Kith & Kin

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Kith & Kin Kith & Kin & Colleagues? & Colleagues?

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Kith & Kin. & Colleagues?. Kith & Kin – and Colleagues?. The effects, consequences and inter-relationships between chemical dependency and family dynamics have been studied over the years from a variety of angles – both in terms of causative factors for substance use and as consequences of it. - PowerPoint PPT Presentation

Transcript of Kith & Kin

Kith & KinKith & Kin

& Colleagues?& Colleagues?

Kith & Kin – and Kith & Kin – and Colleagues?Colleagues?

The effects, consequences and inter-The effects, consequences and inter-relationships between chemical relationships between chemical dependency and family dynamics dependency and family dynamics have been studied over the years have been studied over the years from a variety of angles – both in from a variety of angles – both in terms of causative factors for terms of causative factors for substance use and as consequences substance use and as consequences of it.of it.

Definitions:Definitions:

““Addiction” is non scientific. The same Addiction” is non scientific. The same can be said for “alcoholism”. We have can be said for “alcoholism”. We have criteria for drug dependency and criteria for drug dependency and abuse; alcohol dependency and abuse – abuse; alcohol dependency and abuse – DSMIV – yet we also throw around DSMIV – yet we also throw around Drug Misuse, Problematic Drug Use Drug Misuse, Problematic Drug Use and even Binge Drinking- usually and even Binge Drinking- usually without much distinction often without much distinction often interchangeablely or without any clear interchangeablely or without any clear understanding. understanding.

Definitions “2” Definitions “2”

Even the word “family” can have varying Even the word “family” can have varying meanings:meanings:

““Family of origin”Family of origin” ““Current Family”Current Family” ““Significant Others”Significant Others” Use of “genogram” in treatment.Use of “genogram” in treatment. A Google search gave 27 English Language A Google search gave 27 English Language

definitions of addiction. No wonder then that definitions of addiction. No wonder then that treatment and/or recovery is seen as difficult if treatment and/or recovery is seen as difficult if there is no common definition as to what the there is no common definition as to what the problem is!problem is!

Predictive/Causative Predictive/Causative FactorsFactors

Protective factors:Protective factors: strong and positive family bonds; strong and positive family bonds; parental monitoring of children's activities and parental monitoring of children's activities and

peers; peers; clear rules of conduct that are consistently clear rules of conduct that are consistently

enforced within the family; enforced within the family; involvement of parents in the lives of their involvement of parents in the lives of their

children; children; success in school performance; strong bonds success in school performance; strong bonds

with institutions, such as school and religious with institutions, such as school and religious organizations; and organizations; and

adoption of conventional norms about drug use. adoption of conventional norms about drug use.

Predictive/Causative Predictive/Causative Factors(2)Factors(2)

Risk factors:Risk factors: chaotic home environments, particularly in which parents chaotic home environments, particularly in which parents

abuse substances or suffer from mental illnesses; abuse substances or suffer from mental illnesses; ineffective parenting, especially with children with ineffective parenting, especially with children with

difficult temperaments or conduct disorders; difficult temperaments or conduct disorders; lack of parent-child attachments and nurturing; lack of parent-child attachments and nurturing; inappropriately shy or aggressive behavior in the inappropriately shy or aggressive behavior in the

classroom; classroom; failure in school performance; failure in school performance; poor social coping skills; poor social coping skills; affiliations with peers displaying deviant behaviors; and affiliations with peers displaying deviant behaviors; and perceptions of approval of drug-using behaviors in family, perceptions of approval of drug-using behaviors in family,

work, school, peer, and community environments. work, school, peer, and community environments.

