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FAMILY SUPPORT GROUP. Purpose of Today. Provide Education Discuss Family Impact Gain support and share experiences. Group Facilitators. John – Hamilton Family Health Team Adrienne – Alcohol, Drug & Gambling Services. Group Rules/Norms. Confidentiality for: Group leaders Group members

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  2. Purpose of Today • Provide Education • Discuss Family Impact • Gain support and share experiences

  3. Group Facilitators • John – Hamilton Family Health Team • Adrienne – Alcohol, Drug & Gambling Services

  4. Group Rules/Norms Confidentiality for: • Group leaders • Group members • Your family member/loved one

  5. Introductions • First Name • Relationship with family member/loved one • What would you like to gain from today’s session?

  6. Outline Part 1: Understanding Substance Use and Problem Gambling • Continuum of Use and Problem Gambling • Substance Misuse and Problem Gambling: Challenges for the family • Ways of Coping • Stages of Change • Treatment options for your family member

  7. Outline Part 2: Boundaries, Self Care, and Strategies What can you do and what can you control? Taking care of yourself Setting your own Boundaries and Limits Communication Strategies Treatment options for Family

  8. Part 1: Understanding Substance Use and Problem Gambling

  9. Substance Use Continuum

  10. Experimental Use • Triggered by curiosity • Use is usually approached with caution • Removes much of the normal fear connected with substance use • Experience is usually positively reinforcing at this stage • Positive experience often leads to using again

  11. Social Use • Triggered by social norms/peer influence • Offers the users a sense of inclusion, acceptance and belonging • Use is still within the individual’s control (can take it or leave it) • Use is viewed as enhancing a social activity

  12. Abuse • Use is now triggered by certain emotional and environmental factors • Individual feels the “need” to use when confronted with a trigger • Individual has progressed to depending on the substance to help manage/function in certain situations • There is some form of regular pattern to the substance use • The individual has lost some ability to choose and/or control their use

  13. Dependence • Triggers for using are becoming more numerous • The individual feels the “need” to use the substance in a wide variety of normal daily situations • There is a component of both physical and psychological dependence • The individual is experiencing an increase in both the number and severity of consequences from use • Defenses such as denial, avoidance and rationalization develop to protect the habit

  14. Tolerance • Develops with continuous use of a substance • This means that as time goes on, the body needs more and more of the drug to produce the desired effect. • Tolerance is a strong indicator of dependence

  15. Withdrawal • Is a group of symptoms that occur upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and/or alcohol to which one has developed tolerance • Symptoms can include: • Sweating • Shaking • Nausea • In extreme cases, hallucinations

  16. Cycle of Dependency MAY START HERE

  17. What is Gambling? • Gambling means risking something of value when there is an element of chance associated with the outcome • 63.3% of Ontarians gambled in the last year • You know you’re gambling when: You risk something of value Once the bet is made, it’s irreversible The outcome of the game is largely determined by chance

  18. Problem Gambling • Problem gambling is defined as a pattern or gambling behaviour that may compromise, disrupt, or damage family, personal, or vocational pursuits

  19. Problem Gambling Continuum

  20. No Involvement No involvement means exactly what it says – absolutely no gambling activity at all. Approximately 36% of the population in Ontario are ‘non-gamblers.’

  21. Casual Social Gamblers Occasional Part of a larger leisure life Not the only form of recreation Gamble for recreation and excitement Losses are accepted Does not interfere with life or self-esteem Would not miss gambling

  22. Serious Social Gamblers Main form of entertainment Regular gambling Serious pastime, but does not interfere with life Unlikely to progress if pattern is longstanding Would miss gambling

  23. Harmful Involvement Gambling to escape and to experience relief from problems and anxiety Gambling is having a negative impact on life 2.6% of the population are harmfully involved with gambling

  24. Pathological Gambling DSM IV diagnosis 10 possible symptoms .8% of the population meet the DSM IV criteria for Pathological Gambling

  25. SIGNSOF A GAMBLING PROBLEM • How do you know that someone has a gambling problem? • Financial cues • Emotional cues • Time cues • Behavioural cues

  26. Signs and Symptoms • Financial cues: • Placing larger and more frequent bets in order to get the same level of excitement • “Chasing” losses • Watching debts grow, borrowing money, not paying bills • Cashing in RRSPs, savings bonds, insurance • Money or valuables missing • Changes in spending priorities • Defensiveness or secrecy about money

  27. Signs and Symptoms • Emotional Cues • Pinning hopes on a ‘big win’ to solve problems • Feeling frequent highs and lows, on edge, moody, irritable • ‘Spacing out’, dissociating, or withdrawing • Feeling ‘like a different person’ or feeling cold, closed off, or unemotional

  28. Signs and Symptoms • Time Cues: • Increased time spent on reading race scores, the stock market, or sports statistics (“handicapping”) • Arriving late for work, family events or other commitments • Large blocks of time unaccounted for • Prefer gambling to anything else

