# Presentation: 321580

**Working with Substance Abusing Families**

**Rosemary Tisch, M.A.**
- Author
*Celebrating Families!*
**Linda K. Sibley, M.A.**
- Co-Author
*Celebrating Families!*

##    “WOW! Celebrating Families! TM sets the standard with this comprehensive, clear, step-by-step, in-depth guide to family education about addiction.  This encyclopedic curriculum should be the starting point for anyone who wants to intervene positively with adults and children to build healthy families.  Celebrating Families!TM  is richly layered on a solid base of research, practical experience and evaluation.

This is a curriculum that works!”

    Stephanie Brown, Ph.D., Director of The Addictions Institute, Menlo Park, Ca.  Author of numerous books including Treating the Alcoholic – A Development Model

**This is a curriculum that works!”**
**   **
**    ****Stephanie Brown, Ph.D., ****Director of The Addictions Institute, Menlo Park, Ca.  Author of numerous books including *****Treating the Alcoholic – A Development Model***

## Why a specialized program for 
recovering families?

All members of a chemically dependent family need to learn: 

How they each have been affected by the disease of chemical dependency.
How to determine and keep their own boundaries.
That they are not alone.  
The Truth Statements.

**recovering families?**
- All members of a chemically dependent family need to learn:
**How they each have been affected by the disease of chemical dependency.**
**How to determine and keep their own boundaries.**
**That they are not alone.  **
**The Truth Statements.**

## Breaks the cycle of addiction and abuse in families.

**Impacts the family system.**
**Increases successful family reunification.**

## Family InterventionsWORK!

- Meta Analytic reviews of randomized clinical trials conclude that **treatments that involve family result in**** **
- Higher levels of abstinence
- Fewer drug related arrests (8 vs. 28 %)
- Fewer inpatient treatment episodes (13   vs. 35%).
***Science Practice Perspectives, Vol. 2, No. 2, August 2004, NIDA***

## Preliminary Evaluation Reveals

**Time to reunification significantly decreased (to 6 - 12 months).**
**Reunification rate significantly increased (to 73%) with Drug Treatment Court.**

## Year II Summary

- “Findings show **significant accomplishments** have taken place.
- Classes helped parents and children **learn and apply new skills**, such as, identifying issues of chemical dependency and understanding how these issues affect their families.
- Jrapko, A., Ward, D., Leakey D., Hazelton, T. and Foster, T. *Family Treatment Drug Court head Start Program, Annual Report October 1, 2003-September 30, 2004*.  Center for Applied Local Research.

## Teaches 

- Facts about ATOD, Chemical Dependency
- Recognition of Influence of Media & Advertising
- Facts about Domestic Violence
- Caring & Empathy: Acts of Kindness
- Knowledge that we are part of something larger than ourselves (Wonder of the World Moments)
- Centering & Reflection
- Self Worth & Self Efficiency: recognizing and celebrating each person’s uniqueness

## Is Unique!

- Uses teaching strategies effective with individuals with learning differences.
- Integrates teaching of parenting skills with strategies to break the cycle of addiction in families.
- Reinforces and explains what clients learn in treatment and recovery programs.
- Is fully scripted, including role-plays, handouts, children’s stories and activity sheets.

## Population’s Needs

## 	Substance abuse and addiction are the primary causes of the dramatic rise in child abuse, neglect and the immeasurable increase in the complexity of cases. (National Center on Addiction and Substance Abuse, 1999).  

	Substance abuse contributes to almost three fourths of incidents of child abuse and neglect of children in foster care.        (U.S Department of Health and Human Services, 1999.)

- 	Substance abuse contributes to almost three fourths of incidents of child abuse and neglect of children in foster care.        (U.S Department of Health and Human Services, 1999.)

