What Your Child Should Know If You Have A Family History Of Substance Use Disorder

Like other difficult subjects, alcohol is a topic that many parents would rather avoid when talking to their kids. Sometimes, concerns about saying the wrong thing prevent us from starting the conversation. Or we may believe that what we say won’t matter and that all teens will inevitably experiment with drinking.

The truth is that the biggest mistake we can make is to say nothing. Research shows that when it comes to substance abuse, parents’ actions (like allowing kids to drink at home) matter — and so do their words. Studies have found that teens who believe their parents have a zero-tolerance policy when it comes to alcohol are less likely to drink in college.

“We see that youth are less likely to use alcohol and other substances when their parents have the expectation that they won’t” and communicate this expectation to their children, Dr. Maria Rahmandar, medical director of the substance abuse and prevention program at Lurie Children’s Hospital in Chicago, told HuffPost.

Parents can also let go of the thinking that “all teens use, and so it’s inevitable,” Rahmandar said. “It doesn’t have to be.”

Data from the University of Michigan’s Monitoring the Future found that in 2021, 54.1% of teens reported having ever used alcohol by grade 12 and 25.8% in the last 30 days. These numbers have declined dramatically over the past decades: in 1978, 93.1% of high school seniors reported ever having used alcohol, and 72.1% in the past 30 days. The observation that “everybody else is drinking” used to be much more true than it is now.

If not all teens are drinking and parents’ rules around alcohol use do impact kids’ actions, then parents have a real opportunity to prevent underage drinking, which we know puts kids at risk for alcohol use disorder.

“The longer you can delay, the lower your risk of developing a substance use disorder,” Rahmandar said, adding that “most people who have a substance use disorder started using when they were a teenager.”

Among all the risk factors for substance use disorder, genetics play an important role. Dr. Marc Schuckit, a researcher at the University of San Diego who has authored multiple studies about genetics and alcohol use disorder, has concluded that genetics accounts for approximately 60% of a person’s risk for developing alcohol use disorder. However, there is not one “alcoholism gene”; many genes are involved, and their interplay with other risk factors determines whether a specific individual develops a problem.

Parents need to make sure that teens have a solid understanding of the risks of alcohol use on their developing brains and know that they can minimize their risk by either not using or delaying their use of alcohol and other substances.

Teens also need to know if their family history puts them at risk in order to make informed decisions. This conversation can be a difficult one for parents — particularly if a parent is the one who has struggled with substance use. Here, experts offer tips on how to navigate this discussion.

Jessica Lahey, author of “The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence,” told HuffPost that she was open with her school-aged children about her own use and that of other family members. Using age-appropriate language, she told her children, who were 9 and 14 years old at the time, about her own alcohol use disorder when she decided to seek treatment.

“I told them I would not be drinking alcohol anymore because I can’t control it, and in order to be the best mom I could be for them, I had to stop,” she said. “I also told them I could not stop on my own and was getting help.”

Lahey was also honest with her kids a few years earlier, when a relative’s relapse derailed the family’s Christmas plans. Although it was “upsetting for everyone,” she said, “lying … would not have been helpful.” She now views the experience as “another piece of helpful information” for her kids concerning the consequences of substance use.

“If there has been dysfunction in the home because of someone misusing substances, the child is already aware something is not right and may benefit from a conversation sooner rather than later,” Michael Roeske, a psychologist and senior director for the Newport Healthcare Center for Research and Innovation, told HuffPost.

By sharing the information openly, you prevent kids from coming up with their own explanations, which might be frightening or simply untrue. You also turn the situation into an opportunity for them to understand what substance use disorder looks like.

While we can estimate that about 60% of a person’s risk for substance use disorder is genetic, we can’t precisely calculate any individual’s risk. In addition to genetics, there are simply too many factors at play: both negative ones (like trauma and mental health conditions) and positive ones (like having role models and strong family bonds). It can be empowering for kids to know that one significant risk factor — whether they drink and at what age they first do so — is entirely within their control.

“It’s nearly impossible to calculate a specific risk for a child, so I prefer to think of risk and protections like the scales of justice: the heavier your risk side, the more protections you will need to heap on the other side in order to zero out or outweigh risk.” Lahey said. “Those protections include mental health interventions, academic interventions, supportive and responsive parenting, and many other factors.”

While kids have a right to know about a family history of substance abuse — just as they would a history of heart disease or cancer — Roeske said that “educating them about an increased risk for a substance use disorder, while important, is not nearly as impactful as a family working on communication, addressing their own issues, providing structure and warmth, and just being as good at parenting as they can be.”

Kids can’t control who their family members are, but there are plenty of things that they do get to decide.

“In order to develop a substance use disorder, you need to be exposed to substances, which means that if you choose not to use drugs or alcohol, you cannot become addicted to drugs or alcohol,” Rahmandar said.

It may be daunting for young people to contemplate a lifetime of abstinence, but parents can remind them that whether (or when) they drink is a choice they get to make for themselves and that their risk goes down the longer they delay drinking.

You can also remind kids that a higher risk does not mean destiny. Roeske recommended presenting addiction “as one of many potential outcomes for them.” He added that you can point out “that many people, even those with a strong family history of substance use disorders, do not end up misusing drugs or alcohol.”

Talking about substance abuse, particularly when it is a parent’s own, can certainly be nerve-racking. A parent might worry that a child will judge them or even be more likely to try drinking if a parent raises the subject. But we know that when parents tell their kids why they don’t want them to drink, children are, in fact, less likely to drink.

Understanding genetics as one piece of the puzzle can be part of this explanation.

“Giving kids information about their risk for substance use disorder is no different from helping them understand they have a genetic predisposition for other negative health outcomes,” Lahey said.

“If they know their grandmother died of diabetes or their grandfather had high blood pressure or cholesterol, they may make better decisions about diet and exercise,” she continued. “If they know they are predisposed to alcohol use disorder, that’s another piece of essential information they need to make informed decisions about drinking.”

It’s frightening for a parent to learn that their child has been offered drugs or alcohol and tried them. There are real concerns about both their short-term safety and their long-term health, especially if there is a family history of addiction. But it doesn’t mean you’ve failed or that your actions don’t matter.

Having a loving, warm relationship with your children, supporting them even when they make mistakes, and maintaining firm boundaries for their well-being are all ways to help your child overcome any challenge, whether it’s substance use or something else.

“It is this ongoing effort that is most important,” Roeske said.

Even if your child does go on to develop a substance use disorder at some point in their life, that doesn’t mean all your efforts have been for nothing.

“I think of getting to recovery from alcohol use disorder like a 100-piece puzzle,” Lahey said. “It’s fun to be piece 100, where everything falls into place and someone who has been suffering with substance use disorder finally admits they need help and starts the process of recovery. Here’s the thing, though. For piece 100 to fall into place, pieces two, 17, 72 and 99 have to be in place.”

With all the protective factors you have given them over the years, including honest information about their genetic risk, Lahey added that “if they do end up with substance use disorder, they may start on piece 39 rather than piece one and can get to recovery faster.”