CHEMICAL DEPENDENCY & SUBSTANCE ABUSE

1. CHEMICAL DEPENDENCY&SUBSTANCE ABUSE In relation to sexually abused children and adolescents Carrie Meiners Laura Monteiro Anna Smith Mariah Snow

2. The Problem: Chemical Dependency • chemical dependency - addiction to a mood-altering chemical. • includes both drug addiction and alcoholism • When a person is chemically dependent, they have lost the power of choice over using mood-altering chemicals. They may be able to stop for awhile, but they will return to its use again and again despite their best intentions and exertions of logic and willpower. • Chemical dependency is characterized by continuous or periodic: impaired control over drinking and/or drug use (prescribed or illegal), preoccupation with the mood-altering chemical, use of the addictive substance despite adverse consequences, and distortions in thinking--most notably denial. • Though the disease can't be cured, it can be arrested and treated (kept in remission). The disease is far more complex than the mere use and abuse of mood-altering chemicals and recovery is far more complex then just becoming abstinent. • Anyone can become chemically dependant, starting even in children of elementary age! • As you will find out, one common population can be found among those who have been sexually abuse, physically abused or have experience traumatic stress early in life.

3. Study #1: Women in Methadone Treatment • In 2008, A research study was done at the University of Chicago to study the direct and meditated relationships between childhood sexual abuse among a random sample of 416 women in methadone treatment • 59%of all women reported high rates of childhood sexual abuse • 89.7% reported intimate partner violence • 28.6% reported Posttraumatic stress disorder • 19.5% reported global psychological distress

4. Study #1: Women in Methadone Treatment • What the findings prove: • Over half of the methadone addicted women were sexually abused as children • Majority of women that were sexually abused as children and addicted to meth, continued to be abused in adult relationships • PTSD and global psychological distress are both 2 possible correlates of sexually abused children that could lead them to chemical dependency

5. Study #2: Sexually Abused Men in Treatment for Substance Abuse • A retrospective chart review was performed of 222 men admitted to an outpatient chemical dependency treatment program • 6 dependant variables were examined and compared among the men • Freq. & quantity of alcohol use • Freq. & quantity of use of cocaine and heroine use • Age of first use • Multiple substance abuse • Psychiatric co-morbidity • # of prior treatments

6. Study #2: Sexually Abused Men in Treatment for Substance Abuse • Results: • Men who reported history of sexual abuse used cocaine more frequently, started drinking earlier, used multiple substances and had greater psychiatric co-morbidity than the control group • Men who reported history of physical abuse used cocaine more frequently, used multiple substances reported a higher number of treatment attempts, and had a greater psychiatric co-morbidity than the non-physically abused group. • What the findings confirm • There is indeed a strong link between childhood sexual abuse, childhood physical abuse and substance abuse,

7. Study #3: Associations between types of maltreatment and substance use during adolescence • All 10th through 12th graders (n=2,187) at 6 public schools in rural Oregon county filled out an anonymous survey that included questions about their experience of emotional, sexual, and physical abuse, and their use of a variety of substances. • Substance use was categorized as: • Tobacco use • Alcohol use • Illicit drug use • Physical abuse • Sexual abuse

8. Study #3: Associations between types of maltreatment and substance use during adolescence • Results: • Suggested that all types of maltreatment including emotional abuse, are related to significantly higher levels of substance abuse and should be considered serious risk factors for substance use during adolescence • strength of association between maltreatment and substance abuse use varies by the types of maltreatment • Youth who have experience both physical and sexual abuse are at especially high risk of substance use!!

9. Symptoms & Manifestations of Chemical Dependency • Symptoms • unable to stop drinking or taking a particular mood-altering chemical despite serious health, economic, vocational, legal, spiritual, and social consequences are become visible. • Adolescents begin to do poorly in school, stop caring about the world around them • Manifestations • Loss of reality • Ex) Defense Att. Ramsey • Death

10. Cultural Variation • Overall A chemically dependent person is unable to stop drinking or taking a particular mood-altering chemical despite serious health, economic, vocational, legal, spiritual, and social consequences. It is a disease that does not see age, sex, race, religion, or economic status. It is progressive and chronic and if left untreated can be fatal. • However some variations can be found from one culture to the next such as: • how the culture/society views chemical dependence • What is the cultural definition of dependence • Could just be a way of life • What substances are deemed “legal” and “illegal”