Predictive/Causative Predictive/Causative Factors(2)Factors(2)

The preceding 2 slides were taken The preceding 2 slides were taken from the USfrom the US

National Institute on Drug Abuse:National Institute on Drug Abuse:

http://www.nida.nih.gov/NIDA_Notes/http://www.nida.nih.gov/NIDA_Notes/NNVol16N6/Risk.htmlNNVol16N6/Risk.html Please note that the above refers to Please note that the above refers to

substance use – not substance abuse substance use – not substance abuse or substance dependencyor substance dependency

GENETICSGENETICS It has been. established in various It has been. established in various

research including Cotton (1979) that research including Cotton (1979) that alcoholism and other drug abuse is alcoholism and other drug abuse is familially transmitted. Several studies familially transmitted. Several studies of alcoholic groups have reported of alcoholic groups have reported alcoholism rates of 50% among their alcoholism rates of 50% among their fathers, 30% among their brothers, fathers, 30% among their brothers, and 6% among their mothers(Goodwin, and 6% among their mothers(Goodwin, 1980). Among first- and second-1980). Among first- and second-degree males relatives, the risk is 25% degree males relatives, the risk is 25% (Cotton, 1979)(Cotton, 1979)

Predictive/Causative Predictive/Causative Factors(3)Factors(3)

For an up to date summary of the For an up to date summary of the research see research see

““The Science of Addiction” – From The Science of Addiction” – From Neurobiology to Treatment by Carlton Neurobiology to Treatment by Carlton K. Erickson – WW Norton – 2007.K. Erickson – WW Norton – 2007.

Attachment Theory – Thomas Attachment Theory – Thomas Hedlund et alHedlund et al

See See http://www.thomashedlund.comhttp://www.thomashedlund.com

Families and Addiction: Families and Addiction:

Contrary to widely held belief, Contrary to widely held belief, alcoholics and other drug abusers alcoholics and other drug abusers are far more often found in the are far more often found in the context of intact family situations context of intact family situations than on Skid Row. Only a minority than on Skid Row. Only a minority of addicts live in social isolation and of addicts live in social isolation and homelessness (World Health homelessness (World Health Organization, 1977)Organization, 1977)

Family Adaption:Family Adaption:

The family of the addict is The family of the addict is characterized by denial(Bean, characterized by denial(Bean, 1982). There is an atmosphere of 1982). There is an atmosphere of shame (Arentzen, 1978) and an shame (Arentzen, 1978) and an underlying core of fear and tension. underlying core of fear and tension. In most alcoholic families, there is a In most alcoholic families, there is a major secret. The maintenance of major secret. The maintenance of that secret, the alcoholism, is the that secret, the alcoholism, is the central focus around which the central focus around which the family is organized (Brown and family is organized (Brown and Beletsis, 1981)Beletsis, 1981)

Characteristics of Families Characteristics of Families with Addictionwith Addiction

ChaosChaos InconsistencyInconsistency Unclear rolesUnclear roles UnpredictabilityUnpredictability ArbitrarinessArbitrariness Changing limitsChanging limits RepetitiousnessRepetitiousness Illogical argumentsIllogical arguments Violence (sometimes incest)Violence (sometimes incest)

(Beletsis and Brown, 1981)(Beletsis and Brown, 1981)

Enabling BehavioursEnabling BehavioursEnabling behaviours allow the addicted person to continue Enabling behaviours allow the addicted person to continue

with the addiction. It feels helpful, but it promotes the with the addiction. It feels helpful, but it promotes the addiction and the denial that is so crucial to the process.addiction and the denial that is so crucial to the process.

Examples:Examples:

Making excuses for the addictMaking excuses for the addict Paying their billsPaying their bills Bailing them out of jailBailing them out of jail Making rationalizations for irresponsible behavioursMaking rationalizations for irresponsible behaviours Ignoring the problems caused by the addict's useIgnoring the problems caused by the addict's use Cleaning up their messesCleaning up their messes Accepting their excuses or believing their liesAccepting their excuses or believing their lies Not discussing the problem Not discussing the problem Not getting help for themselvesNot getting help for themselves

Why work with families?Why work with families?

