How to Talk to Kids About Substance Use Disorder

Today on the show, we're going to.

Talk about a difficult subject, how to talk to our kids about substance use disorders. And I know some of you might be thinking, no one in my life has a substance use disorder. I'm not sure if this episode is for me. I totally get that. And at the same time, I think this episode is really about how to talk to your kids in a way that's honest when you're discussing difficult topics. You know, I've received a lot of requests to talk about this.

So many of you have written in.

Saying, my partner has a major alcohol use problem or a family member just went to rehab. They usually come over every week. What do I tell my kid? And I think I was hesitant for a little bit about getting into this.

But I thought about it, and I came back to a guideline that really.

Drives me in the work I do here, the things I talk about with you and the way I discuss things.

With my own kids. And that's truth over comfort.

There are things that are uncomfortable to discuss, but that mantra, truth over comfort, helps me make decisions that are in line with my values. In this episode, I'm joined by Dr. Nicole Kasenke, as I really felt I needed an expert to help tackle this important discussion. Nicole is a clinical psychologist and the director of family services at the center for Motivation and Change. She works with a lot of people who have substance use disorders and helps family members and friends know what to do when someone they care about is struggling. In this episode, you'll learn more about what kind of language to use, how to follow your child's lead in answering the questions they might have, and so much more. I'm Dr. Becky, and this is good inside. We'll be back right after this.

So we're going to be answering some questions that came in directly from listeners about addiction, about how to explain addiction to kids, about how to deal with addiction within a family when there are young kids around. Before we go into those questions, can you give us, like, a definition of addiction? Like, how do you think about that word?

To be honest, I don't really use that word very much. I use the diagnosis, which is a substance use disorder. The reason why is because a lot of people have a lot of different feelings about the word addiction. And it's sort of a catch all it can be, you know, I'm addicted to coffee. I'm addicted to, you know, this Netflix series, you know, and that kind of minimizes the intensity of a real diagnosis and the impact that it can have on a Family. So I really talk about it in terms of that, in terms of the impact on people's lives. Is it causing consequences? Is there any diagnosis is going to include using something or doing something despite the consequences? That's kind of the formal definition, but many people think about it differently. So if it's really important to sort of drill down into how is it impacting people's lives, what does it feel like, what's happening? And not get too bogged down by the labels because that can just be messy and make people. Well, people have big feelings about different labels and that can get in the way of actual communication.

I love that. Before we address the specific questions we're going to hear from parents, are there any general guidelines you think about, but about how to address this topic, this topic of substance use disorders with families or with kids?

Sure. So I mean, it's a big question because just talking about substances with other adults is challenging. Right. So like what we think as a culture about substances right now is in huge flux. Right. Some things are being legalized. This is a changing landscape. So we have that backdrop and we also have a lot of, well, an absence of research really about treatments. And is it a moral problem, a characterological problem? Is it a scientific or disease problem? Like, there are a lot of big questions that lead us to this moment in our history of psychology. So when I talk with families about substances, I'm talking about the impact on them specifically and again, trying to get away from labels, but speaking more to the validity of people's experience. So for a child, there's even bigger questions, right? Right. There's bigger questions of trying to protect children, speaking to them in a language they can understand developmentally appropriate ways. You know, kids tend to see the world from a self centered perspective because that's how their brain works and they will take responsibility for things that aren't their fault. So that is a big issue that I talk to families about, is trying to really open up dialogue with kids around what their perceptions are and be curious and empathic and try and understand what it is that they're seeing and what they're making of it. Because it may not at all be obvious to the adults around them what they're making of what they're seeing.

I love that point. I think that's so important. Okay, before we jump into some of these recordings and hear these specific questions, anything you want listeners to keep in mind as, you know, as we talk.

Through these, I mean, there's a lot of, a lot of judgment and shame inducing Thoughts and feelings that people have about substance use. And I think that that can get interwoven with these questions of how do we respond to kids who are asking good questions about what's going on with dad or mom or the neighbor or that person we passed when we walked to the subway? Or there's a lot of big valid questions and our own feelings of judgment or sort of punishing thoughts or questions or, you know, those can really get in the way of being able to have an honest and clear, curious conversation with our kids. So I think that is the backdrop that we're coming to this conversation with. That is kind of tricky because adults themselves are gonna have a hard time talking about this.

