Tips for Talking with Children about Addiction and Overdose Loss

Tips for Talking with Children about Addiction and Overdose

We’ve all read about it and heard about it in the news. In 2016 the number of opioid overdose deaths in the United States topped 63,000. Not only does this number surpass the total killed by car accidents and firearms, it also surpasses the number of Americans who were killed in the 19 years of the Vietnam War. This epidemic has impacted the entire fabric of American life. Many who have died are young people and adults with children. So how do we talk about overdose death with children? What words should we use? How do we address a topic that brings up complicated feelings of sadness, anger, guilt, blame, worry, isolation, and anguish, as well as the big “why” questions and the desire to protect those we love?

There are really two parts to these questions. First, how do we talk about drugs and addiction and second, how do we talk about death by overdose. Another point to consider is children’s exposure to the loved one’s substance use. Some children who have lost a family member to overdose already know that life had been a struggle or had been “different”, that the person had been experiencing ongoing trauma and change. Other children are not aware that their loved one struggled with drug-related issues, so both the drugs and death are foreign experiences. Either way, the death of a loved one is a difficult and often overwhelming experience for children.

Explaining Addiction to Children: Points to Consider

Not everyone who dies a drug-related death has struggled with addiction (also known as substance use disorder (SUD)), but many have. If this is the case, it is important to acknowledge the addiction and how it may have already impacted the child’s life.

  • Addiction has multiple causes and is unique to each individual, but factors of genetics, personality, environment, exposure, and past trauma all play a role. In adult terms, it is a chronic relapsing condition, and in children’s terms it is an illness that impacts the brain and behavior—an illness that can be treated.
  • One helpful approach is to use the “gum” analogy with young children– that treating addiction is like getting sticky gum out of their hair—very difficult to do and requiring a lot of time and effort. Another helpful image is that of a fish stuck on a hook—wanting to get “unhooked” can be a frustrating and difficult task.
  • With children, offer as much clarity as possible around drugs of abuse versus medicine that the doctor prescribes for medical needs. For example, with a prescription drug overdose, one might say, “Joe used more of the medication than the doctor prescribed or was safe to use.” An addiction is an “invisible disease that causes a person to use more (alcohol or other drugs) than is safe and can be treated but sometimes can end in death.” The words “drug,” “medicine,” and even “substance” can be unclear. Clarify that not all medicine is addictive or bad for us, and that it is important to never take someone else’s prescribed medication. Teenagers can often understand the different meanings of the words, but you must keep it clear.
  • Addiction “highjacks” or controls the brain and can make people do or say hurtful things that they don’t really mean. In other words, try to separate the person from the disease. In addition, it is important to clearly state that the child did not cause the addiction, so as to separate the child from the cause.  
  • Children growing up in homes with a family member who struggles with addiction can experience a confusing array of emotions. They can both be very protective and loyal to their family member, but also resentful and hurt. Often, they are reluctant to open up due to the fear of sharing a long-held family secret or of feeling shame and embarrassment. It can be helpful to acknowledge this conflict, and that multiple feelings can be experienced at the same time.

The following “Seven Cs of Addiction”, from the National Association for Children of Alcoholics, is a helpful tool for your discussion of addiction with your child:

  • I didn’t Cause it.
  • I can’t Cure it.
  • I can’t Control it.
  • I can Care for myself
  • By Communicating my feelings,
  • Making healthy Choices, and
  • By Celebrating myself.

Explaining Overdose Loss to Children

Now we address the challenge of explaining overdose death to children. There is no exact script, but there are some talking points that may help. The initial conversation is not the time to share all of the available information about the death. Instead, the beginning conversation lays the groundwork, allowing the child to react and ask questions while allowing the adult to support and draw out what the child is thinking and feeling. Some children may have heard the terms “overdose” or “drug-related death”, but many have not. Well-meaning adults are sometimes tempted to “protect” children and to avoid the truth when talking about overdose death. Children will inevitably discover the true cause of death of close family members and friends, and it is best to first hear this information from the adults they trust. Adults can reassure children in these moments and talk about their concerns.

 Below are guidelines we can use to address this sensitive topic:

  • Take care of yourself first:  Consider the airplane analogy — put on your own “oxygen” mask before placing one on your child.  Take a couple of deep breaths and give yourself time to collect your thoughts.
  • Think about the conversation in terms of building blocks:  Telling “the truth” does not mean sharing all the information at once. This foundation of truth can be built upon during future conversations.
  • Name your feelings but try to keep them in check: When we are processing difficult news, we will experience waves of feelings; after all, we are human. Name your feeling, e.g. “I am feeling very sad right now,” but stay as calm as possible and take breaks when needed.
  • Keep language clear: Try to use language that is appropriate to your child’s age, level of understanding, and previous knowledge of the situation.
  • Younger children need a concrete explanation of death and overdose: “Death means the body has stopped working” and “An overdose is when someone takes too much of a drug or the wrong drug, and it makes their body stop working.”
  • Talk about the person who died in a caring and respectful way: “Your Grandma died by an overdose, but this does not define who she was.”  Just as a period does not define a sentence, the cause of death does not define a person.  He or she is not “an overdose” but a person who died by an overdose.
  • Avoid assigning fault and blame: Underline that it is not anyone’s fault that this person died—and that the death is certainly not the child’s fault. Remember that in the course of normal development, children can experience “magical thinking” which sometimes leads them to see a death as their fault. 
  • Guide children in learning to share information appropriately: Children may need assistance in sharing with others what has happened. Let them know that sharing does not mean telling everything—it is not a lie to keep some things private. They may need guidance in answering questions from peers or community.

