Answers for Families
Answers for Families
Last Updated (Saturday, 29 March 2008 20:04) Sunday, 24 February 2008 09:07
Substance Abuse as a Family Illness:
- Partners or spouses of substance abusing individuals are likely to develop a hostile or codependent relationship with their substance abusing mate.
- It is highly likely that a parent with a substance abuse problem will negatively impact the wellbeing of their children - not because they intend to but because the substance gradually becomes the center of the substance abuser's life. In extreme circumstances, children in these situations try to stabilize the family by parenting their parents.
- Substance abusing elderly people are likely to have concurrent physical problems. They are much more prone to accidents and may become dependent upon the care of their grown children. This often produces stresses between the substance abusing elder and their grown children.
- Substance abusing adolescents are much more likely to have legal problems and to fail in school. They are likely to have conflict with their parents and to make poor adaptations to adult life.
- Adults with a serious substance abuse problem may have trouble sustaining jobs and the resultant financial problems may result in them having to move back with their parents. This often results in depression and severe injury to the self-esteem of the substance abusing person and is likely to bring financial hardship for the parents.
Probably the most serious concern for our culture is the emergence of substance abuse in adolescents. We know from multiple studies on the subject that adolescents who begin abusing drugs or alcohol by the age of 15 are four times as likely to develop a substance dependence in adulthood.
http://oas.samhsa.gov/2k6/AgeDrugTX/AgeDrugTX.cfm
What are Signs that My Adolescent may be using Alcohol or Drugs?
- Negative changes in school performance or sloughing classes
- Increased secrecy about possessions and activities
- Use of incense or room deodorizer to mask room smells
- Use of coded language when speaking with friends
- New friends
- A change in clothing choice that have drug or alcohol references on them
- Borrowing of money without a defined purpose
- Drug paraphernalia, pipes or rolling paper, inhalants and paper bags
- Bottles of eye drop medications to mask red eyes
- Excessive use of mouthwash or other means to mask alcohol use
- Missing prescription drugs, especially narcotics and mood stabilizers
http://www.theantidrug.com/pdfs/ei/parents_brochure.pdf
http://oas.samhsa.gov/2k2/academics/academics.cfm
What do I do if I Suspect my Adolescent is using Drugs or Alcohol?
Talking with your teen about substance abuse is a difficult task for most parents. It's an emotional and frightening subject. Parents often feel that if their teen has a substance problem that it is their fault. Parents may feel that their authority is compromised because they are presently or have in the past struggled with a substance-use problem. Even though this may be the case, parents are still in a better position to understand the causes and consequences of substance misuse than is a teen. Parents have a right and obligation to intervene if their child is using drugs or alcohol. You don't have to be perfect to be right.
Prior to sitting down with your teen, make a plan for talking about the main issues and don't lose sight of these issues throughout the discussion. Try to choose a time when the tensions in the house are at a low ebb and when you and your teen have enough time to talk. Then, when you do sit down with your teen, tell them about your concern for their wellbeing. Be genuine and avoid scare tactics.
When you feel that you have laid out the reason for your concern, get your child's point of view. You don't have to agree with them, but listen carefully and try to see the world from their perspective. Try to form a partnership with them for solving the problem. If you are successful, you have taken an important first step toward resolution. Set firm but reasonable rules for your teen that clearly define your expectations and that allow your teen to regain trust and appropriate independence.
If the attempt at forming an alliance fails the first time, try again on another occasion. If, after repeated attempts, you feel that you are not able to succeed with this effort, it is time to seek professional help. The following is a list of resources that you might engage in this effort:
- A pediatrician
- Substance abuse counselors, social workers, psychiatrists or psychologists
- Your county or state substance abuse or mental health departments (usually found in the blue pages of your phone book)
- A school counselor
- Church leaders
Remember that, although parents don't have absolute control over the choices that teens make, parents are never-the-less important resources for providing structure, love and good information for children.
http://theantidrug.com/ei/conversations_teen.asp
When it comes to our loved ones, whether it’s treatment for cancer or treatment for addiction, we only want the best. Most communities in Utah have several agencies that offer substance abuse treatment services. Furthermore, if you ask each agency if they provide the best treatment services, it would be remarkable if the answer was anything but yes. So how does one go about finding a good substance abuse treatment agency? Below is list of questions to help guide you.
- Are you licensed by the State to provide substance abuse treatment and do you accept my insurance?
- Agencies must be licensed and financial considerations are a reality. Many agencies have sliding scales. Agencies that are the most expensive do not necessarily offer the best services.
- What philosophy of treatment do you use?
- There is no superior philosophy. A philosophy of treatment that includes caring about individuals who have addictions and working with them during fluctuating motivation is critical. If clients feel comfortable in treatment, they stay in treatment. If they stay in treatment, they improve.
- How long is treatment?
