“I missed open arms”: The Need for Connectedness among Black Youth Affected by Parental Drug Use

Abstract

Parental drug use has significant impacts on the physical, behavioral and social well-being of adolescents, particularly those from disenfranchised communities. We conducted a qualitative study to understand connectedness among Black adolescents affected by parental drug use in Baltimore, Maryland. In-depth interviews (N=30) were conducted with three groups: parents with a history of drug use, youth (18-24yo) who had a biological parent with a history of drug use and youth providers with experience working with families affected by drug use. Data were analyzed inductively using a content analytic approach. Three salient themes emerged: (1) missing parental connections, (2) the desire for consistent, trusted adults and (3) the consequences of missed connections. All participants emphasized the limited emotional support and guidance provided to youth affected by parental drug use. However, extended family members (e.g., grandmothers, aunts, and older siblings) and community mentors stepped in to fulfill unmet needs, when possible. The consequences of missed connections were increased involvement in risky behaviors, fewer basic necessities and a missed childhood. Findings from the study deepen the understanding of how to support the well-being of youth impacted by parental drug use and highlight the value of including the voices of vulnerable families in research.

Introduction

Nearly one in eight (8.7 million) U.S. youth 17 years and under are living with at least one parent who suffers from a substance use disorder (SUD)(Lipari & Van Horn, 2017), with 2.2 million youth directly affected by parental opioid use disorder (Brundage & Levine, 2019). In 2017, one in three children entered into the foster care system because of parental drug use (Sepulveda & Williams, 2019), a 10% increase in the last five years (Ghertner, Waters, Radel, & Crouse, 2018). While parental drug use effects families across racial ethnicities and socioeconomic classes, disparities persist in diagnosis, treatment access and consequences of use. Despite Black Americans being less likely to have a substance use disorder in comparison to non-Hispanic Whites, the negative consequences of drug use are exacerbated, including disproportionate representation in the criminal system, less access to treatment and recovery services and overrepresentation in the foster care system (Wallace, 1999; Welty et al., 2016; Zapolski, Pedersen, McCarthy, & Smith, 2014). Thus, the need to establish targeted public health programs and policies to mitigate the negative experiences associated with parental drug use for Black families is evident.

Parents with a substance use disorder are more likely to experience homelessness, incarceration, domestic violence and co-occurring mental illness (Adamson & Templeton, 2012; Barnard, 2003; Barnard & McKeganey, 2004; Velleman & Templeton, 2016); all of which have detrimental immediate and long-term physical, behavioral, emotional and academic impacts on their children (Jackson, 2013; Kuppens, Moore, Gross, Lowthian, & Siddaway, 2019; Shorey et al., 2013; Yule, Wilens, Martelon, Simon, & Biederman, 2013). Statistics show that many of these children may be subjected to some form of abuse or neglect. These households are characterized by a social environment of secrecy, loss, constant conflict and role reversal; leading to disruptions in family routines and instability (Daley, Smith, Balogh, & Toscaloni, 2018; Lander, Howsare, & Byrne, 2013). Parenting styles and behaviors are heavily impacted by drug use, often leading to a lack of parental monitoring, emotional support, direct parent-child communication, or harsh disciplinary actions (Daley et al., 2018; Jackson, 2013). Research on Black youth has shown the value in parental control and authoritative parenting; however when parents are dealing with addiction those positive parent-child interactions are lost (Beach et al., 2016; Schinke, Fang, Cole, & Cohen-Cutler, 2011; Zapolski et al., 2014). The level of social isolation places a strain on the dependability and sustainability of the young person’s social support and network (Calhoun, Conner, Miller, & Messina, 2015). In light of the current opioid epidemic where more youth are faced with the negative effects of drug addiction in their families, it cements an immediate need to understand more deeply the needs, experiences and missed opportunities potentially stifling their well-being.

