Preventing substance use: The role of parent education groups’
M. BROUMOU, V. PAPPA, L. ILIOPOULOU
1Counseling Psychologist, M.Sc., Parent Education Groups Instructor of Ioannina, Scientific Associate of the Hellenic Parent Education Groups’ Association
2Counseling Psychologist, M.Sc., Ph.D., President and scientificically responsible of the Hellenic Parent Education Groups’ Association, Scientific Associate Department of Early Childhood Education, TEI of Athens
3Psychiatrist, Drug Counseling Center of Ioannina

Abstract
The role of the family in preventing substance abuse seems to be huge, as it relates to multiple protective factors (stable family relationships/ bonds, care and support, sense of security, limits/ boundaries), as well as to risk factors (chaotic family environment, family conflict, inadequate parental role, indifferent upbringing, lack of communication in the family), associated with substance use, thus strongly argues the need to establish prevention programs in substance abuse. The current presentation aims at examining: a) the role of family in the prevention and promotion of the mental health of children and (b) the role of education and counseling parents in the prevention of drug use. Refer to the basic concepts of prevention (primary, secondary, tertiary), and more specifically, in primary prevention in which parent schools aims and the role of family in shaping the personality of the child. Finally, attempts to highlight the importance of parents counseling, in the context of Parent Education and Counseling Groups, in prevention of substance use, as well as to support parents in their challenging role. In Greece, parent education and counseling groups, Parent Schools, operate as an institution of primary prevention since 1962 and are designed to offer parents: a) information on major development issues of children and b) the setting-differentiation (formation) of their attitudes and behavior towards their children and, therefore, all family members. Encephalos 2011, 48(4):159-169.

Key words: Parent education and counseling, parent school, prevention, substance abuse.

Maria Chourdakis often used to say: “Parenting is a great responsibility. You need to be simple to succeed. Treat your child as a person with his own personality. Get to know him. If you find this hard, let love be your guide into your child's heart. Mind you though, I said love be your guide; not overprotection as a means to overcome your parental guilt. Only when you speak to his language and respond to his needs, only then have you earned his love. Only then have you shielded him against any forms of dependency.”

(Ladia, 2010)

Α. Introduction-Core concepts:

A great deal of family researchers has argued that there is an indivisible link between family life and the personality that a child develops as he grows up (Satir, 1989). The conditioning factors for the emergence of drug use are usually at work during childhood and teenage years. These periods of life have been recognized as having a crucial impact on the formation of personality and mental health. In particular, the study of substance use cases has led to a history of troubled childhood (Chourdakis, 1984, 2001). Therefore, particular attention should be drawn to substance use prevention programs, as well as to group counselling and support programmes for parents.

Before embarking on parent counselling, it is important to clarify several different concepts which will help us gain a better understanding of the substance use prevention phenomenon. According to Marselos, such concepts are Use, Dependence, Tolerance and Abuse, and they are parts of the chain of the different stages that an addicted person goes through (as cited in Georgakas, 2007).

Drug use means the casual, experimental use of substances or the experience with an addictive agent out of curiosity or for pleasure. By all means, substance use does not mean that the person will definitely become addicted. The first experience with an addictive agent often occurs by chance and it is only then that the user finds out that it helps him cope with his emotional and functional problems.

Following a period of time which varies from one person to another, the user is not satisfied with the quantity or the frequency of use of the addictive agent because of the tolerance developed; as a result, he is led to its abuse (Georgakas, 2007).

