coming home: the place of family in treatment · parent with addictions: bio -...
TRANSCRIPT
Coming Home: The Place of Family in Treatment
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TWO TAIL
PHENOMENONADDICTION - MENTAL HEALTH
MENTAL HEALTH - ADDICTION
PARENTING ISSUE - CHILD ISSUE
CHILD ISSUE - PARENTING ISSUE
YOUNG CHILDREN – ADULT CHILDREN
Addiction & Mental Health
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Biological
SocialPsychological
ADDICTION & Mental Health
BiosocialBiopsycho
Psychosocial
Ecological Systems Theory
Policies, institutional practices, program development, access to resources
Cultural, societal attitudes, communities, neighbourhoods, workplaceavailability of resources
Family, partners, parents, children extended family, kinship networks, peers
Parent with addictions: bio-psycho-social-spiritual-intellectual (vocational) factors
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No person (or family) is an island
The individual and family are nested within surrounding ecologies
These are inter-dependent ecological systems
What Psychoactive Drugs Do
What is NOT an addiction
Eating Disorders
Compulsive Behaviours: Shopping, Internet Use, Sex
Problem Gambling
Why are these not an addiction?
No Psychoactive Change to Brain
Different Treatment Approach
Different Treatment System
Different Policies
STOP││
CONTACT ─────┼────────────┐INTEGRATED (casual/occasional)─────┬──────────┐WITH DRUG │ │ USE │ │
│ │ │ ││ │ ┌─STOP │ ││ │ │ │ │
EXPERIMENTATION └──────EXCESSIVE───┼─RETURN─────────┘ │(curiosity/peer USE │ │
pressure) ├─STABLE ││ STATE ││ ┌─STOP ││ │ │└──────ADDICTION│ │
├─STABLE ││ STATE ││ │├─PROGRESS ││ │└─RETURN────┘
Treatment Philosophy
Client Responsibility For Solution
high low
Client
Responsibility high MORAL ENLIGHTENMENT
For Problem
low COMPENSATORY MEDICAL
Foundation Principles for Families
All families have problems; addiction & mental health prevents simple resolution and instead creates new and more complex issues
No individual can force another to change
Personal change can occur only when responsibility can be acknowledged
All members of the family are involved
Removal of drug use is essential but incomplete; mental health a constant?
Healthy Families
A PARENT IS ONLY AS HAPPY AS HER OR HIS SADDEST CHILD
.Characteristics of Healthy Families Addiction and Mental Health Issues Produce:
SAFETY - emotionally unavailable parents- failure to protect children from hazards- neglect and abuse
OPEN COMMUNICATION - secrets kept to keep the peace- façade of normality maintained- feelings hidden- children made into confidants
SELF-CARE - scarcity economy- drug using parent’s needs come first- children feel responsible for adults
INDIVIDUALIZED ROLES - family’s needs dictate roles
- roles become rigid, especially during times of stress
.Characteristics of Healthy Families Addiction and Mental Health Issues Produce
CONTINUITY - chaos- arbitrariness- dissolution of the family
RESPECT FOR PRIVACY - parents become intrusive- secrets confused with privacy- no respect for the individual
BROAD FAMILY FOCUS - family focus determined by needs of drug using adult
- drug using parent’s needs come first
QUALITY OF FAMILY LIFE - restricted range of emotions
- lack of emotional resolution of issues
Impact on ParentingIn-utero exposure of psychoactive drugs leads to physical effects, withdrawal syndrome, cognitive issues –deprivation (maternal substance abuse impact on early child development most researched area)
Adverse health and child developmental outcomes well documented with drug addicted mothers
Heightened risk of child maltreatment and neglect
Attachment disruption – not attuned to children’s emotional and/or physical needs; misreading or missing emotional cues of the child; inability to respond to child’s cues and expressed needs; general emotional unavailability
Inter-parental conflict
Child exposure to domestic violence is heightened with addiction and mental health issues
Two vs one parents addicted/mental health issues enhanced; child welfare involvement more likely; IPV exposure more likely
Parental Addiction & Mental Health Through a Family Systems Lens
Hierarchies
Boundaries
Roles
Skewed hierarchy as parents do not function in executive system –often isolated; emotionally unavailable; parental absence; heightened conflict between co-parents
Boundaries can be enmeshed or disengaged. Over involvement; lack of adult supervision .
