It's common to blame parents for their child's drug addiction, but research shows other factors are at play. Experts weigh in on causes of drug addiction and how parents can talk to their children about substance use.

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Elise Schiller remembers her daughter, Giana Natali, as smart, beautiful, and loving. She was a standout athlete who swam on scholarship at Rutgers University and worked as a vet nurse because she "loved dogs."

Sometimes, Schiller forgets these memories are all she has left. "I have three daughters," says Schiller, before clarifying, "I had three daughters."

Natali died of a heroin overdose while in residential treatment in 2014. She was 33. Though Schiller doesn't believe other parents are to blame for their child's drug use, she's harder on herself. "I have a tremendous amount of guilt for not knowing then what I know now," says Schiller, a member of the Philadelphia Department of Behavioral Health and Intellectual disAbility Services advisory board whose book, Even if Your Heart Would Listen, details her family's story.

Steve Chassman, the executive director of Long Island Council on Alcoholism and Drug Dependence in New York, would likely encourage Schiller to be more forgiving. “All too often, there is a stigma attached to this disease,” says Chassman. “Parents think, ‘I must have failed.’ That’s part of the shame and stigma parents take on...and that’s not the case in our recent experience.”

It's also common for others to blame parents for their child's drug addiction, yet researchers have found more compelling reasons that may lead a young person to substance abuse. And parents can use evidence-based solutions to help their children make healthy choices.

What are the causes of addiction?

Natali remained drug-free throughout high school but gravitated towards opioids after a work injury in her 20s. Opioids can be highly addictive, and about 1.7 million people in the U.S. suffered from “substance use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder” in 2017, according to the National Institute on Drug Abuse. That year, 47,600 people died from an opioid overdose, including 4,173 people under the age of 24 and 13,181 people ages 25-34. This marked a 32 percent rise from 2015 in deaths among people under the age of 24 and a 54 percent increase in people ages 25-34.

Schiller’s daughter also struggled with depression and anxiety throughout her life. About 20 percent of people with an anxiety or mood disorder, such as depression, have a substance use issue, according to the Anxiety and Depression Association of America. Schiller sent her to a therapist and begged her to look at herself objectively, but Natali didn't see it. Drugs helped her numb that pain.

There are other early flags that put a person at a higher risk for developing a substance use disorder, including the fact addiction can be hereditary. Schiller's father died of alcoholism. "If parents know there is a genetic predisposition to alcohol or mind or mood-altering drugs, they should let their children know very young," says Chassman. The hope is that, by giving children this information, they’ll exercise more caution.

But what a child does can be out of a parent's control. Researchers like psychologist Judith Rich Harris have long argued that peers are more influential than parents. Chassman tends to agree but doesn’t think that should discourage parents from talking to their children about substance use.

“I think the peer group will always win out, but I think for parents it’s important to form a disciplinary and open dialogue,” he says.

How to talk to your child about drugs

Conversations about substance use should be age-appropriate. Chassman suggests focusing on identifying and communicating emotions with students in kindergarten through seventh grade. "Emotions are like weather reports," says Chassman. "Someone woke up sad. They get to school and are happy." If children understand this concept from an early age, they may be less inclined to self-medicate later.

As children enter junior high, the conversation must become more direct. "Try, 'As your parent, I am willing to go to any length to keep you safe,'" says Chassman.

Sometimes, these discussions feel hypocritical. Parents may have experimented with drugs and alcohol and turned out fine. But tests show that even marijuana is more potent than it used to be. "There's a real teachable moment to play parent and say, 'I'm here to give you all the guidance you need to get through adolescence safely. What I did growing up is irrelevant. This is about you,'" says Chassman.

Actions also matter. It can be a slippery slope letting your child drink under parental supervision. Especially in cases where a child may be at risk for substance abuse, Chassman advises against it. Though he stops short of saying parents who do this are to blame for their child's addictions, he calls it irresponsible. "Parents need to understand they may be green-lighting substance use disorder not just for their child but for someone else's child," says Chassman, adding that parents should keep their alcohol and medications secure.

But no matter what parents do, children will make mistakes. Parents may tell them to call for a safe ride home if they or their friends have been drinking. Chassman doesn't discourage this. But are there consequences? It's not an easy answer. Chassman recommends looking at the situation from a healthcare perspective. "What do you do when you find out your kid went to the deli on his bicycle, bought three pints of ice cream and got sick later?" says Chassman. "There doesn't have to be a consequence. It's a teachable moment to say, 'This is a really unhealthy choice.'"

Once in a while a child may have a slip up and get too intoxicated to drive. Calling their parents rather than getting behind the wheel is responsible. But if a child is constantly calling their parents for rides because they've had too much to drink, it may be a sign of a substance abuse issue. In these cases, Chassman says the dialogue and interventions will need to escalate.

What resources can parents turn to?

If a child is having issues with drugs, parents can get recommendations for therapists through their insurance or word of mouth. Research the staff's credentials and ensure they meet the state's requirements for licensed therapists. Schiller was discouraged to learn many of her daughter's therapists didn't have degrees in psychology or social work. She says their most relevant experiences were often that they were recovering addicts. Instead of stabilizing Natali on opioid-blocking drugs like Suboxone, they suggested avoiding medications and attending 90 meetings in 90 days.

Indra Cidambi, M.D., the medical director for Center for Network Therapy, an addiction treatment center in Middlesex, New Jersey, did not treat Natali, but she said medications should be considered as part of the detoxification process.

“The optimal use of medications in the detoxification stage of addiction treatment makes the patient physically comfortable by minimizing withdrawal symptoms and craving,” says Dr. Cidambi. “The patient is able to engage in and benefit from therapy. The patients are also able to better integrate into of self-help groups such as AA and NA, which will become their life-long support system.”

Though Narcotics Anonymous and Alcoholics Anonymous can be useful parts of recovery, their efficacy is controversial, and recovery is not one-size-fits-all.

“It is my belief that treatment fit the patient, and not the other way around,” says Dr. Cidambi. “Medications, individual and group therapy, family interventions, and self-help groups should all be part of the treatment milieu.”

Schiller knows all too well that this strong support system beyond the family unit is needed to make meaningful change.

"It takes a community of people," she says. "Families and counselors need to know what the best care looks like because we're talking about a huge number of deaths."