Substance abuse is a state of complete addiction where the person is predominated by an acute need to use the substance. It is distinguished into psychological and physical dependence:

Drug dependence occurs when the person realizes that the constant use of the addictive agent is necessary, whereas withdrawal painful, difficult or impossible. In more general terms, dependence is a state in which a person develops a fixation or a bondage with a substance, an activity or another person where, despite having realized how detrimental it is to his health, or his wish to end it, the person finds it particularly hard or impossible to abstain from it. The dependent person revolves his life around the object of dependence and/or focuses his entire being on it (Georgakas, 2007). Considering the term “dependence” more widely, we can then identify other areas of life where dependent behavior can develop. Bearing in mind the features of this behavior such as loss of control, a recurrent pattern of return to the harmful habit despite the cost, weakness to withdraw from the habit, addiction, the need to escape from reality, continuing this bad habit merely for the joy of it, we could bring in more such behaviors other than abusive substances, which persons often develop in their relationships, at work, or as followers of a certain ideology (Source: www.prevention.gr).

At this point, we should clarify the concept of prevention; by prevention we mean the measures taken to avert the manifestation of an unpleasant phenomenon. In particular, according to the Florida Alcohol Drug Abuse Association (FADAA), substance use prevention is: A proactive process that empowers individuals and systems to meet the challenges of life events and transitions by creating and reinforcing conditions that promotes healthy behaviors and lifestyles (Florida Alcohol Drug Abuse Association - FADAA). At the website of the Prevention Department of the KETHEA (Center for Treatment of Dependent Persons), substance use prevention is described as follows: “The obstruction or delay in the use and abuse of substances brought about by the supply of timely, valid and scientifically backed information on how to deal with drug addiction and on the core principles of prevention, the reinforcement of protective factors as regards drug use and the reduction of risk factors, the promulgation of personal and social education so as to develop emotional, cognitive and communication skills as well as the building of resistance against dependence and the promotion and development of a healthy attitude towards life.” Substance use prevention is distinguished into three levels:

  1. Primary prevention programs which are addressed to the general healthy population and are aimed at preventing or delaying the phenomenon of use and abuse of psychoactive substances.
  2. Secondary prevention programs which are useful when the problem has already started and they are aimed at controlling its expansion.
  3. Tertiary prevention programs which are put in place to stop dependence from becoming chronic and minimize the consequences that had not been averted. Treatment and rehabilitation work at this level.

To recap briefly, we could argue that the family is associated with a great number of protective factors - stable family bonds, care and support, sense of security, boundaries - as well as with risk factors - chaotic family environment, poor parent role model, indifferent upbringing, lack of communication in the family - which are associated with drug abuse and vulnerability to psychopathology. The change of the parents’ attitude by means of experiential learning, which is supported by the teamwork model, can be successful in terms of prevention, in the framework of wider programs furthering mental health (Koutras et al., 2008).

B. The Contribution of parent education groups in the prevention of substance use

In Greece, parent counselling emerged in 1962 at the initiative of Maria Chourdakis with the participation of parents in Parent Education Groups. To this day, parent education groups have done – and are still doing – an excellent job in the field of primary prevention. Their main goals are: a) to support the tormented family institution; b) to safeguard and protect mental health and the positive development of the child and of all members of a group family; c) to shape a concrete parent identity and; d) to educate parents in using more effective communication methods with their children (Chourdakis, 2001; Pappas, 2008). Alarmingly, communication between parents and children is becoming more difficult, as approximately 40% of pupils are in bad terms with their parents. What’s more, they choose not to discuss their problems with anyone (Broumou & Brouzos, 2005. Broumou, 2008). In order to achieve such goals, Parent Education Groups, according to Maria Chourdakis’ Evolutionary System (which is based on the principles of an “International Federation for the Education of Parents”) are aimed at: a) informing parents regarding the contemporary data of Evolutionary and Family Psychology and b) forming the parenting frame of mind and attitude, as well that of all family members. Based on the age level of children, the Groups are categorized into: a) Parent Education Group for Infant & Preschool Age Children, b) Parent Education Group for School Age Children and c) Parent Education Group for Teenagers (Chourdakis, 2000a).

