4 This is a FAMILY disease When addiction enters a family, everyone is prone to:PreoccupationArgumentsGuiltStressDefensivenessMood SwingsProblems in LivingDepressionRageNumbness
5 CODEPENDENT: A CLOSED SYSTEM I want to fix you because it hurts me to see you this way or live like this – I don’t want to hurt so I have to make you better.I want to feel good, happy – I can’t do that if you are going to be sick (i.e. I depend on you to make me feel good).When I am feeling bad, I blame you. If only you were taking care of yourself, then I wouldn’t have to feel this way.I feel empty because nothing is getting through to you and I don’t know what else to do or who to turn to who will understand. I am all alone.I feel responsible FOR you: I have to:FixRescueProtectControlI feel:TiredAnxiousFearfulGuiltyAngryRejectedSelf pity
6 Enabling “Standing between a person and his or her consequences.” “Doing for someone something he or she should be doing for him or herself.”“Engaging in actions that ultimately perpetuate someone’s problematic behavior.”
7 Families will enable their loved ones and keep them from recognizing the seriousness of their problem by:Getting stuck in the defensesDenying there is a problemMinimizing the problemAvoiding discussions about the problemBlaming others or lashing out with angerJoining in the rationalizations/justifications that their children createTaking over their responsibilitiesContinuing to provide financial supportHelping to resolve legal problemsPromising rewards for abstinenceSuggesting a physical fitness program or a job changeThreatening to kick them outProvoking arguments/naggingAvoiding getting help for themselves
8 CODEPENDENT: A CLOSED SYSTEM I want to fix you because it hurts me to see you this way or live like this – I don’t want to hurt so I have to make you better.I want to feel good, happy – I can’t do that if you are going to be sick (i.e. I depend on you to make me feel good).When I am feeling bad, I blame you. If only you were taking care of yourself, then I wouldn’t have to feel this way.I feel empty because nothing is getting through to you and I don’t know what else to do or who to turn to who will understand. I am all alone.I feel responsible FOR you: I have to:FixRescueProtectControlI feel:TiredAnxiousFearfulGuiltyAngryRejectedSelf pity
9 Approximately 5 million Americans either abuse alcohol or are alcohol dependent and have at least one child under the age of 18 living in their home (SAMHSA.gov).Fathers (8%) are nearly twice as likely to abuse substances as mothers (4%). However, these rates are lower than the general population (men, 14%; women 6%) (SAMHSA.gov).Children living with an addicted parent are at greater risk for abuse, neglect and trauma (NACoA.org).80% of child welfare professionals report that substance abuse causes or contributes to at least half of all cases of child maltreatment. 40% say it is a factor in over 75% of cases (NACoA.org).72% of child welfare professionals cite substance abuse as the top cause for the dramatic rise in child maltreatment since 1986 (NACoA.org).During 2002, each day, an average of 2,454 children were found to be victims of abuse or neglect. During that same year, 532,000 children lived in foster homes because they could not safely remain in their own homes (SAMHSA.gov).
10 There are an estimated 28. 6 million COA’s in the United States There are an estimated 28.6 million COA’s in the United States. 11 million are under age 18 (NACoA.org)Children of addicts are up to four times more likely than other children to develop substance abuse and mental health problems (NACoA.org)Most children of alcoholics have experienced some form of neglect or abuse. A child in such a family may have a variety of problems:Guilt. The child may see himself or herself as the main cause of the mother’s or father’s drinking.Anxiety. The child may worry constantly about the situation at home. He or she may fear the alcoholic parent will become sick or injured, and may also fear fights and violence between the parents.Embarrassment. Parents may give the child the message that there is a terrible secret at home. The ashamed child does not invite friends home and is afraid to ask anyone for help.
11 Most children of alcoholics have experienced some form of neglect or abuse. A child in such a family may have a variety of problems (cont’d):Inability to have close relationships. Because the child has been disappointed by the drinking parent many times, he or she often does not trust others.Confusion. The alcoholic parent will change suddenly from being loving to angry, regardless of the child’s behavior. A regular daily schedule, which is very important for a child, does not exist because bedtimes and mealtimes are constantly changing.Anger. The child feels anger at the alcoholic parent for drinking, and may be angry at the nonalcoholic parent for lack of support and protection.Depression. The child feels lonely and helpless to change the situation. Although the child tries to keep the alcoholism a secret, teachers, relatives, other adults, or friends may sense that something is wrong.From the Academy of Child and Adolescent Psychiatry, No. 17, Updated November 2002
12 The following behaviors may signal a drinking or other problem at home Abuse of drugs or alcoholFailure in school; truancyLack of friends; withdrawal from classmatesDelinquent behavior, such as stealing or violenceFrequent physical complaints, such as headaches or stomach achesAggression towards other childrenRisk-taking behaviorsDepression or suicidal thoughts or behaviorOver-responsible “parent-like” behavior within the family and among friends.From the Academy of Child and Adolescent Psychiatry, No. 17, Updated November 2002
15 INDEPENDENT: DIFFERENTIATED, DETACHED I can’t control you. I can only control me. If I am hurt then I have to take care of me. I have to get my center back so I can function again. I heal through connections and balance.