Yeah, I think that's a really helpful note. Like all of us notice our judgment and listen with the same curiosity that we really do often listen to anyone else's struggles. So on that note, let's listen to a question from a listener. We'll listen together, and then we'll talk about what's going on. Here we go.

Hi, Dr. Becky. My name's Ashley, and I was calling to get your help with family situation with my daughter and my mom. So my mom is an active alcoholic, as best I can tell. And we still have a guarded relationship with a lot of boundaries and done a lot of therapy, but, you know, still want her to be an active part of my life and my kids life. So we've continued to have very structured and kind of walled interactions rather than shutting the door to those relationships completely, which I've done in the past. But my question is, my daughter, who is in kindergarten and is so smart and observant, more than I could possibly give her credit for, is starting to notice things like the fact that we have my in laws over more often or that they'll go to my in laws to babysit. And my parents are much closer, but we never have them for those kinds of things. And I just want to try and figure out a age appropriate way to explain to my daughter that relationships are complicated and that we love Nana very much, but we also need to be careful around her and also keep it where she's comfortable coming to me and telling me anything that she saw around my mom that might make her uncomfortable. So, yeah, that's my question. If you have any insight or guidance, I'm here for it. Because me word vomiting, 37 years of childhood feelings about alcoholism, I don't think.

Is the way I want to go.

What a like, poignant, beautiful way to lay out this question. So, Nicole, I'll let you go first. What comes to mind for Ashley here?

Well, first of all, I mean, I'm really appreciating how thoughtful she is and how much time and consideration, careful consideration she's put into this question. She's trying to maintain a relationship for the sake of her kid and maybe herself. But there are these ways that she has worked really hard to put up boundaries that feel safe, and that's really smart and great for her and for her kid. And now she's noticing that her kid is pretty observant and is noticing things. And that's a great observation because it allows her to have a dialogue and allows her to really ask what it is that her kid is seeing. I mean, this is the thing that we talk about in parenting all the time, right? Is like, what is the biggest thing that you want to focus on is keeping the dialogue going, continuing to be a person that your kid is willing and able to come to when they have difficulty, et cetera.

Yes. And, you know, I. I want to also say for all the listeners, right? Our kids do notice things, right? And I think there's some belief out there, like, oh, she's in kindergarten. Like, what does she need to know about alcohol, about substance use, about conflictual family relationships? I think that's a narrative that's, I don't know, been passed down to us or somewhere in the ether that we've picked up. But, Nicole, I think you and I are saying the same thing where kids are insanely good observers of the world. They really are. It actually what scares me is the way that we almost teach kids to stop observing the world, because when they're young, so often they hear, you're wrong or you're too young for this. And then we wonder why years later, you know, things happen where we say to them, like, didn't you notice? Or why didn't you say something? You know, and sometimes I feel like kids are like, well, you've told me for the first 10 years of my life that I wasn't supposed to notice things that are kind of tricky around me. So I kind of just did as told, Right? So the fact that kindergartner notices, hey, some grandparents come around more than others. And that doesn't even really make sense because one of my grandparents lives closer than the other. So I can put two and two together, but it's not adding up. A kid is actually doing exactly what we want them to do. That's amazing. And I think this mom really recognizes that. And then I think the next step is Something that can feel really uncomfortable where it's like, oh, like, am I going to enter into this conversation? It's messy and it feels awkward. And I think we'll always have that thing in the back of our head, like, are they too young for this? But I think a different way of seeing it is like they, they already notice the pieces. So they're clearly not too young to notice the pieces. So either I'm gonna leave them to write the story, to connect the pieces on their own, which I know is not gonna be good or accurate, or I can kind of help them do that. And so let's just push it. Nicole, let's say this. You know, mom's daughter's like, why don't we see grandma more often? Why don't, don't you have grandma come over? And then you could just leave her with me and you guys could go out the way that you do with, you know, my other grandparents, like. Cause kids ask it so on the nose sometimes.

