People who have a history or are currently dealing with addiction are especially vulnerable to relapse when faced with isolation, and this is especially worrisome given the intensity and duration of isolation associated with the COVID-19 crisis. With restrictions on travel and unusually stressful economic and social changes, people across the world are forced to find ways to pass time and to cope with stress. Substance use can be a maladaptive coping strategy that many people may fall back on during these difficult times.

A Forbes article noted that the sales of spirits spiked about 50% the week of March 21, a week when the onset of the pandemic began to overwhelm the United States.

“Nationally, tequila saw the biggest spike, up more than 75%, underscoring its status as the fastest growing spirits segment in the U.S,” said Forbes contributor, Joseph V Micallef. “It was followed closely by gin. Wine sales were up 66% and beer sales, in a reversal of the usual recession consumption pattern, lagged even though they still rose 42%.”

A study was conducted by the Pacific Neuroscience Institute (PNI) on the effects of stress and isolation on relapse. The results indicated that the effects of people who struggle with drug or alcohol use are at increased risk of relapse in isolation. “Preclinical studies show that animals kept in isolation are more likely to press a lever to receive a dose of drug or alcohol than animals able to interaction with other animals.”

The connection between isolation and an increased need for stress-relieving rewards is proven to be a chemical reaction. The PNI recommends that those who are struggling seek out regular social interactions with sober family members, friends or other people who can offer support. There are online platforms set-up to support individuals who are struggling and cannot receive in-person help during the pandemic.

AA and SMART Recovery are two recovery platforms that have online services including specialized group forums, peer support groups, meetings, and other events designed to create remote support systems for individuals in need.

Doctors and mental health specialists are also accessible throughout this time and available to ensure that everyone has the resources they need during this global health crisis. Personal health is of the utmost priority during this time and is something we could all focus more time on.

Reach out to any people or organizations who can help you get through this difficult time, and don’t forget to make your support available to others as well. We’ll all get through this together.

To understand the opioid epidemic in America, it is crucial to understand the structures of families who are affected, and how they must adapt to non-traditional family dynamics as a result of addiction. Research and interventions often focus on the individual living with addiction or a substance use concern as a means to provide treatment services. Growing research and the attention of child welfare agencies, mental health providers, and state and local officials are shedding light on the complexity of addiction as it relates to family units. The lives of individuals who are addicted, their children, and other relatives are often uprooted and refocused around the opioid addiction and the repercussions of that disease.

As the number of individuals affected by opioids increases, so does the number of children affected. These effects can be a result of physical abuse, ignoring children’s needs, or exposing them to unsupervised or harmful situations. Children are often displaced from their homes if their parents are unable to care for them due to addiction, incarceration, or if they are no longer alive. As a result, grandparents are often accountable for raising their grandchildren, and in situations that are frequently sudden and precarious. While the stress of these situations can be overwhelming, many grandparents wouldn’t want their grandchildren with anyone else.

According to the Public Children Services Association of Ohio, about 100,000 grandparents are currently raising their grandchildren in Ohio. The United States Census reported that nationwide 2.7 million grandparents are raising grandchildren. Grandparents often assume their role as a caretaker without preparation or warning, and often in the midst of another familial crisis. In this case, they may be assuming the responsibility of a caretaker while simultaneously dealing with the trauma of their own child’s addiction. These complications can make for an onerous transition for the entire family.

The American Society on Aging found that one in five grandparents raising grandchildren lives below the poverty line, and one in four has a disability. These grandparents are forced to navigate uncharted territory as they adopt new financial responsibilities, and stress from grandchildren who are often struggling with emotional trauma and separation anxiety from their parents.

A study published in Children and Youth Services Review was conducted to understand the impact of stress on grandparents raising grandchildren. The study involved 214 grandparent caregivers and 86 other kin caregivers. The researchers summarized that grandparent caregivers faced unique challenges due to guilt, birth parent concerns, and generational gaps. It revealed that grandparent caregivers experienced and higher level of parenting stress compared to other kin caregivers, partly due to their advanced age and lower overall health. Grandparent caregivers also related that financial strain, child behavior concerns, navigating service systems and schools, and problematic relationships with birth parents all contributed to their stress.

Families seeking resources can visit Grandfamilies.org, a national legal resource in support of grand-families both in and out of the child welfare system.

