Family Membersas Addiction Service Clients

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Rationale, Client Profile & Outcomes

Paul Welsh, MSW, Executive Director, RideauwoodGiselle Neville, BSW, Family Program Manager, Rideauwood

1st Annual Addictions and Mental Health ConferenceMay 27, 2013

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Overview• Rationale for providing services to

family members.• Client profile.• Rideauwood’s Family Program is part

of a Whole Family Model:• A three phase program;• Examples of some of the tools used;

• Outcomes.

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Client Profiles: N=124• 87% female and 13% male• At Intake:

40% married 19% single 15% divorced 13% separated 7% common-law relationship 6% widowed

• 15% had past history of substance abuse themselves

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Client Profiles Continued• 14% had attempted suicide• 43% had previous/current suicidal thinking• 37% had been fearful of the addicted person• Client reports on emotional health:

42%” fair” 30% “poor” 21% “good” 31% reported feeling depressed 17% reported being anxious

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Rationale• Family members suffer from addiction in the family.• They are the majority who suffer from addiction.• Addiction treatment services have mandates to “reduce

suffering from addiction”.• Addiction problems in families have unique and specific

characteristics.• Addressing addiction problems in families requires

addiction specific knowledge and methods.• Addiction troubles move from generation to generation.• Breaking the cycle is a mandate of addiction services.

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Observations, Assumptions• Children from families with addiction have higher

prevalence of addiction, mental health, education and relationship challenges.

• “Recovery” of any caregiver reduces those lifelong challenges to children.

• Partners, spouses, children, parents and other family are Primary Clients (served to address their own distress and not “fix” the addicted person).

• Addicted persons have higher recovery rates when the family environment is healthy.

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Rationale – Why Provide Services to Family Members?

Addiction wreaks havoc on families

Psycho-education, therapy and support help family members cope and influence addicts’ recovery

Rideauwood’s Family Program has been proven to foster healthier individuals and families as part of a Whole Family Model

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Rideauwood’s Family Program Model

The Family Program

Examples of Other Rideauwood and Community Services and Programs

GamblingPrograms

Family & Couples

CounsellingFamily

Intervention

Children’s Aid & Social Services

Family Community Outreach & Education

Self-help Groups

Supports for Children &

Youth

WholeFamilyModel

Coordination &

Collaboration

Drug Treatment

Court

Coordination &

Collaboration

Residential & Non-residential Adult Addiction Programs

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The Family Program

Family Program

Ontario Works ASI

Parent Program

Drug Treatment

CourtYoung Adult Concurrent

Youth Justice

Addiction

School-Based

Addiction

Youth Addiction

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Client Profile

Partners and former partners

Parents Adult children from

families with addiction Adult siblings Extended family members People in recovery

Have been, or are being affected by addiction

Have significant stress and coping issues

Are sufficiently stable

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Family Member Programs Structure

• Family Spiral (2 Structured Evenings – 25 Clients);• Phase 1 (6-8 weekly groups, assessment);• Phase 2 (5 day program – 9:00-4:00 Monday to Friday);• Phase 3 (8 month weekly groups and Individual

Counselling);• Family of Origin Program (advanced group program – 10

months).

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On Concurrent Disorders• Trauma informed practice is paramount.• Eating disorders, mood disorders, personality disorders,

suicide risks, meds and drug misuse issues are common;• Frequent childhood abuse ranging from physical and

sexual to emotional;• Frequent adult experiences and current abuse or;• Client safety must be spelled out first, agreed to by all:

Expectation of emotional safety by being silent; Expectation to be heard and validated when we speak; Expectation to speak to counsellor individually as opposed to in a group; Safe from criticism from emotions; Safe to be scared and vulnerable; Safe from gender politics, sexual advances, sexism and racism; Safe from financial dealings or requests from clients.

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Rideauwood’s Family Program Model

Phase II

Phase III

Five-day Intensive Program

Eight-month

Structured Program

Individual Counsellin

g

Intake

“Family Spiral”

InitialSuppor

tGroup

Assessment

Phase I

+Family of

Origin Program &

Ongoing Personal Growth

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Phase I: Participation in the Initial Support Group

• Provides clients a safe space to allow them to explore their issues and feelings.

• Prepares for participation in the Family Program.

• Continuation of psycho-education, introduction to basic concepts, stress release techniques.

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Phase I: The assessment − determining client needs

• Personal background.• Specific issues and problems.• If the client is a good match, they proceed to

the Five-day Intensive Program.• If the program isn’t right for them, then

prerequisite work, or alternatives are sought.

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Phase II − 5-day Intensive Program

• Whole Family Program Team is involved.• Intensive day-long psycho-education, group work

and group therapy.• Experiential exercises.• Emotional outpouring.

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Phase III - 8-Month Structured Program

• 32 two-hour group sessions.• Ongoing psycho-education, group work and

group therapy.• Experiential exercises.• Individual counseling as required.

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Areas of focus include

• Boundaries• Communication• Relationships• Grief and loss• Self-care

• Feelings• Emotional Enmeshment

“Co-dependence”?• Detachment

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Fostering AwarenessUsing a rating scale, ranging from seldom to usually, clients respond to a series of statements regarding their emotional entanglement, for example:

1. I struggle to identify and express my feelings2. I put others’ needs before mine3. I am afraid of how others might respond if I shared

honestly with them4. I am very loyal even if others are not loyal to me5. I find it difficult to ask for help from others6. . . .

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Letting my feelings have a voice• My guilt would say . . .• My anger would say . . .• My shame would say . . .• My fear would say . . .• My sadness would say . .• My loneliness would say• My joy would say . . .• . .

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What happens if we don’t deal with

our feelings?

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Unchecked Negative Emotions are Destructive:

Skin problemsHair lossMemory lossSleep problemsSevere headachesDepressionAddictions . . .

Eating disordersDecreased sex driveEyelid spasmsStomach troublesTinnitusHeart palpitations

and chest pains

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Outcomes

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Outcomes• Greater awareness about feelings.• Better communications.• Development of persistent support networks.• Improved self-esteem.• Improved health.• Better parenting.• More constructive relationships with the addict

– whether recovering or not.• Often leads to fundamental life change.

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