Children and Spouses of Substance Abusers Stress, Strain, and Interventions.

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1 Children and Spouses of Substance Abusers Stress, Strain, and Interventions. Diana Moesgen 1 & Michael Klein 1 1 German Institute on Addiction and Prevention Studies, Catholic University of Applied Sciences Northrhine Westphalia, Cologne, Germany Lisbon Addictions Conference, Symposium: Addiction & the Family

2 Declaration I hereby declare there are no conflicts of interest.

3 Overview Definition Epidemiology Stress experienced by family members Psychological consequences Existing interventions Discussion

4 Definition Family and significant others of people who have a substance use disorder = heterogeneous group Characteristics: Gender Age Status: spouse, partner, (adult or minor) child, parent, friend, coworker, etc. Kind of addiction: alcohol, illegal drugs, prescription medication, behavioural addictions (gambling, internet, etc.) Duration of addiction and exposure Access to help services (relative and/or person with substance use disorder)

5 Epidemiology (example Germany) Spouses/life partners 5-7 Mio. persons are relatives of people who have a substance use disorder, esp. spouses of alcoholics, mainly females (DHS 2013) However, many people with a substance use disorder do not live in committed relationships (Brand et al. 2014; Steppan et al. 2014) in outpatient treatment 50%; more in inpatient treatment Most committed relationships: clients suffering from pathological gambling, alcoholism and cocaine addiction Patients with cannabis use disorder least committed relationships often young age, living together with parents in general, females suffering from a substance use disorder in inpatient settings indicate more temporary relationships than males Usually, status of relationship does not change over time

6 Epidemiology (example Germany) Children Alcohol: 5-6 Mio. children have at least one parent suffering from alcohol addiction (EMCDDA 2008) Illegal drugs: estimates only; approx children are living together with a parent with heroin addiction (NACOA 2006) children living together with a parent suffering from pathological gambling (EBIS 2014) In total, there are more affected relatives than people suffering from addiction problems (estimate: approx. every person has 3 close relatives)

7 Stress experienced by family members Spouses/life partners The relationship has become disagreeable, and sometimes aggressive: alcoholic or drug user isolating himself or herself, taking little part in family life, unexplained changes in mood, physical violence not universal, but often verbal aggressiveness, lying and sometimes making of false accusations Conflict over money and possessions, e.g. gifts being sold, borrowing money without asking, selling valuable objects from the home, failing to pay rent, family member felt pressured by the alcoholic or drug user to give or lend money (request often accompanied by an accusation, threat or actual violence) esp. with pathological gambling! Experiencing uncertainty: e.g. unreliability of the user s presence in the home, coming and going, being absent when expected at home, arriving home at uncertain times and uncertain states (Orford et al. 2010)

8 Stress experienced by family members Spouses/partners Family members are worried: worries about frequency and amount of substance use, company, mental and physical health, safety and career of alcoholic or drug user central concern! Home and family life are threatened: financial situation, unpleasant family atmosphere, adverse effects on children s well-being, physical integrity and security of the home affected on account of damage or neglect by addicts or by invasion of the home by others, unwanted presence of other excessive drinkers or drug users, distressing contacts with police Restricted normal social life: Pleasant events often being avoided (e.g. parties, visits) worried about how user would behave, shame, fear of critiscism or fear of what might take place in family member s absence (Orford et al. 2010)

9 Stress experienced by family members Children Disruption of family rituals Disruption of family roles Changes of family atmosphere and interactions Family conflicts, divorce Sometimes domestic violence children witness or victim Unpredictable behaviour of substance abusing parent Acquisition of inappropriate tasks and resposibilities (e.g. parenting) (Moesgen 2014)

10 Stress experienced by family members Other family members, e.g. mothers of sons with drug addiction (Orford et al 2010, Ruckstuhl & Candrian 2012) Fear of overdose Feelings of helplessness and loneliness Feelings of guilt and self-accusations Worried about career of son At times you feel sorry for them for what they are going through, then you get annoyed, then you feel guilty, then you end up hating them but they can t see what they re doing. You go through it all. Mother of drug misuser I hardly ever speak to him, he scares me. It s horrible, he s my own brother and I actually hate him. Sister of drug misusing brother

11 Psychological consequences Negative emotions: feeling worried and anxious, helpless and despairing, low and depressed, guilty and devalued, angry and resentful, sometimes frightened, and very often feeling alone. Chronicity of negative emotions, lack of coping possibilites within the family as well as common negative self-concept may lead to psychological disorders: e.g. insomnia, own substance use, depressive symptoms, anxiety, panic disorders, somatic symptom disorders (Klein et al., 2002, 2005; Orford et al., 2010; Thomasius, 2000) Affected children are the highest risk group for own substance-related disorders and have a higher risk for developing other mental and behavioural disorders (Hill et al., 2008, 2011; Klein, 2005, 2008; Thomasius et al., 2009; Ulrich et al., 2010)

12 Existing interventions Adult family members Self-help groups often based on controversial concept of co-dependency (family members = culprits ; enabling behaviour, postulating a dependent personality structure) Modern, evidence-based concepts: No pressure for abstinence of addicted client Motivating approach Reduce stress level of family members, enhance competences and social support systems Often CBT-based Example: Community Reinforcement Approach Family Training (CRAFT) (Meyers & Smith 2009)

13 Existing interventions Children Various interventions, in Europe usually not evaluated according to scientific standards In Germany, only one evidence-based programme: Trampoline Target group: 8-12 year olds with at least one substance abusing parent Goals: e.g. teaching coping strategies, reducing psychological stress caused by parental substance abuse by talking about addiction, extend children s knowledge about alcohol and drugs, improve feelings of self-worth and self-efficacy 9 modules for children (à 90 min.) with topics like e.g. how I feel about myself, alcohol and/or drug problems in my family, handling difficult emotions, finding help and support + 2 parent modules (Klein et al. 2014)

14 Discussion More research is needed Acknowledge heterogeneity of family members coping with people who have a substance use disorder Affected family members (and significant others) are in need of early, specific, and evidence-based interventions Ideally, interventions for family members are offered as an integral part of the addiction help systems Help services should gain more knowledge on stress experienced by affected family members, ways of coping, and existing interventions

15 Thank you very much for your attention! Contact: Dr. Diana Moesgen Prof. Dr. Michael Klein German Institute for Addiction and Prevention Studies Catholic University of Applied Sciences Woerthstraße Cologne Germany

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