Family Issues in Dual Recovery

1. Family Issues in Dual Recovery

2. I. The Symptoms II. Ways of Coping - (Expressed Emotion & Loving Detachment) III. Available Resources - (MFGs, NAMI, Al-Anon, ?)

3. I. The Symptoms

4. The Symptoms Thought Disorders (Schizophrenia, Schizoaffective Disorder) • Loss of control over thoughts • Delusions, paranoia, hallucinations, apathy, amotivation, isolation

5. The Symptoms Mood Disorders (Depression, Bipolar, Schizoaffective Disorder) • Loss of control over moods • Mood swings, depression, suicidal thoughts and attempts, grandiosity, irrational / racing thoughts, hypersexuality, spending sprees

6. The Symptoms Personality Disorders(Dependent, Borderline, Narcissistic, Antisocial) • Loss of control over emotions • Dependent on others, critical of others, manipulative, challenging authority

7. The Symptoms Addiction (Alcohol, Marijuana, Cocaine, Heroin, etc) • Loss of control over substance use • Cravings, withdrawal, manipulative, dishonest, challenge authority

8. Consequences of Untreated Mental Illness and Addiction • Hospitalization (psychiatric and medical) • Incarceration • Unemployment, financial instability • Homelessness • Difficulty maintaining relationships • Death

9. The Family as the Primary Caregiver • > 65% of individuals discharged from psych hospitals live with their families • 50% of individuals fail to connect with aftercare if professionals depend only on the consumer’s motivation

10. The Family as the Primary Caregiver • Families experience a loss in expectation for what their loved one’s lives will become • Families experience an unexpected increase in responsibilities and stress associated with caring with a loved one with dual disorders

11. Stress associated with recovery from dual disorders • Contact with professionals is transient and irregular, often centered around crisis resolution • A lack of understanding about the causes and treatments for dual disorders often leads to conflict about how to manage and/or cope with them • The loved one often becomes “the center of the family” with time, energy, and resources

12. Stress associated with recovery from dual disorders • Families can experience “caregiver burnout” as a result of attempts to care for their loved one without expected results • The family can experience a “loss of control” • Family members (especially mothers) were supposedly determined to be the cause of schizophrenia in the 1970s, and labeled, “Schizophrenogenic mothers”

13. II. Ways of Coping

14. What we know about family coping strategies(Expressed Emotion - “EE”) • EE defined as “criticism, hostility, and emotional over-involvement directed at the individual by his or her family” • Individuals with schizophrenia living in homes with high levels of EE are significantly more likely to suffer relapses of psychotic symptoms

15. What we know about family coping strategies (Expressed Emotion - “EE”) • Levels of EE in families w/a schizophrenic member vary by culture • Families in India have lowest rates of EE (23%), families in Anglo-America have the highest rates (67%)

16. Expressed Emotion (EE) • Behavioral factors within the family affect the course and outcome of schizophrenia across cultures • In the modern American society, schizophrenia is thought of as being internal to the individual and incurable • Because a high degree of independence and self-sufficiency is expected of all individuals in the modern American society, the individuals are viewed as personally inadequate and therefore stigmatized

17. Families demonstrate more adaptive coping when they . . . • . . . have large social support systems • . . . have self-efficacy in dealing with loved ones • . . . belong to a NAMI chapter • . . . feel affirmed and valued for the information and skills they possess

18. Loving Detachment • Ability to maintain an emotional bond of love, concern, and caring, while holding back from the need to rescue, save, or fix another person from being sick, dysfunctional, or irrational • Willingness to accept that you cannot control a person, place, thing • Ability to allow people the freedom and dignity to be themselves; who they are, not who you want them to be

19. Loving Detachment • “Tough love” – ability to let people you love and care for accept personal responsibility for their actions, without “giving in” when they ask you to “bail them out” when their actions led to unfavorable results • Disengaging from unhealthy relationships with people in need, establishing emotional boundaries between you and those people you have become enmeshed or dependant with, to allow everybody to develop their own sense of autonomy and independence

