FASD -> ACOA LOOKING BACK – LOOKING FORWARD

1. FASD -> ACOA LOOKING BACK – LOOKING FORWARD CONNECTING THE DOTS ANNE HARRINGTON RN CADC PERINATAL ADDICTION RISK REDUCTION SPECIALIST GATEWAY NORTHWEST MATERNAL AND CHILD HEALTH NETWORK

2. Childcare Financial concerns Support for pregnant women Job training Life skills training Transportation Peer support Housing Special women’s programs for minorities, HIV/AIDS, trauma, domestic violence, Post Traumatic Stress Disorders, etc. SCOPE OF WOMEN’S TREATMENT PROBLEMS

3. ISSUE: • 35 TO 50% OF WOMEN IN SUBSTANCE ABUSE TREATMENT HAVE POST TRAUMATIC STRESS DISORDER Najavits 2002

4. PROBLEM: Failure to understand and address issues specific to women leads to: • Increased symptoms • Increased behavior management • Increased relapse • Early discharge or self termination

5. Terminology • FETAL ALCOHOL SYNDROME • Term first used in 1973 by Drs. Smith and Jones at the University of Washington • One of the diagnoses used to describe birth defects caused by alcohol use while pregnant • A medical diagnosis (760.71) in the International Classification of Diseases (ICD)

6. Fetal Alcohol Spectrum Disorders (FASD) • Umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy • May include physical, mental, behavioral, and/orlearning disabilities with possible lifelongimplications • Not a diagnosis

7. FASD Facts • 100 percent preventable • Leading known cause of preventable mental retardation • Not caused on purpose • Can occur anywhere and anytime pregnant women drink • Not caused by biologic father’s alcohol use • Not a new disorder

8. Cause of FASD • The sole cause of FASD is women drinking alcoholic beverages during pregnancy. • Alcohol is a teratogen. “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” —IOM Report to Congress, 1996

9. FASD and Alcohol Binge = 4 or more drinks on one occasion for women One Drink = 12 ounces of beer, 5 ounces of wine or 1.5 ounces of hard liquor

10. HOW DOES ALCOHOL CAUSE BRAIN DAMAGE • Excessive cell death • Reduced cell proliferation • Migrational errors in brain development • Inhibition of nerve growth factor • Disruption of neurotransmitters

11. FAS and the Brain

12. FAS and the Brain A. Magnetic resonance imaging showing the side view of a 14-year-old control subject with a normal corpus callosum; B. 12-year-old with FAS and a thin corpus callosum; C. 14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum. Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

13. BEHAVORIAL EFFECTS FOLLOWING PRENATAL ALCOHOL EXPOSURE • Hyperactivity, reactivity • Attention deficit disorders, distractibility • Lack of inhibition • Mental retardation, learning difficulties • Reduced habituation • Perseveration

14. BEHAVIORS, CONTINUED • Feeding difficulties • Gait abnormalities • Poor fine/gross motor skills • Developmental delays (motor, social, language) • Hearing abnormalities

15. Primary Disabilities of Persons With a FASD • Lower IQ • Impaired ability in reading, spelling, and arithmetic • Lower level of adaptive functioning; more significantly impaired than IQ

16. Typical Difficulties for Persons With a FASD • Sensory Integration Issues • Information Processing Problems • Memory Problems • Executive Function Deficits

17. SENSORY INTEGRATION ISSUES • Are overly sensitive to sensory input • Upset by bright lights or loud noises • Annoyed by tags in shirts or seams in socks • Bothered by certain textures of food • Have problems sensing where theirbody is in space (i.e., clumsy)

18. INFORMATION PROCESSING PROBLEMS • Appear to be oppositional • Have trouble determining what to do in a given situation • Do not ask questions because they want to fit in

19. CONTINUED • Say they understand when they do not • Have verbal expressive skills that often exceed their level of understanding • Misinterpret others’ words, actions, or body movements • Have trouble following multiple directions

20. EXECUTIVE FUNCTIONING DEFICITS • Go with strangers • Repeatedly break the rules • Frequently do not respond to point, level, or sticker systems • Have trouble with time and money • Give in to peer pressure • Do not learn from mistakes or natural consequences

