Rx Summit Spotlight: Gisela Rots on Supporting the Hidden Victims of the Opioid Epidemic

Those impacted by substance use disorder are not limited to the individuals themselves who are misusing or abusing illicit substances. Children and youth can be traumatized by their caregivers’ struggles with opioids, which can, in turn, lead to the young people developing substance abuse issues of their own later in life.

At the upcoming Rx Drug Abuse & Heroin Summit, April 22-25 in Atlanta, staff members from the Education Development Center in Waltham, Mass., will discuss strategies to support these youth in various settings. Project director Gisela Rots, MSc, CPS, who will be among the presenters, recently spoke with Addiction Professional about the impact of caregivers’ substance use disorders on children and youth, building support systems, and the unique opportunities of out-of-school settings.

Editor’s note: This interview has been edited for length and clarity.

What was the thought process behind developing this presentation and the strategies that will be discussed?

Taking the long view, we all recognize children and youth who are exposed to opioid use disorder, especially in the home—mother, father, sibling or other caretaker who has an opioid use disorder and has maybe overdosed in front of them before—living in that context puts them at a much higher risk of a substance use disorder for themselves down the road. By thinking about how we, in our different work, can help those children and set up a series of protective factors or ways to think about interacting about the children exposed to this, we can go a long way toward reducing their risk for future substance use disorders.

There are quite a few factors that come up. One of the things we all have a lot of energy around is that we, as adults—regardless of whether we are related to children—can support children in building attachments and bonding with adults. Whether it’s us because we work in schools or in out-of-school settings, whether we interact with these children in their neighborhoods, whether we are related to these children, that support around providing opportunities for relationship building and attachment is one of the key pieces we think is important in reducing that risk.

When we say these children are at greater risk for developing a substance use disorder of their own, are they at a heightened risk of developing an addiction to the same substance as their caregiver or is it more of an increased risk for repeating the behavior, regardless of substance?

It’s not substance-specific. A lot of it comes down to what’s in their immediate environment. For example, there has been research that children who are exposed to marijuana early on have a greater risk for developing opioid use disorder. It’s substance use disorder generically; it’s not tied to a specific substance.

In a lot of instances, it can be difficult for the individuals with a substance use disorder to get the treatment they need. As so much energy is focused on breaking down barriers to treatment, are the children who are in these individuals’ lives being overlooked in the process?

That’s what we’re trying to say: We should do both. If we’re thinking about treating adults who have children, we should be thinking about the types of programs we could institute to support the relationship between the parent and child. It’s not always in the child’s best interests to be placed in foster care. We’re saying whenever possible—and if it’s in the best interests of the child—we want to keep that relationship intact because that helps with attachment and bonding. And we think that it’s not just up to the parents and treatment providers. A lot of us in the community interact with children in different ways. If we can all carry a piece of that, if we all contribute to helping that child feel more secure and safe, wherever they are, if we can all help them, then we are helping to ensure down the road they have healthier coping mechanisms and skills.

It’s not just about the parents. It’s about all of us. There are a lot of reasons people develop substance use disorders. It’s not about judging a lack of parenting. It’s about looking at that child and how we can support them.

Can you discuss the unique opportunities adults have to make an impact when they interact with children in an out-of-school setting, such as an afterschool program?

We think there is an opportunity to help these adults identify what they can specifically do to help the kids. Out-of-school settings tend to be less formal. They are not structured in the same way as school systems are. They don’t have the requirements of passing tests and those kinds of things. There’s an opportunity to make sure that the space feels safe, that the adults have relationships with the kids. We see this over and over. Adults in afterschool settings or out-of-school settings do have interesting and different bonds with children and often know there is something going on in the children’s lives, even if no one else does. Unfortunately, out-of-school time staff are also really underpaid. There is not a formalized training or credential requirement for them. Sometimes, they are put in situations that are unfair to them. Thinking about how we, as communities, can work with out-of-school time program staff to support those kids is an opportunity for development and growth.

We hope that folks will walk away with the idea that regardless of where you sit in a community, there is an opportunity for folks to be engaging directly with families being impacted by this. We are giving four examples—treatment, home visiting, schools and out-of-school time. Some of the concepts and ideas we’re talking about are absolutely applicable to not-for-profits interacting. There is an opportunity to dig into this and support these kids in a time that has been really challenging.

The Rx Drug Abuse & Heroin Summit, April 22-25 in Atlanta, is where solutions are formulated, stakeholders from Federal to family convene, and change begins. It is the annual gathering for stakeholders to discuss what’s working in prevention and treatment. For more information, visit rx-summit.com.