##   Children of Alcoholics/Addicts

**Are Stressed  **
** **Difficult Temperament
-  Behavioral Disinhibition
-  Hyperactivity or Rapid Tempo
-  Autonomic Hyper- reactivity
-  Rapid Brain Waves - alcohol medicates
** **

##  Children of Alcoholics/Addicts (2)

**Have Cognitive Dysfunctions **
-  High Visual-Spatial Abilities
-  Analytic Abilities
-  Kinesthetic Talents
**More likely to be arrested as a juvenile **(2/3’s of youth reported a family member abused substances while they were growing up) _[Alcohol, drugs and crime: a study of juveniles in detention](http://www.aic.gov.au/publications/rpp/67/)__" __[http://www.aic.gov.au/publications/rpp/67/](http://www.aic.gov.au/publications/rpp/67/)__) _

##  Children of Alcoholics/Addicts (3)

**Are at Risk of Addiction **
- Different Liver Metabolism (quick acetaldehyde build-up, drunk on little alcohol, lose control rapidly)
**2-18 x greater risk of addiction****  **

## COA/A’sExperiencing Abuse

**Are often angry, antisocial, physically aggressive and violent. **
**Can suffer from low self-esteem, depression, hopelessness, suicide, and self-mutilation. **
**May behave compulsively, suffer panic attacks, be highly distrustful of others****.**

## COA/A’s Experiencing Abuse (2)

- Tend towards dangerous play and sexual promiscuity.
**At high risk of developing their own substance abuse.  **
**Likely to repeat the cycle of abuse and neglect. **
- Many are affected in utereo by their parents alcohol/drug use.

## Research with Addicted Mothers 

**“****Universal” horrific abuse **
- 50% experienced physical violence during pregnancy
- 33% had been sexually abused
- 44% raped
- 30% had experienced loss due to violent death
**74% were pregnant by age 19**
**25% had died by the time of 5-year follow up**

## Addicted Mothers(2) 

- 80-85% had mental health issues: co-morbid issues averaged 3-5 per birth Mom.
**35% were children of alcoholics/**
**    ****addicts.**
- 20% had Fetal Alcohol Spectrum Disorders themselves.** **
- All lacked support systems or sources  of potential help.
- Ira Chasnoff, MD, and Sterling Clarren, MD.

## Prenatal Complications from Meth

- Premature births or low birth weight; prone to pre-birth strokes and brain hemorrhages
- Trouble eating and digesting foods
- Altered neonatal behavior patterns, such as abnormal reflexes and extreme irritability
- Congenital deformities: spina bifida, intestinal & skeletal abnormalities, cardiac defects, cleft palate, club foot
- Can increase risks of HIV/AIDS and Hepatitis B and C.

## Domestic Violence

- Alcohol is present in 70% of domestic violence cases, based on court files.
- With self reported domestic violence, **the co-occurrence becomes 75% - 90%. **
- Re-involvement in relationship can make clients **more vulnerable to relapse**.
- Exposure to domestic violence alone **increases risks for kids** to abuse drugs/alcohol.
- Alcohol/substance abuse do not cause violence.

## Is Strength Based,  IncorporatingRisk/Resiliency & Asset Development Research

## 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**

## In Chemically Dependent Families

**Family history (quadruples risk)**
**Parental drug use OR                      positive attitude towards use **
**Family management problems**
**Need for loving care and support.**

## FAS Protective Factors

**Long term outcomes **
**CAN significantly improve if a child**
**Lives in a stable, nurturing home esp. from 8-12**
**Has minimum changes in household (2.8 years)**
**Is protected from violence: witnessing or being victimized.**
**Receives early diagnosis before age of 6**
**Obtains early intervention services**

## Protective Factors For Any Child

**At least one caring adult in a child’s life**
**Opportunities to contribute/help others**
**Social skills, which increase effectiveness at work, school and home**
**Self-discipline**
**Healthy experiences**

## Asset Development

**Positive Values:**
- Caring			Equality
- Social justice		Integrity
- Responsibility
**Positive Identity:  sense of personal power**
**Sense of purpose**
**Positive view of life and world – WOW**