Lee, E., Clarkson-Hendrix, M., & Lee, Y. (2016). Parenting stress of grandparents and other kin as informal kinship caregivers: A mixed methods study. https://www.albany.edu/chsr/Publications/Leeetal2016%20parenting%20stress.pdf

Lent, Jaia Peterson. “Grandparents Are Raising the Children of the Opioid Crisis.” Grandparents Are Raising the Children of the Opioid Crisis | American Society on Aging, www.asaging.org/blog/grandparents-are-raising-children-opioid-crisis.

Public Children Services Association of Ohio. (2019). PCSAO – Factbook. Retrieved May 31, 2019, from http://www.pcsao.org/factbook

US Census Bureau. (2019). The opioid crisis and grandparents raising grandchildren. Retrieved May 31, 2019, from https://www.census.gov/library/stories/2019/04/opioid-crisis-grandparents-raising-grandchildren.html

Children in foster care are highly at risk

The approach to treating substance use disorder (SUD) has been changing to be more recovery-oriented. There is a shift from treatment and control of symptoms to treatment focused on approaches that empower the client to maintain long-term recovery.  Peer recovery supporters (PRS), trained individuals with their own recovery experience, are thought to provide significant advocacy and support for individuals struggling with addiction. PRS support and advocate for their clients as they navigate the successes and setbacks of the recovery process.

Some of the advantages of using PRS are that clients paired with PRS:

• Formed better relationships with their treatment providers and greater utilization of social supports
• Stayed in treatment longer and reported higher satisfaction with treatment
• Had reduced substance use and were less likely to relapse

Peer Recovery Supporters, in turn, express that having the opportunity to share their lived experience with addiction and recovery with others helps them to:

• gain better insight into their own symptoms
• increase social engagement and
• improve their sense of life satisfaction

The use of PRS as a component of a recovery-oriented treatment model is showing promise for promoting long-term recovery. It is expected that the use of PRS in SUD recovery will continue to grow, and agencies may need to make additional adjustments to support PRS. Cultivating agency culture to embrace and promote the inclusion of peers in SUD treatment is vital to having a successful PRS program. Further, agencies should consider the expansion of peer occupational growth opportunities as well as professional development efforts that allow PRS to qualify for advanced positions. Considering the PRS as a valued professional member of the SUD treatment team will help maximize their ability to help clients engage in treatment and work toward long-term sobriety.

References:

Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., … Kelly, J. F. (2019). Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology, 10(JUN), 1–12. doi:10.3389/fpsyg.2019.01052

Ahmed, A. O., Hunter, K. M., Mabe, A. P., Tucker, S. J., & Buckley, P. F. (2015). The Professional Experiences of Peer Specialists in the Georgia Mental Health Consumer Network. Community Mental Health Journal, 51(4), 424–436. doi:10.1007/s10597-015-9854-8

Chapman, S. A., Blash, L. K., Mayer, K., & Spetz, J. (2018). Emerging Roles for Peer Providers in Mental Health and Substance Use Disorders. American Journal of Preventive Medicine, 54(6S3), S267–S274. doi:10.1016/j.amepre.2018.02.019

Research from the U.S. Census Bureau has found that states with higher opioid prescribing rates have higher numbers of grandparents raising grandchildren, even after taking into account other socio-economic factors such as poverty. Data from the 2012-2016 American Community Survey allowed researchers to study the relationship between opioid prescription rates at the state and county level and the number of grandparents raising grandchildren. The study found that opioid misuse was involved in 46% of cases where grandparents are caring for grandchildren in rural areas, compared to 32% in urban areas. Nationally, 32% of children in foster care are being raised by relatives with many more are being raised by relatives outside of the foster care system. Currently, 2.7 million grandparents are raising grandchildren. According to the Public Children Services Association of Ohio, about 100,000 grandparents are currently raising their grandchildren in Ohio.

Ohio is making progress in reducing its opioid prescribing rates, but rates are still high. Since 2010, Ohio’s overall opioid prescribing rate has dropped from 102.4 to 63.5 per 100 persons, which is still higher than the national rate of 58.7. Cuyahoga is the only urban county, at 50.1 per 100 persons, have an opioid prescribing rate lower than the national rate. In rural counties, the prescribing rate ranges from Nobel the lowest (17.8) to Jackson the highest (112.5). Ohio continues to be challenged by the misuse of opioids with the second-highest opioid overdose death rate of 39.2 deaths per 100,000 persons.