Right, right, totally. And I think the first thing is to just validate the perception, right. So that you're not. As you were saying. Like, I think that we do a disservice to kids by sort of shutting them down because we're uncomfortable or we don't think they're ready for it or inappropriate or whatever the reasons are. And whether you're going to have a conversation about the 27 year history of your relationship with your mother or not with your kindergartner, I think we all know that's not going to happen. But the fear that that's what you need to do if you're going to open the can of worms at all is what keeps you from having any kind of conversation. So I think to notice that, to notice that you have some obstacles around having a big conversation and notice that your kid has some good observations that are worth validating. You're right. We do really different things with your grandparents, don't we? That's a good observation. Like, I'm really liking how you notice the world around you. What else do you notice about the relationships? Like, they're really different people, those four individuals that you have in your life. Like, what else do you notice? Like, broaden it to what her perceptions are and ground yourself in those to be responding to rather than start with your huge story and narrative and throw it on top of the kid's head. That can feel unwieldy to both of you. But start with what they're seeing and what are they noticing and go from there.

Okay? So let's. Let's go from there. And I think sometimes as a parent, you kind of know your kids asking a question, like, they're kind of like, well, maybe they do. There's like, but why? Like, so why don't you leave me with Grandma? You were talking about going on a work trip. Grandma could stay with me. Right? Let's say. Right. And I do think parents are eager for, like, what are the words? Like, how do you describe alcohol, substance use disorder to a kindergarten? Like, if that is really the reason why that grandma doesn't stay alone, how do you enter into that? I'm happy to hear from you. Or if you want, I'm happy to give it a go, Nicole, and take your edits, because as an expert in the field, I'm sure you'll be like, becky, don't say that. Or, no, I would shift that. So I'm happy to put a version out there if we want to play the game that way.

Whatever. I mean, that's fine. But I think the big pieces that I would say about having a conversation is to follow the lead of the child. So if the child notices something, attend to that. And it's much more organic to the child's brain and to your relationship if you can go from what their perceptions are. So in other words, if this child has seen. Seen the grandmother act loopy or fall down the stairs or knows about her being in the hospital or knows that she goes to therapy every day or she goes to meetings, whatever the child knows is where I would start with. So if the child says, hey, you know, she lives closer than my other grandma, like, how come we never see her? Is it because she has, you know, she has to go to the doctor? Or, you know, is it because she fell, or is it because she's always drinking? I mean, kids might go straight for it, right? They might know exactly what's going on, and you're trying to beat around the bush, but they've seen things, and they know, you know, what's happening. She seems like a really different person when we see her at night. Like that. She made me uncomfortable that one time that she came over, she was so loud, and. And you seem to get rid of her really fast like that. Is that why she doesn't come over is because her voice is too loud? Like, there may be some very specific thing that the child is actually asking about. Like, loud voices are things that upset mommy or, you know, if you have medical problems, you shouldn't be around kids. Like, it could be very, like, Magical thinking. Or, or it could be very specific, like, she makes me uncomfortable, she hugs me too tightly when we see her at night or when we see her, whatever it is. And those very specific things I think you can speak to. So if she says, like, is it because this is because that you can say, actually it is because of that. Because there are ways that she can behave at night that I think do have to do with her, her emotions and her medical state. And if the kid asks a lot more questions, then they're ready to hear the answers, you know. But I like to sort of go hand in hand with kids to not get ahead of them too much.

And so I just want to kind of summarize or maybe mirror what you're saying and you tell me if I got it right. So you're saying, really follow the lead of your kid. We have a whole story from our history. We have so many feelings, we have so many worries about telling them or how to get it right. And one of the things you can do is say, okay, let me actually just zone in on what my kid is saying and exactly where they are. Not as a way of avoiding the conversation, but actually getting closer to the thing that's actually on their mind and what they actually either want to say or ask. And so then every conversation is going to look a little different because if you say to a kid, well, what did you notice? You know? Or what, why does that grandma not come around as often? I don't know. I wonder what you notice about, like, why do you think? Right. That makes sense. What about when a kid. Because I think this happens a lot too. They're like, I don't, I don't know. I'm asking you, like, why, why don't you leave me alone with grandma?

