Recovery: The Family’s Process of Healing and Hope

1. Recovery: The Family’s Process of Healing and Hope CMHACY Conference Steve Hornberger, MSW May 2014 Pacific Grove, CA

2. Three Questions • Generally, in my community when someone hears a family has an alcohol or drug problem they believe… • Working with a family in need of alcohol or drug treatment is challenging because… • I have been successful working with a family receiving drug treatment when I …

3. 1 in 10 Americans 1 in 5 families 1 in 7 workers 1 in 20 newborns 35% of ALL school children 1 in 8 veterans 1 in 2 homeless 1 in 4 elderly 80% of those in jail 60% of families in children and youth services Why are we here today

4. Unmet Prevalence • In 2012, 23.1 million people aged 12 or older needed treatment for an AOD problem. • Of those, only 2.5 million received any treatment.

5. The System Gaps • Of the 20.6 million who needed treatment but did not receive it, only 1.1 million (5%) felt they needed it (denial gap) • Of that 1.1 million, 347,000 (31%) said they made an effort but were unable to get it (treatment gap) • 753,000 (69%) reported making no effort (motivation gap).

6. Why are we here today • In 2005, federal, state and local government spending as a result of substance abuse and addiction was a least $467.7 billion or 10.7 % of their combined $4.4 trillion budget. • For each dollar of the $467.7 billion spent, • 95.6 cents went to shoveling up the wreckage and only • 1.9 cents on prevention and treatment, • 0.4 cents on research, • 1.4 cents on taxation or regulation and • 0.7 cents on interdiction.

7. Impact • ½ of all children (35.6 million) live in a household where a parent or other adults use tobacco, drink heavily or use illicit drugs. • 13% of children under 12 live in a household where a parent or other adults use illicit drugs. • 1 in 4 children under the age of 18 has a family member who abuses alcohol or has alcoholism.

8. Intergenerational Connections • Approximately 45% of all NYS clients admitted to being a “child of an alcoholic or substance abuser” • A child of an AOD abuser is 3 to 4 times more likely to develop AOD problems as well as negative health, educational and employment outcomes • Over 90% of all women in residential substance abuse treatment report history of child abuse and/or neglect

9. Some CA BH Facts 1 • Beliefs: • About 3 in 5 (58.9%) 12- to 17-year-olds in California in 2011- 2012 perceived no great risk from drinking five or more drinks once or twice a week. • About 7 in 9 (77.9%) 12- to 17-year-olds in California in 2011-2012 perceived no great risk from smoking marijuana once a month • About 3 in 10 (31.9%) 12- to 17-year-olds in California in 2011- 2012 perceived no great risk from smoking one or more packs of cigarettes a day

10. Some CA BH Facts 2 • Usage: • Among 12- to 17-year-olds in California, the mean age of first marijuana use was 13.8 years, and the mean age of first cigarette use was 13.2 years.   • about 195,000 youths (6.2% of all youths) per year in 2008-2012* reported using cigarettes within the prior month   • about 353,000 youths (11.2% of all youths) per year in 2008-2012* reported using illicit drugs within the prior month  

11. Some CA BH Facts 3 • Treatment: • among persons aged 12 or older with illicit drug dependence or abuse, about 117,000 persons (12.4%) per year in 2008-2012 received treatment for their illicit drug use within the year • among persons aged 12 or older with alcohol dependence or abuse, about 212,000 persons (9.1%) per year in 2008-2012 received treatment for their alcohol use within the year • about 947,000 persons aged 12 or older (3.1% of all persons in this age group) per year in 2008-2012* were dependent on or abused illicit drugs within the year  

12. Some CA BH Facts 4 • Mental health: • about 259,000 youths (8.4% of all youths) per year in 2008-2012* had at least one MDE within the year prior to being surveyed • about 83,000 youths with MDE (32.0% of all youths with MDE) per year in 2008-2012 received treatment for their • 72% of youths reported improved functioning from treatment received through the public mental health system