Several theories and frameworks including attachment theory, theory of social supports and networks and positive youth development, all highlight the link between positive relationships and health outcomes (Lerner, Phelps, Forman, & Bowers, 2009; Pittman, Irby, Tolman, Yohalem, & Ferber, 2011). Extensive research has been conducted on the importance of connectedness as a protective factor for youth, defined as a sense of being cared for, supported and belonging (Camara, Bacigalupe, & Padilla, 2017; Noble-Carr, Barker, McArthur, & Woodman, 2014). In past studies, Black youth have identified the value of family connections, primarily closeness with maternal figures, in providing guidance, knowledge and emotional support (Jackson, 2013; Opara, Lardier Jr, Reid, & Garcia-Reid, 2019; Schinke et al., 2011). Youth who feel connected are less likely to engage in highly risky behaviors including decrease in substance use, sexual or criminal activity; but rather have an increased sense of citizenship, access to resources and health information and engagement in pro-social activities (Foster et al., 2017; Steiner et al., 2019). However, youth affected by parental drug use often miss these opportunities for positive connections due to lack of parent-child attachment, limited social supports and unhealthy social networks (Winstanley & Stover, 2019). Despite Black families experiencing worse outcomes and consequences as result of drug addiction, limited research has explored more intently how parental drug use effects the sense of connectedness among Black youth and their heightened vulnerability (Daley et al., 2018). A greater understanding of what connections are present and missing, will illuminate the lived experiences of these youth and provide insight on how best to ensure they have the necessary components for healthy youth development.

Methods

Data from this qualitative study were taken from a larger multiphase project designed to take a community approach to preventing early substance use and injury among Black youth ages 10 to 13 in Baltimore, MD. The aim of the current study was to explore connectedness among Black youth affected by parental drug use and identify the consequences of when connectedness is missed. The study team partnered with local organizations to recruit participants. Four recruitment strategies were used: (1) existing networks of the study team, (2) referrals from partner organizations, (3) participant referrals, and (4) flyers and information sheets posted in partner organizations. A screening tool was used to determine eligibility. All data were collected between November 2018 and July 2019. All research protocols were approved by the university’s institutional review board.

Research Setting

The current study is based in Baltimore, MD, a city heavily impacted by drug addiction, with one of the highest per capita rates of drug use and overdose mortality rates in the country (Hogan & Rutherford, 2017; Irwin et al., 2017; Tempalski et al., 2013). With a population of 620,000 residents, nearly 25,000 individuals have an opioid use disorder (Baltimore City Heroin Treatment and Prevention Task Force, 2016). In a study, 45% of Black youth in Baltimore reported having a family member with a substance abuse problem (Latimore, Tandon, & Sonenstein, 2015); demonstrating the social norm of drug addiction. Given the context, there is an opportunity to better understand the experiences of youth in vulnerable circumstance and how public health practitioners can provide support to prevent risky behaviors associated with parental drug use.

Participants

A total of 30 participants were included in the study. This sample size is consistent with other exploratory, qualitative studies (Patton, 1990; Toma, 2006). Three groups were included in this study to provide multi-informant perspectives to the phenomenon of drug use among Black families in Baltimore: youth affected by parental drug use (N=14), parents with a drug use history (N=11) and youth providers who had experience working with families affected by drug use (N=5). To participate, youth had to be between 18 and 24 years of age, identify as Black/African American, live in Baltimore and have a biological parent with a history of drug use. Older youth were selected for the study due to the sensitivity of the topic and the ability to reflect on their past childhood experiences. Inclusion criteria for parents were as follows: (1) be over 25 years of age and (2) report a history of drug use. Lastly, youth providers had to be (1) over 25 years of age, (2) live or work in Baltimore, MD and (3) experience working with families affected by drug use (e.g. social workers, counselors, and organization leaders). All participants were required to speak and understand English. Participants ranged between 18 and 59 years of age. Ninety percent of participants were Black. The majority of the participants (60%) were female. More than half of participants completed high school or received a GED (60%). Table 1 lists detailed demographic information about participants.

Table 1.

Basic Demographics for Entire Sample (N=30)

Variable	N (%)
Age (M, SD)	(35, 14.3)
- 18-24 (Young Adults)	14 (46.7%)
- 25+ (Parents & Providers)	16 (53.3%)
Race
- Black/African American	27 (90.0%)
- White	2 (6.7%)
- More than One Race	1 (3.3%)
Gender
- Female	18 (60.0%)
- Male	12 (40.0%)
Education
- Less than HS Diploma	6 (20.0%)
- HS Diploma	17 (56.7%)
- Some College	1 (3.3%)
- Unreported	6 (20.0%)
Participant Type
- Youth	14 (46.7%)
- Parent with drug use history	11 (36.7%)
- Provider	5 (16.7%)

Measures

Demographic Questionnaire.

