1.Substance Abuse:The Impact on Children and FamiliesPresent by: Connie MilesPulaski County Health Center

2.Please turn off all cell phones RestroomsFood and Drink

3.Objectives TheDynamics of Alcohol andDrug Abuse Indicators Theof Substance AbuseAffect of Parental SubstanceAbuseon a child Substance Abuse and FamilyViolence

4.Substance AbuseThe Impact on Children and Families

5.The DynamicsofAlcohol &DrugAbuse

6. Moststudies indicate thatnationally between one–third andtwo-thirds of substantiated childabuse and neglect reports involveparental substance abuse. In thestate of Missouri, the numbersreported indicate 80% of CANreports involve parentalsubstance abuse.

7.Drug Abuse and Brain Chemistry• Our brains work to promote our survival.• Eating is governed by specific brain systems. When we eat (or dovarious other activities), the brain‘s reward systems are activated.• Activation of brain reward systems produces changes in affect rangingfrom slight mood elevation to intense pleasure and euphoria, and thesepsychological states help direct behavior toward natural rewards. Caffeine, alcohol, and nicotine all activate the brain reward mechanismsdirectly, and moderate use of these substances has grown sociallyacceptable.• Other drugs activate the brain‘s reward centers much more intensely.Use of other drugs can elevate mood as well as other affective changes(relaxation, etc.) that are desirable.• The enjoyment of this affect can lead to abuse. Since the activation ismore intense, it begins to cause cravings for this heightened level ofstimulation. www.addictionscience.net Especiallytrue with methamphetamine.www.addictionscience.net

8. Researchershave reported that as much as 50 percent of thedopamine-producing cells in the brain can be damaged afterprolonged exposure to relatively low levels of methamphetamine.Researchers also have found that serotonin-containing nervecells may be damaged even more extensively. Although there are no physical manifestations of a withdrawalsyndrome when methamphetamine use is stopped, there areseveral symptoms that occur when a chronic user stops takingthe drug. These include depression, anxiety, fatigue, paranoia,aggression, and an intense craving for the drug.www.methamphetamineaddiction.com

9.Patterns of Use ExperimentalUse Functional Use Dysfunctional Use Harmful Use Dependent Usehttp://www.unescap.org/esid/hds/training/se-m4arelationshipdrugabuse.pdf

10.Abuse or Dependence Abuseand Dependence are seenvery differently by the DSM-IV-TRwhich is used by mental healthprofessionals to diagnosesubstance abuse problems. Substance Abuse precedesSubstance Dependence. A personmay be using a substance and notqualify as either a substanceabuser or as substance dependent.

11.Substance Abuse “Amaladaptive pattern of substance use leading to clinicallysignificant impairment or distress, as manifested by one (ormore) of the following, occurring within a 12-month period”: Recurrentsubstance use resulting in a failure to fulfill major roleobligations at work, school, or home (e.g., repeated absences or poorwork performance related to substance use; substance-related absences,suspensions, or expulsions from school; neglect of children or household)• Recurrent substance use in situations in which it is physicallyhazardous (e.g., driving an automobile or operating a machine whenimpaired by substance use) Recurrent substance-related legal problems (e.g., arrests for substancerelated disorderly conduct) Continued substance use despite having persistent or recurrent social orinterpersonal problems caused or exacerbated by the effects of thesubstance (e.g., arguments w/ spouse about consequences ofintoxication, physical fights) AND The symptoms have never met the criteria for Substance Dependencefor this class of substance.DSM-IV-TR, 2000

12.Substance Dependence Amaladaptive pattern of substance use, leading toclinically significant impairment or distress, asmanifested by three (or more) of the following,occurring at any time in the same 12-month period”: Tolerance,either of the following: - a need for markedlyincreased amounts of the substance to achieve intoxicationor desired effect - markedly diminished effect withcontinued use of the same amount of the substance • A great deal of time is spent in activities necessary toobtain the substance (e.g., visiting multiple doctors ordriving long distances), use the substance (e.g., chainsmoking), or recover from its effects • Important social, occupational, or recreational activitiesare given up or reduced because of substance use