20. If you are unable to detach . . . • . . . You will have people, places, things become over-dependent on you • . . . You will be easily influenced by perception of helplessness which these people, places, things project • . . . You will run the risk of being manipulated or intimidated into doing things for people, at places, or with things which you don’t want to do

21. If you are unable to detach . . . . . . You can become caught up with your idealistic need to make everything perfect for people, places, or things important to you, even if doing so makes your life become unhealthy • . . . You can become an obsessive “fix it” person, who needs to fix everything perceived to be imperfect

22. Family GuidelinesDr. William McFarlane (1991) • Go slow: Recovery takes time, rest is important • Keep it cool: Enthusiasm and disagreement are normal, but tone it down • Give ‘em space: Time out is important for everyone, it is okay to offer or refuse

23. Family GuidelinesDr. William McFarlane (1991) • Set limits: Everyone needs to know what the rule are, a few good rules keep things clear • Ignore what you can’t change: Let some things slide, but don’t ignore violence

24. Family GuidelinesDr. William McFarlane (1991) • Keep it simple: Say what you have to say clearly, calmly, and positively • Follow doctor’s orders: Take medications as prescribed, only those prescribed • Carry on business as usual: Re-establish family routines as quickly as possible, stay in touch w/family and friends • No street drugs or alcohol: substance use makes symptoms worse

25. Family GuidelinesDr. William McFarlane (1991) • Pick up on early signs: Note changes, consult with treatment team • Solve problems step by step: Make changes gradually, work on one thing at a time • Lower expectations, temporarily: Use a personal yardstick, compare this month to last month, rather than this year to last year

26. III. Available Resources

27. Three Helping SystemsThomas Powell (1990s) 1. Informal Support System: (Community, family, friends) 2. Formal Self-Help: (Al-Anon, NAMI, AA, DRA) 3. Professional System: (WCCSTS w/MFGs, therapist)

28. Informal Support • Only 39% of persons with psychotic disorders visited mental health professionals in the last six months • The majority of people who need help rely on informal methods more than on the formal mental health system

29. Informal Support • When people do seek professional or self-help, it is usually because of encouragement from informal caregivers • The use of one system increases the probability of using the other • The use of the two together produces benefits that exceed those available from one or two

30. “Formal” Self-Help: Al-Anon • Follows the 12-Step format from Alcoholics Anonymous (1935) • Many anonymous meetings throughout the community at various times during the week;

31. Al-Anon themes and concepts • “Our misplaced concern for others becomes intrusive, meddling, resented, and doomed to failure.” • “We admit that we did not Cause, cannot Control, and cannot Cure an alcoholic.” • “Those of us who learned to control whatever we could in order to survive in an alcoholic environment now continue to try to control everything and everybody without realizing what we are doing.”

32. National Alliance for the Mentally Ill (NAMI) • First meeting in 1979 in Madison, Wisconsin, of “NAMI Mommies” • Started as an informal support group, led to advocacy group for policy and program change (national and local) • Fastest growing, most effective advocacy group in health care (NY Times)

33. National Alliance for the Mentally Ill (NAMI) • Women’s involvement expanded to family members, government officials, and professionals • Nancy Domenici (Founder) and Senator Pete Domenici, and Senator Paul Wellstone demanded insurance coverage; (67/100 Senators had relative w/MI)

34. Local NAMI Chapter • Advocacy w/WCHO and CSTS programming and policy (WC Jail mental health, Police Crisis Relief Training) • Annual Family Day • Family Education and Support Training (FEST) about to start

35. Multi-Family Psychoeducation Groups (MFG)Dr. William McFarlane, Dr. David Milkowitz • Model emphasizes basic communication and problem-solving skills to accommodate the needs of the consumers who have a core information-processing deficit often associated with serious mental illness

36. Multi-Family Psychoeducation Groups (MFG)Dr. William McFarlane, Dr. David Milkowitz • The 3 phases of MFGs include: Relapse prevention, Rehabilitation, and Network formation • MFGs (FACES) in Washtenaw County active bi-weekly at each Clinic location (Towner, Ellsworth, ACT, Residential)

37. Core Components of MFGs • Joining • Education • Problem-solving • Structural change in the treatment • Multi-family contact

38. Questions and / or comments?