Family interventions are indicated Family interventions are indicated in circumstances in which the in circumstances in which the patient's abstinence upsets a patient's abstinence upsets a previously well-established but previously well-established but maladaptive style of family maladaptive style of family interaction and in which other interaction and in which other family members need help in family members need help in adjusting to a new set of individual adjusting to a new set of individual and familial goals, attitudes, and and familial goals, attitudes, and behaviors.(APA, 2004)behaviors.(APA, 2004)

Why work with families?Why work with families? Family therapy that addresses interpersonal Family therapy that addresses interpersonal

and family interactions leading to conflict or and family interactions leading to conflict or enabling behaviours can reduce the risk of enabling behaviours can reduce the risk of relapse for patients with high levels of family relapse for patients with high levels of family involvement. Couple and family therapy are involvement. Couple and family therapy are also useful for promoting psychological also useful for promoting psychological differentiation of family members, providing a differentiation of family members, providing a forum for the exchange of information and forum for the exchange of information and ideas about the treatment plan, developing ideas about the treatment plan, developing behavioural management contracts and behavioural management contracts and ground rules for continued family support, and ground rules for continued family support, and reinforcing behaviours that help prevent reinforcing behaviours that help prevent relapse and enhance the prospects for relapse and enhance the prospects for recovery. (APA, 2004)recovery. (APA, 2004)

Family RolesFamily RolesFamily members in addict families take on roles. Family members in addict families take on roles.

Based on the work of Virginia Satir, Wegshieder-Based on the work of Virginia Satir, Wegshieder-Cruse(1985) proposed that the roles in these Cruse(1985) proposed that the roles in these families are:families are:

HeroHero ScapegoatScapegoat Lost childLost child MascotMascot

These “roles” are learnt in the family and are taken These “roles” are learnt in the family and are taken on as a means of survival in the family. Learnt in on as a means of survival in the family. Learnt in childhood they are carried forward into adult life – childhood they are carried forward into adult life – influencing relaionships, carer choices etcinfluencing relaionships, carer choices etc

Adult Children of Adult Children of Alcoholics:Alcoholics:

1. Guess at what normal is.1. Guess at what normal is.

2. Have difficulty in following a project through from beginning to end.2. Have difficulty in following a project through from beginning to end.

3. Lie when it would be just as easy to tell the truth.3. Lie when it would be just as easy to tell the truth.

4. Judge themselves without mercy.4. Judge themselves without mercy.

5. Have difficulty having fun.5. Have difficulty having fun.

6. Take themselves very seriously.6. Take themselves very seriously.

7. Have difficulty with intimate relationships.7. Have difficulty with intimate relationships.

8. Overreact to changes over which they have no control.8. Overreact to changes over which they have no control.

9. Constantly seek approval and affirmation.9. Constantly seek approval and affirmation.

10. Feel that they are different from other people.10. Feel that they are different from other people.

11. Are either super responsible or super irresponsible.11. Are either super responsible or super irresponsible.

12. Are extremely loyal, even in the face of evidence that loyalty is undeserved.12. Are extremely loyal, even in the face of evidence that loyalty is undeserved.

13. Have money dsyfunction, such as hiding it or being disorganized with it. 13. Have money dsyfunction, such as hiding it or being disorganized with it.

Codependents:Codependents: Think and feel responsible for other people---for other people's Think and feel responsible for other people---for other people's

feelings, thoughts, actions, choices, wants, needs, well-being, lack of feelings, thoughts, actions, choices, wants, needs, well-being, lack of well-being, and ultimate destiny. well-being, and ultimate destiny.

Feel anxiety, pity, and guilt when other people have a problem. Feel anxiety, pity, and guilt when other people have a problem. Feel compelled - almost forced - to help that person solve the Feel compelled - almost forced - to help that person solve the

problem, such as offering unwanted advice, giving a rapid-fire series problem, such as offering unwanted advice, giving a rapid-fire series of suggestions, or fixing feelings. of suggestions, or fixing feelings.

Feel angry when their help isn't effective. Feel angry when their help isn't effective. Anticipate other people's needs. Anticipate other people's needs. Wonder why others don't do the same for them. Wonder why others don't do the same for them. Don't really want to be doing, doing more than their fair share of the Don't really want to be doing, doing more than their fair share of the

work, and doing things other people are capable of doing for work, and doing things other people are capable of doing for themselves. themselves.

