ADDICTIONIS A FAMILY ILLNESS

Kristine Hitchens, LCSW-C, LCADC, CCDCDirector of Family Services, Father Martin’s Ashley

Havre de Grace, MDkhitchens@fmashley.comFatherMartinsAshley.org

The Process of Addiction

This is a FAMILY diseaseWhen addiction enters a family, everyone is prone to: Preoccupation Arguments

Guilt Stress Defensiveness Mood Swings Problems in Living Depression Rage Numbness

CODEPENDENT: A CLOSED SYSTEMI 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:

FixRescueProtectControl

I feel:TiredAnxiousFearfulGuiltyAngryRejectedSelf pity

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.”

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

CODEPENDENT: A CLOSED SYSTEMI 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:

FixRescueProtectControl

I feel:TiredAnxiousFearfulGuiltyAngryRejectedSelf pity

• 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).

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.

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

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

How to Help

Goal:Break the Cycle

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.

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.

How to Help:The Family

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.

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.

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: www.ncsacw.samhsa.gov

Motivational InterviewingMotivational 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:

1. Express empathy through reflective listening.2. Develop discrepancy between clients’ goals or values and

their current behavior.3. Avoid argument and direct confrontation.4. Adjust to client resistance rather than opposing it directly.5. 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.

How to Help:The Children

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.

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.

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.

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.

Reading RecommendationsThe 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

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.

ResourcesThe 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. http://www.acf.hhs.gov/index.html

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. http://nccanch.acf.hhs.gov

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.http://www.niaaa.nih.gov

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. http://www.nida.nih.govThis NIDA website provides a list of commonlyabused drugs, how they are ingested or used, andintoxicating effects of types of drugs.http://www.drugabuse.gov/DrugsofAbuse.html

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. http://www.samhsa.gov/index.aspx

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. http://www.ncsacw.samhsa.gov(714) 505-3525.

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. http://www.ncadi.samhsa.gov(800) 729-6686

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.

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. AA’s primary purpose is to

stay sober and help other alcoholics to achieve

sobriety. http://www.alcoholics-anonymous.org

(212) 870-3400

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

(310) 534-1815

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

(310) 559-5833

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

(602) 277-7991

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

(800) 736-9805

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

(818) 773-9999

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. http://www.nacoa.org

(888)554-COAS

Thank you!

Questions????