## Asset DevelopmentTeach Social Competencies

**(Healthy Living Skills)**
**Planning and decision making**
**Interpersonal competence:  ability to articulate feelings, have empathy, and friendship skills**
**Resistance Skills**

## Children’s Resilience 

**Social competence:**
- ability to gain other people’s positive attention
**Problem Solving Skills:**
- active, evocative approach toward solving life’s problems
**Development of Autonomy:**
- tendency to perceive experiences constructively, even if they cause pain and suffering.
**Sense of purpose and future: **
- strong ability to use faith in order to maintain positive vision of meaningful life.
***E. E. Werner, in S. Brown, 2005.***

## Family Resilience

**Core Identity: **images, metaphors, attitudes, family rituals and practices.
**Boundaries:**  Clear and appropriate rules.
**Allocation of roles: ** Delegate functions appropriate to family member’s age, ability, and available time.
**Problem Solving:**  Early recognition of problems, open discussion, contracts, and review.
**Communication:  **Direct, clear and containing a full range of feelings.

## Families Need Education and Support To

**Develop healthy living skills **
**Foster communication  **
**Encourage positive relationships**
**Increase the rate of sustained recovery from alcoholism/**
**   ****addiction.**

## What Doesn’t Work

**Waivers to Adult (Criminal Courts) – more likely to re-offend**
**Bootcamps – 4x as costly as probation, same recidivism**
**DARE (traditional) – revised under evaluation**
**Guided Group Interaction and Positive Peer Culture**
**Gun Buyback Programs (2/3’s didn’t work)**
**Peer Counseling Programs**
**Summer Job Programs**
***Delbert Elliott, PhD, Blueprints Conference March 2006***

## What Doesn’t Work (2)

**Neighborhood Watch**
**Arrests of Unemployed Domestic Abusers**
**Scared Straight - harmful, encouraged **
**Shock Probation/Parole **
**Home Detention with Electronic Monitoring**
**Casework/Counseling**
***Delbert Elliott, PhD, Blueprints Conference March 2006***

## Video: Lost Childhood: Growing up In An Alcoholic Family.

-    			Available for $12.50 for VHS; $13 for DVD.
- 			Call 1-800-729-6686

## Celebrating Families! TM  Intergenerational Strength-Based, Cognitive-BehavioralGroup Model for Families in Early Recovery

## Typical Class Session

**CHILDREN’S****	****	****                          PARENT**
**GROUPS****	****	****	****  ****	****                   GROUP**
** **_**Childcare**__** **_
**	****	****	****	**

**90 Minutes Simultaneously**

**FAMILY STYLE MEAL**

**+**
**30 Minutes**

**FAMILY **
**ACTIVITY**
_**Transportation**_

## Why Dinner? 

- Kids who eat dinner with their families are less likely to use alcohol, tobacco, or other drugs.
- Those who did _not_ were
- 3x more likely to try marijuana,
- more than 2x as likely to smoke,
- 1.5x more apt to drink alcohol.
**The National Center for Addiction & Substance Abuse at Columbia University (9/04/2005 and 1998)**

**Addresses Four Aspects of **
**Healthy Living**

## Topics

**Topics**

- Orientation
- Healthy Living
- Nutrition
- Communication
- Feelings
- Anger Management
- Facts about ATOD
- Chemical Dependency
- CD Affects the whole family

- Goal Setting
- Health Choices
- Healthy Boundaries
- Healthy Friendships  & Relationships
- How We Learn
- Uniqueness
- Celebration!

**First, helps participants break the rules **
- Don’t Talk		Don’t’ Feel
- Don’t Trust
**Then teaches about the disease of chemical dependency**
- That it is a brain disease.
- How it impacts families.
- Facts about alcohol, tobacco, prescription & illegal drug use.

