ADDICTION IS A FAMILY ILLNESS

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ADDICTIONIS A FAMILY ILLNESS

• Kristine Hitchens, LCSW-C, LCADC, CCDC
• Director of Family Services, Father Martins
  Ashley
• Havre de Grace, MD
• khitchens_at_fmashley.com
• FatherMartinsAshley.org

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The Process of Addiction
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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

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• CODEPENDENT A CLOSED SYSTEM
• I want to fix you because it hurts me to see you
  this way or live like this I dont want to hurt
  so I have to make you better.
• I want to feel good, happy I cant 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 wouldnt
  have to feel this way.
• I feel empty because nothing is getting through
  to you and I dont 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

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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
  someones problematic behavior.

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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

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• CODEPENDENT A CLOSED SYSTEM
• I want to fix you because it hurts me to see you
  this way or live like this I dont want to hurt
  so I have to make you better.
• I want to feel good, happy I cant 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 wouldnt
  have to feel this way.
• I feel empty because nothing is getting through
  to you and I dont 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

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• 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).

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• There are an estimated 28.6 million COAs 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 mothers or fathers
  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.

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• Most children of alcoholics have experienced some
  form of neglect or abuse. A child in such a
  family may have a variety of problems (contd)
• 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 childs 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

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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

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How to Help
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GoalBreak the Cycle
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• INDEPENDENT DIFFERENTIATED, DETACHED
• I cant 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.

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• 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.

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How to HelpThe Family
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• 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.

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• 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.

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Stages of Change
Motivational Tasks for Worker
Precontemplation No perception of having a problem or need to change Increase familys perception of the risks and problems with the current behavior raise familys 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 www.ncsacw.samhsa.gov
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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
  02-3629. Rockville, MD Center for Substance
  Abuse Treatment, Substance Abuse and Mental
  Health Services Administration.

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How to HelpThe Children
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• SUPPORT AND EMPOWER
• Let the child know that he or she is not alone
  and that a parents 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 childs 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 childrens programs.

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• EDUCATE
• Debunk the addicted rules Dont talk, dont
  trust, dont feel, dont think, dont question,
  dont ask, dont play, dont 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.

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• 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.

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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.

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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

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• Reading Recommendations (contd)
• 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 Childs 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.

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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. http//www.acf.hhs.gov/index.html ACFs 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. http//nccanch.acf.hhs.gov 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. http//www.niaaa.nih.gov 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. http//www.nida.nih.gov This NIDA website provides a list of commonly abused drugs, how they are ingested or used, and intoxicating effects of types of drugs. http//www.drugabuse.gov/DrugsofAbuse.html 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. http//www.samhsa.gov/index.aspx SAMHSAs/ACFs 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. http//www.ncsacw.samhsa.gov [phone]. SAMHSAs 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. http//www.ncadi.samhsa.gov [phone]
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SAMHSAs 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. http//www.findtreatment.samhsa.gov 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. AAs primary purpose is to stay sober and help other alcoholics to achieve sobriety. http//www.alcoholics-anonymous.org [phone] 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. http//www.al-anon.alateen.org (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. http//www.adultchildren.org [phone] 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. http//www.ca.org [phone] 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. http//www.codependents.org [phone]
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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. http//www.familiesanonymous.org [phone] 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. http//www.na.org [phone] 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. NACOAs website provides access to research, books, videos and other resources to help families, raise public awareness and advance professional knowledge. http//www.nacoa.org (888)554-COAS
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• Thank you!
• Questions????