Not knowing what they want and need, or if they do, tell themselves Not knowing what they want and need, or if they do, tell themselves what they want and need is not important. what they want and need is not important.

Try to please others instead of themselves. Try to please others instead of themselves. Find it easier to feel and express anger about injustices done to Find it easier to feel and express anger about injustices done to

others rather than injustices done to themselves. others rather than injustices done to themselves. Feel safest when giving. Feel safest when giving. Feel insecure and guilty when somebody gives to them. Feel insecure and guilty when somebody gives to them.

CodependentsCodependents Feel sad because they spend their whole lives giving to other Feel sad because they spend their whole lives giving to other

people and nobody gives to them. people and nobody gives to them. Find themselves attracted to needy people. Find themselves attracted to needy people. Find needy people attracted to them. Find needy people attracted to them. Feel bored, empty, and worthless if they don't have a crisis in their Feel bored, empty, and worthless if they don't have a crisis in their

lives, a problem to solve, or someone to help. lives, a problem to solve, or someone to help. Abandon their routine to respond to or do something for somebody Abandon their routine to respond to or do something for somebody

else. else. Overcommit themselves. Overcommit themselves. Feel harried and pressured. Feel harried and pressured. Believe deep inside other people are somehow responsible for Believe deep inside other people are somehow responsible for

them. them. Blame others for the spot the codependents are in. Blame others for the spot the codependents are in. Say other people make the codependents feel the way they do. Say other people make the codependents feel the way they do. Believe other people are making them crazy. Believe other people are making them crazy. Feel angry, victimized, unappreciated, and used. Feel angry, victimized, unappreciated, and used. Find other people become impatient or angry with them for all of Find other people become impatient or angry with them for all of

the preceding characteristics. the preceding characteristics.

ACOA/Nursing StudyACOA/Nursing Study The purpose of this study was to determine the The purpose of this study was to determine the

incidence of adult children of alcoholics (ACOA) among incidence of adult children of alcoholics (ACOA) among the students and faculty in a Midwestern diploma the students and faculty in a Midwestern diploma school of nursing. The sample included 201 students school of nursing. The sample included 201 students and 17 members of the faculty. The instrument used and 17 members of the faculty. The instrument used was the Children of Alcoholics Screening Test(C.A.S.T.) was the Children of Alcoholics Screening Test(C.A.S.T.) (Jones, 1981). A questionnaire to elicit demographic (Jones, 1981). A questionnaire to elicit demographic and self-report data regarding the participant's marital and self-report data regarding the participant's marital starus, drinking patterns and level of concern over starus, drinking patterns and level of concern over personal drinking behavior was also administered. personal drinking behavior was also administered. Analysis indicated 23% of the overall sample were Analysis indicated 23% of the overall sample were ACOA and 8% were children of problem drinkers. In ACOA and 8% were children of problem drinkers. In the student sample, 23% were ACOA and 8% were the student sample, 23% were ACOA and 8% were children of problem drinkers; 29% of the faculty were children of problem drinkers; 29% of the faculty were ACOA and 6% were children of problem drinkers. The ACOA and 6% were children of problem drinkers. The total C.A.S.T. (Jones, 1981) score was significantly total C.A.S.T. (Jones, 1981) score was significantly greater in those subjects who identified either parent greater in those subjects who identified either parent as alcoholic.as alcoholic.

http://hdl.handle.net/2092/510http://hdl.handle.net/2092/510

Hypothesis:Hypothesis:

People from addictive family backgrounds are People from addictive family backgrounds are more likely to find their way into work in the more likely to find their way into work in the caring professsions in general & particularly caring professsions in general & particularly AOD services.AOD services.

They will bring any unresolved family of They will bring any unresolved family of origin issues/roles with them into the origin issues/roles with them into the workplace.workplace.

These can be “acted out” in their These can be “acted out” in their relationships with clients.relationships with clients.