**Finally it empowers by teaching Healthy Living Skills****  **
** **Anger Management
-  Communication
-  Feelings/Defenses
-  Health Living: Nutrition
-  Problem Solving & Goal Setting
**Always integrates recovery with every member of the family.**** **

## Helps
All family members learn and incorporate the Truth Statements into their lives. 

_**All**_** family members learn and incorporate the Truth Statements into their lives. **

***I did not CAUSE the disease.***
***I can not CURE the disease.***
***I cannot CONTROL the disease.***
***I can take CARE of myself – ***
***        ******One day at a time*****.**

## Parents Also Learn 

**Parents Also Learn**** **
**How to incorporate recovery into their daily lives as parents.**
**Risk & Resiliency Factors.**
**How to break the cycle of addiction:**
**Saying “I love you.” **
**Affirming their children.**
**Spending one-on-one time.****   **

## Sample Activities

## Evaluation Outcomes

***“******I now call my son twice a day.  I used to think of calling him once a week.”***

## Celebrating Families! TMPreliminary Evaluation Reveals

**Time to reunification significantly decreased (to 6 - 12 months).**** **
**Reunification rate significantly increased (to 73%) with Drug Treatment Court.**

## Celebrating Families! TMYear II Summary

-   “Findings show **significant accomplishments** have taken place.”
- Classes helped parents and children **learn and apply new skills**, such as, identifying issues of chemical dependency and understanding how these issues affect their families.

##  CF! Summary II (2)

-    Qualitative data from the focus groups, demonstrated that parents recognize that the program has been a **tremendous help to them in becoming closer** to their children and in **assisting them in their efforts for family reunification**.”
-       **Jrapko, A., Ward, D., Leakey D., Hazelton, T. and Foster, T. *****Family Treatment Drug Court head Start Program, Annual Report October 1, 2003-September 30, 2004*****.  Center for Applied Local Research.**

## CF! Year II Results

**Parents understand**
- How to set goals
- How to have more control of their lives
- How to think things through before taking action.

## CF! Year II Results (2)

**Stated in last 30 days they**
- 100% had not used marijuana or prescription drugs.
- 96% had not used alcohol or other illegal drugs.
- 74% had not used tobacco.

## CF!  Year I Results 

**100% of parents now know it is important to recognize their feelings.**
**86% responded it is “Important to tell children you love them.”**
**80% understand how their addiction affected their children.**

##  CF! Year I (2)

**74% agree that their children’s ability to connect with safe people has improved.**
**100% know it is important to recognize one’s feelings.**
**“****Almost all” parents attended an organized group where they felt accepted and respected.**

**Parent’s addiction is not their fault.**
**Chemical dependency is a disease.**
**How to choose and make healthy friendships with safe peers and adults.**
**Alcohol and drug use even once in awhile (for them) is harmful.**

**Primary Knowledge ****Gained by Children & Teens**

## Spontaneous Responses of 4-10 year olds on post test:

**   **** **_**True/False    Statement**_
- 1. I can help my parent stop drinking if I try hard enough.
- 2. I can change how other people feel.
- 3.  I can make healthy choices for myself.

**	**_**Spontaneous  Response**_
- 1.  I can’t cure it.
- 2.  I can’t control it.
- 3.  I can take care of myself.

## Replication 

**Family Treatment Drug Court (FTDC).**** **Families where parents have lost custody of their children due to abuse/neglect and substance abuse.
**Friends Outside****.  **Families of people in prisons/jails.
**House on the Hill.**** **Santa Clara County’s only residential treatment facility for chemically dependent women with children.** **
**EMQ.****  **The largest children’s mental health organization in Northern California.
- El Dorado County Child Protective Services.

**Celebrating Families! is currently being implemented at:**

## Replication (2) 

** ****Additional sites**** **are currently being sought.
** ****Evaluation is provided by Karol Kumpher, Ph.D.,**** **University of Utah and former Director of the Center for Substance Abuse Prevention and Center for Applied Local Research (1988-2000).