So I, I again, I'm not trying to dodge the question because I really love that you're as specific as you are. I think people really need words to use, but it really is so specific to the situation. Like if, if the child knows that there is a particular thing going on, they know details about it, then you can work with those. And that makes the story much more organic to the child and allows you to sort of stay in the lane of what they're ready for. So if it's about leaving, it probably isn't about leaving the child alone, because that's not how a kid would think. Right? They would think more like, how come I can't ever go to grandma's house? Or she's like two minutes away. Maybe I could Ride my bike there. Or you know, it would be something more specific about doing a thing. Right. So if, if that were the question, like, how come I can't do that? Well, I think you can do that someday, but not yet. Because you know, there are lots of things at grandma's house that are. Just don't feel safe. Like, remember that time when we came over and it seemed like the stove had been on for too long and there was smoke in the kitchen? Like that makes me too nervous and I. It's my job to keep you safe. So there is some stuff in that house that just make me a little nervous. But that's okay. We can have them over on the weekends. And you know how we went to this place or that place and you know. But it might feel a little disappointing to you. Are you feeling disappointed about that or.

And what, what you're doing here, Nicole, that I think is so helpful for parents as they hear you model it is in our mind, our parents substance use disorder is centered. And that makes sense. Like I hear it from this parent, like she's been through a lot of pain around it. She's very focused on it. For a kid, their own emotions are probably what we need to center. Like, yeah, they might be like, that's a bummer. I wanna sleep over at grandma's house. And like we think, okay, I'm gonna tell them about the alcohol and I'm gonna tell them about this thing that happened. And it really might not be what's on their mind. Their experience might be very similar to the other day when you told them they couldn't see a certain movie cause they weren't old enough. And you know, and so asking some questions is really a way of making sure we're like centering on our kids experience. And I, I love that you're making that so clear. And I think that also gives parents a lot of permission to not have some perfect words to say, I'm going to this conversation.

I'm gonna say this thing.

Because first of all, it might not be what your kid needs. Second of all, I get a lot of comfort with my own kids where I'm like, there's no one conversation about anything. Like there's no the talk. There's no one talk about sex. There's no one talk about the grandma's alcohol struggles, right? And so like, if I ease in and I learn more and I later.

Say, you know what?

I kind of feel like I wish I said more. I feel like my daughter was asking, guess what?

Amazing.

You can go into her room, be like, hey, did that leave you having more questions? You could always do it. Right. And there's not one moment that you're gonna, like, get this right. And so I just want all the listeners to know, to have a little faith in yourself. Right. That over a number of conversations, a number of years. Right. It's gonna end up feeling more complete to you with your child, even if it doesn't in. In that one moment.

Absolutely. Absolutely. I love that you're pointing that out, because I encounter that a lot, too, that. That people put a lot of pressure on one conversation. They're going to ask me someday. They're going to ask me, and what am I going to say? You know, that is a totally understandable and valid fear. And you're putting a lot of pressure on yourself to have that one conversation answer all the questions they might have. Kids don't have a long attention span. Like, they're not in it for a long conversation about anything. So having the confidence and faith that you're going to be able to have many conversations with them, you're going to be able to. You're going to make mistakes. You're going to say addict or something and then regret that, and that feels judgmental. And so you're going to go back to them the next day or the next week or the next month and say, you know. You know, when we were talking about grandma and I use that word, it doesn't. I didn't feel good about that because it feels like that's all she is, which isn't true. Right. She has long hair, she's a little short, she has a red nose, and she drinks too much. And that's part of who she is. And we can talk more about that anytime you have questions.

The one thing I want to add that I know we talked about earlier is how often kids need to hear things like, and it's not your fault you can't sleep at grandma's house. And sometimes it seems like a non sequitur where, like, they didn't ask if it was their fault. But when kids feel disappointed and upset, it is just so quick to get to, oh, and I must have done something to cause this. And part of that is, for a kid is like, well, if I caused it, I can maybe fix it. But we don't want kids to kind of wire fault and blame. And so I think that's always helpful just for parents to, like, have that line in the back of your head and, like, trust yourself. You're gonna Know when to sprinkle it in and you don't have to do it every conversation. Right. But I think just knowing that sometimes kids do use that idea to kind of again, connect the dots. There's been so many moments with my own kids with things where I've watched myself say, I don't know, this babysitter can't come anymore that they love. And I'll be like, and you didn't do anything to cause that. And I kind of see, see that somewhere deep in them they like needed to hear that even though they didn't explicitly ask.