- Research shows that treatment needs to be at least three months in length. When there are complicating factors such as another mental health disorders (e.g., depression, anxiety, etc.) or the lack of other external resources (i.e., unemployed, homeless, etc.), treatment will need to be longer.
- Will my loved one have access to both group and individual therapy?
- Agencies should offer a variety of treatment, including psychoeducational classes, group therapy, and individual therapy. If clients only receive group therapy it is difficult for the staff to truly evaluate their clients’ progress in treatment, and almost impossible to address the personal issues that lead to urges, cravings or relapses.
- Do you have someone who can provide medication management if necessary?
- Simultaneously addressing health, mental health and addiction is the best practice. Sometimes there is a need for medication in addition to therapy. Agencies that employ or have access to prescribers can provide more comprehensive treatment.
- How do you deal with relapses or continued use?
- Residential treatment agencies should examine each situation on a case by case basis rather than implementing a global policy to immediately discharge someone who has relapsed. Agencies should express awareness that addiction can be a relapsing disease. They should indicate they explore relapses, help their clients learn from them, and bolster coping strategies for future high risk situations. Termination from outpatient treatment should be based on a sustained period during which the client has not participated in treatment.
- Will you work with my loved one even when he/she isn’t very motivated?
- It is normal for motivation to fluctuate during treatment. Agencies should believe in the importance of keeping clients engaged, including calling them when they have missed appointments and providing continued support during the more difficult times.
- Will you encourage my loved one to sign a release of information just so I know they are showing up for treatment?
- Therapy is a very private experience and it is unnecessary and often counterproductive for you to know what is being discussed in treatment. However, when your loved one is an adult who lives in your home, or you are paying for their treatment, having knowledge of their participation will help you set the appropriate limits, make the best decisions you can, and help you determine the best way for you to support your loved one.
- Will you involve me in the treatment process?
- Treatment should involve the participation of those who are closest to the individual struggling with addiction. Groups, classes, couples counseling or individual time spent educating loved ones about addiction and how they can respond in a supportive manner which is respectful of their own personal boundaries is important and should be available in treatment.
- Do you offer recovery services such as aftercare groups?
- Recovery services are critical for sustaining abstinence. Agencies should either offer their own services or should encourage client participation in other services such as community support groups (e.g., AA, NA). Ideally, the agencies should develop an aftercare plan with their clients and encourage attendance in recovery services prior to their actual discharge from treatment. Kelly Lundberg, PhD, Associate Professor, Department of Psychiatry, University of Utah.
THINGS TO DO WHEN A LOVED ONE HAS AN ADDICTION
Educate yourself. Read books. Go online. Understand that addiction is a brain disease.
Remember that addiction has hijacked your loved one’s brain, and thus their personality. Addiction can distort thinking and behavior. It may contribute to your loved one taking advantage of you and others. Addiction gets in the way of learning from painful experiences. Understand that part of your anger toward your loved one is actually grief. You simply miss them.
Seek treatment. Explore treatment options. Ask the right questions (see Finding the Best Treatment). When a window of opportunity arises and your loved one is willing to consider treatment, be prepared to make a phone call immediately before that window closes.
Give yourself permission to struggle with your decisions. Do I turn my son in to the police? Should I kick my daughter out of the home? Should I pay for treatment again? Often times doing what is best for your loved one seems counterintuitive to your paternal instincts to protect and love your child. Although friends and family members will be quick to tell you what you should do, it is much different when you are actually in the situation rather than watching from the sidelines. However, you don’t have to make these decisions alone. Talk with a professional who will help you sort through your options and their potential consequences. What is most important is that you make decisions you can live with regardless of what happens.
Understand that relapse is part of treatment. And because of that, it’s like walking a tightrope to find the balance between hope and fear. Think of it as similar to the treatment for cancer. If it’s caught early, then maybe a single episode of treatment can eradicate the disease. But if the disease is more advanced, then there may need to be multiple treatments and, even after a period of remission, a recurrence of the disease is still a concern. Treatment for addiction, however, always strengthens the body and the mind, and never weakens it.
Get involved with treatment. Addiction affects every family member differently and, tragically, can tear relationships apart. If you love someone who has an addiction, you are likely living in fear. You, or others in your family, may be experiencing episodes of depression or anxiety. Furthermore, different coping styles as well as different beliefs about how to handle the situation can strain partnerships and marriages. Even if your loved one is not involved in treatment, and perhaps especially if they are not, be sure that you are doing the right things, the healthy things, to take care of yourself and your family.
Don’t punish yourself for not having seen it right away. Believing them is what we do for people we love – we trust them and have faith in them – it is the cornerstone of intimate and loving relationships. So, of course you didn’t see it right away. It may seem clear in hindsight, but it is often the case that in the early stages of addiction, there is simply no way you could have known.
Don’t blame yourself. We don’t yet completely understand why some people are more vulnerable to addiction than others. We do understand, however, that despite our best efforts, people from healthy homes can still develop an addiction.
