How do Programs for Children of Substance Abusing Parents Work and Why?

by Dr. Amelia Usher and Dr. Kelly McShane

Ed. Note: Renascent’s partnership with Dr. Kelly McShane, clinical psychologist and credentialed evaluated at Ryerson University, has helped to fuel international knowledge exchange, with Dr. McShane and Dr. Amelia Usher’s research about Renascent’s Children’s Program now featured in the highly-regarded UK journal site BioMedCentral and reprinted here.

The language of addiction permeates many areas of our lives. This often occurs in ways we are not even aware, whether it be the terms “I am addicted to coffee,” “He is such a workaholic”, or “I get such a high from that”.

Despite this commonplace exposure, the attention to the impact of addiction in people’s lives is often quite limited. This has been a concern for us given that addictions are among the most common social problems in western society.

Stigma is a large part of the reluctance to seek treatment. Even more distressing is the fact that the impacts of addiction extend beyond the individual user to the whole family and children of substance abusing parents (COSAPs) in particular suffer disproportionately.

We know that COSAPS are at higher risk of emotional and psychological problems and are ultimately more likely to develop a substance use problem themselves later in life. The cycle of addiction is well documented, yet COSAPs are often forgotten when it comes to addiction interventions.

The idea for our realist systematic review study was born out a community-based research partnership with Renascent (an addiction treatment center in Toronto, Canada) to evaluate a newly developed COSAP intervention program.

The realist review was an ideal way to supplement this evaluation with a comprehensive, theory-driven systematic review of how and why other COSAP intervention programs achieve successful outcomes.

Our research, which is published in Systematic Reviews, found that certain underlying processes can help explain why COSAP intervention programs are effective.

We found that tackling shame and stigma through knowledge and education about the impact of addiction on the family can have positive outcomes.

COSAPs often bear a weight of guilt and shame for their parent’s substance use. Educating parents and children about addiction and how it impacts the family can help to expose what is often referred to as the “elephant in the room”.

Similarly, peer support can be hugely beneficial and may be key to reducing social isolation. Many children experience extreme isolation and loneliness as a result of parental addiction. The mere fact of being in a group with other children who share their experience can be hugely validating. This was one of the mechanisms we uncovered in our study.

Our findings show that there is not a one-size-fits-all approach to COSAP interventions. Context is an important factor and thus services should be tailored to the specific needs of the community.

Using a realist approach was vital to capturing the underlying mechanisms of change for COSAPs. Not only did it allow us to delve into the “black-box” of program evaluation, but it allowed us to expand our search for evidence beyond academic publications. This approach is reflective of the reality of community social programming, where lack of capacity or time poses challenges to publishing evaluations of effective programs.

This study has meaningful implications for program developers or community agencies wishing to implement a COSAP intervention program. Our findings show that there is not a one-size-fits-all approach to COSAP interventions. Context is an important factor and thus services should be tailored to the specific needs of the community.

This could mean providing families in need with a meal, transportation, or other basic needs in order to improve program engagement. Or it could mean appropriately incorporating a community’s cultural identification or lived experience with addiction when developing programming.

Our goal in undertaking this research was to delve into the underlying processes by which intervention programs might be helpful for COSAPs. We were also committed drawing attention to the real and substantial need for children and families to have dedicated supports when struggling with addiction.

For Renascent, this realist systematic review provided helpful insights into their own program implementation. It also served to validate and reinforce their approaches to programming. We hope that our study is but one step in continued efforts to expand the dialogue on family addiction.

About the Authors

Renascent Alumni
Members of Renascent's alumni community carry the message by sharing their experiences and perspectives on addiction and recovery. To contribute your alumni perspective, please email