Participants completed a brief demographic questionnaire. The demographic questionnaire asked youth participants’ age, gender, race, and highest grade in school. Adult demographic questionnaire asked participants’ age, race, gender, highest education level, and their interactions with youth. The brief demographic questionnaire was completed on a tablet provided by the project.

Interview Guide.

The interview guide was developed based on the overall aim of the larger project. Participants talked through a semi-structured interview guide with 16 primary questions that was categorized into four sections (i.e., personal history, family relationships, health, and program recommendations). Sample items include, “Tell me about your life growing up”, and “If we wanted to create a way for youth to get the resources they need when they need them, what would you suggest.” Follow-up probes were used to allow for completeness of participant responses.

Procedures

The study team consisted of five Black women, with varying years of experiences with community-based research, public health and youth development. Table 2 provides an overview of the research team. Despite a majority of the participants sharing similar racial and ethnic backgrounds with the research team, there was an evident difference in the level of education and personal experiences regarding drug use between the researchers and participants. To foster a comfortable environment for participants, all team members introduced themselves by first name when meeting participants. Despite our attempt to reassure participants that they were the experts, the research team was cognizant of the power dynamics between the local community and research institution. In addition to recognizing that the team’s education level, access to resources and knowledge would frame the qualitative analysis process. While none of the team members were originally from Baltimore, MD, the lead researcher had been rooted in the community for nearly ten years and developed strong partnerships with local leaders (e.g. pastors, program directors, activists, and youth organizers). Every team member participated in the data collection and analysis process. After each interview, techniques such as memo writing and bracketing were used to reflect on our personal understanding, perspectives and bias that presented during the collection process.

Table 2.

Description of research team

Characteristics	RM1	RM2	RM3	RM4	RM5
Age Range	35-40	30-34	30-34	30-34	20-25
Race/Ethnicity	Black	Black	Black	Black	Black
Years in Baltimore	9	3	2	2	>10
Education Level	PhD	Masters	Masters	Masters	Bachelors
Position	Lead researcher	Graduate student	Graduate student	Graduate student	Research assistant

In-depth interviews were scheduled at a time, date, and location convenient for participants. Round-trip transportation was offered to each participant. Each participant was provided written, informed consent before participation. After a review of the consent form, the interviewer used the semi-structured guide to facilitate the interview. All interviews were conducted by a trained member of the study team. Participants were assigned a unique study identification number to protect their privacy. All interviews were digitally recorded and ranged from 32 to 91 minutes in duration. Upon completion of the demographic survey and interview, participants were thanked for their participation and given information about the next steps of the broader research project. They were also given $25 for their time.

Data Analysis

The digital recordings of the interviews were transcribed verbatim using an online transcription service. Study team members compared each of the transcripts to the original digital recordings to verify the accuracy of the transcriptions. Transcripts were edited as needed by a study team member and then imported into the qualitative software program, Atlas.ti (version 8), to assist with data management and analysis.

A phenomenological approach to data analysis was used, which explores how individuals define and describe a concept or phenomenon based on their lived experiences (Creswell, 2007). Phenomenology synthesizes individuals’ experiences of a phenomenon to its essential components, per Van Manen (1990) “grasping at the very nature of a thing”. In this study, youth and adult perspectives were integrated to explore how parental drug use influenced youth connectedness; thus developing descriptions of “what” and “how” they experience the phenomenon (Creswell, 2007; Moustakas, 1994).

Transcripts were analyzed inductively using a qualitative content analytic approach (Hsieh & Shannon, 2005). Using this approach, the study team created a coding manual to identify the basic themes in the data. Initially, nine in-depth interview transcripts were independently read and coded by the study team. The codes were then discussed and refined as a group. There were 58 codes, categorized into seven groups, in the final codebook. This codebook was applied to the full data set.

Each transcript was coded by two study team members. To ensure consistent coding, team members met after coding each interview to discuss the coded material and address any discrepancies until a consensus was met. Once all interviews were coded, comparisons were made across interviews to allow themes to emerge. Ultimately, the study team developed themes based on patterns and topics that persisted throughout the interviews. We employed three techniques to augment the credibility of findings: triangulation, negative case analysis, and peer debriefing. Codes describing the available and lack of support and resources for adolescents were used in the current analyses. Demographic data was analyzed using STATA (version 15).