In terms of prevention, Parent Education Groups are focused in generic primary prevention as they are addressed to the general parent population. However, use prevention falls into the special primary prevention field, since Parent Education Groups focus on something more special and more specific. According to Cheng Gorman and Balter (1997), Parent Education Programs are:

In small groups of 12-15 persons coordinated by a mental health professional and by means of group work, parents are led to the realization of their role so they can gradually and progressively understand where they are different. Meetings are carried out on a weekly or fortnightly basis and last for one hour and a half. The issues discussed vary and depend on the parents' interests and the needs as well as the particularities of each group. Several issues are discussed. These include:

Parent Education Groups provide parents with a social and emotional support framework provided not only by the specialist but also by the other parents participating in the groups. Additionally, they provide parents with input on child development and the necessary skills for easier family relations. Parent Education Groups are a very important prevention platform which promotes the mental health not only of parents but also of all the family group members (Pappas, 2006), as they help parents develop better quality relationships with their spouse and offspring. That said, they help parents to feel adequate in their role and to build a concrete parent identity (Chourdakis, 2000a; Pappas, 2008). Finally, they help them see that it is not life changes themselves which lead to practical or psychological difficulties but the way in which adults cope emotionally with different circumstances as well as other arising practical (i.e. insufficient supportive network, added responsibilities) or psychological issues (i.e. parent low self-esteem, feelings of insecurity) (Amato, 2000; Block, Block & Gjerde, 1986; Broumou, 2011; Pappas, 2006).

C. Conclusions-Suggestions

The conclusions drawn in this paper underline the necessity to elaborate preventive programs addressed to parents in order that they may reinforce their adjustment to the parent role and promote as much as possible the quality in the relationship of children with their parents so that parents are able to ward them off substance use (Pappas, 2002). The planning of programs will contribute to maintaining a positive atmosphere at the level of partner-parent relationships and to creating a safe environment for children, thus promoting the mental health of all members of a family group.

What can we do?

There are specific features in a family which can lay the foundations for a child's healthy development and may serve as a protective shield. Based on international literature, whether or not a young person will succumb to substance use lies heavily on his family and friends. A socially active family with strong emotional ties between parents and children, which adheres to a set of rules and establishes concrete boundaries while maintaining control over children activities, minimizes the chances of involvement with antisocial or substance user peers. Thus, the chances for substance use during the pre-teenage years are substantially reduced (Oxford, Harachi, Catalano, & Abbott, 2001).

According to Matsa (2009), the family may serve as a bridge for the child's transition and his inclusion in the wider society. Democratic relationships between parents and children ̶ where suppression is not an option and where respect, understanding and dialogue prevail ̶ do not imply that children and parents are equal. Distinct roles between parents and children are necessary, boundaries ought to be respected. As noted by Nilsen (2002), children who grow up as part of a properly structured group where boundaries are set by parents have a greater sense of balance and are more easily incorporated into groups such as school and society. Especially as regards teenagers, their psychosocial development means more quality time with their parents, the exchange of views and concrete and stable principles. It also implies that direct communication is encouraged, their emotions, be they negative or positive, can be expressed and be accepted and roles are clearly delineated (Dinckmeyer & Mckay, 2009). They encourage their independent thinking by urging them to test the soundness of their opinions. What is more important, though, is the opinion of the teenagers themselves about their family rather than how their family is presented to others (Matsa, 1994, 2009).

A few basic points that could help parents to reinforce the teenager's personality and defenses against substance use, within the family entourage, so as to promote the child's mental health and lay the foundations for preventive action are included in the “Decalogos tis Maria Chourdaki gia ta narkotika” (Decalogue of Maria Chourdakis about Drugs) (2000b, pp. 35-36):

