What percentage of American families are dysfunctional?

Children of addicted and mentally ill parents: Addiction is a family disease

Addicts can get all the help they need when they want. However, their children's problems often remain in the dark. At the annual meeting of the Federal Drug Commissioner, a call was made to look at the whole family system.

Natalie was strong enough. For years she lived with her alcoholic mother and two significantly younger siblings. At twelve she looked after the little ones on her own, did the housework and put away the empty bottles, while the mother slept off her intoxication on the sofa. The mother's aggressive outbursts, who blamed the children for their misery, got worse and worse. . . “At some point Natalie called the police, who started the help system: The children were taken care of by the child and youth welfare service. "I was so unhappy and for a long time didn't know a way out - in the home I was finally able to just look after myself," says the 19-year-old who has just moved into a supervised shared apartment. Covered with a hood, cap and sunglasses, she sits on the podium at the annual meeting of the Federal Drug Commissioner on the subject of "Children from families with addiction" in Berlin in mid-June - and touches those present with her story. *

Dysfunctional families

"Only a third of the children from families with parents with addictions - like Natalie - get away with healthy skin and psyche," emphasizes drug commissioner Marlene Mortler (CSU). Risk factors for developing the disease themselves include the parentification of children, conflicts, aggressiveness and violence in the family, neglect, unstable parenting behavior and unreliability of parents, insecure attachment and social exclusion. "The consumption of addictive substances is only superficially the problem - it is more the dysfunctionality of the family that permanently affects all members as stress", explains Prof. Dr. phil. Michael Klein, Clinical Psychology and Addiction Research, Catholic University of Applied Sciences Cologne. In more than 50 percent of cases, addiction occurs comorbidly with depression - with the corresponding effects on the family. Klein criticizes the health care system: “Addiction is a family disease, but in terms of health care policy we leave the children out in the rain, because the health system only takes into account individuals, not systems.” In other words, addicts parents get the help they need - the children have to first get sick to get therapeutic help. In the opinion of the scientist, in addition to treating the parent with addiction as early as possible, selective preventive measures for the children and coordinated parent-child therapies would be ideal.

If the children remain unnoticed and neglected, they usually accompany the consequences of their parents' drug consumption for a lifetime, as Prof. Dr. med. Rainer Thomasius, German Center for Addiction Issues in Children and Adolescents at the University Medical Center Hamburg-Eppendorf, explains: Anxiety disorders, attachment disorders, depression, hyperactivity, post-traumatic stress disorders, self-harm, somatic disorders, self-esteem disorders and personal addictions. Thomasius also considers measures that include the whole family to be necessary. He also sees the responsibility of the doctors who treat the parents: "Every doctor who knows that a high-risk patient has children at home must take care of them." This also applies to mentally ill parents. A current resolution of this year's German Medical Congress in Freiburg now demands: "Doctors, especially general practitioners, psychiatrists and psychotherapists who treat mentally ill parents should also think about their children, include them in their treatment concept or, if necessary, forward them to appropriate support systems."

"We want to get as many children as possible out of the shadows", is the concern of the drug commissioner Mortler. "Many affected children also fall through the mesh of our help system," she criticized. The addiction help primarily cares for the sick parents: only five percent of all addiction counseling centers also look after the children of their clientele. The youth welfare offices, which are often overburdened, often only become active when there is a massive risk to the child's welfare.

"The addict is well covered by the social security books - but their children are not," criticized Henning Mielke, from the NACOA (National Association for Children of Alcoholics) eV advocacy group. Although there are around 200 offers nationwide for affected children, there is no overview . Many affected children also benefit from group offers, such as the evaluated prevention program “Trampolin” (www.projekt-trampolin.de), which is also covered by the health insurance companies.

Karen Zimmer from the Cornelius Foundation in Cologne, which supports children from families with addiction problems, presented another outstanding offer: the kidkit project, an Internet portal that offers information and advice to "problem parents" who are addicted to children aged ten and over are mentally ill or violent. Those affected can anonymously contact the advisors in an online chat or get help over the phone. With the help of kidkit networks, a nationwide database project that should be completed in 2018, affected children and young people can also look for suitable advice centers there (www.kidkit.de).

“When a child clearly needs help, everyone has to pull together. It is crucial that youth welfare offices, addiction support and the local public health service work together and not side by side, ”the drug commissioner warns. In addition, the municipalities would have to name clear contact persons in the youth welfare offices, whom doctors, psychotherapists, educators or teachers could turn to if they had any suspicions. Dr. med. Franziska Diel, National Association of Statutory Health Insurance Physicians (KBV). There are definitely promising approaches: "There are good experiences from quality circles in the context of networked care for mentally ill children, which we initiated in the KBV contract workshop: A doctor or psychotherapist and a youth welfare officer each form a tandem."

Unfortunately, such collaborations are still far too rare. Help for children of addicts and mentally ill parents often fails due to different responsibilities and cost bearers or the coordination of the same. In an affected family, up to six social security codes (SGB II, III, V, VI, IX and XII) can be responsible. A motion by the CDU / CSU, SPD and Bündnis90 / Die Grünen parliamentary groups, which was adopted by the Bundestag on June 20, calls for the deployment of an interdisciplinary working group to examine the problems of interfaces and make suggestions for improving the situation of children of addicts and people mentally ill parents (Drucksache 18/12780). Ultimately, multi-professional care for affected families from a single source is necessary.

Petra Bühring

* Natalie's story was filmed: "Happiness is an illusion" is the name of the feature film that can also be shown in schools (www.schizoproductions.de).

Dear Affected Children

The Federal Government assumes that one of the parents of around 3.8 million children and adolescents under the age of 18 will be mentally ill within a year. Parents were diagnosed with alcohol abuse or addiction in 2.65 million of these children. An estimated 6.6 million children live with one parent with high risk alcohol consumption.

It is estimated that around 60,000 children have an opiate dependent parent and some of them live with them. The dark field is considered to be very high.

About 37,500 to 150,000 children have parents who are pathologically addicted to gambling, and in most cases the father is affected. There are no figures available on the children of parents who suffer from other behavioral addictions such as shopping addiction or online addiction. There are also few figures in Germany on children from families in which cannabis, cocaine, methamphetamine, new psychoactive substances or drugs are consumed.

"It is critical to evaluate the fact that the previous statistics on children from families with addiction problems are often based on estimates or projections, provided that information is available," says the brochure "Children from families with addiction problems", which the drug commissioner published especially for her annual meeting . According to her information, the 70-page brochure provides a condensed overview of the study situation on the subject for the first time. To be requested via: [email protected]