Children and teens need to make sense of the death and embrace their feelings as much as adults do. Be sure to remind the child that if they themselves ever struggle with their feelings, there is always help available. Avoid comments like, “Your loved one wouldn’t want you to be sad.”  These will only serve to shut down conversation. Instead, reassure them that it is okay to feel any emotion and share with you if they choose. Avoid trying to make sense of the loss for your child or teen with blanket statements like, “They are in a better place now.”  Instead, invite curiosity and questioning.  Even when we do not have the answers, it is reasonable to share that you do not know and ask, “What do you think?”

Help them identify the people around them who are available to talk with during tough times. Help them to identify what safe activities bring them a sense of comfort and control when they are distressed, such as drawing pictures of their feelings, petting their cat, or listening to favorite music.

Substance abuse and overdose losses are complicated topics, difficult even for sensitive and thoughtful parents. Please reach out to a mental health provider if you need additional support or if you have on-going concerns.  Remember, it is a sign of health to ask for guidance in times of need.


About the Authors: 

Sarah Montgomery LCSW-C is the Coordinator of Children and Family Programs at the Chesapeake Life Center at the Hospice of the Chesapeake. She has over 20 years clinical experience providing individual, family, and group counselling in a variety of settings including school-based, outpatient psychiatry and community-based organizations. She holds a BA from Williams College and an MSW from University of Maryland School of Social Work. Sarah has also co-written three books Helping Your Depressed Teenager (1994) and the Clinical Uses of Drawings (1996) and recently Supporting Children After a Suicide Loss: A Guide for Parents and Caregivers (2015) with Susan Coale LCSW-C.

 

 

Joy McCrady, MS, LGPC, NCC, is a bereavement counselor with the Chesapeake Life Center of Hospice of the Chesapeake. She offers family-centered grief support and works with clients throughout the lifespan who have experienced traumatic loss. She co-facilitates a support group for those who have lost a loved one to substance abuse as well as a group for grieving teens.

One Comment

Catherine C

My sons father just died of an overdose. My son lived with him, he was a lawyer, the best Dad. No one knew he was on drugs. Jack found him, thought he was sleeping and went to other room and came back later…..He is only 13. His Dad was EVERYTHING to him. Please, how do I help the most? I am in recovery. If it happened to me they would not be shocked. How will he get through this.

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Anxiety is a sign that the brain has registered threat and is mobilising the body to get to safety. One of the ways it does this is by organising the body for movement - to fight the danger or flee the danger. 

If there is no need or no opportunity for movement, that fight or flight fuel will still be looking for expression. This can come out as wriggly, fidgety, hyperactive behaviour. This is why any of us might pace or struggle to sit still when we’re anxious. 

If kids or teens are bouncing around, wriggling in their chairs, or having trouble sitting still, it could be anxiety. Remember with anxiety, it’s not about what is actually safe but about what the brain perceives. New or challenging work, doing something unfamiliar, too much going on, a tired or hungry body, anything that comes with any chance of judgement, failure, humiliation can all throw the brain into fight or flight.

When this happens, the body might feel busy, activated, restless. This in itself can drive even more anxiety in kids or teens. Any of us can struggle when we don’t feel comfortable in our own bodies. 

Anxiety is energy with nowhere to go. To move through anxiety, give the energy somewhere to go - a fast walk, a run, a whole-body shake, hula hooping, kicking a ball - any movement that spends the energy will help bring the brain and body back to calm.♥️
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#parenting #anxietyinkids #childanxiety #parenting #parent
This is not bad behaviour. It’s big behaviour a from a brain that has registered threat and is working hard to feel safe again. 

‘Threat’ isn’t about what is actually safe or not, but about what the brain perceives. The brain can perceive threat when there is any chance missing out on or messing up something important, anything that feels unfamiliar, hard, or challenging, feeling misunderstood, thinking you might be angry or disappointed with them, being separated from you, being hungry or tired, anything that pushes against their sensory needs - so many things. 

During anxiety, the amygdala in the brain is switched to high volume, so other big feelings will be too. This might look like tears, sadness, or anger. 

Big feelings have a good reason for being there. The amygdala has the very important job of keeping us safe, and it does this beautifully, but not always with grace. One of the ways the amygdala keeps us safe is by calling on big feelings to recruit social support. When big feelings happen, people notice. They might not always notice the way we want to be noticed, but we are noticed. This increases our chances of safety. 

