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FASD -> ACOA LOOKING BACK – LOOKING FORWARD. CONNECTING THE DOTS. ANNE HARRINGTON RN CADC PERINATAL ADDICTION RISK REDUCTION SPECIALIST GATEWAY NORTHWEST MATERNAL AND CHILD HEALTH NETWORK. Childcare Financial concerns Support for pregnant women Job training Life skills training

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Fasd acoa looking back looking forward
FASD -> ACOA LOOKING BACK – LOOKING FORWARD

CONNECTING THE DOTS

ANNE HARRINGTON RN CADC

PERINATAL ADDICTION RISK REDUCTION SPECIALIST

GATEWAY NORTHWEST MATERNAL AND CHILD HEALTH NETWORK


Scope of women s treatment problems

Childcare

Financial concerns

Support for pregnant women

Job training

Life skills training

Transportation

Peer support

Housing

Special women’s programs for minorities, HIV/AIDS, trauma, domestic violence, Post Traumatic Stress Disorders, etc.

SCOPE OF WOMEN’S TREATMENT PROBLEMS


Issue
ISSUE:

  • 35 TO 50% OF WOMEN IN SUBSTANCE ABUSE TREATMENT HAVE POST TRAUMATIC STRESS DISORDER

    Najavits 2002


Problem
PROBLEM:

Failure to understand and address issues specific to women leads to:

  • Increased symptoms

  • Increased behavior management

  • Increased relapse

  • Early discharge or self termination


Terminology
Terminology

  • FETAL ALCOHOL SYNDROME

    • Term first used in 1973 by Drs. Smith and Jones at the University of Washington

    • One of the diagnoses used to describe birth defects caused by alcohol use while pregnant

    • A medical diagnosis (760.71) in the International Classification of Diseases (ICD)


Fetal alcohol spectrum disorders fasd
Fetal Alcohol Spectrum Disorders (FASD)

  • Umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy

  • May include physical, mental, behavioral, and/orlearning disabilities with possible lifelongimplications

  • Not a diagnosis


Fasd facts
FASD Facts

  • 100 percent preventable

  • Leading known cause of preventable mental retardation

  • Not caused on purpose

  • Can occur anywhere and anytime pregnant women drink

  • Not caused by biologic father’s alcohol use

  • Not a new disorder


Cause of fasd
Cause of FASD

  • The sole cause of FASD is women drinking alcoholic beverages during pregnancy.

  • Alcohol is a teratogen.

    “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”

    —IOM Report to Congress, 1996


Fasd and alcohol
FASD and Alcohol

Binge = 4 or more drinks on one occasion for women

One Drink = 12 ounces

of beer, 5 ounces of wine

or 1.5 ounces of hard liquor


How does alcohol cause brain damage
HOW DOES ALCOHOL CAUSE BRAIN DAMAGE

  • Excessive cell death

  • Reduced cell proliferation

  • Migrational errors in brain development

  • Inhibition of nerve growth factor

  • Disruption of neurotransmitters



Fas and the brain1
FAS and the Brain

A. Magnetic resonance imaging showing the side view of a 14-year-old control subject with a normal corpus callosum; B. 12-year-old with FAS and a thin corpus callosum; C. 14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum.

Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.


Behavorial effects following prenatal alcohol exposure
BEHAVORIAL EFFECTS FOLLOWING PRENATAL ALCOHOL EXPOSURE

  • Hyperactivity, reactivity

  • Attention deficit disorders, distractibility

  • Lack of inhibition

  • Mental retardation, learning difficulties

  • Reduced habituation

  • Perseveration


Behaviors continued
BEHAVIORS, CONTINUED

  • Feeding difficulties

  • Gait abnormalities

  • Poor fine/gross motor skills

  • Developmental delays (motor, social, language)

  • Hearing abnormalities


Primary disabilities of persons with a fasd
Primary Disabilities of Persons With a FASD

  • Lower IQ

  • Impaired ability in reading, spelling, and arithmetic

  • Lower level of adaptive functioning; more significantly impaired than IQ


Typical difficulties for persons with a fasd
Typical Difficulties for Persons With a FASD

  • Sensory Integration Issues

  • Information Processing Problems

  • Memory Problems

  • Executive Function Deficits


Sensory integration issues
SENSORY INTEGRATION ISSUES

  • Are overly sensitive to sensory input

    • Upset by bright lights or loud noises

    • Annoyed by tags in shirts or seams in socks

    • Bothered by certain textures of food

  • Have problems sensing where theirbody is in space (i.e., clumsy)


Information processing problems
INFORMATION PROCESSING PROBLEMS

  • Appear to be oppositional

  • Have trouble determining what to do in a given situation

  • Do not ask questions because they want to fit in


Continued
CONTINUED

  • Say they understand when they do not

  • Have verbal expressive skills that often exceed their level of understanding

  • Misinterpret others’ words, actions, or body movements

  • Have trouble following multiple directions


Executive functioning deficits
EXECUTIVE FUNCTIONING DEFICITS

  • Go with strangers

  • Repeatedly break the rules

  • Frequently do not respond to point, level, or sticker systems

  • Have trouble with time and money

  • Give in to peer pressure

  • Do not learn from mistakes or natural consequences


Memory problems
MEMORY PROBLEMS

  • Multiplication

  • Time sequencing


Multiple other issues
MULTIPLE OTHER ISSUES

  • Cannot entertain themselves

  • Have trouble changing tasks

  • Do not accurately pick up social cues


Secondary disabilities of persons with a fasd
Secondary Disabilities of Persons With a FASD