Grandparents raising grandchildren face many special challenges including mental health concerns for themselves and their grandchildren due to the death or temporary loss of their grandchild’s parent (their son or daughter), financial obligations, navigating the school system, and building networks of social and other supports. To respond to the impact of the opioid crisis on grandparents, the federal government enacted The Supporting Grandparents Raising Grandchildren Act in July of 2019. The act created a federal task force to identify and share information to help grandparents raising grandchildren.

Anderson, L. (2019). The opioid prescribing rate and grandparents raising grandchildren: State and county-level analysis. Retrieved from https://www.census.gov/content/dam/Census/library/working-papers/2019/demo/sehsd-wp2019-04.pdf

Centers for Disease Control and Prevention. (2017). U.S. Opioid Prescribing Rate Maps | Drug Overdose | CDC Injury Center. Retrieved May 31, 2019, from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

Cole, P. E., Clausen, K. A., Cook, L., Johanson, M., Cunliffe, J., Associate, R., Rostan, M. (2016). 2016 state of poverty: A portrait of Ohio families. Retrieved from www.oacaa.orgwww.researchpartners.org

National Institute on Drug Abuse (NIDA). (2019). Opioid summaries by state. Retrieved May 31, 2019, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state

Public Children Services Association of Ohio. (2019). PCSAO – Factbook. Retrieved May 31, 2019, from http://www.pcsao.org/factbook

Learn to Cope is a support group based in Massachusetts for family members of people who primarily use opioids. The goals of this group are to increase knowledge about overdoses, conduct prevention trainings, and provide naloxone rescue kits (OEN). The objective of this study was to describe the benefits and motivations of family members who receive OEN and specify the frequency of naloxone used during an overdose rescue.

OEN began in 2007 and soon became one of the first organizations to offer OEN training. OEN training lasts about 20 minutes and includes education on how to recognize and respond to an overdose. The program emphasizes the importance of involvement from family members and provides potential opportunities to save lives.

The cross-sectional study provided OEN training at eight different sites. Participants completed a survey at the end of the 20 minute training to assess experience with overdose and motivation to receive OEN.

Among the 126 individuals with complete survey data, 52% financially supported their loved one and 50% reported daily contact. Those who received the OEN training were more likely to be a parent, apply to court-mandated treatment, attend more meetings, and witness an overdose. 72% of trainees reported wanting to have a naloxone kit in the household, and 57% heard about the benefits from other Learn to Cope members.

Trainees reported a greater sense of security, improved confidence to handle an overdose, and a greater understanding of overdose prevention and management. 22% of participants did not want OEN due to believing the training was not necessary or that they would not use the kit. Thirty-seven participants reported they had witnessed an overdose, and five participants administered naloxone to a family member or stranger after being trained through Learn to Cope. Due to the use of the naloxone kit, 4 of 5 overdoses restored breathing and individuals were responsive until an ambulance arrived.

Policymakers should consider mobilizing family members as part of the response to the opioid overdose epidemic and make efforts to empower family members who might feel stigmatized and isolated. OEN programs at support groups should be considered a part of an overdose prevention public health strategy. Programs such as these have the potential to provide education which could lead in an increase in confidence, and reduce the likelihood of fatal opioid overdoses.

Bagley, S. M., Peterson, J., Cheng, D. M., Jose, C., Quinn, E., O’Connor, P. G., & Walley, A. Y. (2015). Overdose Education and Naloxone Rescue Kits for Family Members of Individuals Who Use Opioids: Characteristics, Motivations, and Naloxone Use. Substance abuse, 36(2), 149–154. doi:10.1080/08897077.2014.989352

Kinship care placements have become an important part of the child welfare system due to the lack of adequate foster care homes for maltreated youth. Kinship care is generally defined as providing full-time nurturing and protected care to a child by relatives or those who have “family-like” relationships with a child. These relationships are often categorized into formal or informal arrangements. Formal arrangements involve public child welfare agencies arranging legal custody of children, while informal arrangements exclude government involvement.