16 You take care of you; I take care of me; We support each other. INTERDEPENDENT:AN OPEN SYSTEMI take responsibility for myself and bring the benefits of my healthy lifestyle back into my relationships. I share myself with other healthy people. I am responsible TO them by being:SensitiveEmpatheticEncouragingConfronting when appropriateOpen to listeningI feel:RelaxedFreeAwareYou take care of you; I take care of me; We support each other.
18 SUPPORT AND EMPOWER Contact Social Services if children are in danger. Be aware of the process of addiction.Avoid judging or shaming. Remember this is a disease.Be empathetic.Encourage the utilization of support systems such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Al-Anon and Nar-Anon.Discuss options. Review the process of addiction and treatment/recovery. Supply resource information, including intervention materials.Offer hope. Change can and does happen.Praise and encourage efforts. Do not expect perfection.
19 EDUCATE Allow for open communication and questions. Suggest educational and supportive reading material.Provide AA, NA, Al-Anon and Nar-Anon pamphlets.Review community and clinical support services, including treatment options, family support, life skills, health care, child care, transportation help, housing and TANF.Kindly discuss the potential negative impact of parental substance abuse on children.Discuss how an assessment can help to clarify the situation and options.
20 Stages of Change Motivational Tasks for Worker PrecontemplationNo perception of having a problemor need to changeIncrease family’s perception of the risks and problemswith the current behavior; raise family’s doubts aboutbehaviorContemplationInitial recognition that behaviormay be a problem and ambivalenceabout changeFoster and evoke reasons to change and the risks of notchanging; tip the balance toward changeDecision to changeMakes a conscious decision tochange. Some motivation identifiedHelp family to identify best actions to take for change;support motivations for changeActionTakes steps to changeHelp family to implement strategy and take stepsMaintenanceActively works on sustainingchange strategies and maintaininglong-term changeHelp family to identify triggers and use strategies toprevent relapseLapse or relapseSlips (lapses) from change strategyor returns to previous problembehaviors patterns (relapse)Help family re-engage in the contemplation, decision,and action stagesSource:
21 Motivational Interviewing Motivational interviewing is a technique in which the worker becomes a helper in the change process and expresses acceptance of the individual he or she is working with. The role of the worker in Motivational Interviewing is directive, with a goal of eliciting self-motivational statements and behavioral change. The five general principles to be practiced by a worker using motivational interviewing include:Express empathy through reflective listening.Develop discrepancy between clients’ goals or values and their current behavior.Avoid argument and direct confrontation.Adjust to client resistance rather than opposing it directly.Support self-efficacy and optimism.Source: U.S. Department of Health and Human Services (1999). Enhancing Motivation for Change in Substance Abuse Treatment. Publication No. SMA Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.
28 SUPPORT AND EMPOWERLet the child know that he or she is not alone and that a parent’s substance abuse is not his or her fault or responsibility to fix. Discuss how the child can get help for him or herself.Consult with the child’s school counselor.Be consistent.Be clear with expectations, boundaries and rules/limits.Follow through with consequences.Allow for open communication and questions.Monitor your own stress level. Children will take cues from you.Be a role model.Focus on the behavior, not the person, when using praise or criticism.Encourage friendships and participation in school activities.Praise and encourage efforts. Do not expect perfection.Utilize support systems such as Alateen, local child therapists and children’s programs.
29 EDUCATEDebunk the addicted rules: Don’t talk, don’t trust, don’t feel, don’t think, don’t question, don’t ask, don’t play, don’t make a mistake.Discuss how substance abuse is an illness that needs treatment.Teach relaxation skills.Provide age-appropriate readings about being a child of a substance abusing parent.Teach words that express feelings.Teach appropriate ways to express anger and other difficult feelings.Talk positively to children and encourage them to talk positively to others.Teach children that mistakes are okay. We can learn from them.Teach decision making skills and that it is okay to say, “No.”Teach children that the use of drugs/alcohol is not the norm.Encourage students to get an assessment so that concerns can be more clearly understood.