Of course, kids and teens still need our guidance and leadership and the conversations that grow them, but not during the emotional storm. They just won’t hear you anyway because their brain is too busy trying to get back to safety. In that moment, they don’t want to be fixed or ‘grown’. They want to feel seen, safe and heard. 

During the storm, preserve your connection with them as much as you can. You might not always be able to do this, and that’s okay. None of this is about perfection. If you have a rupture, repair it as soon as you can. Then, when their brains and bodies come back to calm, this is the time for the conversations that will grow them. 

Rather than, ‘What consequences do they need to do better?’, shift to, ‘What support do they need to do better?’ The greatest support will come from you in a way they can receive: ‘What happened?’ ‘What can you do differently next time?’ ‘You’re the most wonderful kid and I know you didn’t want this to happen. How can you put things right? Do you need my help with that?’♥️
Big behaviour is a sign of a nervous system in distress. Before anything, that vulnerable nervous system needs to be brought back home to felt safety. 

This will happen most powerfully with relationship and connection. Breathe and be with. Let them know you get it. This can happen with words or nonverbals. It’s about feeling what they feel, but staying regulated.

If they want space, give them space but stay in emotional proximity, ‘Ok I’m just going to stay over here. I’m right here if you need.’

If they’re using spicy words to make sure there is no confusion about how they feel about you right now, flag the behaviour, then make your intent clear, ‘I know how upset you are and I want to understand more about what’s happening for you. I’m not going to do this while you’re speaking to me like this. You can still be mad, but you need to be respectful. I’m here for you.’

Think of how you would respond if a friend was telling you about something that upset her. You wouldn’t tell her to calm down, or try to fix her (she’s not broken), or talk to her about her behaviour. You would just be there. You would ‘drop an anchor’ and steady those rough seas around her until she feels okay enough again. Along the way you would be doing things that let her know your intent to support her. You’d do this with you facial expressions, your voice, your body, your posture. You’d feel her feels, and she’d feel you ‘getting her’. It’s about letting her know that you understand what she’s feeling, even if you don’t understand why (or agree with why). 

It’s the same for our children. As their important big people, they also need leadership. The time for this is after the storm has passed, when their brains and bodies feel safe and calm. Because of your relationship, connection and their felt sense of safety, you will have access to their ‘thinking brain’. This is the time for those meaningful conversations: 
- ‘What happened?’
- ‘What did I do that helped/ didn’t help?’
- ‘What can you do differently next time?’
- ‘You’re a great kid and I know you didn’t want this to happen, but here we are. What can you do to put things right? Do you need my help with that?’♥️
As children grow, and especially by adolescence, we have the illusion of control but whether or not we have any real influence will be up to them. The temptation to control our children will always come from a place of love. Fear will likely have a heavy hand in there too. When they fall, we’ll feel it. Sometimes it will feel like an ache in our core. Sometimes it will feel like failure or guilt, or anger. We might wish we could have stopped them, pushed a little harder, warned a little bigger, stood a little closer. We’re parents and we’re human and it’s what this parenting thing does. It makes fear and anxiety billow around us like lost smoke, too easily.

Remember, they want you to be proud of them, and they want to do the right thing. When they feel your curiosity over judgement, and the safety of you over shame, it will be easier for them to open up to you. Nobody will guide them better than you because nobody will care more about where they land. They know this, but the magic happens when they also know that you are safe and that you will hold them, their needs, their opinions and feelings with strong, gentle, loving hands, no matter what.♥️
Anger is the ‘fight’ part of the fight or flight response. It has important work to do. Anger never exists on its own. It exists to hold other more vulnerable emotions in a way that feels safer. It’s sometimes feels easier, safer, more acceptable, stronger to feel the ‘big’ that comes with anger, than the vulnerability that comes with anxiety, sadness, loneliness. This isn’t deliberate. It’s just another way our bodies and brains try to keep us safe. 

The problem isn’t the anger. The problem is the behaviour that can come with the anger. Let there be no limits on thoughts and feelings, only behaviour. When children are angry, as long as they are safe and others are safe, we don’t need to fix their anger. They aren’t broken. Instead, drop the anchor: as much as you can - and this won’t always be easy - be a calm, steadying, loving presence to help bring their nervous systems back home to calm. 

Then, when they are truly calm, and with love and leadership, have the conversations that will grow them - 
- What happened? 
- What can you do differently next time?
- You’re a really great kid. I know you didn’t want this to happen but here we are. How can you make things right. Would you like some ideas? Do you need some help with that?
- What did I do that helped? What did I do that didn’t help? Is there something that might feel more helpful next time?

When their behaviour falls short of ‘adorable’, rather than asking ‘What consequences they need to do better?’ let the question be, ‘What support do they need to do better.’ Often, the biggest support will be a conversation with you, and that will be enough.♥️
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#parenting #positiveparenting #mindfulparenting #anxietyinkids

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