13. Parent who is abusing alcohol or other drugs • May be less attentive to the child while drunk or high • May be unable to fulfill their role as a parent, including providing medical treatment • Is more likely to be diagnosed with a co- morbid psychological problem

14. Parent who is abusing alcohol or other drugs • May be chronically physically ill from using drugs or alcohol • Spends times procuring, using, and recovering from the alcohol or drug use instead of parenting • May be engaged in illegal activities • Places financial stress on the family system

15. Adverse Child Experiences Study

16. Adverse Childhood Experiences Study • Fairly common • Generally clustered • Have a cumulative effect on healthy development and health care status

17. HOPE

18. National Prevention Strategy

19. Priorities Source: National Vital Statistics Report, CDC, 2008 Tobacco Free Living Preventing Drug Abuse and Excessive Alcohol Use Healthy Eating Active Living Mental and Emotional Well-being Reproductive and Sexual Health Injury and Violence Free Living

20. EXTERNAL ASSETS

21. EXTERNAL ASSETS (2)

22. INTERNAL ASSETS

23. INTERNAL ASSETS (2)

24. A complex behavioral and neurobiological disorder HISTORICAL PHYSIOLOGICAL - previous history- expectation- learning - genetics- circadian rhythms- disease states- gender DRUGS ENVIRONMENTAL - social interactions- stress- conditioned stimuli BRAIN MECHANISMS BEHAVIOR ENVIRONMENT Source: National Institute on Drug Abuse Presentation

25. Risk and Protective Factors What is a Risk Factor?Something in a person’s life that increases the chance of a problem occurring. Risk Factors include: • Availability of ATOD • Family history of addiction – 4X • Parental use or positive attitude toward use • Other problems in the family: abuse, poverty, domestic violence • Behavior/learning problems • Friends who use and think it is fun or “cool” • Early use

26. Risk Factors in Families • Lack of love, caring, and support • Low expectations for children’s success and school performance • Lack of adult supervision and severe or inconsistent discipline • Lack of family rituals (e.g. family gatherings) • Poor family management or communication • Sexual and physical abuse

27. Risk and Protective Factors What is a Protective Factor?Something that increases the likelihood that substance abuse can be resisted. Protective Factors include: • Relationship to an adult outside the family • Involvement in activities: clubs, scouts • Positive self esteem • Involvement in religious activities, providing hope, purpose, see beauty in the world, connection to Higher Power

28. Risk and Protective Factors Family Protective Factorsinclude: • Strong bonds between children and parents • Involvement in children’s lives • Clear limits/rules with consistently enforced consequences • Clear, honest respectful communication • Chores for all family members • Family Rituals

29. Primary Conclusions 1. People were always more important than programs. 2. Often just one person made the difference. 3. Programs that helped simulated living in a healthy family. 4. Gandhi’s Story

30. Wellness Models Are Emerging HEALTHY l I NOT ILL--------- l ----------ILL l l l NOT HEALTHY

31. A Person/Family Centered Approach • Is Strengths Based –Assumes people have abilities, capacities • Role focused, not problem focused (problems interfere with performing desired roles, diagnosis is not a role) • Promotes direction of the process by the person/family • Adopts an individualized approach to services (not a cookie cutter set of programs) • Where changes made in individual circumstances may have system wide implications that benefit others (innovations)

32. CMS Definition “...identify and access a PERSONALIZED mix of paid and non-paid services and supports that will assist him/her to achieve PERSONALLY-DEFINED OUTCOMES in the most inclusive community setting. The individual identifies planning goals to achieve these outcomes in COLLABORATION with those that the individual has identified , including medical and professional staff ….”

