Part A: Factors Hindering Healthcare Autonomy in Youth Affected by Parental Substance Use and Restoration through Art based Support
Essay by Nichelle Sterling
According to the National Institutes of Health (2025) out of 19 million U.S. children, as of 2023, approximately one in four live with a parent or primary caregiver who had a substance use disorder. In Canada however, research suggests it is one in five children who face this reality and as a result, they are three times greater risk of developing a substance use disorder, mental illness or succumbing to suicide (Chen & Zybinova, n.d.). A key concern posited by not-for-profit organization Starlings Community is the removal of age-based barriers for youth—living with a parent or primary caregiver that has a substance use disorder—who are attempting to access mental health care services. Developed under the guidance of the Catamount Fellowship, this paper will assess the factors proposed in the extensive body of research conducted. Solutions to tackle the issue at hand require the involvement of political systems, healthcare industries among other public welfare institutions. Researching this topic, three major factors were highlighted as barriers that prevent access for young people and they are as follows: Social Stigma and Psychological Barriers, Rights and Legislations, and finally, Accessibility to Mental Health Services or the lack thereof. These three categories were derived from the guidelines of the Impact Gaps Canvas and the Iceberg Model—both of which were utilized throughout the systems mapping process to develop a better understanding of the problem at hand (Kim, 1999; Papi-Thornton, 2016). After further analysis the researcher was able to deconstruct the underlying barriers limiting young people under 18 from independently accessing mental health care, and of course propose a new framework in attempts to aid in the battle combatting this issue.
Social Stigma and Psychological Barriers
It is well documented Substance Use Disorder remains one of the most stigmatized medical concerns and may hinder not only the parent affected from seeking professional help and rehabilitation, but also the at-risk child under their care (Dir et al., 2025). Whether it be due to fear of family alienation or societal pressures from the wider population, substance use is a difficult health matter to navigate through for all involved. According to Stringer and Baker’s (2018) analysis on the intersection of parenthood and gender on perceived social stigma, parents who use substances tend to be more discriminated against than individuals who are not parents. They are more likely to be shunned and criticized as incompetent or neglectful parents. Unhelpful remarks such as these in turn feed the loop of shame and self-stigma, making parents who use substances less likely to seek or engage in the available systems of care (El Hayek et al., 2024). Stigma can then be said to have a positive correlation with substance use when individuals already engage in their use. These detrimental impacts however do not only stop at the parents and the accumulation of prejudiced factors can lead to psychological and social deficits and adaptations in development of their children as well.
Origins of Stigma
Through the creation of a systems map, this project aimed to identify the barriers impacting youth, and through research found that stigma presented itself in a variety of means. Substance use is treated differently amongst cultures and societies but in many, individuals that do use substances tend to be ostracized or criticized as weak and dangerous to themselves and others. According to El Hayek et al. (2024), individuals with substance use disorders are often viewed through the lens of criminalization which increases the risk of stigma faced by others who use substances. It also plays a part in shifting attention away from medicalized or otherwise health-related models of addiction and instead thinking of those who rely on substances as violent or immoral. These forms of stereotypical thinking can lead to already susceptible minorities and individuals experiencing homelessness to suffer greater discrimination.
The media also tends to rely on dehumanizing language and moral judgment when discussing individuals that are addicted to using substances. Research suggests that narrative reporting and negative or otherwise stigmatizing language used to describe drug addiction can be guilty of exploitation, leaning into the perspective that using substances makes one an immoral or weak person (McGinty et al., 2019). Framing substance use disorders as a moral plight or a failure of society feeds into underlying preconceptions of substance use, emphasizing certain aspects of the issue over others (McGinty et al., 2019). The media is often the greatest source of information and has significant influence when forming mass opinions. Agenda setting by media outlets guides public attention to the perceived priorities of intervention. For example, research shows that matters surrounding illicit drugs are typically reported on more in the USA than that of tobacco and alcohol even though they are among the more commonly used substances worldwide (McGinty et al., 2019).
Impact on Mental Health
Much like Bandura (1977) posited in his social learning theory, it is highly likely that children learn from observing their environment. A qualitative study done by Meulewaeter et al. (2022) asked participants who had been raised in the context of parents that used substances and also developed substance use disorders themselves to recall moments from their childhood. The participants were referred to as “adult children” as they were already 18 or older at the time this study was conducted. Results from the Meulewaeter et al.study revealed largely similar feelings of shame, guilt and humiliation. It was difficult for participants to engage in healthy interpersonal connections as children and some still struggle in adulthood. Social isolation plays a large role in the construction of their self concept and the lack of self esteem seemingly experienced by the majority of those interviewed. There was also difficulty in referring to or making mention of their parents especially under the label ‘drug addict’. Many of the respondents found they experience neglect and different forms of violence from parental figures. Some went as far as to blame themselves for the dysfunction in their homes.
