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Kristin Caroza, Tonya DeDera, Edith Feld,
Davis Legaspi-David, Jared Hansen, Leslie
Ramos, & Sara Silverberg

Breaking Night
Liz Murray grew up in the Bronx with
her older sister and two drug
addicted parents
Her need to care for her parents, lack
of supervision and love of the streets
as a young child superseded her
desire to attend school, eventually
leading to homelessness
While living on the streets it became
clear to Liz that only she was in
control of her own future and needed
to make changes, if she wanted to
While still homeless, Liz obtained her

Retrieved from:

(Murray, 2010

Effect of Substance Abuse on Children

Children of substance abusers are a population without a clear
Children of Addicts/Children of Substance Abusers is any child
whose parent (or parental caregiver) uses alcohol or other drugs in
such a way that is causes problems in the childs life

The parent does not have to still be actively drinking or using for the
child to continue to feel the impact of the abuse

Alcoholism and other drug addictions have genetic and

environmental causes

Both have serious consequences for children who live in homes where
parents are involved with drugs and/or alcohol

(American Academy of Experts in Traumatic Stre

More than 28 million Americans are children of alcoholics
More than 8 million children live with at least one parent addicted to
alcohol or drugs

14% are younger than 2 years

12% are 6 and 11 years old
10% are between ages 12 and 17 years

(Children of Addicted Parents, n.d; Drug Rehab,

Statistics of Homeless Children in Part Due to

Drug Addicted Parents
23,790 : Number of homeless children in Nevada in 2012 2013
11,253 : Number of homeless youth enrolled in Clark County schools in
2014 2015
2,232 : Number of unaccompanied homeless children and youth living on
the streets or in homeless shelters in Southern Nevada on an average day in
4th : State of Nevadas nationwide ranking for the prevalence of
unaccompanied homeless children and youth residing in our state in 2014
1st : State of Nevadas nationwide ranking for the rate of unaccompanied
homeless children and youth living unsheltered on our streets in 2014

(Nevada Partnership for Homeless Youth, 2

Parents Path Towards Addiction

Background of chronic abusers:
Product of dysfunctional parents who were substance abusers

Felt neglected
Abused: Physically and sexually

Mental illness or genetic disorder

Drug use progression:
Social/Experimental (Use)
Coping or avoiding (Abuse)
Becomes primary need (Dependence)

(Martin, Smith, Rogers, Wallen, & Boisvert,

Parental Substance Abuse and Its

Child abuse and neglect: Between and of all maltreatment
cases involve some type of substance abuse

Children with addicted parents are 3 times more likely to be abused, and
4 times more likely to be neglected when compared to peers

According to my grandparents, my mom was such a lively, smart,

vivacious, and respectable woman. She was generous and would
give the shirt off her back to someone in need. However, as soon
as she would use drugs she would lie, cheat, and steal. She would
go missing for weeks at a time (R. M., personal communication, February 15, 2016).

Developmental and mental health issues

More likely to exhibit behavioral problems at home and school and at a

higher risk of developing anxiety or depression

Foster care or other placement

(Drug Rehab, n.
Increased likelihood of being next generation substance abusers

(Brook, Brook, Rubenstone, Zhang, Castro, &

Role Reversal

Child becomes a young carer

Place adult burdens on childrens shoulders

Role Confusion

Forfeit of authority and power shift between child and parent

Acquired loss of respect of parent due to substance addiction
Assertive and parental behavior of child
Sneaky behavior of parent
Strong feelings of disgust and hatred toward parent

(Kroll, 2004)

Youth from lower SES families are more likely to smoke
Youth from higher SES families are prone to alcohol use, heavy
episodic drinking, and marijuana use
Adults from higher occupational status are associated with more
alcohol and substance use disorders

(Patrick, Wrightman, Schoeni, & Schulenberg

Neglect and Abuse

Food, clothing, school supplies, and other necessities that a child
needs is disregarded because parents focus on their addiction,
mostly out of fear of withdrawal from their substance abuse
Parents spend money to support their drug habit instead of
financially supporting the childs basic needs
Parents are entangled within their addiction, which consumes their
parenting responsibilities
I was five years old but I remember vividly the times when my mom
would be extremely high. She was also addicted to men who were
verbally and physically abusive. She would get beat and dragged
down the hall by her hair. As a five year old, I couldnt wrap my brain
around the fact that this behavior was substance induced. It was very
frightening to live with her (R. M., personal communication, February 15, 2016).
(Manly, Oshri, Lynch, Herzog, & Wortel,

Emotional and Behavioral

Neglected children of substance abuse parents may
experience as a result the following:

Erratic attendance
Repeating a grade
Stress from conflicts at home

(Manly et al., 2013

Emotional and Behavioral

Hostile home environment increases risk for multiple emotional and
behavioral problems
Displays anger, antisocial, hyperactive, physical aggression, and
delinquent behavior
Associated with panic attacks, compulsiveness, personality disorder,
dissociation, depression, and dangerous play

This one time I punched my boyfriend in the head and it

made him cry because he was an abused child too. I have this
relationship with this person that I care about and Im doing
the same things my father did to me. Realizing Im following
in my fathers footsteps and thats something I never wanted
to do (Q. N., personal communication, Februrary 12, 2016).
(Hser, Evans, Li, Metchik-Graddis, &

Long-Term Consequences
The concentration of drug addiction, criminal activity, and HIV/AIDS
in urban low-income communities may constitute a stressful
environment for adolescents, and increase their likelihood of
engaging in substance use
Ecological factors, such as drug trafficking, gangs and less
neighborhood cohesion, may impact adolescents through a lack of
community norms against drug use or the absence of informal
social controls
Children growing up with substance abuse parents, include
increased mortality, self-destructive behaviors, which include
suicide or drug addiction

(Brook et al.,

Long-Term Consequences
Adolescents who live in underserved, low-income environments with
high levels of drug use, drug trafficking, and gang activity, are at
increased risk of psychological maladjustment and problem
behaviors, including substance abuse (Brook et al., 2008)
I always told myself I would do better than my parents. It
wasnt until I broke my foot in 2007 that I discovered the
euphoric effects of vicodin and I started stealing vicodin from
my grandpa. My lower self confidence in school heightened
my use exponentially. It was my way out! It relieved my
stress and made me feel extremely confident. No longer could
I drink just one drink or take just one hit (R. M., personal communication, February
15, 2016).

Diversity Factors: Non-Discriminatory

Impacts all races, genders, and socioeconomic status
However, in one 10 year study behavioral problems were higher
with Caucasians (52.76) compared to African Americans (50.05),
Hispanics (49.11), and Asians/other (47.35)
Hispanics demonstrated better family and social outcomes than
Caucasians, due to more family support during recovery process
A comparative study on Caucasian and African American
adolescents found that Caucasians wanting to be in the in crowd
were more susceptible to negative role modeling than African
Asian culture putting emphasis on ethnic identity, conformity, and
collectivism discouraged them from deviant behaviors

(Hser at al., 2013

Lifestyle Choices
Instead, what I was beginning to understand was that
however things unfolded from here on, whatever the next
chapter was, my life could never be the sum of one
circumstance. It would be determined as it had always
been, by my willingness to put one foot in front of the other,
moving forward, come what may (p. 191).
Sleeping in a hallway around Bedford Park later that week,
I took out my blank transcripts and filled in the grades I
wanted, making neat little columns of As. If I could picture
it If I could take out these transcripts and look at them
then it was almost as if the As had already happened. Day
by day, I was catching up with what was already real. My


Population: Common

Customary Practices
Family life
characterized by
chaos and
Role Reversal
Secrecy and Denial

Occupational Injustice



(Durocher, Gibson, & Rappolt, 20

Occupational Apartheid
Mr. Doumbia had promised to put me in a home if I kept
up my truancy, and now I hadn't been to school in
months. I was not going back into the system. But being
on the streets was not working out either. I would go
pack bags for tips again, but child labor laws had become
more strictly enforced over the last few years (p. 119).


Occupational Deprivation
Many nights, I longed for a home. But it occurred to me
as I struggled for a feeling of comfort and safety: I have
no idea where home is (p. 145).
A couple nights later when our stomachs finally ached
from hunger, and it became too awkward to knock on 1A
and ask for leftovers again, Lisa and I split a tube of
toothpaste and a Cherry-flavored ChapStick when we got
hungry (p. 51).

(Murray, 2010

Occupational Marginalization
Professional adults had credibility and were my standard
for deciding what was legitimate or not, including myself.
Previously, when teachers like Ms. Nedgrin saw me as a
victim - despite her good intentions - thats what I
believed about myself, too (p. 286).

(Murray, 2010

Occupational Alienation
As a child, I hated Mothers and Fathers day! I hated
having to answer the question: Why do you live with your
grandparents? I hated feeling like I was handicapped (R. M.,
personal communication, February 15, 2016).

I think it only got worse when I came out to my parents that

I was gay and he would try to make it like as bad as possible
to do that. My father would just drink more often; he would
burn me with cigarettes as if it was a consequence for being
who I am (Q. N., personal communication, February 12, 2016).