Results

Youth affected by parental drug use discussed a range of physical, emotional and mental needs. The connections between a parent and child were viewed as the missing link in the lives of these young people. The lack of emotional support often left youth in these families feeling unloved, misunderstood and lacking guidance to make healthy decisions. Youth and adult participants shared stories of disappointment, hardship and missed opportunities linked to their family history of drug use and abuse. Yet, youth participants still desired consistent, healthy connections with adults, including their parents who abused drugs. When youth needs were unmet, the consequences led to engagement in risky behaviors, feelings of abandonment and a missed childhood. The following themes were driven by the youth participants but endorsed by both parents with a history of drug use and providers.

Missing Parental Connections

Nearly all youth participants (79%) described missing the presence of their parent in their lives growing up. Parents and youth alike shared how they missed opportunities to bond and spend time with their families during holidays and every day, normal life. Youth participants reported being unable to talk to their parents about pertinent issues such as developmental changes, navigating romantic relationships and life lessons. A 19-year old female participant, whose mother had a history of drug use, expressed her experience with both physical and verbal abuse. She felt that the presence of and an emotional connection to her mother would have protected her from the trauma experienced during her childhood.

I really wish our relationship was stronger and that I could have relied on her to make sure I was safe and that nobody was going to harm me. You feel as though you would think your parent is the one who’s going to make that promise to you. (19yo Female)

Parents were honest about the reasons for their absences. As one parent stated,

I placed drugs over them, to a degree. (51yo Mother)

When asked about their relationships with their parent who used drugs, many youth participants noted that they also missed having healthy, functional families without trauma. For some, the only possible way to have avoided these negative experiences would have been to have a different family:

I wish I was born into a better family …Everybody’s educated. Well-protected, less abuse, less drug abuse. Abuse in general. Because all of it happened in my family. Physical, emotional, psychological. It still happens even to this day. I would say middle Mass family in the suburbs. (22yo Male)

Youth participants recognized the impact of these strained relationships on their interactions with others. The lack of physical and emotional support framed how they behaved and perceived the world. Through these experiences, they learned to trust no one and accept broken promises as the norm. For example, several youth described failed systems and unreliable people whose actions often contradicted their commitments. As noted by three male participants,

I always got empty promises from my parents, but I got used to it. I don’t want to expect nothing. (24yo Male)

I got fiends, they my age right now and don’t got a care in the world. You don’t care about nothing. That’s because as long as they can remember, they had nobody but they self. They grow up like this, on some f-the-world type stuff (24yo Male)

That mentality comes from being screwed by so many people. So many people done stabbed me in my back and brought me pain. I’m at a point, I don’t trust nobody. Then people be acting like they there for you, but they ain’t really there for you. It’s not like I learned it from anywhere. I learned it based off my life. (18yo Male)

Parental absence during childhood and adolescence served as the beginning to physical and emotional needs being unmet. Love and care were identified as the emotional support most needed and often missing for youth affected by parental drug use. The lack of nurturing relationships from parents, left youth seeking attention, understanding and comfort from others.

Desire for Consistent, Trusted Adults

All participants stated that young people affected by parental drug use greatly needed consistent, committed adults who could provide emotional support and ensure tangible needs were met (e.g., safety, housing, food). The lack of consistency in people led to inconsistencies in structure, provision of basic needs and resources. Parents were viewed as the responsible parties to provide the emotional support that youth often reported was lacking in their childhood. However, the presence of any trusted adults would have provided an escape and safety net from the problems faced at home. Several youth mentioned being overwhelmed by their unstable family situations. In these moments, they noted that the presence of any adult at school or local community center would have been the saving grace.

All somebody had to do was ask me [what was going on]. Nobody asked, so I didn’t care to tell. (21yo Female)

It’s just the need for someone stable. The need for someone to care regardless of anything. To know that they’re not getting anything out of it, but they’re still going to be there for you. (23yo Female)

All they want to know is that somebody cares. A hug, a little conversation, even listening can get you a long way with kids. I personally think that youth need more to hold on to… A lot of these kids didn’t really have no parents. If you talk to people and you just observe…You can tell. They need somebody to hold their hand, like, “I’ll walk with you.” (57yo Mother)

Youth reported the high turnover in guardianship and care led them to living with different family members, changing schools often and receiving intermittent emotional support. In some cases, parents provided money or food stamps to the caregiver, but it was sporadic. Therefore, different people (e.g. family members, mentors, neighbors) stepped in to meet the basic needs of youth. Specifically, grandmothers were identified as being the most consistent in providing daily needs. However, when adverse circumstances such as poverty, incarceration, death and/or personal struggles with addiction occurred, it became difficult for their needs to be met by one, consistent person. As a result, the lack of consistency preceded limited supervision, guidance and structure during their childhood.