This will impact on the quality of service This will impact on the quality of service delivery and treatment outcomes.delivery and treatment outcomes.

Worrying trends:Worrying trends:

““Service User Involvement”- often Service User Involvement”- often becomes little more than a vehicle for becomes little more than a vehicle for staff recruitment/volunteer recruitment staff recruitment/volunteer recruitment where the needs of the organisation get where the needs of the organisation get put before the needs of both current put before the needs of both current and recent clients. ie it can be and recent clients. ie it can be exploitatative.exploitatative.

Family and Carers – often services can Family and Carers – often services can do the same thing here, seeing family do the same thing here, seeing family members as helpers rather than clients. members as helpers rather than clients.

Worrying Trends (2)Worrying Trends (2)

Services are driven by “contract culture”Services are driven by “contract culture” Services are driven by “targets” as part of Services are driven by “targets” as part of

the above and targets are often the above and targets are often inappropriate and serve no useful purpose inappropriate and serve no useful purpose in terms of service development.in terms of service development.

Outputs rather than OutcomesOutputs rather than Outcomes Staff increasingly become unpaid Staff increasingly become unpaid

bureaucrats – monitoring and data bureaucrats – monitoring and data collection hinders the therapeutic alliance. collection hinders the therapeutic alliance.

Managing growth and “founders syndrome”Managing growth and “founders syndrome”

Warning SignsWarning Signs

Stress becomes distressStress becomes distress Team members fall back into family Team members fall back into family

of origin roles.of origin roles. ““5 year big bang theory”5 year big bang theory” ““My clients”My clients”

PossesivenessPossesiveness SecretsSecrets Collusion with clientsCollusion with clients

Warning Signs (2)Warning Signs (2) BoundariesBoundaries

Time – workaholismTime – workaholism Personal details (home phone number)Personal details (home phone number) Health and Safety:Health and Safety:

Home VisitsHome Visits Putting self and agency at riskPutting self and agency at risk

Catering to the addiction:Catering to the addiction: Appointment timesAppointment times LiftsLifts Taking “responsibility” for “my clients” rather Taking “responsibility” for “my clients” rather

than giving them opportunities to learn to take than giving them opportunities to learn to take responsibility for themselves. responsibility for themselves.

Some Suggestions:Some Suggestions:

Organisations need Strong Boards, Organisations need Strong Boards, CEO’s are as prone to be dysfunctional CEO’s are as prone to be dysfunctional as everybody else. Possibly more so!as everybody else. Possibly more so!

Focus on quality, not quantity. Quality Focus on quality, not quantity. Quality of staff service delivery – not the of staff service delivery – not the growth of the staff team. Staff growth of the staff team. Staff Retention not expansion.Retention not expansion.

Have policies that are more than paper Have policies that are more than paper to please the commissioning managers. to please the commissioning managers.

Some Suggestions (2)Some Suggestions (2)

Separate Supervision from line Separate Supervision from line management. The 2 are different management. The 2 are different functions and don’t always mix.functions and don’t always mix.

Have staff support groups, not just team Have staff support groups, not just team meetings. Use an “outside” facilitator.meetings. Use an “outside” facilitator.

The staff represent 70% of the assets of The staff represent 70% of the assets of any treatment service. Invest in any treatment service. Invest in training.training.

Develop staff retention strategies. Develop staff retention strategies.

Final Thoughts:-Final Thoughts:-

I have seen it said that the career span I have seen it said that the career span of most people in the AOD treatment of most people in the AOD treatment field is around 5 years from beginning field is around 5 years from beginning to end. This means that the average to end. This means that the average client uses drugs for much more time client uses drugs for much more time than the average worker will last than the average worker will last around the addiction field. Ask yourself around the addiction field. Ask yourself why.why.

An agency cannot treat its clients better An agency cannot treat its clients better than it treats its staff.than it treats its staff.

Contact DetailsContact Details

John ChamberlainJohn Chamberlain

The Alchemy Project LtdThe Alchemy Project Ltd [email protected]@alchemyproject.c

o.uko.uk 07970 94490707970 944907