  • Confinement in jail or treatment facilities

  • Alcohol and drug problems

  • Dependent living

  • Employment problems


Secondary disabilities of persons with a fasd1
Secondary Disabilities of Persons With a FASD

  • Mental health issues

  • Disrupted school experience

  • Trouble with the law

  • Inappropriate sexual behavior


Risks to an adult of not accurately identifying and treating fasd

Unemployment

Loss of family

Homelessness

Jail

Premature death

Increased substance abuse

Risks to an Adult of Not Accurately Identifying and Treating FASD


General issues with fasd
General Issues With FASD

  • Often undiagnosed among persons without FAS facial features

  • More difficulties seen in those without FAS facial features and with higher IQs

  • Adaptive functioning more impaired than intelligence


Economic costs of fasd
Economic Costs of FASD

  • FASD alone cost the United States more than $4 billion in 1998.

  • The average lifetime cost for each child with FAS is $2 million.

    • $1.6 million for medical care services

    • $0.4 million for loss of productivity


One prevented case of fasd saves
ONE PREVENTED CASE OF FASD SAVES

  • $130,000 in the first 5 years

  • $360,000 in 10 years

  • $587,000 in 15 years

  • More than $1 million in 30 years

Increased savings through prevention

Lupton, Burd, and Harwood (2004)

)


Definition of alcoholism
DEFINITION OF ALCOHOLISM

  • PRIMARY

  • DISEASE

  • OFTEN PROGRESSIVE AND FATAL

  • IMPAIRED CONTROL

  • PREOCCUPATION

  • ADVERSE CONSEQUENCES

  • DENIAL


Problems as a result
PROBLEMS AS A RESULT

  • PHYSICAL HEALTH

  • PSYCHOLOGICAL FUNCTIONING

  • INTERPERSONAL ISSUES

  • IMPAIRED SOCIAL RELATIONSHIPS

  • OCCUPATIONAL FUNCTIONING

  • FINANCIAL PROBLEMS

  • SPIRITUAL BANKRUPTCY


Adult children of alcoholics acoa core issues
ADULT CHILDREN OF ALCOHOLICS ( ACOA ) CORE ISSUES

  • Always need to be in control / No sense of personal power

  • Unable to trust ( rigid boundaries ) / Too trusting ( no boundaries ) – Inappropriately loyal

  • Do not share feelings – little faith in the power of talking so talk very little or too much ( to hide )


Acoa issues
ACOA ISSUES

  • Over responsibility ( “ I’m responsible for everything” ) / Under responsibility ( “ You’re responsible for everything” )

  • Overly self – reliant ( no needs ) / Overly dependent ( only needs – little self – sufficiency )

  • Difficulty having fun, relaxing / Only plays – difficulty with work


Acoa issues1
ACOA ISSUES

  • Guess at what “normal” is / Assume “normal” is what they knew as children

  • Take themselves very seriously / Minimize their pain


Addicted families vs healthy families
ADDICTED FAMILIES VS HEALTHY FAMILIES

  • RULES

  • ROLES

  • SECRETS

  • OUTSIDERS

  • SERIOUS


Addicted families vs healthy families1
ADDICTED FAMILIES VS HEALTHY FAMILIES

  • PRIVACY / BOUNDARIES

  • LOYALTY

  • CONFLICT

  • CHANGE

  • UNITY


Characteristics
CHARACTERISTICS

  • NO TALK

  • NO FEEL

  • NO TRUST


Characteristics1
CHARACTERISTICS

  • EMOTIONAL

  • PHYSICAL

  • BEHAVIORAL

  • MENTAL


Emotional

Fear

Anger

Hurt

Resentment

Distrust

Loneliness

Sadness

Shame

Guilt

NUMB

EMOTIONAL


Physical

Tense shoulders

Lower back pain

Sexual dysfunction

Stress related behaviors

Allergies

Gastro – intestinal disorders

PHYSICAL


Mental

Thinking in absolutes

Lack of information

Compulsive thinking

Indecision

Learning disabilities

Confusion

Hypervigilance

MENTAL


Behavioral

Crisis oriented living

Manipulative behavior

Intimacy problems

Unable to have fun

Tries to fit in

Compulsive – addictive disorders

BEHAVIORAL


Paradigm shift
Paradigm Shift

  • “We must move from viewing the

    individual as failing if s/he does not do

    well in a program to viewing the program

    as not providing what the individual

    needs in order to succeed.”

    • —Dubovsky, 2000


Retention is key
RETENTION IS KEY

  • EDUCATE THE STAFF AND CLIENT

  • RUN COLLATERAL GROUPS

  • INCREASE AWARENESS

  • PROVIDING SAFETY IS IMPERATIVE

  • OFFER CHOICES AND OPTIONS

  • HELP WOMEN GET THEIR POWER BACK


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