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
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.
2
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
3
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
4
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.
5
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.
6
Rationale – Why Provide Services to
Family Members?
Addiction wreaks
havoc on families
 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
7
Rideauwood’s Family Program Model
The Family Program
Whole
Family
Model
Coordination &
Collaboration
Supports for
Children’s Aid &
Social Services Children & Youth
Family
Intervention
Gambling
Programs
Family & Couples
Counselling
Coordination &
Collaboration
Family Community
Outreach & Education
Drug
Self-help
Residential & Non-residential
Treatment
Groups
Adult Addiction Programs
Court
Examples of Other Rideauwood and Community Services and Programs
8
The Family Program
Ontario
Works ASI
Youth
Addiction
Parent
Program
Family
Program
SchoolBased
Addiction
Youth
Justice
Addiction
Drug
Treatment
Court
Young
Adult
Concurrent
9
Client Profile
 Partners and former
partners
 Parents
 Adult children from
families with addiction
 Adult siblings
 Extended family members
 People in recovery
 Have been, or are being
affected by addiction
 Have significant stress
and coping issues
 Are sufficiently stable
10
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).
11
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.
12
Rideauwood’s Family Program Model
Intake
“Family
Spiral”
Initial
Support
Group
Assessment
Phase I
Five-day Intensive
Program
Phase II
Eight-month
Structured
Program
Phase III
+
Individual
Counselling
Family of Origin
Program &
Ongoing
Personal Growth
13
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.
14
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.
15
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.
16
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.
17
Areas of focus include
• Feelings
• Emotional
Enmeshment
“Co-dependence”?
• Detachment
• Boundaries
• Communication
• Relationships
• Grief and loss
• Self-care
18
Fostering Awareness
Using a rating scale, ranging from seldom to usually, clients
respond to a series of statements regarding their emotional
entanglement, for example:
1. I struggle to identify and express my feelings
2. I put others’ needs before mine
3. I am afraid of how others might respond if I shared
honestly with them
4. I am very loyal even if others are not loyal to me
5. I find it difficult to ask for help from others
6. . . .
19
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 . . .
..
20
What happens if
we don’t deal with
our feelings?
21
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 . . .
22
23
24
Outcomes
25
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.
26
27