Role reversal can occur at heightened levels; greater care-giving responsibilities (sibs and parents)
THE MYTHS OF FAMILIES AND MENTAL HEALTH
MYTHS:
Fanciful stories relating
to non-existent events,
often relating to ordained
events
Mental Health Consumer Survivors are Always Abandoned By Their Families
I have moved my son22 times in his lifetime
We always have to be ready for him to lose his housing
Living with uncertainty
Witnessing Inadequacies
If you have schizophrenia and you’re hearing voices and you’re paranoid and there are people sleeping in the same room with you…it’s just terrifying for my son. Because of this, he prefers to sleep on the street rather than go to a shelter
Witnessing Inadequacies
Our daughter was certified and kept at <hospital name> and our involvement was somewhat limited – well, there was no involvement. Nobody talked with us. Whenever we called to ask how she is, we didn’t really get any answers. It just seems like an endless cycle trying to get anything for her.
Witnessing Inadequacies
Families are a great resource, but they need help too. They need help to understand these illnesses. Families need resources to help them cope.
Creating a Better World
It’s up to families to advocate. We certainly are not very organized and the politicians aren’t going to do anything without a good shove because we have limited resources – they have to be allocated but they are certainly not coming our way…families should be working together because we have families associated with schizophrenia societies and CMHAs but all these people are not connected
Peer Support
Historically Individually Focused With No Opportunity for the Entire Family to Come Together
Addiction Community: Mental Health Community:Al-AnonAl-Ateen
Types of Family Based ApproachesFamily Orientation: this orientation involves informing family members about the rehabilitation program upon which the identified client is embarking. It is used to enlist family support in the client’s treatment.
Family Education: this approach is used to inform family members about family-relation issues and how they may be relevant to substance abuse and the substance abuser.
Family Counselling: this is employed to bring about the resolution of problems identified by family members as related to the substance abuse.
Family Therapy: this method is employed to bring about significant and permanent changes to intractable areas of systemic family dysfunction related to the substance abuse
(Alaggia & Csiernik, 2010)
Family Based Treatment OptionsStand-alone/parallel Individual and
family support
•12 step recovery program (AA, NA, CA, Al-Anon, Al-Ateen)
•Abstinence focused; disease view•Group modality•Family not Integrated•Family programs attached to
rehabilitation programs• Johnson Institute/Intervention
(staging intervention) to engage resistant client (last resort, poor outcomes)
Parenting programs; evidence informed
•Psycho-educational •Attachment-based (evidence-
informed) (Niccols et al., 2012)•Group modality•Most likely child welfare
referred/children’s mental health•Often done with addiction
residential treatment support; out-patient clinic; 12 step program (matching essential)
Integrated individual with family; evidence–informed
•Couple therapy (Fletcher, 2013; O’Farrell & Clements, 2012)
•Community reinforcement approach and family training (CRAFT)
• Comparisons of Johnson method, 12 step recovery and CRAFT
•Adolescent substance abuse family models –multi-dimensional family therapy (MDFT) (Liddle et al., 2001; Liddle, 2004) multi-systemic and behavioural
Aftercare: An Important Consideration
After in-patient treatment planned re-entry back into the family system whether it is nuclear or bi-nuclear is an important stepSolid Recovery Plan; - i.e., support groups, Al-Anon, Smart Recovery, Recovery Counselling Services,
CAMH, etc.Aftercare Family Support; –i.e., support groups, Al-Anon, Al-Ateen, children’s group at RTCParenting Groups Family Sessions to help re-structure the family –develop a new family culture
RESOURCES [email protected]