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FIRE AND FIREWATER

FIRE AND FIREWATER. The Clinical Relationship between Substance Abuse & Domestic Violence. REVIEW OF THE LITERATURE. 50% of men in BIP appear to have SA issues (Gandolf, 1999) & are 8X likely to batter on the day they were drinking (Fal-Stewart,2003)

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FIRE AND FIREWATER

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  1. FIRE AND FIREWATER The Clinical Relationship between Substance Abuse & Domestic Violence

  2. REVIEW OF THE LITERATURE

  3. 50% of men in BIP appear to have SA issues (Gandolf, 1999) & are 8X likely to batter on the day they were drinking (Fal-Stewart,2003) • Approx 50% of partnered men entering AOD svc have battered in the past year (Chermack, Fuller & Blow, 2000; Fals-Stewart & Kennedy, 2005) • 25% to 50% of women receiving victim svc for IPV have SA issues (Bennett & Lawson, 1994; Downs, 2001; Ogle & Baer, 2003)

  4. Between 55 & 90% of women who have SA issues have been victimized at some point in their lives (Moses, et a, 2003) and between 67 & 80% of women in SA tx are IPV victims. • Women in recovery are likely to have a history of violent trauma and are at high risk for having PTSD (Fullilove, et al, 1993)

  5. Higher rates of substance abuse in offending populations and poor outcome in tx with victims whom are substance abusing if trauma is not addressed. • High rates of child abuse protection reports and homicides in the home when both SA & DV exist.

  6. Wife Assault in Latino Families Wife assault prevalence rates were higher among Mexican American and Puerto Rican families than among Mexican and Anglo-American families (Aldarondo et al. 2002).

  7. Husband to Wife Violence by Gender and Ethnicity of Respondent • Mexican American 26% • Puerto Rican 21% • Mexican 17.6% (Aldarondo et al. 2002)

  8. National Alcohol Family Life Survey, 1994 & 2002 • Puerto Rican couples: 20.4% prevalence • Mexican American: 17.9% • Mexican: 10.5% • Cuban American: 2.5% • White: 9.9%

  9. Regional and Cultural Utility of Conventional Batterer Counseling Variations in the intervention systems, may help adapt batterer programs to different regions, and specialized counseling may be beneficial for men with high cultural identification (Gondolf 2004)

  10. Men of Color • Americans of color are at greater risk of victimization by violent crime regardless of gender. • Black Males are disproportionately victims of homicide. • Maori men are 15% of the total population, yet make up 50% of the prison population in New Zealand.

  11. Cultural Variables • Migration • Acculturation • Language and cultural world view • Values: personalismo, familialismo, group vs individual; cooperation vs competition; spiritual vs material; youth oriented vs eldership • Cara y Corazon

  12. LESSONS LEARNED • Modeling • Moral Correction • Love and Pain • Spirit (Soul) Wound • Internalized Oppression

  13. NEUROBIOLOGY OF ATTACHMENT • Structure and function of the brain are directly shaped by interpersonal experience. • Human connections create neuronal connections (Siegal, 1999) It is these connections and the developing brain that allow for the regulation of affect, thus establishing the context for relationships

  14. ATTACHMENT Adverse social experience during early critical periods such as neglect, abuse, abandonment, violence and chaotic chemically dependent behavior seriously impair the functioning of the LIMBIC SYSTEM.

  15. Hypothalamic Pituitary-Adrenal Axis. Stress results in the release of CRH. Excessive HPA is maladaptive. Extended exposure to Cortisol is toxic and the Adrenal switch cannot be turned off. IMPAIRED LIMBIC SYSTEM

  16. Impaired Central Nervous System • Impaired judgment: frontal lobe • Short fuse: temporal lobe • Obsessive thoughts: cingulate gyrus • Melancholic Depression. • Victim / Perpetrator of Violence. • Obsessive-Compulsive. • Panic. • Genrealized Anxiety. • Alcoholism. • Substance Abuse. • PTSD

  17. Effects of Trauma on Neurobiology • Frozen memory • Increased emotional triggers • No context for prior trauma memory • Hyperaroused limbic system • Speechlessness • Retraumatization • Avoidance • Physiological conditioning (Van der Kolk)

  18. Attachment Theory • Secure. • Anxious-avoidant: Dismissing. • Anxious-ambivalent: Preoccupied. • Disorganized: Fearful.

  19. Assessment of Lethality • History of Violence: frequency and severity increased over time. • Rule out Mental Illness and Organic Conditions. • Substance Abuse. • Criminal Justice Involvement. • Weapons & Threats of Weapons. • Relationship is ending.