Fight the stigma. Addiction does not arise because of a moral weakness or a lack of character. Whether it is remaining silently resolved in your beliefs, or correcting a friend’s or family member’s erroneous beliefs, or testifying to the legislature for parity in insurance coverage for treatment, fight the stigma.
Realize there are things you can do. One of most terrible feelings to experience is helplessness. It is unlikely you’re going to be able to “cure” your loved one of an addiction. But with the help of a professional, you can learn to make things better. You can learn how to give your loved one opportunities to make improvements. And you can love them. Kelly Lundberg, PhD, Associate Professor, Department of Psychiatry, University of Utah.
BEING A WISE PARENT IN AN UNCERTAIN WORLD
First we must recognize that substance misuse represents a real threat to the wellbeing of our kids. We know from numerous studies that adolescents that begin abusing drugs before the age of 15 are 4 times as likely to develop a substance dependency in their adult years.
Drug or alcohol abuse is defined as:
- Use that results in a reduced ability to function in school, work or family roles
- Repeated use that threatens health or legal standing
- Use that repeatedly damages family or peer relationships
Drug or alcohol dependency is defined as:
- The development of tolerance or the need for markedly greater amounts of the substance to become intoxicated.
- Withdrawal symptoms or craving when the substance is discontinued. Withdrawal is a state of physical and psychological distress that in some cases is life threatening.
- A loss of control over the use of the drug resulting in greater use of the drug than the individual intends, more time and money being spent in conjunction with use and the gradual loss of important social, occupational or recreational activities.
- Continued use despite the knowledge that the substance is seriously damaging the social, emotional and physical wellbeing of the individual.
SOME OF THE DRUGS OF ABUSE
Tobacco is extremely addictive and is a real danger. In the year 2000, tobacco related deaths in the US were estimated to be 440,000 – more than the total of all other drugs and alcohol combined. In addition, tobacco is widely regarded as a “gateway” drug in the sense that it seems to lead to the abuse of other psychoactive substances. Marijuana, when used chronically, reduces ambition and exposes the individual to more carcinogens than smoking cigarettes. The abuse of amphetamines and club drugs like MDMA (ecstasy) have been demonstrated in research to produce brain damage. Alcohol plays a prominent role in auto accidents, domestic violence and suicide. All substances of abuse have attendant direct and indirect risks. Finally, we know that by the time our kids reach senior high, 80% have experimented with drugs and/or alcohol.
How Drugs Work
Drugs have their effect by causing chemical changes in the brain. Under natural conditions, the brain releases dopamine, serotonin and other neurochemicals in response to pleasurable experiences. Drugs of abuse drastically overstimulate the brain with these same chemicals. The brain may be temporarily or permanently damaged with the consequence that the individual may have trouble finding pleasure in a normal life experiences, and may become seriously depressed. People who become addicted to substances have a brain disease and must be treated by trained professionals with medications and specialized therapy. In many ways, drug and alcohol dependence is like diabetes, heart disease and asthma in the sense that it requires medical intervention as well as behavioral change to manage the disorder.
The Big Picture
Ok, if you weren’t alarmed before, now we’ve done it. But let us put things in perspective and suggest some hands-on things that we can do. To begin with, even though most kids experiment with alcohol or drugs, most do not use these substances in concentrations that are permanently damaging. Secondly, most kids do not become addicted to these substances. Some of our kids are more vulnerable to developing serious substance abuse problems than are others and we have a pretty good ability to identify them. We can identify them because not only are these kids vulnerable to getting into trouble with substances, but they are at risk in many other ways as well.
Risk Factors
Here are some common risk factors that have been identified by researchers Hawkins and Catalano in their review of the literature:
- High availability of drugs and alcohol in the home or community
- Being raised in a home where one or both parents are substance abusing
- Genetic predisposition to substance abuse
- Family conflict and chaos
- Early and persistent antisocial behavior
- The presence of other illnesses like AD/HD, depression or anxiety
- Academic failure
- Having a peer group that frequently engages in antisocial behavior
- An early sense of being excluded from the benefits of society
Protective Factors
Conversely, research tells us that we as parents, teachers and community members can have a positive and protective effect on our youth by establishing and promoting the following:
- Develop and strengthen the bonds with your child. Encourage healthy relationships with the family, school and community. Kids who feel that they are loved and belong get into less trouble.
- Help your kids feel successful. Kids who feel that they have something genuine to contribute do better. Children should be recognized for their achievements.
- Help kids develop healthy beliefs and clear standards. Kids should feel comfortable and capable of defending their values.
- Teach your kids thinking, social and communication skills that allow them to participate in their community.
- Give your children acknowledgment about their positive qualities and helped them develop these qualities.
- Develop trust and open communication with your child from their early years and keep the communication flowing through their adolescence.
- Be a positive role model. Show your kids how you solve problems, manage your impulses and build positive relationships with others. Do as I say – not as I do – has never worked with an adolescent.