CHAPTER 11: Working with Selected Populations: Treatment Issues and Characteristics

1. CHAPTER 11:Working with Selected Populations: Treatment Issues and Characteristics Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

2. Overview of Chapter • Children and Adolescents • Women • The Gay/Lesbian/Bisexual/Transgender Community • People with Disabilities • Older Adults • Homelessness

3. Children and Adolescents • Key risk periods for drug abuse occur during major transitions • Vulnerable life periods are transitions • Moving from one developmental stage to another • First major transition for children is when they leave the security of the family and enter school • Next is when they advance from elementary to middle school • It is at this stage (early adolescence) that children are likely to encounter drug use for the first time • Next is entering high school • Greater exposure to available drugs, drug users, and social activities involving drugs • Life changes • Moving • Parents divorcing

4. Children and Adolescents • Research indicates that signs of risk can be seen as early as infancy or early childhood, including: • Aggressive behavior • Lack of self control • Difficult temperament • Family situations also increase a child’s risk for later drug abuse when there is: • A lack of attachment and nurturing by parents and caregivers • Ineffective parenting • A caregiver who abuses drugs

5. Children and Adolescents • Research suggests that conduct disorders and other behavioral and temperament traits that increase a youth’s vulnerability to drug use develop as a fairly stable pattern as early as 5 years of age. • Characteristics of these children • Impulsivity • Attention Deficit Disorder • Difficult temperament • Below-average verbal IQ • Academic underachievement • Negative affect • Difficulties with emotional regulation • Social incompetence • Aggression

6. Children and Adolescents

7. Children and Adolescents • Individual Risk Factors: • Early and persistent behavior problems such as stealing, vandalism, conduct disorder, atttention-deficit hyperactivity disorder (ADHD), rebelliousness, and aggressiveness, particularly in boys • High-risk personality factors such as sensation seeking, low harm avoidance, and poor impulse control • Low self-esteem • Deficits in behavioral-affective regulation • Antisocial behaviors • Alienation • High tolerance for deviance and strong need for independence • Psychopathology • Attitudes favorable to drug use

8. Children and Adolescents • Family Risk Factors • Low parental involvement • Family history of alcohol or drug use • Poverty • Parental substance use and modeling • Poor family management and parenting practices • Poor parent-child relationships • Family conflict • Physical and sexual abuse • Peer Risk Factors • Negative peer influence • Peer influence; peer rejection or low acceptance

9. Children and Adolescents • School Risk Factors • Low commitment to school/lack of school bonding • School failure • Failure to achieve in school • Low school involvement • Negative school involvement • Community Risk Factors • Lack of social competence • Community and interpersonal violence • Deficient cultural and social norms • Neighborhood disorganization that reduces the sense of community

10. Children and Adolescents • Important goal of prevention is to change the balance between risk and protective factors. • Most frequently identified protective processes • Parent-child attachment • Parental supervision • Communication of family values • Second-most important socializing agent for children, after the family, is the school. • School-bonding and achievement are critical protective factors.

11. Children and Adolescents • Factors which were found to increase resiliency: • Optimism and hope • Self-efficacy • Strong self-regulation skills • Problem-solving skills • Adaptability • Self-regulation • Sense of humor • Easy temperament • Close relationship among family members • Low discord between parents • Warm and structured parenting style

12. Children and Adolescents • Prevention and Intervention • Family support programs that encourage involvement of the parents in their children’s lives • Prevention programs designed to increase positive peer relationships • School Prevention Programs should be integrated within the school’s own goals of increasing academic performance and should focus on: • Improving academic and social-emotional learning to address risk factors for drug abuse • Support for positive peer relationships • Education component designed to correct the mispercetion that most students are using drugs

13. Children and Adolescents • Meeting adolescent specific needs • Steps • Initial screening • In-depth assessment covering: • Psychological and medical problems • Learning disabilities • Family functioning • Other aspects of youths’ lives • Treatment program

14. Women • Risk Factors • Agrawl reports that women (18-49 years of age) who are married have a lower rate of substance abuse or dependence than unmarried women • History of divorce is positively associated with illicit drug use, not dependence. • Partners can influence each other’s drinking and drug use. • Women are more likely than men to have co-occurring mental and substance use disorders. • Affects on pregnant women • Alcohol is the most common cause of malformation to the embryo or fetus in pregnancy.