I never had the chance to relax where I laid my head. I never had the chance to relax. It was always go, go, go (21yo Male)

I didn’t have nobody around to teach me the correct way of love. (22yo Female)

I was supporting them, feeding them, doing different things like that. After that, I went to jail. When I went to jail, it’s like I fell out their lives. (46yo Father)

For those involved in foster care, aging out of care was a significant transition and the onset of inconsistent support. Some youth described having no support system outside of the people that were mandated to look after them. Therefore, when those people left, there was a disruption in support, services, and resources. A 23-year old female participant expressed her dissatisfaction in social workers because the support appeared ingenuine and temporary. She felt that everyone, including family were paid to care for her, which was not sustainable nor to her benefit.

Yeah, it was never like they did it because they wanted to. Even now, all those people are gone. I’m dealing with real world, real life things, and I can’t call on them. (23yo Female)

Youth reported that as they grew older, the inconsistency in care, support and resources became more evident. As noted by a participant:

Nobody helped me get a bank account. Nobody opened a savings account up for me. When it was time to for me to age out at the age of 21, they dropped me like a fly. I’m telling you. I had to move from my apartment because I didn’t have no money saved up because I didn’t know what a bank account [was]…I didn’t know how to start a bank account. I didn’t know about saving. (24yo Female)

In some instances, connections were built by concerned community members. A provider disclosed that her commitment to young people included offering housing, food and educational resources. She encouraged society to be more sensitive to the needs of these young people, particularly given the complexity of their family situations.

It makes me think about when we see so many young people who don’t have a sense of hope. If you stand in their position and think about it, why would somebody have a sense of hope if you feel like the people that are supposed to take care of me are not taking care of me? (34yo Provider)

When consistency from a caring adult was provided, youth described the value it contributed to their personal growth and success. These trusted adults were perceived as mother/father-like figures because they provided emotional and spiritual support (i.e. available when needed, encouraging and someone to talk to). One youth reported the persistence and relentlessness of a youth worker, who ensured that she enrolled in a GED program and received social services despite her continued involvement in illegal activity.

She just never gave up. As much as I try to run, run, run, she would not leave me alone…She just kept pushing me to come back to school. She kept pushing me to do something… “You can fight me all you want, but I’ll find you. We going to find you, going to put you back where you were. “I just got tired. That’s all I needed. I needed somebody to say, “C’mon, I got you.” She just wrapped her arms around me and kept me like that since day one… She like my mother from God. She’s not my blood, but I feel like she’s my mom (24yo Female)

All participants reported inconsistencies in guardianship, short-term provision of basic needs and instability. It was not simply about youth having connections, but rather connections to the right people at the right time. Many parents and youth participants expressed the transient nature of their lives, which contributed to chaotic daily circumstances and increased distrust of systems intended to support them.

Consequences of Missed Connections

When parents were physically and/or emotionally absent due to drug use, there were serious negative consequences experienced by youth. The lack of parental engagement forced many youth participants to navigate life in constant survival mode. For example, several reported being required to care for themselves and other siblings as early as eight years old. The inability to participate in extracurricular activities such as sports left youth feeling that they missed out on normal childhood experiences. As noted by two male participants,

I had responsibilities of an adult as a child. I had to take care of my siblings. I had to make money. I’ve seen things that children shouldn’t see. I didn’t have the ideal childhood, but I don’t think I had the worst either. When I was in high school, I wrestled but I couldn’t continue to do it because I had to go get my little brother. My responsibilities fucked up my childhood, literally. (24yo Male)

At eight years old, my mother told me I’m a man, nobody going to do nothing for me. Gave me candy, I was selling that. Got my school clothes, my food, everything. I was basically taking care of myself. (21yo Male)

The limited connections left youth feeling as if they had little guidance and preparation to be adults. For example, one participant explained losing the apartment she received through an independent living program because she had lacked financial literacy or the proper skills to be responsible and self-sufficient. Without a supportive network to rely upon, youth made risky decisions and were unable to sustain resources provided to them. Youth approached situations based on what seemed appropriate in the moment regardless of its legality. Both parents and youth discussed the need to engage in illegal behaviors such as selling drugs and stealing to provide basic needs.