30 HEALTHY FAMILIES1. A healthy family communicates honestly, directly and thoughtfully.2. A healthy family supports and affirms one another.3. A healthy family maintains trust through reliability and consistency.4. A healthy family practices respect for each other and for others.5. A healthy family shares a sense of order and responsibilities.6. A healthy family shares leisure time and a positive sense of humor.7. A healthy family teaches traditions, values and right from wrong.8. A healthy family shares attention among members in a balanced way.9. A healthy family respects appropriate boundaries among each other.10. A healthy family values service to others.11. A healthy family is flexible under stress.12. A healthy family resolves disagreements without damaging words.13. A healthy family is a system that is open to other people and new ideas.14. A healthy family admits problems and seeks help from others.15. A healthy family shares a sense of optimism for the future.
31 The 7 Cs of Addiction I didn't Cause it. I can't Cure it. I can't Control it.I can Care for myselfBy Communicating my feelings,Making healthy Choices, andBy Celebrating myself.
32 Reading Recommendations The Disease of Chemical DependencyAlcoholics Anonymous or any publication from AA, NA, Al-Anon or Nar-AnonUnder the Influence - A Guide to the Myths and Realities of Alcoholism by Dr. James Milam and Katherine KetchamChalk Talks on Alcohol by Father Joseph C. MartinPassages Through Recovery by Terence T. GorskiStaying Sober: A Guide for Relapse Prevention by Terence T. Gorski and Merlene MillerThe Recovery Book by Al J. Mooney, M.D., Arlene Eisenberg, and Howard EisenbergAddiction as a Family DiseaseBeautiful Boy by David SheffBeyond Codependency & Getting Better All The Time by Melody BeattieCodependent No More by Melody BeattieIt Will Never Happen To Me by Claudia Black, Ph.D., MSWFamily Recovery - Growing Beyond Addiction by Merlene Miller and Terence T. GorskiThe Joy of Being Sober - A Book for Recovering Alcoholics - and Those Who Love Them by Jack MorneyGrandchildren of Alcoholics - The Next Generation by Ann SmithChoice Making for Codependents, Adult Children and Spirituality Seekers by Sharon Wegscheider-CruseAnother Chance: Hope and Health for the Alcoholic Family by Sharon Wegscheider-CruseI Won’t Wait Up Tonight: What To Do To Take Care of Yourself When You’re Living With an Alcoholic or an Addict by Terence WilliamsThe Family Recovery Guide: A Map for Healthy Growth by Stephanie Brown, Ph.D.Adult Children of Alcoholics by Janet Woititiz, Ed.D.Struggle for Intimacy by Janet Woititiz, Ed.D.Perfect Daughters by Robert J. Ackerman, Ph.D.Silent Sons by Robert J. Ackerman, Ph.D.My Dad Loves Me, My Dad Has A Disease by Claudia Black, Ph.D., MSWStraight Talk from Claudia Black: What Recovering Parents Should Tell Their Kids About Drugs and Alcohol by Claudia Black, Ph.D., MSWThink of Wind by Catherine MercuryMommy’s Gone to Treatment by Denise Crosson, Ph.D.Mommy’s Coming Home from Treatment by Denise Crosson, Ph.D.It’s Not Okay To Be A Cannibal by Andrew T. Wainwright and Robert Poznanovich
33 Reading Recommendations (cont’d) Personal GrowthThe Courage to Change, Daily Meditations, purchased through Al-Anon MeetingsOne Day At A Time in Al-Anon, Daily Meditations, purchased through Al-Anon MeetingsThe Language of Letting Go by Melody BeattieFeeling Good: The New Mood Therapy by David S. Burns, M.S.Eating Right to Live Sober by Katherine Ketcham and L. Ann Mueller, M.D.The Road Less Traveled by M. Scott Peck, M.D.Overcoming Perfectionism by Ann SmithDeveloping a Child’s Spiritual Growth Through Sight, Sound, Taste, Touch & Smell by Judy Gattis SmithLost in the Shuffle by Robert SubbyThe Relaxation and Stress Reduction Workbook by Martha Davis, Ph.D., Elizabeth Robbins Eshelman, MSW, and Matthew McKay, Ph.D.Who Moved My Cheese by Spencer Johnson, M.D.
