Empowering Women Toward Long-Term Recovery

1. Empowering Women Toward Long-Term Recovery Kathleen Tavenner Mitchell, MHS, LCADC Vice President and International Spokesperson National Organization on Fetal Alcohol Syndrome (NOFAS)

2. 2 Things Necessary for Life: • water • women

3. FASD; AN UNEXAMINED CAUSE OF RELAPSE IN WOMEN • Women that have used during pregnancy have severe guilt and shame that needs to be addressed in order to prevent relapse • Women that have children with unidentified FASD are at high risk for relapse due to the behaviors of their children and the belief that they are poor parents • Women that were exposed to alcohol prenatally may have FASD putting them at high risk for relapse

4. Key Clinical Practices • Ask: • All women of childbearing age about alcohol use • All pregnant women about alcohol use • Advise: • All women planning a pregnancy that no alcohol is the safest choice • All pregnant women that no alcohol is the safest choice • women who consumed alcohol during their pregnancy to contact local resources and services • Assist: • assist women to stop drinking through information, counseling, care and referral to appropriate programs and services

5. Opportunity • Pregnancy is an opportunity for change • Women who are pregnant are more receptive to intervention programs and treatment than women who are not currently pregnant

6. Discuss Birth Experiences with Women : Red Flags: • Two or more miscarriages? • Stillbirths? • Infant/child deaths (SIDS)? • Children with LD, ADHD, MH or behavioral disorders ? • Children diagnosed with FASD? Positive response to any of the above questions should warrant a screening of all children for possible FASD (where substance use is known or suspected) K Mitchell, 2004

7. During Screening • Follow up the screening questions with probes • Be non-judgmental • Listen attentively to her concerns • Refrain from negative comments or reactions • Focus on your patient as well as her baby • Be sensitive to broader issues and contexts such as poverty or abuse • Make positive statements about the woman seeking prenatal care • Make positive statements about progress during each visit

8. Refer to Treatment!

9. Locate Treatment that provides Feminine Focused Recovery: Address the unthinkable: • Sexuality • Biological differences • Menstruation • Abuse • Substance use during pregnancy and possible consequences • Secrets • Desires, dreams and fantasies

10. 3 Things that Keep and Addict Using • Stigma • Family Enabling (Guilt) • Defense Mechanisms

11. Women and Addiction • The center of the addict’s life is no longer God, the family, and/or her job/career, it is her addiction • All of her behavior has the ultimate goal of feeding the addiction • The family members become objects, means to an end, rather than “real people” • This causes the alcoholic to become their entire focus and center, or they abandon her

12. Progression of Alcoholism

14. Empowering and Honoring the Feminine • Intuitive wisdom • Motherhood / life-giving • Healers • Caretakers • Artisans • Visionaries

15. The Natural Order of the Universe • To live in tune with the Earth we need to remember that we too are a precious natural resource to be cared for and valued just as we value the trees or the sea. Like them we live in the rhythms of the seasons and the days. Addiction is a hurricane; an earthquake: These events can bring balance to Mother Nature

16. Feminine and Masculine Balance • Yin and Yang • Shakti and Shiva • The basis for harmony in all of life.

17. Change Perception: linear to circular

18. Yin Energy • Taoist term for the Feminine force. • The receptive, the watery, the earth. • Associated with the negative magnetic pole, with the moon, with coolness, with attraction rather than assertion. • The power of Yin comes from natural responsiveness, nurturing and support not direct independent action. • The receptive force is sensual, flowing, accepting and allowing. • Yin energy moves through feelings rather than thoughts, it is diffuse, spacious, and open.

19. The Feminine represents fertility, and is often seen symbolically as a chalice, cup, container, valley or womb. • She is the earth, the ground, the mother, the maiden, and the crone.

20. Honoring the Feminine • The essence of the Feminine is Love. • The pure white light of the Divine Mother’s unconditional love for all her children. • The Feminine is also the power of unity, of connection, of relatedness, which weaves all of creation together. • The Feminine emphasizes togetherness, similarities, correspondences, and Oneness.

21. Biological Differences • Women’s bodies have less body water than men of similar body weight • Achieve higher concentrations of alcohol in the blood with equivalent amounts of alcohol • NIAAA Alcohol Alert 1999

22. Women experience major organ complications more rapidly than men: Liver damage Cirrhosis Brain damage Heart disease High blood pressure Stroke Breast cancer Gastrointestinal hemorrhage Anemia Malnutrition Colon cancer NIAAA, Alcohol Alert 1999 Biological Differences

23. Menstrual Cycle • Calendar to chart bleeding, cravings, moods, behavioral reactions, depression • Discuss ovulation • Half-way through cycle • Increase in vaginal discharge • Slight cramping in abdomen • May augment moods

24. PMS Emotional Symptoms(Relapse Vulnerability) • Mood swings • Critical of loved ones • Negative thinking • Crying spells • Depression • Controlling attitudes/behaviors • Forgetfulness • Indecision • Panic attacks-Suicidal ideation

25. PMS Wellness • Reduce sugar & salt (diet soda’s) • Reduce or eliminate caffeine • Increase soy • Consider natural hormones (perimenapause or menopause) • Good Quality Multi-vitamin • Vitamin B compound & vitamin E • Calcium with magnesium • Limit dairy/increase green leafy vegetables • More AA, naps, relaxation, yoga

26. Honoring our cycle • Let others know what your needs are. • Indulge your creativity; it is keenest now. • Take a nap.  • Have a piece of chocolate. • Cook if you want to, or don’t. • If you need to cry…go ahead (set a time limit though, no all night pity parties allowed!) • Wear loose comfortable clothes. • Listen to your body, your inner wisdom knows best.