## Implementation:Materials, Costs & Savings

## CF! Course Materials: (Distributed on CDs)

**Manuals**: Age-graded Session Plans for Parents, Youth and Children’s Groups and all Family Activities. Includes stories, songs, role plays, games and worksheets.
**Preface & Appendix: **Information regarding   implementation and research foundations of curriculum and
-     support documents on chemical dependency and its impact on children and families.
**Evaluation:****  **Parent and Youth instruments, Fidelity Checklists, Client Satisfaction Surveys,  Leader Ratings.

## Implementation 

**Training**
- Up to 25 staff trained at your site
-     OR
- Attend training in San Jose, CA
**Logistics:  space, food, supplies**
**Supervision/Technical Assistance **
**Evaluation **
**Continued Learning for Team**

## Leader Qualifications

**Desire to work with families **
**Desire to learn the model**
**Personal Skills: one to one & group**
**Understanding of chemical dependency**
**Balance teams by gender, **
**ethnicity, recovery**

## Sample Budget

**4-DayTraining **at your site             **                        **$ 5,000+exp.
**Registered Sites:  **Supervision & Evaluation**	****             **$ 7,000+exp.
**Group Leaders:**
- (10 x 18 weeks x $20/hr x 5 hrs/week)		             $18,000
**Site Coordinator/Clinical Supervisor**
- (18 weeks x $30/hr x 10hrs/week)	 	             $  6,400
**Food:**
- (16 sessions x 15 families x $10/family)		            $  2,400
**Child Care: **
- (16 wks x 2 staff x $15/hr x 3 hrs)			$  1,650
**Supplies: **(paper products, toys)			$     500
**Manual Duplication:** (10 x $65/each)		$     650
**	****	****Total:  $41,600+                          $29,600**
**	****	****    ****Year One                                  Year Two**

## CF! Saves Money

- Estimated cost per participant (40)
- 					            Year I          $  1,040 				                     Year II         $     740
- Estimated cost per child/month in
-    child welfare system (CWS)                        *$ 1,945
-    including indirect                                     ** $ 2,123
- Estimated cost including system
-    (medical, law, special education)		      ** $17,584
- Cost per month to house youth in county  ***$  2,600
-     Cost per month to house a youth at CYA	$  6,666
- *    California Child Welfare System – Child and Family Futures
- **  Edna McConnell Clark Foundation
- ***Legislative Analyst's Office, 2002-03 George Kita, Former Deputy District Attorney

## Savings

- For every dollar spent on treatment, taxpayers save more than 7** **in other services: reduced crime, medical fees, emergency room visits and increased
- productivity.
- _[University of California at Los Angeles (UCLA)](http://www.newswise.com/articles/view/515638/)__: __[Health Services Research](http://www.blackwellpublishing.com/journal.asp?ref=0017-9124)__.  _
**NY Times Magazine 2/10/02 RAND corporation**

## Drug Court Savings

**Participation in drug court program saved the county**** ****$2,102,641 in public assistance, foster care, substance-free births, and child support:**
- $1,349,154 in public assistance, food stamps, Medicaid.
- $206,588 by family members in public assistance.
- Over $58,000 annual savings in foster care: children  returned to their homes, pr allowed to stay in their  homes because of a parent's involvement in drug court.
- $360,000 9 healthy babies born,.
- $97,392. improved child support by graduates reducing public assistance payments.
-  $15,000 in child support collected in arrears payments.

## Study Source

**Drug Court Savings Extend Beyond Prison Costs: **New York State's Lackawanna Drug Court and Erie County Department of Social Services.

## “This group is different – this is not another parenting class.This is a class on being a family.”                                                                                                                                                

## Rosemary Tisch
rstisch@aol.com  or 408-406-0467

Linda Sibley
lksibley@msn.com  or 805-614-2824

www.celebratingfamilies.net

**rstisch@aol.com  ****or 408-406-0467**
**Linda Sibley**
**lksibley@msn.com  ****or 805-614-2824**
**www.celebratingfamilies.net**