In addition to this, research shows that parental addiction can be lifelong resulting in a number of psychological health issues. One in five youth grow up in homes affected by substance use challenges and due to a number of factors, are unable to access proper support systems (Mental Health Commission of Canada, n.d.). Anxiety and depression are commonly experienced by children and young adults due in part to the parent’s sudden mood swings and behavioural changes (American Addiction Centers, 2025). As noted before, social isolation, abuse and neglect can be prevalent within these homes, which often leads to fear and emotional dysregulation. There is also the possibility of more distressing internalized and externalized long-term health consequences due to domestic violence and witnessing a primary caregiver’s decline. Children that are exposed to parental substance use are four times more likely to experience depression and three times more likely to develop anxiety related disorders like phobias, generalized anxiety or PTSD (Lipari & Van Horn, 2017; Substance Abuse and Mental Health Services Administration [SAMHSA], 2021). Parental substance use can affect the child’s cognitive, social, psychological and physical development as well as their economic wellbeing.
Access to Mental Health Services
A key barrier to access relates to the service design of existing mental health and rehabilitation institutions. The initial concern after receiving this question as a Catamount fellow was the possibility of parental impairment or abuse impeding on a child’s clinical autonomy. For this report, the working definition adopted for a child’s clinical autonomy referred to the right of a minor to refuse, consent to, or participate in any form of medical treatment or intervention, contingent upon their level of maturity (Parsapoor et al., 2014). The design of any services would have to keep in mind affordability, scheduling barriers and transportation for ease of access. Working with youth under eighteen in Calgary, one must keep in mind students with jobs typically make 13 dollars an hour, and it is not guaranteed the youth that access Starlings’ services will be employed at all (Government of Alberta, n.d.). Therefore, any intervention created must acknowledge financial barriers as a key issue to accessing mental health services. There is also the possibility for them to be managing more adult-level responsibilities if their parents or primary caregiver have a substance use disorder.
With the previously listed sociopsychological factors in mind, it is also clear that although there are pre-existing mechanisms in place to help at-risk youth, there may also be an underlying fear to make use of them. This fear can derive from prejudiced and discriminatory practices pushed by the media, differences in cultural reactions and belief systems, as well as treatment within the home.
Rights and Legislations
As the question explored the idea of age and consent-based barriers, the idea of rights and legislations was initially approached through the lens of the child welfare system and was believed to be the main barrier in retaining medical autonomy as a minor. Within the Canadian Incidence Study of Reported Child Abuse and Neglect, substance use was reported to be the most frequent root cause in caregiver-related cases (Barker et. al., 2014). Additionally, there is a wildly disproportionate representation of First Nations children within these institutions with indigenous youth accounting for over half (53.8%) of all children in the child welfare system in 2021, despite making up only about 7.7% of the child population (Hahmann et al., 2024). Aside from this, state care tends to be placement-focused, wanting to remove the child from dangerous or otherwise neglectful homes. According to the Public Health Agency of Canada ([PHAC], 2019), children are then placed in temporary care while the agency works to address substance use within the home. These temporary placements abide under strict timelines that vary between provinces but often range from 3-12 months.
In terms of health care, it is often thought that youth under 18 are unable to operate independent of their parents, however, there are legislative guidelines that allow them to bypass the terms of parental consent in order to seek medical and mental health care. The mature minor doctrine is one of these legal principles (Sigman & O'Connor, 1991). This doctrine allows youth under 18 or 19 to independently refuse or consent to proposed medical treatment after being assessed by a healthcare professional to have the necessary cognitive capacity, maturity and understanding to do so. It is one of the legal pathways often relied upon to protect the rights of adolescents within healthcare settings (Alberta Health Services, 2010). In Canada this common-law doctrine is often paired with other provincial legislation to ensure the best interests of a child whose parent might have a substance use disorder. They include but are not limited to child welfare laws, provincial privacy laws, and the United Nations Convention on the Rights of the Child (UNCRC) (Department of Justice Canada [DOJ], 2015).
Therefore, there are considerable mechanisms within policy in place to protect and maintain the rights of youth within healthcare spaces, ensuring their bodily autonomy and agency are kept in-tact. Despite this, confounding variables to accessing support systems—often related to stigma and stereotypes—are what act as barriers and prevent youth from utilizing the frameworks constructed for them.
