1. ADDICTION IS A FAMILY ILLNESS
Kristine Hitchens, LCSW-C, LCADC, CCDC
Director of Family Services, Father Martin’s Ashley
Havre de Grace, MD
FatherMartinsAshley.org

2. The Process of Addiction

4. This is a FAMILY disease
When addiction enters a family, everyone is prone to:
Preoccupation
Arguments
Guilt
Stress
Defensiveness
Mood Swings
Problems in Living
Depression
Rage
Numbness

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:
Fix
Rescue
Protect
Control
I feel:
Tired
Anxious
Fearful
Guilty
Angry
Rejected
Self 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 defenses
Denying there is a problem
Minimizing the problem
Avoiding discussions about the problem
Blaming others or lashing out with anger
Joining in the rationalizations/justifications that their children create
Taking over their responsibilities
Continuing to provide financial support
Helping to resolve legal problems
Promising rewards for abstinence
Suggesting a physical fitness program or a job change
Threatening to kick them out
Provoking arguments/nagging
Avoiding 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:
Fix
Rescue
Protect
Control
I feel:
Tired
Anxious
Fearful
Guilty
Angry
Rejected
Self 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 alcohol
Failure in school; truancy
Lack of friends; withdrawal from classmates
Delinquent behavior, such as stealing or violence
Frequent physical complaints, such as headaches or stomach aches
Aggression towards other children
Risk-taking behaviors
Depression or suicidal thoughts or behavior
Over-responsible “parent-like” behavior within the family and among friends.
From the Academy of Child and Adolescent Psychiatry, No. 17, Updated November 2002

13. How to Help

14. Goal: Break the Cycle

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 SYSTEM
I 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:
Sensitive
Empathetic
Encouraging
Confronting when appropriate
Open to listening
I feel:
Relaxed
Free
Aware
You take care of you; I take care of me; We support each other.

17. How to Help: The Family

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
Precontemplation
No perception of having a problem
or need to change
Increase family’s perception of the risks and problems
with the current behavior; raise family’s doubts about
behavior
Contemplation
Initial recognition that behavior
may be a problem and ambivalence
about change
Foster and evoke reasons to change and the risks of not
changing; tip the balance toward change
Decision to change
Makes a conscious decision to
change. Some motivation identified
Help family to identify best actions to take for change;
support motivations for change
Action
Takes steps to change
Help family to implement strategy and take steps
Maintenance
Actively works on sustaining
change strategies and maintaining
long-term change
Help family to identify triggers and use strategies to
prevent relapse
Lapse or relapse
Slips (lapses) from change strategy
or returns to previous problem
behaviors patterns (relapse)
Help family re-engage in the contemplation, decision,
and action stages
Source:

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.

22. How to Help: The Children

28. SUPPORT AND EMPOWER
Let 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. EDUCATE
Debunk 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 FAMILIES
1. 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 myself
By Communicating my feelings,
Making healthy Choices, and
By Celebrating myself.

32. Reading Recommendations
The Disease of Chemical Dependency
Alcoholics Anonymous or any publication from AA, NA, Al-Anon or Nar-Anon
Under the Influence - A Guide to the Myths and Realities of Alcoholism by Dr. James Milam and Katherine Ketcham
Chalk Talks on Alcohol by Father Joseph C. Martin
Passages Through Recovery by Terence T. Gorski
Staying Sober: A Guide for Relapse Prevention by Terence T. Gorski and Merlene Miller
The Recovery Book by Al J. Mooney, M.D., Arlene Eisenberg, and Howard Eisenberg
Addiction as a Family Disease
Beautiful Boy by David Sheff
Beyond Codependency & Getting Better All The Time by Melody Beattie
Codependent No More by Melody Beattie
It Will Never Happen To Me by Claudia Black, Ph.D., MSW
Family Recovery - Growing Beyond Addiction by Merlene Miller and Terence T. Gorski
The Joy of Being Sober - A Book for Recovering Alcoholics - and Those Who Love Them by Jack Morney
Grandchildren of Alcoholics - The Next Generation by Ann Smith
Choice Making for Codependents, Adult Children and Spirituality Seekers by Sharon Wegscheider-Cruse
Another Chance: Hope and Health for the Alcoholic Family by Sharon Wegscheider-Cruse
I 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 Williams
The 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., MSW
Straight Talk from Claudia Black: What Recovering Parents Should Tell Their Kids About Drugs and Alcohol by Claudia Black, Ph.D., MSW
Think of Wind by Catherine Mercury
Mommy’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 Growth
The Courage to Change, Daily Meditations, purchased through Al-Anon Meetings
One Day At A Time in Al-Anon, Daily Meditations, purchased through Al-Anon Meetings
The Language of Letting Go by Melody Beattie
Feeling 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 Smith
Developing a Child’s Spiritual Growth Through Sight, Sound, Taste, Touch & Smell by Judy Gattis Smith
Lost in the Shuffle by Robert Subby
The 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 and
Human Services (HHS) is responsible for federal
programs that promote the economic and social
well-being of families, children, individuals, and
communities.
ACF’s National Clearinghouse on Child Abuse
and Neglect Information connects professionals
and concerned citizens to practical, timely, and
essential information on programs, research,
legislation and statistics to promote the safety,
permanency and well-being of children and
families.
The National Institute on Alcohol Abuse and
Alcoholism (NIAAA) provides leadership in the
national effort to reduce alcohol-related problems.
Its research programs include genetics,
neuroscience, epidemiology, health risks and
benefits of alcohol use, prevention and treatment.
The National Institute on Drug Abuse (NIDA)
leads the national scientific effort to address drug
abuse and addiction. The website provides
information for students and young adults, parents
and teachers, and researchers and health
professionals.
This NIDA website provides a list of commonly
abused drugs, how they are ingested or used, and
intoxicating effects of types of drugs.
The Substance Abuse and Mental Health
Services Administration (SAMHSA) administers
and funds a portfolio of grant programs and
contracts that support States’ efforts to expand and
enhance prevention programs and to improve the
quality, availability and range of substance abuse
treatment and mental health services in local
communities.
SAMHSA’s/ACF’s National Center on
Substance Abuse and Child Welfare (NCSACW)
provides assistance to local, State, and tribal
agencies to improve systems and practice for
families with substance use disorders who are
involved in the child welfare and family judicial
systems.
(714)
SAMHSA’s National Clearinghouse for Alcohol
and Drug Information (NCADI) is the Nation's
one-stop resource for information about substance
abuse prevention and addiction treatment. NCADI
distributes a wide range of free or low-cost
materials, including fact sheets, brochures,
pamphlets, monographs, posters, and video tapes.
Information specialists are available to answer
questions about alcohol and drug abuse 24 hours a
day, 7 days a week.
(800)