15. Women • Prevention and Intervention • Reports concerning treatment of women have shown: • Women experience a number of barriers to receiving treatment, including: • Child Care • Stigmatization • Inability to pay for treatment • Women are more vulnerable than men to some of the physiological effects of substance abuse • Substance abuse among women is more often rooted in psychosocial problems and traumatic life events

16. Women • Protective Factors • Parental Warmth • Spousal or Partner Support • Spiritual Presence • Coping Skills

17. The Gay/Lesbian/Bisexual/ Transgender Community • Gay/Lesbian/Bisexual/Transgender Identity Development • “Coming Out” • Assumptions of Cass’s Model • Identity is acquired through a developmental process • Change in behavior stems from the interaction between individuals and their environment • Stages of Identity Development • Identity confusion • Identity comparison • Identity tolerance • Identity acceptance • Identity pride • Identity synthesis

18. The Gay/Lesbian/Bisexual/ Transgender Community • Risk Factors • Prejudice and discrimination • Cultural issues • Legal issues • Accessibility • Families of origin • Health issues • Gay bars • Treatment is the same as that for other individuals • However, some GLBT clients will need to address their feelings about their sexual orientation as a part of their recovery

19. People with Disabilities • Risk Factors • Substance abuse behaviors need to be identified as to whether they are a consequence of, or a response to, the disabling event. • Contributing factors • Stress • Crisis • Loss and Grief • Body Image • Sigma

20. People with Disabilities • Risk Factors cont. • Most frequently experienced psychosocial reactions to a disability that affect one’s ability to cope: • Shock • Anxiety • Denial • Depression • Anger/Hostility

21. People with Disabilities • Prevention and Intervention • Substance abuse treatment for people with disabilities should include the following: • Family psychoeducation • Disability and medication management and education • Independent living skills education • Anger and stress management • HIV risk reduction, counseling, and testing • STD and infectious disease education • Interpreted self-help meetings for the deaf and hard of hearing • Health and wellness education • Case management and crisis intervention • Educational, Vocational, and residential referrals • Medical and psychiatric services • Domestic violence and victim assistance counseling • Development of social support networks • Self-esteem and body image

22. Older Adults • Risk Factors • Various biological, psychological, and social that accompany aging make older adults uniquely vulnerable to problems associated with substance abuse, including: • Loneliness • Diminished mobility • Impaired sensory abilities • Chronic pain • Poor physical health • Poor economic and social supports • Social stigma • Change in social support and work-related activities • Loss • One in four older adults have a significant mental disorder.

23. Older Adults • Prevention and Intervention • Research supports including the following into substance abuse treatment for older adults: • Age-specific group treatment that is supportive and nonconfrontational with focus on self-esteem building • Coping with depression, loneliness, and loss • Rebuilding the client’s social support network • Pace and content of treatment appropriate for the older person • Staff members who are interested and experienced in working with older adults • Linkages with medical services, services for the aging, institutions for treatment, and case management • Kinney stresses the importance of groups in substance abuse treatment for older adults.

24. Homelessness • An estimated 20%-25% of homeless people have a serious mental illness • One-half has an alcohol or drug problem. • Cause/Effect debate • Risk Factors • Four main groups that often suffer from homelessness and its effects: • Families • Youth • Veterans • Chronic Homelessness

25. Homelessness • Treatment • When homeless individuals feel humanized and treated with respect, they are more receptive to treatment services. • Another important factor in successful abuse treatment is housing.