Substance Affected Families and Resource Management

1. Mara J. Briere Concordia University – St. Paul Substance Affected Families and Resource Management

2. Explore the monetary and non-monetary costs to society and families that are induced by substance use and abuse. • Acquire greater understanding of how families are affected. • Identify risk and protective factors. • Determine the types of community resources available to families. • Increase awareness of the monetary and non-monetary costs to families affected by substance use and abuse. Presentation objectives

3. In the United States today: • Half of all children (35.6 million) live in a household where a parent or other adult uses tobacco, drinks heavily or uses illicit drugs. • 37.4 percent of children (27 million) live in a household where a parent or other adult smokes or chews tobacco. • 23.8 percent of children (17 million) live in a household where a parent or other adult is a binge or heavy drinker. • 12.7 percent of children (9.2 million) live in a household where a parent or other adult uses illicit drugs. (CASA White Report, 2005) Jarring statistics

4. Many of the costs are immeasurable – for example, broken homes, illnesses, shortened lives, and loss of good minds from industries and professions; robbery, assault & battery, prostitution (law enforcement officials estimate that prostitutes take in a total of $10-$20 billion per year). Hanson, G., Venturelli, P., Fleckenstein, A. (2006, pp.39-40). Cost of drug use to society

5. Contributors to the Economic Costs of Substance Abuse and Addiction • Health care expenditures • Alcohol and drug abuse services • Medical consequences • Productivity (lost earnings) • Premature death • Impaired job performance • Institutionalized population • Incarceration • Criminal victimization • Other impacts on society • Crime • Social welfare administration • Vehicular accidents Adapted from Harwood et al., Addiction, 1999.

6. including communicable diseases such as hepatitis and HIV; STDs; • impact on developing fetus during and after pregnancy such as Fetal Alcohol Syndrome. • welfare for affected children, • drug-related deaths, • emergency room visits and hospital stays, • automobile fatalities • Cancer, diabetes, heart disease medicAL and psychological care

7. The research shows that 70% of all current illegal drug users ages 18-49 are employed full-time. 90% of alcoholics work. This means that 1 out of every 6 employees uses alcohol and/or other illicit drugs. Hanson, G., Venturelli, P., Fleckenstein, A. (2006, p.45). Drugs in the workplace

8. These workers are 3x more likely than the average employee to be late to work; They are 3x more likely to receive sickness benefits; They are 16x more likely to be absent from work; They are 5x more likely to be involved in on-the-job accidents (note that many of these hurt others, not themselves); They are 5x more likely to file compensation claims. Hanson, G., Venturelli, P., Fleckenstein, A. (2006, p.45). Summary of the findings re work:

9. It is important to take into account the multitude of economic, psychological and environmental factors, including poverty, lack of permanent housing, mental illness, child abuse and inadequate parenting skills, which can have significant impact on the home environment and parent child relationship in SAFs. How are families affected?

10. Decreased income. Drugs, alcohol, and tobacco are expensive and take away from other family needs. Increased health care costs. Homelessness. Legal complications. Monetary costs of safs

11. Caretaking often falls to one parent or another family member. Children’s behaviors require more attention from the family. Partners disconnect. Energy spent in compensating for the user. Parenting practices suffer. Environmental neglect. Non-monetary costs of safs

12. Robertson, David, & Rao (2003). Preventing drug use among children and adolescents, in brief. 2nd Edition. Retrieved on March 26, 2009 from the National Institute on Drug Abuse (July 15, 2008) from http://www.nida.nih.gov/Prevention/risk.html Risk and protective factors

13. Higher incidence of divorce, • Single parenting, • Domestic violence, • Abuse, • Neglect. • Poverty • Homelessness • Mental illness • Genetic predisposition to addiction • Higher incidence of adolescent drug use. Family risk factors:

14. We Know There’s a Big Genetic Contribution to Drug Abuse and Addiction… ….Overlapping with Environmental Influences that Help Make Addiction a Complex Disease. Stanford (2008)

15. Strong bond between children and parents. • Effective parenting practices. • Cooperation between caregivers. • Parents in recovery. • Parental involvement in child’s activities. • Supervision. • Stability and safety within the home. • Community involvement in constructive activities. Family Protective factors