In recent years, more research has studied the lasting effects of trauma for maltreated youth. As a result, the Substance Abuse and Mental Health Services Administration (SAMHSA) has made efforts to develop models of trauma-informed care. Also, child welfare agencies have been offering trauma-informed parenting programs. Unfortunately, there have been few programs specific for kinship caregivers, leaving questions about what kinship caregivers know about childhood trauma. A recent study examined three research questions: 1) “How do kinship caregivers perceive their knowledge and the knowledge of other kinship caregivers about child trauma?”, 2) “What are the relationships between kinship caregivers’ knowledge about child trauma, reported demographic characteristics, and background training in child trauma?”, and 3) “Is there a difference in kinship caregivers’ perceived knowledge and actual knowledge about child trauma?”.

In the study, researchers collected data from 130 kinship caregivers through online surveys that included the definition of child trauma, training about child trauma and its effectiveness, and both perceived and actual knowledge of child trauma. The vast majority of the caregivers were grandparents (n= 111), while 19 identified as an aunt or uncle to the child. To assess how helpful the training was in understanding child trauma, participants were asked to rank on a Likert-type scale as 1=” Very Unhelpful and 5=” Very Helpful”. Results showed that participants rated their self-knowledge and perceived knowledge of child trauma higher after given more exposure to child trauma training.

Most of the participants in the study were White (95.4%) and about 87% were married. Descriptive findings also indicated that on average, participants had been in a kinship care-giving role for nearly five years. The study suggests that most kinship caregivers (90%) receive some training about child trauma, and that many caregivers knew more about trauma than they thought. However, some groups of kinship caregivers knew more than others, caregivers who were more educated knew more about child trauma.

Agencies are considering mandating trauma assessments to children entering kinship care to ensure a minimum level of understanding. This study, one of the first to focus on this important topic, suggests that these trainings can be helpful for kinship caregivers’ knowledge about trauma, which may improve the lives of the children that they care for.

Reference:

Miller, J., Koh, E., Niu, C., Bode, M., & Moody, S. (2019). Examining child trauma knowledge among kin caregivers: Implications for practice, policy, and research. Children and Youth Services Review, 100, 112-118.

Parents involved with child welfare that have substance use (SUD) are often engaged with multiple systems including child welfare, SUD treatment, and the courts. To help families navigate these services and requirements, they can be assigned a Family Peer Mentor (FPMs). What is an FPM, what do they do, and are they helping families with parental SUD stay together?

An FPM is someone in long-term SUD recovery¹ who also has experience with the child welfare system. They also complete a certification training program¹ to learn how to apply their own experiences to help other families. The FPM is the family advocate, connecting the family to needed services and as emotional support promoting sober parenting. The relationship between the FPM and the family is collaborative with the shared goal of achieving parental sobriety and family safety and stability. FPMs are uniquely positioned not only to help families navigate the child welfare system, but also to provide the hope and motivation needed to achieve and maintain sobriety.

To better understand how FPMs help child welfare involved families, a study² was conducted of the services and outcomes of 28 FPMs involved in the Sobriety Treatment and Recovery Teams (START) in Kentucky. Each FPM was partnered with one child welfare caseworker, and this FPM/caseworker team served 12-15 families. This study shows the importance of FPMs in promoting family unification and parent sobriety:

The study also highlights the importance of supporting FPMs’ own sobriety as they transition from child welfare client to an employee supporting families through a very stressful situation. Of the 28 FPMs, 10 had a relapse or other ethical/policy violation that resulted in their removal; however, the remaining 18 FPMs realized stability and growth either with the child welfare agency or with other, more advanced positions.

With the goal of parental sobriety and family unification, the use of FPMs shows excellent promise. Kentucky START and programs using FPMs or peer supporters are not only helping families; these programs are keeping more children from entering out-of-home care while also giving individuals in recovery an opportunity for steady, full-time employment that appreciates their child welfare and SUD experience to help others.

¹Click here for more information on The Ohio Department of Mental Health and Addiction Services (OhioMHAS) certification for Peer Recovery Supporters in Ohio: (https://workforce.mha.ohio.gov/Workforce-Development/Job-Seekers/Peer-Supporter-Certification).

²Huebner, R. A., Hall, M. T., Smead, E., Willauer, T., & Posze, L. (2018). Peer mentoring services opportunities and outcomes Huebner 2018.pdf. Children & Society, 84, 239–246.