Building “Addiction-Free Families” Step 1 Basic Information What is a drug? What is a drug? It is a substance that alters the structure and function of the body. marihuana? tobacco? alcohol? tea? aspirine? Classifications Legal – Illegal For Health – for Recreation Stimulants – Depressors – Hallucinogens Abuse potential and medical value The addiction process Movie: What is an addiction? - Body - Relationships - Emotions - Life meaning Incurable, progressive, and mortal disease. The addiction process Use Misuse Abuse Dependency/ Addiction Pasos de la adicción The Co-dependency process within the family Addict Family Use Good Control The process of independency could be altered. Misuse Moderate Control The ocasional behaviours are seeing as normal (part of life/ part of growing) Abuse Moderate lack of control The behaviour is enabled They protect the addict from having consequences The topic is not argued The negation process starts as a defense mechanism Internal cohesion sorrounds the famuly member Hiperrresponsability Complete lack of control Family secret Feelings arise: feeling hurt, assamed, unadequate, guilty, worried. The own needs are replaced for the addict needs Dependency Deaths in the U.S. (Please note that death is not the only consequence or even the worst, of abusing drugs) Building “Addiction-Free Families” Step 2 Risk and Protection factors Activity ¿What are the main reasons to take a drug? ¿What are the main reasons for not taking it? Why people use drugs? Why people use drugs? Why people use drugs? Why people don’t use drugs? Why people don’t use drugs? Risk Factors: A class (2 points) Having parents, uncles or brothers with an addiction problem. Been diagnosed with a behavioural problem which includes loss of self control. Trying legal drugs before permitted age or illegal drugs before 20. Non or bad ADHD treatment. Having anxiety or depression. Been exposed to a trauma like sexual or physical abuse. Experimenting a strong transition (loose job, friends, couple) Been in a constant conflict with the family and/or couple. Been exposed to drugs and alcohol within the community. Other risk factors among teenagers (12-17 años) They go two times more to parties, especially when there are not parents available. They belong to a school where is easy to get drugs inside. Between 13 and 14 years old the increase in first time users is considerable. Having low grades. Having separate parents (even more risky than having divorced parents) They don’t attend religious offices. They barely eat or have dinner with their family. They sleep less than 8 hours a day. Protection factors Developing self esteem; assertiveness, and good communication of emotions. School attachment, good social skills, and resiliency. Good family communication. Good family relations Constant and adequate discipline. Having, and giving good and accurate information about alcohol/drugs since they were kids. How to reinforce the protection factors? Be an example: not only about the way you consume, but also the way you relate to others and live your life. Teach your kid to say “No” even with you and others. Value the people who is different in opinions and look. Let your kid have different kinds of friends: it strengths their criteria. Value the effort, not only the success. How to reinforce the protection factors? Help your kid to have realistic goals, but don’t cut their aspirations. Give your kids responsibilities for themselves and for home. Let your kids learn to choose and to defend their point of view. Help them by exploring pros and cons in a decision. Help them reflect after the decision and the consequences are done. Show your emotions to them. How to reinforce the protection factors? Teach your kids about how to talk about their feelings in both positive and negative situations. Don’t be indifferent. Value ethically the actions but not the persons. (but don’t judge your son or others) Let your kids learn the tolerance to frustration. The imporance of waiting. Building “Addiction-Free Families” Step 3 Communication: talking about alcohol / drugs Between 2-5 years Pre-schoolers Need to understand beneficial drugs/substances vs. misused drugs/substances vs. harmful drugs substances Pointing harmful substances at home that the child may not touch Keeping poisonous products out of reach Explaining how medicines work. How to use them and the medical supervision needed Between 5 – 9 years Literal inquisitive and open to new information and experiences. Concrete and immediate world. (along with nutrition, exercise, safety, hygiene, body parts, illness prevention, family life, selfworth, interpersonal communication taught by school and parents) Experiential material What drugs and medicines are. How foods, poisons, and illegal drugs differ. 5-9 Why taking the wrong substance (or too much of it) can hurt you What the rules are at home and at school regarding alcohol, tobacco, and other drugs Refusal skills. Drug Safety Rules Which adults to trust for questions in an emergency Reject unknown candies, pills, especially from strangers How to listen and talk about emotions without offending Between 9 - 12 Enjoy learning and take pride in knowing lots of facts (the more bizarre the better). Some begin experimentation with alcohol, tobacco or other drugs. They need credible information and strong no use messages. Differences between use, abuse, and addiction (biological and psychological) Short and Long Term effects and consequences of alcohol and other drug use. Between 9 - 12 Why people use and or abuse drugs Value choosing not to use. Connection between non-use and self-steem, positive values, and achievement. Media and peer pressures. Refusal Skills. Passive smoking and health. Value of sports, art, etc. Relaxation exercises. Healthy social skills Between 13 - 16 7th-9thSome students begin to experiment, and a few graduate to regular use or abuse. They need encouraging for stopping. For those who still