33. Putting the Pieces Together in a Person-Centered Plan GOAL as Defined by Person Strengths to Draw Upon Barriers Which Interfere Short-Term Objective • Behavioral • Achievable • Measureable • Interventions/Action Steps • Professional/”Billable” Services • Clinical & Rehab • Action Steps by Person in Recovery • Roles/Actions by Natural Supporters

34. HEALING

35. What Do They Need? Children: • Words to say what happened • Understanding of family disease • Time with their caregivers to heal • Knowledge that it isn't their fault Caregivers: • Words to share experiences • Understanding of family disease • Time with their children for healing • Making amends and forgiveness

36. Family engagement/involvement:Why is it important? • Because it works! • Because it is the right thing to do • Stakeholders are advocating for it • System reforms are mandating it

37. Family Involvement Works Treatments involving families result in • Higher levels of abstinence (50 vs. 30%) • Fewer drug related arrests (8 vs. 28 %) • Fewer inpatient episodes (13 vs. 35%) Science Practice Perspectives. Vol. 2 No 2 August 2004 NIDA

38. Family engagement/involvement • Increased involvement equals increased ownership equals improved outcomes • Services can be organized on a continuum from family friendly to family focused to family centered to family driven. • Collaborative partnership of expertise, resources and experience.

39. What Do They Need? Caregivers: • Words to share experiences • Understanding of family disease • Time with their children for healing • Making amends and forgiveness Children and Youth: • Words to say what happened • Understanding of family disease • Time with their caregivers to heal • Knowledge that it isn't their fault

40. Talking Helps to Break the Silence • Talk with the children and family members affected by alcohol and drug addicts and explain the disease and 7 Cs • I didn’t Cause it • I can’t Cure it • I can’t Control it • I can take better Care of myself: • by Communicating my feelings • making healthy Choices • by Celebrating myself.

41. What families must re-learn • Authority and discipline • Roles and responsibilities • Problem solving • Communication • Having fun together • Showing affection

42. Parent’s Support • Who in your family is already supportive of your recovery? • Who in your family is in recovery too? • Who keeps a healthy distance from family members who are not so stable? • How has your child’s caregiver been helpful in your recovery? • Who could help identify when you are headed in a negative direction? Who would see the warning signs? • How can these people help you maintain your recovery? How can you ask them for help?

43. EXAMPLES FROM OTHER SYSTEMS

44. Healthcare Institute of Medicine 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” • Respect patients’ values, preferences and expressed needs • Coordinate and integrate care across boundaries of the system • Provide the information, communication, and education that people need and want • Guarantee physical comfort, emotional support, and the involvement of family and friends

45. Healthcarecont Institute for Patient and Family Centered Care lists the following core concepts of patient and family centered care: • Respect and dignity • Information Sharing • Participation • Collaboration

46. Child Welfare Child Welfare Information Gateway • family-centered and strengths-based approach • partnering with families in making decisions, • setting goals, and achieving desired outcomes • motivating and empowering families - to recognize their own needs, strengths, and resources - to take an active role in working toward change

47. Juvenile Justice National Juvenile Justice Network • Engage in deliberate outreach to meet families • Ensure family members are an integral part of advocacy • Empower families to participate in advocacy through education and training • Assist families with individual and system advocacy • Listen to families • Create a clear structure for engagement and participation • Level the field by providing adequate information and support

48. RECOVERY

49. What is Recovery Perspective • Substance dependence, while often manifested by socially unacceptable behavior (for which there must be responsibility), is an illness. This illness can best be prevented when science is used to inform family and community-based efforts to protect and build resiliency. • The illness is best treated by early identification and intervention or, if not halted before its acute development, by a continuity of care over a lifetime that is built on measures of individual wellness and ongoing opportunities for recovery

50. What does the science say Millions of Americans today receive health care for mental health or substance use problems and illnesses. These conditions combined are the leading cause of disability and death among women and the second highest among men. Institute of Medicine, 2006 Treatment is effective: When given a continuum of care, relapse rates for the treatment of alcohol, opioids, and cocaine are less than those for hypertension and asthma and are equivalent to those of diabetes (all of which are also chronic illnesses). Compliance to addiction treatment is greater than compliance rates for treatment of hypertension and asthma. O’Brien and McLellan, 1996