11. Treatment • Options • Intensive Outpatient Program (IOP) • Partial Hospital Program (PHP) • Residential (Inpatient) Treatment • Problem Solving Techniques • The 12 Steps • Cognitive Behavior Therapy • most effective

12. The 12 Steps: Step 1 - Admit powerless over addiction  Step 2 - believe that a Power greater than ourselves could restore us to sanity  Step 3 – Turn life over to higher power Step 4 – Moral inventory     Step 5 – Admit the exact nature of our wrongs Step 6 – Be ready and willing to have all defects of character removed Step 7 - Humbly asked God to remove our shortcomings    Step 8 - Make a list of all persons we had harmed, and be willing to make amends Step 9 - Make direct amends to such people wherever possible, except when injury may be a result Step 10 - Continue to take personal inventory and promptly admit when wrong   Step 11 - Sought through prayer and meditation to improve our conscious contact with God Step 12 - Having had a spiritual awakening as the result of these steps

13. Treatment • Outcomes • Relapse: “Falling off the Wagon” • 58% fail to complete 12 month period of abstinence • 78% of the 58% relapse in the first 6 months • Of the remaining 22%, 77% stay clean for a whole year • Females 22% likely to relapse, males 32% • Reasons for relapse • Most adolescents who use are troubled prior to addiction • Co-morbidities • Aftercare reduces risk of relapse

14. Role of Professional: Recognition & Assessment • Recognition • Looking for symptoms • Receiving reports of chemical dependency • Numerous substance related violations • Different aspects of life affected by substance abuse • Assessment • Chemical dependency assessments • Screening instruments • Mid-Range instruments • Comprehensive instruments

15. Role of Professional: Intervention & Referrals • Intervention • Limiting their opportunities to use • Conducting an intervention • Court orders • Referrals • Inpatient treatment programs • Outpatient treatment programs • Individual counseling • Group counseling • Alcoholics Anonymous or Narcotics Anonymous

16. Case Study

17. References • Tubman, J. (1993). Parental alcohol use, and problem behaviors among school-age children.Family Relations, 42, 81-86. • Eisen, S., Youngman, D., Grob, M., and Dill, D. (1992). Alcohol, drugs, and psychiatric disorders: A current view of hospitalized adolescents. Journal of Adolescent Research, 7-2, 250-265. • Amodeo, M, Chassler, D, Oettinger, C, Labiosa, W, & Lundgren, L (2007). Client retention in residential drug treatment for Latinos. Evaluation and Program Planning, Retrieved Jan 26, 2009,from http://csaweb113v.csa.com/ids70/view_record.php?id=8&recnum=3&log=from_res&SID=31se7j8f62v8c4imipe6io7ju1&mark_id=search%3A8%3A3%2C0%2C10. • Pelissier, B, & Jones, N (2005). A review of gender differences among substance abusers. Crime and Delinquency, Retrieved January 26, 2009, from http://csaweb113v.csa.com/ids70/view_r ecord.php?id=3&recnum=41&log=from_res&SID=31se7j8f62v8c4imipe6io7ju1&mark_id=search%3A3%3A57%2C40%2C50. • Bergmann, PE. (1995) Adolescent treatment. Implications for assessment, practice guidelines, and outcome management. Retrieve January 25, 2009, from Pubmed. • Simons, L. (2008) Characteristics of drug-abusing women with children in residential treatment: a preliminary evaluation of program retention and treatment completion. Retrieved 27, 2009, from Pubmed. • Evaluation of Adolescent Offenders with Substance Abuse: Validation of the SASSI with Conduct Disordered Youth. CSA ilumina, Retrieved January 27, 2009, from http://csaweb116v.csa. com/ids70/view_record.php?id=6&recnum=5&log=from_res&SID=nfusgcg9a21q7u3okhcenar5o5&mark_id=search%3A6%3A0%2C0%2C8. • Sexual Abuse Correlates: Similarities Between Male and Female Treatment. Csaillumina, Retrieved January 27, 2009, from http://csaweb116v.csa.com/ids70/view_record. php?id=6&re cnum=7&log=from_res&SID=nfusgcg9a21q7u3okhcenar5o5&mark_id=search%3A6%3A0%2C0%2C8.