not use, reinforcement in values and skills is really helpful. They are able to think abstractly and consider their own identity and future. They compare themselves and their families with others. Belonging is very important for them. They need family and emotional support, dialogues and clear rules and expectations, positive role models, opportunities for social bonding, and healthy alternative highs. Between 13 - 16 Risk Factors for abuse and addiction (family history, age of first use, environment).Progression of chemical dependency from use to addiction. Effects of drug use on social, emotional, intellectual and physical development. Specific drugs and how they affect the physiology and psychology of the body and human development. Media and cultural influences. Intervention skills. When, where, and how to seek help. Effects of alcohol and other drugs on driving, pregnancy, sexual responsibility. Between 13-16 Ramifications of drug use for family relationships, personal values, identity development. Refusal skills. Misperceptions surrounding use by their peers and adults. Having clear rules about alcohol and drugs Decision making Between 6 - 19 They have more experience, their own that of others. They are more challenging, and will question what they hear. Some students are looking for reasons to use. Others are looking for reasons to continue to not to use. They appreciate a honest and sincere approach, and the message will be lost if not. Between 16 - 19 Risk Factors for abuse and addiction (family history, age of first use, environment). Progression of chemical dependency from use to addiction. Effects of drug use on social, emotional, intellectual and physical development. Specific drugs and how they affect the physiology and psychology of the body and human development. Media and cultural influences. Intervention skills. Between 16 - 19 Same topics but in a deeper way:When, where, and how to seek help. Effects of alcohol and other drugs on driving, pregnancy, sexual responsibility. Ramifications of drug use for family relationships, personal values, identity development. Refusal skills. Misperceptions surrounding use by their peers and adults. Basic Skills for Communication… Skill 1: Reframe: put in your own words what the kids say. Skill 2: When you are speaking with the kids, watch their faces and body language. Skill 3: Bring support and non verbal feedback. Basic Skills for Communication… Skill 4: Use the proper tone of voice for the response you are giving. Skill 5: Use stimulating phrases that may show your interest and can keep alive the conversation. Others: Choose the right moment. Speak directly about what worries you. Take advantage of the occasions when it comes easy to the conversation (after a movie, a song, an experience, etc.) ABOUT THE OWN CONSUMPTION... The “this is what I did… this is what I regret … because of…” Never! Feel ashamed about speaking about drugs. It is a health problem (check how comfortable you are on this). Lie or exaggerate the consecuences: the fear last a few, and adolescents try everything by themselves. Judge your kid or or his friends: You’ll close the communication. Never! Be self virtuous o hipocrate. Pretend to have all the answers; don’t overwhelm with advises and tips Criticize or make him feel ridiculous Think that your kids problems are less important than the adult problems. Be incongruent between what you say and what you are. Speak in an accusative tone. Activity Role Playing... Talking with a kid. Look for a partner. We’ll share at the end how we felt. Building “Addiction-Free Families” Step 4 Discipline and rules around the use and abuse of alcohol/drugs If I drink sometimes, can I ban my kid from drinking? (the guilt) If his brother does it? If ‘everybody’ does it? Key points Set your own position about drugs. Set rules: few, clear, congruent. Dialogue: what would happen if you…” Don’t feel guilty about setting rules and having consequences. Dare to give consequences: choose approppriate. Have warm discusions Don’t allow everything Supervise Value honesty but at the same time demand commmitment. Clear rules, non changing, fair, not life sentences. Exercise: create rules for certain situations. Giving the consequence Appropiate to the mistake Don’t negotiate the consequence in the moment. Set it when you are calmed and not angry; try to make it soon. NEVER… Constantly spy Pursue and pressure; change the rules suddenly, even if you are suspicious. Give to much freedom to the extent where there is not structure. Threat: they loose strength as a control tool with time. Activity Creating a rule list… The talk and negotiation of a rule list… Building “Addiction-Free Families” Step 5 Assessing the risk and resources available in my community Is my son/daughter using drugs? There are signs like alcohol/drug smell, founding drug paraphernalia like mirrors, rolling papers, pipes, etc. Change of priorities, change of friends Having less interest in routinary activities; slowing down in grades and/or attendance. Sudden changes in the routine, sleeping less; change in the appetite. Isolation or euphoria; drastic mood changes. The Pupil on Drugs How to help somebody close to us Informal Intervention 1. Learn All You Can About Chemical Dependency Addiction is a primary illness Addiction is a progressive illness Addiction is a chronic illness Addiction is is a fatal illness 2. Get Help for Yourself Don’t shoulder the entire burden yourself Seek out a support group Talk to your friend when he or she is sober and clear-headed 3. Pick the Right Time and Place Talking to a person under the influence is a waste of time. Choose a setting that is calm, private, and free of distractions and interruptions. 