At an early age, I understood that by 12 because I was doing it [selling drugs] to support myself. I had nobody. I was sleeping on the streets, and I didn’t want to sell my body. I didn’t want to lose myself like that, so I was like, “You know what? It’s time to harden up.” That’s how I took it, because anything could have happened.” (24yo Female)

I start selling my pills again. Fell right back into it. Paid for everything my kid and I needed every month for three years. (50yo Mother)

Despite or because of these experiences, youth still desired social connections, particularly with their parents and family members.

I missed open arms. I missed unconditional love. I missed being able to go outside and have something structured. Everything I did it was on my own…When it came down to anything, I wanted to do… I was always put on the back burner. (21yo Male)

The value of healthy parent-child connections and the consistency in support were essential for this vulnerable population. The consequences of a having a parent with a history of drug use led to fractured connections to people, resources and tangible supports.

Discussion

Parental drug use is a traumatic experience for families and communities. Study findings echo previous research describing the range of negative effects that parental drug use can have on youth (Barnard & McKeganey, 2004; Solis, Shadur, Burns, & Hussong, 2012). The stories shared by youth and parents showed how drug use complicates an individual’s life, particularly resulting in a missed childhood for youth affected by parental drug use. The salient themes in the study were tri-fold: (1) missing parental connections, (2) the desire for consistent, trusted adults and (3) consequence of missed connections. Participants expressed how the physical and emotional absence of a parent due to drug use led to youth missing opportunities for healthy development. In turn, the consequences of parental drug use were engagement in illegal activities, poor mental health/suicidal ideation, early sex initiation/childbearing, lacking trust in others, abandonment and hopelessness.

Youth affected by parental drug use yearned for healthy relationships with their biological parent. However, this often was not an option based on the realities of drug addiction, which particularly inhibited the young person’s ability to foster healthy connections with others. Parental drug use is associated with violent and erratic behavior that places their children at higher risk of being abused or neglected (Manly, Oshri, Lynch, Herzog, & Wortel, 2013). Prior research demonstrates that parents who engage in unhealthy substance use are often unable to provide developmentally appropriate monitoring (Smith & Wilson, 2016) and attachment (Lander et al., 2013), which could lead to a host of unintentional injuries or engagement in risky behaviors (Henry, Liner-Jigamian, Carnochan, Taylor, & Austin, 2018). As a result, youth miss opportunities for positive parent-child connections that are necessary for optimal emotional and behavioral well-being (Ackard, Neumark-Sztainer, Story, & Perry, 2006).

Research supports drug addiction as a disease that has implications both in the present and enduring effect over the life course (Kuppens et al., 2019). Thus, care for youth affected by parental drug use requires a long-term commitment. Increasing supportive connections must be at the core of this commitment. Study participants expressed the desire for consistent, permanent connections to trusted adults and resources, beyond what is offered through social services or foster care. Interventions and policies should consider strengthening the capacity of existing spaces, resources and people to sustain a lasting impact on the lives of young people and their families. These approaches have been particularly positive for urban Black youth in preventing substance use (Opara et al., 2019; Schinke et al., 2011).

For example, recent trends have shown an increase in kinship care, particularly grandparents raising grandchildren due to the parent’s drug use (Raising the children of the opioid epidemic: Solutions and supports for grandfamilies, 2018). In 2014, more than a third of U.S. children removed from their homes due to parental drug use were placed with a relative. Unfortunately, little to no support was provided for the child or caregiver in informal living arrangements. The Family First Prevention Care Act, a reform of the child welfare system, prioritizes keeping youth with their families in safe living environments (Williams-Mbengue, 2019). While this policy is a step in providing more options for families, not all youth affected by parental drug use interact with the child welfare system. In the current study, participants emphasized the sense of connectedness grandmothers and older adults provided. However, due to unforeseen circumstances like death or poverty, they struggled to sustain the supports needed by the young person. Therefore, additional local and community level support are necessary to ensure that youth and their caregivers have access to resources, which have the potential to result in interpersonal and behavioral improvements.