  1. A child should come into existence at the right time, when you, as parents, are ready to provide a warm atmosphere at home and develop a lasting and meaningful relationship with your child. Otherwise, the child feels insecure, abandoned and the first signs of mental disorders begin to settle.
  2. Teach your child early on how to take personal responsibility, and then bigger responsibility. Avoid being overbearing and constantly finding excuses for your child’s behavior. Give your child opportunities for discussion, learn to listen, maintain communication channels open (drug addicts have long stopped engaging into dialogue with their parents and other people).
  3. Accept your child the way he is: more or less bright, active or no active at all, well-built or ugly, short, fat, tall, boy or girl etc. Do not put your child down or constantly compare him against other children or yourself. Each person has his own value. It is your job to help your child find it.
  4. Build your child’s trust in himself and self-esteem. Praise your child, encourage each initiative he takes, help him develop judgment, highlight the good sides of a problem rather than the bad ones, teach your child to take a stand. Life is full of crossroads. Do not let your child experience choice for the first time before the crossroad of drugs (drug addicts have no self-esteem, they are not used to responsible choices early on).
  5. The pre-puberty and puberty stages are full of questioning during which your relationship with your teenagers is tested. Maintain balance. Show understanding and promote dialogue. What teenagers need is “your understanding, not your judgment.” The key to a successful relationship is collaboration, not authority.
  6. Be realistic in your expectations of your child. Do not overestimate his powers, his intelligence, his studies or his choice of profession. A child who succeeded in the profession of his choice is much happier than a child who sacrificed his ambitions on the altar of your own (a lot of drug addicts obtained degrees with distinction).
  7. Do not alienate your child from his friends, or various cultural, athletic, political groups etc. Do not commit your child to long hours of studying or classes while depriving him of free time (drug addicts were usually isolated as children). Team responsibility is the incentive for action and creation. Besides, a team may give a teenager all these qualities he could not find with you: self-esteem, acknowledgment, and acceptance. Should your child fail to find the correct path at the first attempt, do not turn away from him. Keep the doors of your home and heart open.
  8. Do not conceal from your child the financial, social, professional, psychological difficulties  yet avoid dramatizing them. A child would appreciate more a parent who is a fighter to a parent who offers the child an easy and comfortable life.
  9. Enhance understanding among family members, acceptance between spouses. Should things come to worse, a divorce is not as traumatic for a child if handled in a civilized and dignified way.
  10. Offer your children ideals, no matter how much these are being under attack these days. Do not teach children individualism; they will inevitably crumble under its burden. Wider ideals open up new horizons; they forge optimism and a fighting spirit.

Last but not least, the drugs issue is not a family problem but a wider financial-social problem.

In this day and age, there is the conviction that parents are solely responsible for the well-being and happiness of their offspring and that their behavior not only shapes but also dictates child behavior. This parent determinism, however, seems to have greatly added to the parents’ intense feelings of inadequacy (Fourenti, 2002). Things are not quite that simple. As Pappas argues (2006), the parent-children relationship cannot be equated with any such simplistic equation nor does it fall under any such causal relationship. Clearly, the role of parents is decisive but not the only factor influencing child behavior. Parents should realize that the behavior of their offspring does not necessarily reflect their own personality (Dinckmeyer & McKay, 2007). Today, we have come to a point where parents consider their burden of responsibilities and guilt too heavy to bear; as a result, they feel powerless. The balance has been disturbed to such a degree that parents should get help so as to remove their guilt and regain their self-confidence and self-esteem.

The role of parent education is redefined today. The role of parent training, of parent counselling and of Parent Education Groups consists in reinforcing parenting skills. This can be achieved by offering knowledge and the necessary psychological support so that parents may take on their role. Through the guidance of a professional and their participation in a group, parents place their job in a realistic context and retrieve their lost self-esteem.

Through their participation in a Parent Education Group, they realize that they are not perfect. Indeed, it takes great courage to accept that one is not perfect, but eventually, they do manage to dig it up. Their mistakes are not judged or assessed by the specialist leading the group but by the parents themselves, and they usually serve as a springboard for knowledge and a guide for better choices in the future. Acceptance from the coordinator and the group renders parents more tolerant to defeats, more receptive to their children's behavior and, clearly, more receptive of themselves.

To love one’s child a parent should love oneself first. Indeed, Parent Education Groups do work in that direction (Pappas, 2006).

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