  29. Signs and Symptoms • Behavioural Cues • Decreased attendance at family functions • Neglecting responsibilities/preoccupied • Changes in sleep, eating, sexual behaviour • Being on edge, reactive, defensive, bored easily • Deception, secrecy • Partial confessions

  30. How Have You Been Affected?How Has Your Family Been Affected?

  31. Unpredictability Safety concerns Relational Conflict Role imbalances Children “acting out” Substance Misuse/ Problem Gambling: Challenges For The Family • Sadness • Anxiety and fear • Anger • Guilt and shame • Stigma • Secrecy/Isolation • Stress-related illness • Poor Communication • Financial Difficulties

  32. Impact Of Substance Abuse/Problem Gambling on Family Members In the Early Stage: • Denial • Arguments • Believing excuses as reasons • Confusion and ambivalence • Anxiety and concern • Rescuing, protecting, covering up for family member

  33. In the Middle Stage: • Vague, unclear communication – • “Don’t Trust. Don’t Talk. Don’t Feel” • Unresolved conflict – deterioration of relationship • Gradual shift in role and responsibility • Decreased sociability • ATTEMPT TO CONTROL • Nagging, threatening • Reporting on use and user • Counting drinks, marking bottles, checking on amount of drugs consumed

  34. In the Late Stage: • Attempts to control the user or the use become more extreme until… Eventually: • Self neglect – physical, social and emotional • May increase own use of drugs or alcohol • Anger, rage • Depression • Burnout

  35. What Have You Tried ?

  36. Family Members Try Less Helpful Ways of Coping • Nagging • Controlling • Investigating • Fixing • Protecting

  37. Some suggested responses Instead of…….. • Nagging: speak to family member when he/she is sober/straight to set limits & consequences and follow through – try to avoid being repetitive • Controlling: try to let go, and give the responsibility for recovery over to the substance abuser • Investigating: identify what you are & aren’t responsible for; set limits

  38. Instead of…….. • Fixing: allow family member to fix their own issues/problems • Protecting: Allow family member to experience the consequences of drinking/using • All of these behaviours take time to understand and learn, so be patient

  39. Strategies for Problem Gambler’s family If your loved one has a gambling problem and wants to make changes OR If your loved one has a gambling problem but does not want to make changes at this time

  40. The Three C’s • You did not CAUSE the substance abuse or problem gambling • You cannot CONTROL the substance abuse or problem gambling • You cannot CURE the substance abuse or problem gambling

  41. The Stages Of Change (Prochaska, Norcross & DiClemente, 1994) • Precontemplation • Contemplation • Determination/Preparation • Action • Maintenance

  42. Tasks Of Each Stage Of Change

  43. Tasks Of Each Stage Of Change

  44. Tasks Of Each Stage Of Change

  45. Recovery and Treatment

  46. Recovery: What To Expect • is a process that is unique to everyone. • takes time. • may require treatment of co-occurring mental health problems. • involves learning new ways of coping and behaving. • often involves lapses and relapses. maintenance stressor Achieving Goals relapse lapse Time

  47. Harm Reduction Assumptions: • Not all substance use or gambling is necessarily harmful. • There will always be individuals who misuse substances or gambling harmfully • Not all individuals are willing or able to achieve abstinence. • Individuals can learn to decrease the harms associated with their substance useor gambling • Some individuals are more likely to seek treatment if it does not require abstinence. • There is value to treatment at all stages of change.

  48. Treatment System for Men and Women for substances To access addiction treatment in Ontario Drug and Alcohol Registry of Treatment (DART): www.dart.on.ca OR 1-800-565-8603

  49. SUBSTANCE ABUSE TREATMENT OPTIONS FOR MEN IN HAMILTON Self Help Withdrawal Outpatient Day Treatment Residential · · Management Counselling AA 2 weeks - Individual and · Short - term pre - treatment NA · Group · 18 - 21 days · 6 weeks core CA Counselling program · GA - Assessment Long term · Men for and Referrals · More than 21 Evening Program Sobriety · days 2 weeks Location: (ex. Wayside pretreatment Location : Men’s House) · 8 weeks core Location: Withdrawal ADGS HFHT program Various Management Meeting Sites Centre Location: within Location: across Ontario SUNTRAC Hamilton

  50. SUBSTANCE ABUSE TREATMENT OPTIONS FOR WOMEN IN HAMILTON Self Help Withdrawal Outpatient Day Treatment Residential · - Taking Steps pre - Management Counselling AA - Individual treatment Short - term · NA · and Group - 5 week day 18 - 21 days · CA Counselling treatment program · GA - Assessment - aftercare program Long term · Women for and Referrals · More than 21 Sobriety days Location: Location: Location: Location : Womankind Womankind Various Addiction ADGS HFHT Addiction Location: within Meeting Services Services Ontario Sites across Hamilton

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