Evidence from mentoring models support the concept of natural mentors or “surrogate parents” as an alternative for vulnerable youth. While programs like Big Brother Big Sister (BBBS) are well-known for supporting vulnerable youth (DuBois, Holloway, Valentine, & Cooper, 2002; Mitchell, 2019), there is an opportunity to invest in the people youth already identify as important figures. As noted by participants, extended family members, like grandmothers, aunts and older siblings were trusted for advice and support. Thus, signaling the importance of other people stepping in to provide stability, guidance and safety. However, there is limited literature on strategies or programs that incorporate the strengths of these connections and relationships to promote the well-being of youth affected by parental drug use. While the research on natural mentoring has focused primarily on foster care youth, the positive effects are well documented, including fewer mental health challenges, less engagement in sexual risks, and increased academic achievement (Hurd & Zimmerman, 2010; Klaw, Rhodes, & Fitzgerald, 2003; Munson, Brown, Spencer, Edguer, & Tracy, 2015; Van Dam et al., 2018). Thus, facilitating natural mentor relationships through existing community assets and resources like recreation centers, churches, libraries or organizations could provide an opportunity to strengthen young people’s social network. Strong connections to one’s community can have a significant influence on a young person’s self-efficacy, future orientation and overall wellness (Munson, Smalling, Spencer, Scott Jr, & Tracy, 2010). Natural mentors may serve as an example of positive relationships and help youth develop healthy coping strategies. For youth who lack consistent parent support, these relationships may be especially critical to their development.

The current study has limitations to consider. Primarily, the information reported is based on a small sample size of 30 participant interviews. The findings are not generalizable to all families affected by parental drug use, but rather reflective of the experiences of the participants interviewed. Nonetheless, the sample size is consistent with other qualitative studies that seek to explore the lived experiences of individuals (Patton, 1990; Toma, 2006). It is understood that drug addiction affects individuals and families differently; therefore, the social and environmental context of Black youth living in Baltimore informs their perspectives. Many of the youth and parents included in the study had experienced reoccurring trauma. A majority of participants were referrals from treatment and recovery programs and students enrolled in alternative schools; therefore, youth who would considered “success stories” or those with more positive outcomes were missed. Future researchers should consider recruiting from colleges or young professional organizations. Lastly, it is possible that our study sample consistent of individuals who are more open to discussing their experiences due to currently seeking social services and resources. From our knowledge of the population, some youth who have been provided with adequate connections to trusted adults, resources and support are less likely to discuss their experiences due to stigma, disappointment or shame.

Despite these limitations, there are three strengths to this study. First, study findings speak to the often assumed, but rarely empirically studied, disconnection experienced by youth affected by parental drug use experience. Second, the focus on Black youth and their families offers an opportunity to develop programs and strategies that are context specific. Parental drug use has often been generalized and not considerate of the social and cultural nuances that influence how youth are impacted. More recent research has focused on minority youth in urban settings, but there still lacks sufficient knowledge on the repercussions of drug addiction on Black families and ways to prevent the cyclical pattern (Opara et al., 2019). For Black families in particular, who experience the worse outcomes related to drug addiction, there is a case to delve deeper into the dynamics of these families and how youth can best be supported both emotionally and physically. In which, this study uncovered the value of extended family members, specifically grandmothers and aunts as the anchor for connectedness among Black youth affected by parental drug use. Finally, the multi-informant perspective of youth, parents and providers allowed for triangulation and credibility of the findings. The ability to capture the lived experiences of a vulnerable, and often hard to reach population permits researchers and health professionals to develop strategies and resources that are human centered.

Conclusion

Youth affected by parental drug use are at heightened risk for adverse experiences and negative outcomes. The physical and emotional absence of a parent requires the support and nurturing of other trusted adults to foster connectedness with youth. Programs that support long-term kin and non-kin natural mentorship present an opportunity to meet the physical and emotional needs of these young people. While parental drug addiction has enduring effects on families, the increase in positive connections and consistency may serve as a buffer to the negative experience.

Highlights.

• Parental drug use leads youth to miss opportunities for healthy development

• Extended family are integral to meeting youth’s physical and emotional needs

• Youth desire long term connections to committed and consistent adults

• Missed connections lead to early engagement in risky behaviors