34 Resources The Administration for Children and Families (ACF), within the Department of Health andHuman Services (HHS) is responsible for federalprograms that promote the economic and socialwell-being of families, children, individuals, andcommunities.ACF’s National Clearinghouse on Child Abuseand Neglect Information connects professionalsand concerned citizens to practical, timely, andessential information on programs, research,legislation and statistics to promote the safety,permanency and well-being of children andfamilies.The National Institute on Alcohol Abuse andAlcoholism (NIAAA) provides leadership in thenational effort to reduce alcohol-related problems.Its research programs include genetics,neuroscience, epidemiology, health risks andbenefits of alcohol use, prevention and treatment.The National Institute on Drug Abuse (NIDA)leads the national scientific effort to address drugabuse and addiction. The website providesinformation for students and young adults, parentsand teachers, and researchers and healthprofessionals.This NIDA website provides a list of commonlyabused drugs, how they are ingested or used, andintoxicating effects of types of drugs.The Substance Abuse and Mental HealthServices Administration (SAMHSA) administersand funds a portfolio of grant programs andcontracts that support States’ efforts to expand andenhance prevention programs and to improve thequality, availability and range of substance abusetreatment and mental health services in localcommunities.SAMHSA’s/ACF’s National Center onSubstance Abuse and Child Welfare (NCSACW)provides assistance to local, State, and tribalagencies to improve systems and practice forfamilies with substance use disorders who areinvolved in the child welfare and family judicialsystems.(714)SAMHSA’s National Clearinghouse for Alcoholand Drug Information (NCADI) is the Nation'sone-stop resource for information about substanceabuse prevention and addiction treatment. NCADIdistributes a wide range of free or low-costmaterials, including fact sheets, brochures,pamphlets, monographs, posters, and video tapes.Information specialists are available to answerquestions about alcohol and drug abuse 24 hours aday, 7 days a week.(800)
35 SAMHSA’s treatment program locator website includes more than 11,000 addiction treatmentprograms, including residential treatment centers,outpatient treatment programs, and hospitalinpatient programs for drug addiction andalcoholism. Listings include treatment programs formarijuana, cocaine, and heroin addiction, as well asdrug and alcohol treatment programs foradolescents, and adults.Alcoholic AnonymousAlcoholics Anonymous (AA) is a fellowship ofmen and women who share their experience,strength and hope to help each other to recoverfrom alcoholism. The only requirement formembership is a desire to stop drinking. There areno dues or fees, AA is self-supporting throughmember contributions. AA’s primary purpose is tostay sober and help other alcoholics to achievesobriety.(212)Al-Anon and AlateenAl-Anon and Alateen are organizations to helpfamilies and friends of alcoholics recover from theeffects of living with the problem drinking of arelative or friend. Whether the alcoholic is stilldrinking or not, Al-Anon offers hope and recoveryto all people affected by the alcoholism of a lovedone. Alateen is the recovery program for youngpeople. Alateen groups are sponsored by Al-Anonmembers.(888) 4AL-ANONAdult Children of AlcoholicsAdult Children of Alcoholics is a twelve step,twelve tradition program of women and men whogrew up in alcoholic or otherwise dysfunctionalhomes. Members meet with each other in amutually respectful, safe environment andacknowledge common experiences.(310)Cocaine AnonymousCocaine Anonymous (CA) is open to all personswho state a desire to stop using cocaine, including"crack" cocaine, as well as all other mind-alteringsubstances. There are no dues or fees formembership. Expenses are supported by voluntarycontributions of members. CA uses the 12-steprecovery method, which involves service to othersas a path towards recovery from addiction. CAbelieves that one addict talking to another canprovide a level of mutual understanding andfellowship that is hard to obtain through othermethods.(310)Co-Dependents AnonymousCo-Dependents Anonymous, a program of recoveryfrom codependence, is a fellowship of men andwomen whose common purpose is to develophealthy relationships. The only requirement formembership is a desire for healthy and fulfillingrelationships. The twelve steps and twelvetraditions are used for knowledge and wisdom.(602)
36 Families AnonymousThe Families Anonymous (FA) purpose is toprovide mutual support, and to offer a safe place toshare experiences and concerns for relatives andfriends of those who have alcohol, drug orbehavioral problems. FA is a 12-step fellowship ofsupport groups.(800)Narcotics AnonymousNarcotics Anonymous (NA) is an international,community-based association of recovering drugaddicts with more than 31,000 weekly meetings inover 100 countries worldwide. Meeting sites areonline, as well as, recovery literature in English andSpanish.(818)National Association for Childrenof AlcoholicsThe National Association for Children ofAlcoholics (NACOA) is a national nonprofitmembership organization whose mission is toadvocate for all children and families affected byalcoholism and other drug dependencies.NACOA’s website provides access to research,books, videos and other resources to help families,raise public awareness and advance professionalknowledge.(888)554-COAS