21. MEMORY PROBLEMS • Multiplication • Time sequencing

22. MULTIPLE OTHER ISSUES • Cannot entertain themselves • Have trouble changing tasks • Do not accurately pick up social cues

23. Secondary Disabilities of Persons With a FASD • Confinement in jail or treatment facilities • Alcohol and drug problems • Dependent living • Employment problems

24. Secondary Disabilities of Persons With a FASD • Mental health issues • Disrupted school experience • Trouble with the law • Inappropriate sexual behavior

25. Unemployment Loss of family Homelessness Jail Premature death Increased substance abuse Risks to an Adult of Not Accurately Identifying and Treating FASD

26. General Issues With FASD • Often undiagnosed among persons without FAS facial features • More difficulties seen in those without FAS facial features and with higher IQs • Adaptive functioning more impaired than intelligence

27. Economic Costs of FASD • FASD alone cost the United States more than $4 billion in 1998. • The average lifetime cost for each child with FAS is $2 million. • $1.6 million for medical care services • $0.4 million for loss of productivity

28. ONE PREVENTED CASE OF FASD SAVES • $130,000 in the first 5 years • $360,000 in 10 years • $587,000 in 15 years • More than $1 million in 30 years Increased savings through prevention Lupton, Burd, and Harwood (2004) )

29. DEFINITION OF ALCOHOLISM • PRIMARY • DISEASE • OFTEN PROGRESSIVE AND FATAL • IMPAIRED CONTROL • PREOCCUPATION • ADVERSE CONSEQUENCES • DENIAL

30. PROBLEMS AS A RESULT • PHYSICAL HEALTH • PSYCHOLOGICAL FUNCTIONING • INTERPERSONAL ISSUES • IMPAIRED SOCIAL RELATIONSHIPS • OCCUPATIONAL FUNCTIONING • FINANCIAL PROBLEMS • SPIRITUAL BANKRUPTCY

31. ADULT CHILDREN OF ALCOHOLICS ( ACOA ) CORE ISSUES • Always need to be in control / No sense of personal power • Unable to trust ( rigid boundaries ) / Too trusting ( no boundaries ) – Inappropriately loyal • Do not share feelings – little faith in the power of talking so talk very little or too much ( to hide )

32. ACOA ISSUES • Over responsibility ( “ I’m responsible for everything” ) / Under responsibility ( “ You’re responsible for everything” ) • Overly self – reliant ( no needs ) / Overly dependent ( only needs – little self – sufficiency ) • Difficulty having fun, relaxing / Only plays – difficulty with work

33. ACOA ISSUES • Guess at what “normal” is / Assume “normal” is what they knew as children • Take themselves very seriously / Minimize their pain

34. ADDICTED FAMILIES VS HEALTHY FAMILIES • RULES • ROLES • SECRETS • OUTSIDERS • SERIOUS

35. ADDICTED FAMILIES VS HEALTHY FAMILIES • PRIVACY / BOUNDARIES • LOYALTY • CONFLICT • CHANGE • UNITY

36. CHARACTERISTICS • NO TALK • NO FEEL • NO TRUST

37. CHARACTERISTICS • EMOTIONAL • PHYSICAL • BEHAVIORAL • MENTAL

38. Fear Anger Hurt Resentment Distrust Loneliness Sadness Shame Guilt NUMB EMOTIONAL

39. Tense shoulders Lower back pain Sexual dysfunction Stress related behaviors Allergies Gastro – intestinal disorders PHYSICAL

40. Thinking in absolutes Lack of information Compulsive thinking Indecision Learning disabilities Confusion Hypervigilance MENTAL

41. Crisis oriented living Manipulative behavior Intimacy problems Unable to have fun Tries to fit in Compulsive – addictive disorders BEHAVIORAL

42. Paradigm Shift • “We must move from viewing the individual as failing if s/he does not do well in a program to viewing the program as not providing what the individual needs in order to succeed.” • —Dubovsky, 2000

43. RETENTION IS KEY • EDUCATE THE STAFF AND CLIENT • RUN COLLATERAL GROUPS • INCREASE AWARENESS • PROVIDING SAFETY IS IMPERATIVE • OFFER CHOICES AND OPTIONS • HELP WOMEN GET THEIR POWER BACK