4. Plan What You’re Going to Say Give some thought ahead of time to your feelings about your friend. What do you like and respect about her? How has she helped or supported you in the past? What are the specific behaviors or stated attitudes that fuel your concern? What options exist for helping her? 5. Convey Your Affection and/or Respect Let the person know how much she means to you, how important the relationship is to you. Talk about her fine qualities and all the times she has helped and supported you. This minimizes the possibility of anger or defensiveness on her part. 6. Express Your Concern Be caring and non-judgmental: − “You’re my best friend and I’m really worried about you.” − “I’m afraid you’re going to hurt yourself.” − “I worry that some of the things you’re doing could have harmful and irreversible consequences.” 7. Use Specific Examples Provide examples of the worrisome behaviors you have observed. Avoid hearsay, sweeping generalizations, accusations, or blameful statements such as: − “You’re destroying your life.” − “You have a really big problem with drugs.” − “You’re hurting everyone around you.” − “You’re an addict.” Statements such as these trigger anger and argument 7. Use Specific Examples (cont) Instead, describe the behaviors or incidents you have personally witnessed: − “The last two times we went out you drank so much I had to get home by myself.” − “You said really mean things to Amy and she left the party in tears.” − “Last season you were the lead scorer, and this year you’re warming the bench.” 7. Use Specific Examples (cont) Talk about how the person’s behavior is affecting you and your relationship: − “I miss spending time with you.” − “I don’t like it when you ask me to lie to protect you.” − “I’m embarrassed to invite you over to my house now.” It’s hard to predict your friend’s reaction. Common reactions: tears, anger, deffensive, She might lash out at you as “someone who should talk” considering all of “your problems.” This can be very hurtful. Try to see it as the illness talking, and not your friend. Don’t argue or get angry. Your friend would rather debate the issue than look at her own behavior. Instead… 8. Offer to Help Depending on the circumstances, offer to go with her to the school counselor, her parents or doctor, a 12-step meeting, and/or a local resource for evaluating and treating people with substance abuse problems. Tell her that chemical dependency is not a problem she can solve alone. Your friend may make excuses for why she doesn’t need to get help. She may promise to “quit” or “cut back” on her own. Know in advance how you will respond to this and any other objections to seeking help she is likely to make. 9. Set Limits Don’t be a co-conspirator (enabler) in the problem. Establish limits so that you will no longer be in awkward or dangerous situations: − “I’m not going to let you copy my homework.” − “I only want to spend time with you when you’re sober.” − “I’m not going to lie for you anymore.” 10. Don’t Expect Miracles Your intervention may not appear to have “worked.” Don’t be discouraged. People rarely change long-standing behaviors based on one remark or conversation. Each expression of concern, added to the next, can lead to that point at which your friend is no longer able to ignore the truth. The Formal Intervention Same steps Is run by a proffesional Is usually group focused Requires commitment and changes from the people around. The CRAFT Model(Community Reinforcement and Family Training) Your love has power. You are not alone You attract and are more powerful with love words than critic words. You can try several times by giving little steps. Setting goals might help. Is also about learning how to take care of yourself. It certainly not always works but it never hurts. When you change the way you respond to your people, you can also change your own feelings, even the most destructive ones. Know how to ask for help; know how to accept help Activity: Check list Myths The addicts are bad, fool or crazy. They are bombs and live in the streets. It’s just a question of will power. (the reward system is not conscious in the brain) The addicts need punishments, not treatment. If you are addicted to one drug, you are addicted to the others. (although it’s proven there is a relation) The addicts don’t need medication. It’s only a behavioural problem, not physical. To quit drugs you only need to stay in one place and/or go to AA meetings. The Intervention There are not signs that any teenager can quit drugs by themselves. Although some teenagers learn the resources to get out of drugs after experimenting, this is not always the case. Usually they need some kind of help, sometimes moderate, sometimes emergency help. What to look if you need help? A treatment is… Detoxifying Rehabilitation Continued treatment Other alternatives: Family therapu, individual therapy, support groups, rehabilitation clinics, medical and spiritual support. Is it a good rehab centre? Is it designed for teenagers or there are teenagers in the centre? Is there any kind of assessment in the admission process? Does it last between 3-12 months? Does it reminds more like a home? Can he continue his studies inside? The centre has good patient retention numbers? Is there a support program for the family? Is there professionals available 24hrs a day? Are there any previsions to give continuity and support when the teenager is out of the centre? Do they have information about the effectiveness of the program? Relapses Between the 50% and the 80% of those who get detoxification relapse. 30% relapses in the first year. The best way to prevent a relapse is by giving continuity to the treatment; looking for help in crisis stages, and by looking for the common signs in the patient before the relapse. Resources Choices and Consequences Hoffman, Froemke. Addiction : Why can’t they just stop? HBO Ed. 2007 FCD Magazine/ prevention program. National Survey of addiction and attitudes. USA 2006. Resources on the internet http://www.buenaestima.com/ http://www.edex.es/10pasos/default.asp Bibliography FCD Guidelines (Freedom from Chemical Dependence) Recursos Audiovisuales What the bleep do you know??