Occupational Imbalance
I got through my fathers addiction by just being at
school realizing that if I was just a deadbeat, I would be
at my fathers house. I overloaded myself with a full AP
class load and got tons of extracurricular activities so I
didnt have to be home. Where like if I couldnt fix my
home situation for me, at least I can control my school
situation (Q. N., personal communication, February 12, 2016).

Occupational Engagement
Academic and cognitive functioning

Lower GPA
Increased grade retention
Failure to pursue secondary education
Weaker performance in reading, spelling, and math during early
and middle childhood compared to peers

Earlier onset of substance use

Peer relationships

(Solis, Shadur, Burns, & Hussong, 2012; Kroll,

Health and Well-Being

Substance abuse interrupts normal development

Higher risk for emotional, physical and mental health problems

Higher prevalence of depression, anxiety, eating disorders and
attempted suicide compared to peers
Increased rates of anxiety, depression, oppositional behavior, conduct
problems, and aggressive behavior
Decreased rates of self-esteem and social competence

I was born prematurely due to my moms cocaine use during

pregnancy. I was not very verbal and my learning was
hindered in early childhood (R. M., personal communication, February 15, 2016).
Substance abuse impacts attachment, family dynamics,
relationships and functioning,
risk n.d.;
of violence
(American Academy
of Experts
in Traumatic Stress,
Kroll, 2004; Solis, Shadur, Burns, &

Role of the Health Care Practitioner

Listen and ask questions
Provide support and validation for the patients concerns
Help educate patients and their families about substance use
disorders as a disease that affects the entire family
Take an active anticipatory role in guiding patients and families to
available resources
Help connect patients and their families to specialists and
consultants when needed
Use the acronym TEAR

Express empathy
Advise action
Reach agreement

(Adger, Blondell, Cooney, Finch, Graham, et a

Conspiracy of Silence
Family coping mechanism of silence

Problem is overlooked and/or minimized

Lack of affirmation leads to self doubt

The Hidden Group

Children who dont receive attention of welfare services

Children feel an innate sense of loyalty to their parents
Causes fear for seeking professional intervention

Once you tell an adult they start inspecting your family and
theyre gonna report it. And I felt that I was never safe, like
what happens if I tell an adult and then my father will be taken
away from me (Q. N., personal communication, February 12, 2016).

Expressive-based Group Intervention

Case Study
Enable self-expression of fantasy and
conflict through play and art-based
Aim was to provide children with
tools to cope with emotional and
behavioral, and social difficulties
affecting their lives

Retrieved from

(Peleg-Oren, 2002

Local Resources
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Addiction Helpline: 1-877-478-5973
National Domestic Violence Hotline: 1-800-799-SAFE
National Domestic Violence Hotline (TDD): 1-800-787-3224
National Youth Crisis Hotline: 1-800-448-4663
NDMDA Depression Hotline Support Group: 1-800-826-3632
Poison Control Any Kind of Substance: 1-800-222-1222

Local Resources Cont.

Big Brothers/Big Sisters of Southern Nevada, Inc. 702-731-2227
Youth mentoring program
Truancy program
Boys & Girls Clubs of Las Vegas 702-367-2582
Mentoring programs
After school, track break and summer recreation programs
Andre Agassi Unit: 702-651-4989
Gang Prevention Through Target Outreach Program (GPTTO)
Street Smart Program

Local Resources Cont.

Lied Memorial Unit 702-368-0317
Education & Career Development
Health Education/Life skills Drug/alcohol prevention
Gang prevention
Teen suicide prevention

Adger, H. Blondell, R., Cooney, J., Finch, J., Graham, A. (n.d.) Helping children and adolescents in families
affected by substance abuse. Retrieved from
American Academy of Experts in Traumatic Stress (n.d.) Effects of parental substance abuse on children and
families. Retrieved from
Brook, D. W., Brook, J. S., Rubenstone, E., Zhang, C., Castro, F. G., & Tiburcio, N. (2008). Risk factors for
distress in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers. AIDS care,
20(1), 93-100. doi: 10.1080/09540120701426557
Drug Rehab. (n.d.). Parental drug addiction and its destructive impact on children. Retrieved from
Durocher, E., Gibson, B. E., & Rappolt, S. (2014). Occupational justice: A conceptual review. Journal of
Occupational Science, 21(4), 418-430. doi: 10.1080/14427591.2013.775692
Hser, Y. I., Evans, E., Li, L., Metchik-Gaddis, A., & Messina, N. (2013). Children of treated substance-aabusing
mothers: A 10-year prospective study. Clinical Child Psychology and Psychiatry, 19(2), 217-232 16p.

