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Presentation on theme: "ADDICTION IS A FAMILY ILLNESS"— Presentation transcript:

Kristine Hitchens, LCSW-C, LCADC, CCDC Director of Family Services, Father Martin’s Ashley Havre de Grace, MD

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

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

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 ( 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%) ( Children living with an addicted parent are at greater risk for abuse, neglect and trauma ( 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 ( 72% of child welfare professionals cite substance abuse as the top cause for the dramatic rise in child maltreatment since 1986 ( 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 (

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 ( Children of addicts are up to four times more likely than other children to develop substance abuse and mental health problems ( 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

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????


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