16. Treatment. Child care. Counseling. Parent education. Transportation. Employment skills/school. Prevention programs. monetary Costs of protective factors

17. Time. • Patience. • Willingness. • Availability. • Effort (energy) applied to making changes in the family including how each member engages. • Resumption of roles. • Establishing family stability. • Acquiring new skills. Non-monetary costs of protective factors

18. Needs to consider… • Diversity/culture • Mental illness • Physical health • Employment • Gay, lesbian, bisexual & transgender • Religion • Language • Adolescent • Elderly • Homeless • Immigrants • Runaways • Transportation options Price (2007)

19. Facts of Addiction Treatment • Addiction is a brain disease • A chronic disorder requiring multiple strategies and multiple episodes of intervention • Treatment works in the long run • Treatment is cost-effective NIDA (2007)

20. For families for the addict • Support Groups • 12 Step Groups • Parent Support Groups • Community Coalitions • Churches/Clergy • Community Mental Health Centers • Home-based therapy • Case management • State agencies (DCF, DYS, DPH, DMH) • Prevention Groups • Adventure-based programs • Inpatient treatment • Residential Treatment • Intensive Outpatient Treatment • Psychiatric Hospitals • Detoxification • Outpatient treatment • Home-based therapy • Case management • Private vs. public agencies • Therapeutic boarding schools • Shelters • Vocational training • Drug Courts Types of community resources Price (2007)

21. A Conceptual Model: Continuous Recovery Monitoring Stanford (2008) Determinants of Progress in Treatment: Patient motivation, responsibility, choice Predisposing factors Enabling factors/barriers Illness/Need factors System of Care characteristics Prepare client for Continuous Recovery Monitoring Detox Residential Outpatient Transitional Post-Treatment housing check-ups. Identify within-session patient-therapist behaviors that predict subsequent dropout or relapse and titrate the counseling “dose” accordingly. • Patients are taught to be proactive, not reactive, to their disease. • Continuous monitoring: • Healthy lifestyle • Self management support • Patient & family education • Regular follow ups with provider • Support groups

22. Conceptual Model indicates the lowest level of economic expense related to treatment and recovery for families. • The costs in time, however, remain high because families are asked to participate in counseling, group meetings, drug education and other activities offered for families in recovery. • Parents need to learn how be more effective parents, including how to discipline children reasonably. • The work of re-establishing roles, rules, and responsibilities requires the mobilization of resources including time, temperament adjustments, personal energy, and other intangibles. HBO Addiction (2007) Cost of recovery

23. The problem: Substance use and abuse. The decision to be made, i.e. the process: Impact on society and families. Choice or decision that is made; the solution: Treatment in a continuum; ongoing community options for families. How the choice will be implemented: Treatment, prevention and education. Summary

24. Begun, A.L. (Ed.). (2005, March). Social work curriculum on alcohol use disorders. National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health. Retrieved February 3, 2009, from http://pubs.niaaa.nih.gov/publications/Social/Module10JFamilies/Module10J.html • Gruber, K., Fleetwood, T., & Herring, M. (2001). In-home continuing care services for substance-abuse affected families: The bridges program. Social Work, 46(3), 267-277. • Hanson, G., Venturelli, P., Fleckenstein, A. (2006). Drugs and society, 9th edition. Boston: Jones and Bartlett Publishers. • HBO:Addiction (2007). Retrieved February 21, 2008 from http://www.hbo.com/addiction/understanding_addiction/12_pleasure_pathway.html • Price, D. (2007). Substance abuse treatment and community resources. Unpublished Paper. UMass-Boston: Substance Abuse Counseling Program. • Robertson, David, & Rao (2003). Preventing drug use among children and adolescents, in brief. 2nd Edition. Retrieved on March 26, 2009 from the National Institute on Drug Abuse (July 15, 2008) from http://www.nida.nih.gov/Prevention/risk.html • Stanford, M. (2008). Understanding the science of addiction. Retrieved on March 15, 2009 from http://democrats.assembly.ca.gov/members/a24/Issues/Drug_Alcohol/hearing_20070617.aspx • The National Center on Addiction and Substance Use at Columbia University. (2005). Family matters: Substance abuse and the American family: A CASA White paper. Retrieved August 28, 2008, from http://www.casacolumbia.org/absolutenm/articlefiles/380-Family%20Matters.pdf references