13.Substance DependenceCont. Withdrawal, either of thefollowing: - thecharacteristic withdrawalsyndrome for thesubstance - the same (or aclosely related) substanceis taken to relieve or avoidwithdrawal symptoms The substance is oftentaken in larger amounts orover a longer period thanwas intended There is a persistent desireor unsuccessful efforts tocut down or control The substance use iscontinued despiteknowledge of having apersistent or recurrentphysical or psychologicalproblem that is likely tohave been caused orexacerbated by thesubstance (e.g., currentcocaine use despiterecognition of cocaineinduced depression, orcontinued drinking despiterecognition that an ulcerwas made worse by alcoholconsumption)

14.What is Addiction Addiction Alcohol and drug addiction arediseases that, while treatable, arechronic and relapsing. Chronic and relapsing mean that theaddiction is never ―cured‖, and thatsubstance use may persist orreappear over the course of anindividual‘s life.

15.Indicators ofSubstance Abuse

16.Signs and SymptomsGender Differences Men• Men have more accessto drugs.• Men are more likely toabuse alcohol andmarijuana than women.• Men in treatmentprograms are more likelyto have graduate highschool and be employedthan women intreatment.• More likely to entertreatment because ofreferral by the criminaljustice system, whereas Women• Women are more likelyto become addicted to ordependent on sedativesand drugs that reduceanxiety or sleeplessness.• Women are more likelyto have other healthproblems, seektreatment multiple times,and attempt suicide.• Several researchstudies indicate that

17.Child Signs and SymptomsNote: It is possible for there to be other explanations beyond substance abuse inthe home for these signs/symptoms. It is important to consider alternateexplanations as well. Thechild of a substance abuser may:• Appear unkempt. Can be result of neglect by a substance abusing parent.• Be frequently sleepy--can be connected to fighting, arguing, or violent behavior inthe home in the evening.• Be late to school--may be in charge of getting themselves there because theirparent is still in bed. Their responsibilities in the morning may include preparingbreakfast, taking care of younger siblings, etc.• Have unexplained bruises due to inadequate supervision or abuse from a parent.• Fluctuate regarding school performance, esp. at the end of the day as the childdreads returning home.• May have an unchildlike odor (not poor hygiene) but chemical in nature (metallicor cat urine smell). This could indicate drug usage and manufacturing in the home.www.coaf.org

18.Signs and Symptoms(cont.) Thechild of a substance abuser may:• Know too much about drinking for their age or they may beextremely guarded when the topic of substances areapproached.• Appear withdrawn/depressed• Display behavioral problems.• Be frequently absent from school in order to take care ofthe substance abuser• Complain of stomachaches, headaches, or other physicalailments, with no explainable cause, often at the same timeevery day• Peers may tease/hint about problem in the child‘s home.• Parents can be predictably hard to reach and often do notshow for child‘s activities at school• Parent(s) may attend school related functions drunk orhigh.www.coaf.org

19.Questions for the social serviceworker to ask or situations toconsider… Isthe client driving with the children in the carwhile under the influence? Are the children being left in unsafe care – withan inappropriate caretaker or unattended whileparent is partying? Parent may neglect or sporadically address thechildren‘s needs for regular meals, clothing andcleanliness. Even when the parent is in the home, theparent‘s use may leave children unsupervised. Behavior toward children may be inconsistent,such as a pattern of violence and then remorse.

20.Questions cont. Despitea clear danger to children, the parentmay engage in addiction-related behaviors,such as leaving children unattended whileseeking drugs Is the parent able to work?Is the cost of the substance of abuse causingfinancial issues?Funds are used to buy alcohol or other drugs, whileother necessities, such as buying food areneglected Aparent may not be able to prioritizechildren‘s needs over his or her own for thesubstance

21.Substance Abuse Risk AssessmentQuestions1. What were the issues that brought the children and/orfamily to my attention?2. What is the family’s perspective of this problem?3. How do the current problems impact the immediatesafety of the children?4. Am I relying on labels to influence this assessment? Ifso, what are the behaviors that impact the risk or safety ofthe children?5. Have I considered the family’s cultural background?6. How is my personal framework affecting my assessmentof the family’s problems?7. What is the evidence that supports my conclusions?8. What is the evidence that disputes my conclusions?9. What other evidence should I explore?10. What could be another explanation for the client’sbehavior?11. Have I examined precipitating events as well asconsequences of behaviors?