References Cont.
Holland Christian Psych. (2013, December 1). Substance Abuse Effects on Children. [Video File].
Kroll, B. (2004). Living with an elephant: growing up with parental substance misuse. Child & Family
Social Work, 9(2), 129-140. doi: 10.1111/j.1365-2206.2004.00325.x
Manly, J. T., Oshri, A., Lynch, M., Herzog, M., & Wortel, S. (2013). Child neglect and the development of
externalizing behavior problems associations with maternal drug dependence and neighborhood
crime. Child Maltreatment,18(1), 17-29. doi: 10.1177/1077559512464119
Martin, L. M., Smith, M., Rogers, J., Wallen, T., & Boisvert, R. (2011). Mothers in recovery: An
occupational perspective. Occupational Therapy International, 18(3), 152-161 10p.
Murray, L. (2010). Breaking Night. New York, NY: Hyperion
Nevada Partnership for Homeless Youth. (2015). Problem with youth homelessness. Retrieved from
Peleg-Oren, N. (2002). Group intervention for children of drug-addicted parents--using expressive
techniques. Clinical Social Work Journal, 30(4), 403-418. doi: 10.1023/A:1020768011128

References Cont.
Patrick, M. E., Wightman, P., Schoeni, R. F., & Schulenberg, J. E. (2012). Socioeconomic status and substance
use among young adults: a comparison across constructs and drugs. Journal of Studies on Alcohol and
Drugs, 73(5), 772-782. doi:
Regional ATTC Products & Resources. (n.d.). Substance abuse awareness activity: Time of truth. Retrieved
Solis, J. M., Shadur, J. M., Burns, A. R., & Hussong, A. M. (2012). Understanding the diverse needs of children
whose parents abuse substances. Current drug abuse reviews, 5(2), 135. doi:

Group Activity
Adapted from: Substance Abuse Awareness Activity: Time of Truth
In this activity, we are going to look at the story of Liz Murray from
Breaking Night. We are asking that you put yourself in the position
of a child living with a substance abusive parent.
With your provided cards write down the following:

Write or
Write or
Write or
Write or
Write or

symbolize 1 person or relationship that is important to you.

symbolize 1 item or resource that provides you with a sense of
symbolize 1 treasured memory from your past
symbolize 1 value/belief you live by
symbolize 1 part of your body or health you value

(Regional ATTC Products & Resources,

Liz is a five year old girl, living with her father,

mother and older sister. Both parents are
unemployed due to a serious addiction to heroin.
The family is dependent on government
assistance for food and shelter. Liz often
accompanies her father on trips down University
Avenue to scavenge for food and clothing in
garbage cans. Liz lives in an apartment in New
York City that wreaks of month old garbage and
crack cocaine, and wears the same clothing day
in and day out until it physically falls apart.

Retrieved from

Her family is dependent on supplemental

security income (SSI), most of which is used to
obtain drugs. Liz and her sister are forced to
subside on egg and mayonnaise sandwiches
until the food runs out before the end of the
month at which point they resort to eating
toothpaste and ChapStick. At a young age, Liz is
often responsible for looking after the house and
ensuring the safety of her parents. Liz often
stays awake late into the morning hours to
ensure her parents return safely from their drug
runs. Subsequently, due to taunting for poor

Retrieved from

At eleven years old, Lizs mother shares some

devastating news. Lizzy, pumpkin, Im sick...Im
sick, I have AIDS. They diagnosed me at the
hospital. Daddy thought it would be better not to
say anything until I got sick They gave me a
blood test. I have AIDS, Lizzy. Liz remembers
someone telling her that anyone who has AIDS
eventually dies. Being around her mother forces
her to be around the disease, around the fact that
she is losing her mother fast, which is too painful
for Liz to handle.

Retrieved from

With her mother sick and her dad in and out of

the picture, she begins to pump gas and bag
groceries for money since her parents would
always spend their minimal income on drugs and
alcohol. At thirteen, Liz is separated from her
family and taken into Child Protective Services
due to excessive truancy from school. Liz endured
abuse and maltreatment from peers and felt
belittled and blamed for her current situation by
administrators. After her unpleasant experience
at the residence, she makes her way out of the
system, drops out of school and takes to the

Retrieved from

Carlos leads Liz and Sam on a tumultuous trek

throughout the city. Occasionally relying on her
friends homes, she often finds herself sleeping in
cheap motel rooms, subway stations, and
stairway landings. For sustenance, Liz begs,
steals and trades items. Although Liz experiences
many ups and downs while on the streets, it is not
until she hears the news about a 16-year-old girl
murdered by her drug dealer boyfriend in the
motel room down the hall from her that she
realizes change will be the only thing that will
save her. The thought of what this would do to
her dad, Lisa, and friends, the few people she


Retrieved from