Yes. Because that, especially with issues like that where there's separation of relationship and like what we're talking about with the caller. Right. There's curiosity and concern about the separation. Why is this different than that? Why don't I get to see this person more than that person? Like, this is, this is an especially sensitive area, I think, where kids are likely to fill in the gaps of like, what did I do? What could I do differently? And they're not even necessarily conscious of it, but you can tell by their follow up questions that that's where their brain is going.

Yes, totally agree. Okay, I want to hear from our next parent, so let's listen together.

We've got a tricky situation going on at home. My 9 year old son's favorite person is his dad, who he hasn't seen for two months because his dad's been using drugs and then away at treatment. And unfortunately, this is not the first time this has happened. My son is both the most injured party and the most innocent party and it is heartbreaking to watch him suffering through the consequences of his dad's addiction. It seems to him like his dad's choosing drugs over him and doesn't love him, which I know as an adult is not the truth about how addiction works. But my son doesn't understand that he feels lonely because he can't talk to his friends about this huge struggle and stressor. His trust has been violated so much at this point that he barely has any hope. He's actually depressed to the point of talking about not wanting to be alive. He's afraid of what happens if dad gets out of treatment and relapses again because his dad will lose his job, we lose our house, and we have to move out of state. So the fear is totally legitimate. I don't know how best to help him and it's even more difficult because I'm dealing with a lot of the same feelings as he is. Lack of trust, lack of Hope. Feeling abandoned and betrayed, not wanting my life being terrified because my whole future depends on an addict's single relapse. And I'm angry to help my son. I keep the conversation open. I give him information to help with his anxiety. I tell him I'm glad he's talking to me about his feelings. I try to validate so he doesn't feel alone in it without giving him the impression that I'm feeling out of control too. It's just such a tricky situation and I wish I knew what else would most help him.

So we hear from this parent whose partner is, you know, obviously struggling with a very serious substance use disorder. So much of their life feels like it's literally hanging by a thread and is related, you know, to his functioning. They have this nine year old son and so many things struck me. But hearing the way the nine year old internalizes, my dad is choosing drugs over me.

Right, right. I mean, that's heartbreaking. And so in line with what we were talking about before of how the kid is blaming themselves, right? Like there's something that is more important to my dad than me and maybe if I did something different or, you know, there's an internalizing of that experience that as adults we know it doesn't work like that. And it's so much more complicated but totally valid for that kid to feel, feel that way. And she's also mentioning some really scary things like maybe suicidality, maybe homelessness as a result of him not being able to keep a job. I mean, those are really real valid concerns. So, I mean, that is the first place to really start, I think, is to be giving this child a lot of validation for feeling the way he does. You know, totally understandable. Really valid concerns that she shares too. I feel angry and hurt too. Sometimes when there is substance use in the family, you can start to feel like you need to balance out the other person. Like he feels angry. So she might feel like, well, I have to remind him that he's also a good person or I have to, you know, balance out the perception. But it really is more important sometimes to join with the child. So I really hear how angry you are. That makes a lot of sense. I feel angry sometimes too and hear what the next thing is, you know, allow it to evolve.