  20. IMAGE OF VIOLENCE Underside surface view. Arachnoid Cyst occupying the space of the left temporal lobe in a violent 9 year old boy. Normal

  21. Images of Alcohol and Drug Abuse

  22. Heroin & Methadone 39 y/o - 25 yr. hx of frequent heroin use Normal View

  23. Active side view on high dose methamphetamine Active side view off methamphetamine

  24. Underside active view Hot area deep left temporal lobe Top-down surface view Multiple hole across cortex

  25. Hope for Healing Alcohol Cocaine & Meth On and Off Drugs

  26. Top-down surface view During substance abuse Top-down surface view A year drug and alcohol free

  27. Underside surface view During substance abuse Underside surface view A year drug and alcohol free * Holes and shriveled appearance during abuse

  28. TREATMENT CONSIDERATIONS • Solid Clinical Assessment. • Rule Out Lethal Situations. • Assess Level of Substance Abuse expect Sobriety. • Assess Neurochemical Impairment. • Motivational Enhancement Initially. • Deep Psychotherapeutic Episode to deal with “Living Clean, Sober & Violence Free”

  29. STAGES OF CHANGE • Precontemplation-Denial. • Contemplation-Exploration Preparation. • Prevent Tarzan-Swing Action. • Maintenance-Relapse Prevention. • Balance, Rhythm & Harmony.

  30. Conocimiento Family History Cultural History Community History What behaviors were learned. Lugar: Place Machismo Parenting: how they Were parented How do they want to parent Relationships Healing Compadres Network Intake Process

  31. Domesticated Violence • It takes a nation to raise children to become violent men. • Violence is learned behavior that has been reinforced nationally & internationally. • This is a historical correlation between oppression and the domestication of violence. • La Cultura Cura

  32. Domesticated Violence • Oppression is a spirit breaking process of objectifying people. • Oppression has an inherent pathology of addiction: the Land Rush, Gold Rush, and Oil Rush. • Domesticated violence is a Human Induced Disaster. • Goal: to learn to Honor all sacred relations.

  33. The Altar

  34. Curriculum • Conocimiento • Palabra • History of family • History of colonialization • Migration • Acculturation • Cargas y Regalos • Differential Diagnosis

  35. Entendimiento • Cultural Cura • La Conquista • Machishmo: True vs False Teachings • Patriarchy • Erosion of Cultural values • Palabra • Maleness to Manhood

  36. Integracion • Tortilla de la Vida • Mascara • Cara y Corazon • Altar • Mi Familia, Mi Corazon • Sacredness of Relations • Fire & Water

  37. Movimiento • Perdon • Family Preparation: Cultural congelada • Dando Palabra • Despedida • Compadres Network • Mentoring • Peace Keepers: Jaguares y Aguilas

  38. Las Cargas • A collective sense of unresolved psychic conflicts, being highly functional addicts, relationship problems with spouses/children, enduring emotional pain related to early experience of child abuse and abandonment. The profound effect of internal oppression has caused a pervasive sense of isolation in our lives.

  39. REGALOS • Regalos can be described in terms of academic, business, and personal success. • Many members of the group had experience substantial personal status within their field of expertise. • Having overcome the detriments of poverty and external oppression. • The most impressive gain was gathering to support each other in our pursuit of personal growth and integrity; in the similar vein that may be the reason we are here.

  40. The Group Circulo Process Respeto-no cross talking, no interruptions, no impositions of values or judgments. • Freedom to speak of one’s cargas and regalos. • Empathic listening. • Feedback, cariño. • Closing prayer and sharing. • El abrazo.

  41. Guiding Principle: El Hombre Noble • Occepa iuhcan yez, occepa iuh tlamaniz, iiquin, in canin / Once again it shall be, once again it shall exist, sometime what existed long ago…will exist again. • El Hombre Noble Cumple con su Palabra/Is a man of his word.

  42. El Hombre Noble... • Debe de tener un sentido de responsibilidad para su propio bienestar y para otros en su circulo/ Should have a sense of responsibility for his own well being and that of others in his circle. • Rechaza cualquier forma de abuso...físico, emocional, mental o espiritual asi mismo y a otras personas/ Rejects any form of abuse…physical, emotional, mental or spiritual, to himself and others.

  43. Hombre Noble • Debe de tener tiempo para reflexionar, rezar e incluir la ceremonia en su vida /Should take time to reflect, pray, and include ceremony in his life. • Debe ser sensible y comprensivo /Should be sensitive and understanding.

  44. Hombre Noble • Debe ser como un espejo, reflejando apoyo y claridad de uno a otros /Should be like a mirror, reflecting support and clarity to one another. • Vive estos valores honradamente y con amor /Lives these values honesty, and with love.

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