Mexican-born parents, for example, Van Fleet says her counselors never questioned the authority of the father, knowing it might jeopardize the effect of the therapy.

“There are a lot of factors, a lot of determinants out there in our communities that all contribute to the substance abuse problem,” says Paul Jellinek of the Robert Wood Johnson Foundation in Princeton, N.J., which funds Fighting Back, the nation’s largest privately backed anti-drug initiative.

Not only do families have to be involved, but whole communities, says Jellinek.

“Families are a part of the solution, but they can’t do it on their own. Nobody can handle it on their own.”