The Forgotten Voices in Substance Use Treatment

"Warped lives of blameless children."

That's a line from the Big Book of Alcoholics Anonymous that's referring to alcoholism as an illness that affects those around the sufferer like no other human sickness can. In one of the first published references to this as a "family disease," the line above is an astute identification of one of the most heartbreaking aspects of addiction.

And it's also one of the most overlooked aspects of addiction. 

While I have always been an advocate for giving the children or siblings of treatment clients the attention they deserve, when I wrote my book Rehab Works! in 2014, I mentioned Alateen as the support program for teens impacted by addiction, but I didn't go any further in addressing the needs of these young people.

A Fortuitous Suggestion

As I've been preparing the 2026 Revised Edition of Rehab Works!, I asked Jerry Moe, a leading voice in the field of children and families impacted by substance use, to review my manuscript. One of his suggestions was to say more about Alateen and offering support for young people impacted by substance use in the family. 

In making revisions for a book that was originally focused on teaching families how to support a loved one's treatment, it did not occur to me to add anything more about the "warped lives of blameless children" element of treatment programming. 

All I can say is, Jerry's suggestion was brilliant. 

As the primary shift with this 2026 edition is reflected in the revised subtitle—A Modern Framework for Family Recovery—it only makes sense to include this important aspect of family support. Leaving it out would make me complicit in the exact dynamic I claim to be standing up against. Including the children impacted by substance use in the home completes the framework that addresses recovery for the entire family. 

The following is an excerpt from the new material in my upcoming Rehab Works! 2026 Revised Edition on "The Forgotten Voices." 

I opened this chapter with a line from Alcoholics Anonymous—commonly known as the Big Book—that refers to "warped lives of blameless children." This points to a topic that is near and dear to my heart—yet unfortunately remains one of the most overlooked areas in substance use treatment:

Teenage children and siblings—the ones most often left out of the conversation.

Throughout the years that I ran an adolescent treatment program, I would always pay attention to the siblings in the family. Parents often don’t think of including them in treatment, but I would push for it.  And I can say that some of the most gratifying work I have ever done has been creating opportunities for these young people to have an experience they so desperately need and deserve.

The opportunity to be heard.

To have their experience validated.

To get the immense feelings they’ve been carrying around off their chest.

That experience of being able to process those feelings—in the supportive structure of a family group—can literally be a life changing moment. I have heard countless siblings of my adolescent treatment clients say,

“I feel like a huge weight was lifted off me.”

I am a strong advocate for the “warped lives of blameless children."

 Outside of professional counseling or participation in the family program of a treatment facility, Alateen is a valuable resource for teen children who have been impacted by substance use. This is a free, peer-based support group, that is often facilitated by an adult mentor who is part of Al-Anon (the 12-Step support program for family members impacted by alcoholism). Just as with AA and NA for the substance users, the peer-based format creates a supportive environment that is often more comfortable and conducive to meaningful interaction than the professional setting. (This is not to say the professional setting is to be discounted; there is value in both.)

For many young people who live with hidden feelings that come with addiction in a family—fear, shame, guilt, anger—Alateen may be the first place where they ever feel safe expressing themselves honestly. Where they discover they are not alone. Where they hear, perhaps for the first time, that none of this is their fault. And this can be a game changer. In the family system where all the focus tends to be on the “identified problem,” it’s easy to see how they become the “forgotten voice.” Alateen provides a safe place for that voice to be heard.

Hearing Their Voices

For years I conducted family group programs in treatment that would give siblings of my adolescent clients the opportunity to process their experience of living with a substance use issue in their home. It would often be a very intense experience, where the sibling would express their feelings about the client's substance use impacted them:

The night mom and dad had to call the ambulance when they found you passed out in the bathtub, I felt scared.

When I knew you were sneaking out your window at night and I covered for you with mom and dad, I felt guilty.

When I hear my friends at school talk about what a stoner you are, I feel embarrassed. 

When they were done, they would receive supportive feedback from the group:

It's obvious you really love your brother, and I felt sad listening to you describe how hard that's been for you.

That couldn't have been easy to do. I'm so proud of you.

I would usually go last with my feedback, and I would always begin with:

I'm really grateful you had the opportunity to do this today.

I knew this could be a once-in-a-lifetime opportunity. When else might this sibling have the chance to process their feelings, get them out, and—more importantly—be validated by a supportive group? This can literally change the course of a young person's life. They may either carry those bottled-up feelings forward, where they quietly shape choices and attitudes for decades. Or they can process them, and move forward freely. 

I'm grateful that Jerry Moe pushed me to rekindle my commitment to advocating for the "forgotten voices." In these days when family services are too often hindered by budget constraints and scheduling challenges, let's not lose sight of the blameless children. Including them shouldn't just be an afterthought. It completes the framework.

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