I want to stay on that because when I hear this mom say, my son, you know, basically says that my dad's choosing drugs over me. Right? And then I hear her say, like, I know that's not, you know, exactly what's happening. I Think this is one of the hardest things in parenting. I really do. It's like this dance. It's like, okay, in my head, I know the way my kid is thinking about this both isn't true and isn't kind of helpful. And they are thinking about it this way currently, and they have really big feelings that are very real as a result. And I think the inclination often is even in a very loving way, to try to convince your kid out of that thought. And we'll say, like, I know, but look, let me. Let me explain substance use disorders to you. And your dad is a good person having a very hard time, and he loves you, and it's not a choice. And it's kind of, you know, like this. And there might be a time, I'm sure, for like, a metaphor or something like that, but other times, I think as a parent, you have to kind of hold in your head, like, I know that's kind of not true, but I can't lead with that. And instead, what I lead with, to my kid is like, that is the most painful thought. Like. Like, just. You're not, quote, validating that their thought is true. You're actually just validating that they actually are thinking about it this way, and they actually are having feelings about it that are real. And I think that's really important. And I find myself fighting myself in those moment with my K. Cause I'm like, oh, if I. Like, I see the pathway where I can help you. But I think for this kid, I don't know, I think probably for all of us, the hardest thing is to feel alone, right? I often say, like, we can't change the hard. We can change the alone. And right here, one of the hardest things for this kid, right, it's all the things his mom laid out. But I'm sure what makes all of it harder is, you know, potentially feeling like, I don't even have anyone else in my life who really believes me or understands that I feel this way. And I think just knowing when you sit with your kid and you say things like that is such a painful thought. Sweetie, look, I might see it differently, but I know you don't. And I know that is, like, the biggest pain, right? As big as this house or whatever, however you want to describe it, you are doing your kids such a service, and I think you're really showing support. And kind of like we were saying Nicole before, like, you have. So there's so many conversations we're gonna have with our kids about hard topics over time, that thought that my dad is choosing drugs over me. Like, I think we can have faith that that thought will, I don't know, will loosen or that thought will shift over time, but probably not in, like, one specific conversation or moment with you as the parent.

Yeah. And just to be, like, really concrete about it, like, I think that a parent in that moment of starting a conversation or responding to a statement like, my dad is choosing drugs over me, you have, like a lizard brain impulse to protect this child. Right. That you want desperately to make that feeling go away. To make it go away. And what I think can be a really helpful strategy is to notice and be aware, but also compassionate with yourself that it makes sense that you want this feeling to go away, and that makes you a good parent. And there's nothing wrong with that impulse. But if you can respond to that impulse in yourself by doing something like affectionate, like touching your child or letting them sit in your lap, or like, come here, honey, like, let's talk. Have them sit with you, hold their hand, put your arm around them, that is the connection. That is the way that you are helping their feelings be assuaged, be comforted. And then the words that you use can be, oh, that's horrible that you would feel that way. I would feel awful if I felt that way. Let's talk about this and really allow the child to open up around what it is that their mind is doing with this stuff. So then you can attend to what it is that their brain is doing, how they're feeling. And usually in that moment, kids kind of fall apart. They feel seen and heard, and they let it out. They let it out. And what a gift to give your child is to let those feelings out, to understand those feelings a little bit better. And that is helping the feelings be comforted. Right. It's not the words. It's not correcting their view of addiction and what it's supposed to be called and all the nuances. It's not doing any of that. And maybe over time, all of those conversations happen, but in that moment, helping the child feel like their feelings are valid and worthy of attention and connection.

Yes, Nicole, there's so many other things that I know that are left undone, and it kind of makes me think about actually what we're talking about with parents. Right. All these conversations with our kids will kind of mirror that. I'm sure anything else that you feel like needs to get into this conversation that you want to leave listeners with.

I think that a lot of the ways that our culture in general thinks about substance use disorder is the backdrop of this conversation, right. That there is a lot less compassion that we have for ourselves in loving someone who has a problem and for the person themselves than certainly any other medical problem. Right? Person has cancer, broke their leg. You know, we have a whole lot more compassion for those kinds of situations than we do for substance use disorders. And that being the case brings in a lot of layers and the judgment we were talking about before. So for me, the vocabulary around it, the awareness building, having more of an understanding of why it makes sense, may not make sense from the outside, but from the inside. There's something that makes sense there that can help build compassion. And the more compassion we have, the more ability to have, like meaningful conversations and connection. And I feel like there's a lot of value that friends and family can bring to these conversations when they start from that place of compassion.

Well, ending on compassion, it's never a bad place to end. So thank you, Nicole. Thank you so much for being here.

Thank you.

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