Family Members a s Addiction Service Clients ~ Rationale, Client Profile & Outcomes

1. Family Members as Addiction Service Clients ~Rationale, Client Profile & Outcomes Paul Welsh, MSW, Executive Director, Rideauwood Giselle Neville, BSW, Family Program Manager, Rideauwood 1st Annual Addictions and Mental Health Conference May 27, 2013

2. Overview • Rationale for providing services to family members. • Client profile. • Rideauwood’s Family Program is part of a Whole Family Model: • A three phase program; • Examples of some of the tools used; • Outcomes.

3. Client Profiles: N=124 • 87% female and 13% male • At Intake: • 40% married • 19% single • 15% divorced • 13% separated • 7% common-law relationship • 6% widowed • 15% had past history of substance abuse themselves

4. Client Profiles Continued • 14% had attempted suicide • 43% had previous/current suicidal thinking • 37% had been fearful of the addicted person • Client reports on emotional health: • 42%” fair” • 30% “poor” • 21% “good” • 31% reported feeling depressed • 17% reported being anxious

5. Rationale Family members suffer from addiction in the family. They are the majority who suffer from addiction. Addiction treatment services have mandates to “reduce suffering from addiction”. Addiction problems in families have unique and specific characteristics. Addressing addiction problems in families requires addiction specific knowledge and methods. Addiction troubles move from generation to generation. Breaking the cycle is a mandate of addiction services.

6. Observations, Assumptions Children from families with addiction have higher prevalence of addiction, mental health, education and relationship challenges. “Recovery” of any caregiver reduces those lifelong challenges to children. Partners, spouses, children, parents and other family are Primary Clients (served to address their own distress and not “fix” the addicted person). Addicted persons have higher recovery rates when the family environment is healthy.

7. Rationale – Why Provide Services to Family Members? • Psycho-education, therapy and support help family members cope and influence addicts’ recovery • Rideauwood’s Family Program has been proven to foster healthier individuals and families as part of a Whole Family Model Addiction wreaks havoc on families

8. Rideauwood’s Family Program Model The Family Program Coordination & Collaboration Coordination & Collaboration Whole Family Model Supports for Children & Youth Family & Couples Counselling Family Community Outreach & Education Children’s Aid & Social Services Drug Treatment Court Residential & Non-residential Adult Addiction Programs Gambling Programs Self-help Groups Family Intervention Examples of Other Rideauwood and Community Services and Programs

9. The Family Program

10. Client Profile • Have been, or are being affected by addiction • Have significant stress and coping issues • Are sufficiently stable • Partners and former partners • Parents • Adult children from families with addiction • Adult siblings • Extended family members • People in recovery

11. Family Member Programs Structure Family Spiral (2 Structured Evenings – 25 Clients); Phase 1 (6-8 weekly groups, assessment); Phase 2 (5 day program – 9:00-4:00 Monday to Friday); Phase 3 (8 month weekly groups and Individual Counselling); Family of Origin Program (advanced group program – 10 months).

12. On Concurrent Disorders • Trauma informed practice is paramount. • Eating disorders, mood disorders, personality disorders, suicide risks, meds and drug misuse issues are common; • Frequent childhood abuse ranging from physical and sexual to emotional; • Frequent adult experiences and current abuse or; • Client safety must be spelled out first, agreed to by all: • Expectation of emotional safety by being silent; • Expectation to be heard and validated when we speak; • Expectation to speak to counsellor individually as opposed to in a group; • Safe from criticism from emotions; • Safe to be scared and vulnerable; • Safe from gender politics, sexual advances, sexism and racism; • Safe from financial dealings or requests from clients.

13. Rideauwood’s Family Program Model Initial Support Group Assessment Intake Phase I “Family Spiral” Family of Origin Program & Ongoing Personal Growth Five-day Intensive Program Phase II Eight-month Structured Program + Individual Counselling Phase III

14. Phase I: Participation in the Initial Support Group Provides clients a safe space to allow them to explore their issues and feelings. Prepares for participation in the Family Program. Continuation of psycho-education, introduction to basic concepts, stress release techniques.

15. Phase I: The assessment − determining client needs Personal background. Specific issues and problems. If the client is a good match, they proceed to the Five-day Intensive Program. If the program isn’t right for them, then prerequisite work, or alternatives are sought.

16. Phase II − 5-day Intensive Program Whole Family Program Team is involved. Intensive day-long psycho-education, group work and group therapy. Experiential exercises. Emotional outpouring.

17. Phase III - 8-Month Structured Program 32 two-hour group sessions. Ongoing psycho-education, group work and group therapy. Experiential exercises. Individual counseling as required.

18. Areas of focus include • Boundaries • Communication • Relationships • Grief and loss • Self-care • Feelings • Emotional Enmeshment • “Co-dependence”? • Detachment

19. Fostering Awareness Using a rating scale, ranging from seldom to usually, clients respond to a series of statements regarding their emotional entanglement, for example: • I struggle to identify and express my feelings • I put others’ needs before mine • I am afraid of how others might respond if I shared honestly with them • I am very loyal even if others are not loyal to me • I find it difficult to ask for help from others • . . .

20. Letting my feelings have a voice My guilt would say . . . My anger would say . . . My shame would say . . . My fear would say . . . My sadness would say . . My loneliness would say My joy would say . . . . .

21. What happens if we don’t deal with our feelings?

22. Unchecked Negative Emotions are Destructive: • Eating disorders • Decreased sex drive • Eyelid spasms • Stomach troubles • Tinnitus • Heart palpitations and chest pains • Skin problems • Hair loss • Memory loss • Sleep problems • Severe headaches • Depression • Addictions . . .

25. Outcomes

26. Outcomes Greater awareness about feelings. Better communications. Development of persistent support networks. Improved self-esteem. Improved health. Better parenting. More constructive relationships with the addict – whether recovering or not. Often leads to fundamental life change.