27. Honor Thy Bitch! All women have a dark goddess; she holds the power of the feminine! The dark goddess is the creator and the destroyer. She is depicted as one who cuts off the heads of men. This is a symbolic representation of her challenging the Ego. Embrace her POWER….She will lead her to Healing….to Recovery!

28. Menapause: The Crone Wisdom: Knowing arises from direct experiences This is a valuable natural resource; a teacher…a healer Brings balance to the “family”

29. Women with Addictive Disease Many have lost their voice; have turned off their “inner wisdom”: • Have low self-esteem • Have little self-confidence • Feel powerless • Majority have been physically and/or sexually abused • Are codependent • Have been living in secrecy

30. Traits of Codependency • Over developed sense of responsibility • “Stuff” feelings from traumatic childhood • Lost ability to express feelings • Isolated/afraid people and authority figures • Addicted to approval/excitement (crisis) • Frightened by angry people or personal criticism • See themselves as victims • Judge themselves harshly

31. Traits of Codependency • Abandonment issues • Feelings of guilt when they stand up for selves • Confuse love and pity, love people they pity (rescuers)

32. Ways to Destroy the Culprit ( Codependency) • Perfectionism • 3 P’s (perfectionism, procrastination, paralysis) • Vocabulary • Change “I can’t” to “I choose not to” or “I won’t” • Decision making • Make everyday decisions • Choices • Every action is a chosen action

33. Other Methods to Rescue Women from Addiction: • Relationships • Consider physically separating from partner • Detachment skills • Enabling • Remove client from enabling family members • Investigate “love verses enabling” • ACOA issues • Educate on effects on family • Treat childhood issues with relapse clients

34. Women need Women " How might your life have been different if there had been a place for you to go.. a place of women, to help you learn the ways of women, .. a place where you were nurtured from an ancient flow sustaining you and steadying you as you sought to become yourself. A place of women to help you find and trust the ancient flow already there within yourself. . waiting to be released. . How might your life be different?" Duerck

35. Identify or Create “Natural” Connections • Re-Connecting Women: • Family: • sisters, mothers, grandmothers, daughters, grand daughters • AA/NA • Women’s meetings, women’s retreats • Women Circle’s/Clubs/Meetings • Artist way meetings, inner child groups, quilting • Spiritual Communities • Social Activities • Health Club/Physical Activities/County Recreation • Art or yoga classes

36. Communication Skills:Setting BoundariesnoAssertivenessnot passive-not aggressiveHonesty I can’t to I won’t

37. Confrontation IS: • A challenge to both parties to stay open • An attempt to communicate honestly • A courageous act of good intent to state one’s feelings and thoughts • An effort to keep relationship growing • Misunderstood; It is not yelling, screaming, or guilt making • Part of healthy intimate relationships • An act of self-affirmation • Sets a boundary

38. Confrontation IS NOT: • An attack • An effort to hurt • Verbal abuse when done carefully • A thing to fear or avoid • The same as criticism

41. Parenting Issues • Guilt/shame • Child neglect and/or abuse • Feelings of inadequacy • Difficult past with care-taking of family • Legal/foster care

42. Sexuality • Promiscuity • Prostitution • Rape • Fear of sex • Incest and/or sexual abuse • Loss of orgasm • Painful sex • Sexual orientation • Value conflicts • Sexuality as a relapse trigger

43. Use Spiritual Concepts: (No longer in charge)“Breathe God in and me out”

44. Developing a Sense of Self • Kill the critics: Whose voice is that? • Discover the rule makers: Whose rules are those?

45. Meet the Committee • Have client focus on childhood (i.e. year 0 to 3) • Who were the people who nurtured you and supported you? • Who were the people that were not kind to you, hurt your feelings or hurt you in other ways? • List them, list the behaviors

46. Meeting Yourself • Investigate accomplishments: “Things I do really well” list • Long term goals- Do not let client limit themselves in reality • Short term goals- achievable, measurable, simple • Lists of needs/wants/likes

47. Clearing Negativity ; Releasing Attachments • Stuff • Everything is borrowed, I own nothing • People • It’s okay to love someone and celebrate connectedness • Wanting to possess another = misery • The less you try to control, the closer you become

48. Past  living in “shoulds”  living in “what ifs?”  self pity  criticism Form  preoccupation with appearance  guilt  can’t- they won’t  never- have to Releasing Attachments

49. Releasing Attachments • Being right • prevents communication • inability to listen • competitive • aggressive • don’t answer every remark • don’t give opinion unless asked

50. When life gives you lemons: Make lemonade