35. SAMHSA’s treatment program locator website
includes more than 11,000 addiction treatment
programs, including residential treatment centers,
outpatient treatment programs, and hospital
inpatient programs for drug addiction and
alcoholism. Listings include treatment programs for
marijuana, cocaine, and heroin addiction, as well as
drug and alcohol treatment programs for
adolescents, and adults.
Alcoholic Anonymous
Alcoholics Anonymous (AA) is a fellowship of
men and women who share their experience,
strength and hope to help each other to recover
from alcoholism. The only requirement for
membership is a desire to stop drinking. There are
no dues or fees, AA is self-supporting through
member contributions. AA’s primary purpose is to
stay sober and help other alcoholics to achieve
sobriety.
(212)
Al-Anon and Alateen
Al-Anon and Alateen are organizations to help
families and friends of alcoholics recover from the
effects of living with the problem drinking of a
relative or friend. Whether the alcoholic is still
drinking or not, Al-Anon offers hope and recovery
to all people affected by the alcoholism of a loved
one. Alateen is the recovery program for young
people. Alateen groups are sponsored by Al-Anon
members.
(888) 4AL-ANON
Adult Children of Alcoholics
Adult Children of Alcoholics is a twelve step,
twelve tradition program of women and men who
grew up in alcoholic or otherwise dysfunctional
homes. Members meet with each other in a
mutually respectful, safe environment and
acknowledge common experiences.
(310)
Cocaine Anonymous
Cocaine Anonymous (CA) is open to all persons
who state a desire to stop using cocaine, including
"crack" cocaine, as well as all other mind-altering
substances. There are no dues or fees for
membership. Expenses are supported by voluntary
contributions of members. CA uses the 12-step
recovery method, which involves service to others
as a path towards recovery from addiction. CA
believes that one addict talking to another can
provide a level of mutual understanding and
fellowship that is hard to obtain through other
methods.
(310)
Co-Dependents Anonymous
Co-Dependents Anonymous, a program of recovery
from codependence, is a fellowship of men and
women whose common purpose is to develop
healthy relationships. The only requirement for
membership is a desire for healthy and fulfilling
relationships. The twelve steps and twelve
traditions are used for knowledge and wisdom.
(602)

36. Families Anonymous
The Families Anonymous (FA) purpose is to
provide mutual support, and to offer a safe place to
share experiences and concerns for relatives and
friends of those who have alcohol, drug or
behavioral problems. FA is a 12-step fellowship of
support groups.
(800)
Narcotics Anonymous
Narcotics Anonymous (NA) is an international,
community-based association of recovering drug
addicts with more than 31,000 weekly meetings in
over 100 countries worldwide. Meeting sites are
online, as well as, recovery literature in English and
Spanish.
(818)
National Association for Children
of Alcoholics
The National Association for Children of
Alcoholics (NACOA) is a national nonprofit
membership organization whose mission is to
advocate for all children and families affected by
alcoholism and other drug dependencies.
NACOA’s website provides access to research,
books, videos and other resources to help families,
raise public awareness and advance professional
knowledge.
(888)554-COAS

37. Thank you!
Questions????