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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‘Brave’ doesn’t always feel like certain, or strong, or ready. In fact, it rarely does. That what makes it brave.♥️
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#parenting #mindfulparenting #parentingtips
We teach our kids to respect adults and other children, and they should – respect is an important part of growing up to be a pretty great human. There’s something else though that’s even more important – teaching them to respect themselves first. 

We can’t stop difficult people coming into their lives. They might be teachers, coaches, peers, and eventually, colleagues, or perhaps people connected to the people who love them. What we can do though is give our kids independence of mind and permission to recognise that person and their behaviour as unacceptable to them. We can teach our kids that being kind and respectful doesn’t necessarily mean accepting someone’s behaviour, beliefs or influence. 

The kindness and respect we teach our children to show to others should never be used against them by those broken others who might do harm. We have to recognise as adults that the words and attitudes directed to our children can be just as damaging as anything physical. 

If the behaviour is from an adult, it’s up to us to guard our child’s safe space in the world even harder. That might be by withdrawing support for the adult, using our own voice with the adult to elevate our child’s, asking our child what they need and how we can help, helping them find their voice, withdrawing them from the environment. 

Of course there will be times our children do or say things that aren’t okay, but this never makes it okay for any adult in your child’s life to treat them in a way that leads them to feeling ‘less than’.

Sometimes the difficult person will be a peer. There is no ‘one certain way’ to deal with this. Sometimes it will involve mediation, role playing responses, clarifying the other child’s behaviour, asking for support from other adults in the environment, or letting go of the friendship.

Learning that it’s okay to let go of relationships is such an important part of full living. Too often we hold on to people who don’t deserve us. Not everyone who comes into our lives is meant to stay and if we can help our children start to think about this when they’re young, they’ll be so much more empowered and deliberate in their relationships when they’re older.♥️
When we are angry, there will always be another emotion underneath it. It is this way for all of us. 

Anger itself is a valid emotion so it’s important not to dismiss it. Emotion is e-motion - energy in motion. It has to find a way out, which is why telling an angry child to calm down or to keep their bodies still will only make things worse for them. They might comply, but their bodies will still be in a state of distress. 

Often, beneath an angry child is an anxious one needing our help. It’s the ‘fight’ part of the fight or flight response. As with all emotions, anger has a job to do - to help us to safety through movement, or to recruit support, or to give us the physical resources to meet a need or to change something that needs changing. It doesn’t mean it does the job well, because an angry brain means the feeling brain has the baton, while the thinking brain sits out for a while. What it means is that there is a valid need there and this young person is doing their very best to meet it, given their available resources in the moment or their developmental stage. 

Children need the same thing we all need when we’re feeling fierce - to be seen,  heard, and supported; to find a way to get the energy out, either with words or movement. Not to be shut down or ‘fixed’. 

Our job isn’t to stop their anger, but to help them find ways to feel it and express it in ways that don’t do damage. This will take lots of experience, and lots of time - and that’s okay.♥️
The SCCR Online Conference 2021 is a wonderful initiative by @sccrcentre (Scottish Centre for Conflict Resolution) which will explore ’The Power of Reconnection’. I’ve been working with SCCR for many years. They do incredible work to build relationships between young people and the important adults around them, and I’m excited to be working with them again as part of this conference.

More than ever, relationships matter. They heal, provide a buffer against stress, and make the world feel a little softer and safer for our young people. Building meaningful connections can take time, and even the strongest relationships can feel the effects of disconnection from time to time. As part of this free webinar, I’ll be talking about the power of attachment relationships, and ways to build relationships with the children and teens in your life that protect, strengthen, and heal. 

The workshop will be on Monday 11 October at 7pm Brisbane, Australia time (10am Scotland time). The link to register is in my story.
There are many things that can send a nervous system into distress. These can include physiological (tired, hungry, unwell), sensory overload/ underload, real or perceived threat (anxiety), stressed resources (having to share, pay attention, learn new things, putting a lid on what they really think or want - the things that can send any of us to the end of ourselves).

Most of the time it’s developmental - the grown up brain is being built and still has a way to go. Like all beautiful, strong, important things, brains take time to build. The part of the brain that has a heavy hand in regulation launches into its big developmental window when kids are about 6 years old. It won’t be fully done developing until mid-late 20s. This is a great thing - it means we have a wide window of influence, and there is no hurry.

Like any building work, on the way to completion things will get messy sometimes - and that’s okay. It’s not a reflection of your young one and it’s not a reflection of your parenting. It’s a reflection of a brain in the midst of a build. It’s wondrous and fascinating and frustrating and maddening - it’s all the things.

The messy times are part of their development, not glitches in it. They are how it’s meant to be. They are important opportunities for us to influence their growth. It’s just how it happens. We have to be careful not to judge our children or ourselves because of these messy times, or let the judgement of others fill the space where love, curiosity, and gentle guidance should be. For sure, some days this will be easy, and some days it will feel harder - like splitting an atom with an axe kind of hard.

Their growth will always be best nurtured in the calm, loving space beside us. It won’t happen through punishment, ever. Consequences have a place if they make sense and are delivered in a way that doesn’t shame or separate them from us, either physically or emotionally. The best ‘consequence’ is the conversation with you in a space that is held by your warm loving strong presence, in a way that makes it safe for both of you to be curious, explore options, and understand what happened.♥️
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#mindfulparenting #positiveparenting #parenting

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