22.Click icon to addpictureSubstance AbusingFamiliesDynamic of

23.Family Disease Substanceabuse affects the entire family.• The need for the substance puts aconstant strain on financial resources, andthe effects of the substance can threatenlong-term employment.• The increasing stress level in the home canlead to arguing and hostility, verbal,physical, and sexual abuse, and overallchaos for the family.• The pandemonium in the home leads toanxiety, confusion, and conflict in thechildren who live there.

24.Family Disease• No one member escapes the effect of asubstance abuser in the home, whichmakes substance abuse a family disease• Children whose parents or othersiblings are alcoholics or drug users areat greater risk of developing asubstance use disorder. Having analcoholic family member doubles therisk of a male child later becomingalcohol or drug dependent.www.acde.org/health/riskfact.htm

25.Communication in theHome• Marked by inconsistency andunpredictability• Open and honest communicationdeclines and silence and secretsprevail• When communication occurs, itis usually fluctuates betweensilence and anger

26.Difference in Legal vs.Illegal Use• Additional Element of Secrecy• Barrier to Community Resources• Increased Vulnerability – Violence– Incarceration of a parent – Illegalactivity for financial gain• Rate of Addiction

27.Reassignment of roles/responsibilities• Children begin to learn that they cannot rely onthe substance abuser to follow through on whatthey have said.• Family members adapt by reassigning familyroles/responsibilities• Children may be easily overburden with thetasks of taking care of themselves and theirsiblings, preparing meals, getting to schoolalone, caring for the substance abusing parent,etc.• Due to the family‘s secret, the child has lesssupport for the stress of their increasedresponsibilities.

28.Redefined roles in a substanceabusing family••••••DependentEnablerHeroScapegoatLost ChildMascot

29.Dependent• In the alcoholic home, it isthe drinker.• In a dysfunctional home, itmay be the angry one, thestern disciplinarian, or theunloving and rigidlyreligious one.• (Angry, charming,aggressive, grandiose,righteous, rigid,perfectionist) Jobdescription:• Aggressor• Manipulative• PerfectionistBaggage:• Fear• Pain• Shame• Guilt• Unhealthy, irresponsiblebehavior Relief:• Therapy• skill building• support (sponsor)

30.Enabler• The closest one to theDependent. Theyenable their behaviorto continue out oflove, loyalty, shameand fear. Jobdescription:• Responsible for thealcoholic• Compensates foralcoholic‘s loss ofpowerBaggage:• Anger• Martyrdom• Self-righteousRelief:• Positive adultconnections• Validation of selfworth(Powerless, self-pities,self-blames, serious,fragile, manipulative,

31.Hero• Usually the oldest child• Learns they can help thefamily most by beingvery, very good.• The Enabler leans heavilyon them for support. TheMascot tags on them forattention. Job description:• Perfectionist• Excellent student• Over-achievers• Makes family look good• Follows rulesBaggage:• Guilt• Hurt• InadequacyRelief:• Permission to makemistakes and not beperfect• Opportunities to play• Opportunities toexpress feelings andneeds

32.Scapegoat• Usually the second child• Cannot compete with theHero. Attracted to peers whoare in negative environments.Job description:• Problem child• Accepts blame for familyproblems• Seeks approval outsidefamily• Provide distraction and focusto family• Aggressive• Behavior problems• Acting out may include use ofATODBaggage:• Anger• Hurt• Rejection• JealousyRelief:• Permission to be successful• Supportive confirmation• Structure and consistency(Strongly values peers,withdraws, unplannedpregnancy, chemicalabuser, sullen, acts out,defiant)

33.Lost Child• Usually the third child• Handles the chaos bywithdrawing. Does not feelclose to parents or siblings.• Passive and never sure wherethey fit. May get lost inalcohol and drug abuse.Job description:• Forgotten Child• Dreamer• Attaches to things, not people• Solitary, anti-social• Artistic• Provides relief to familyBaggage:• Rejection• Invisibility• Anxiety• Depressed, suicidalRelief:• Positive attention• Encouragement to takechances•Feel connected to otherpeople (Withdrawn, aloof,eating disorder, quiet,distances, rejects, superindependent) pa

Line: “Things are fine, really! We’re all doing just fine!” Dependent person and Enabler say their lines together (Dependent person is focused on back wall) Hero: Usually the oldest child. Learns they can help the family by being very good. The Enabler leans heavily on her/him for support. Caretaker, high achiever, very responsible

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