Addiction, Recovery and Hope. Overview 7/23/2014. Which substances affect women and their fetuses the most?

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1 Addiction, Recovery and Hope Texas Behavioral Health Institute Mary DeJoseph DO July 2014 Overview Prenatal alcohol use and its impact on women, fetuses and families Common themes among birth mothers, affected individuals, families Recovery, forgiveness, hope Interventions and strategies to support families, including health maintenance Which substances affect women and their fetuses the most? Alcohol Tobacco Heroin/ Methadone Cocaine/ crack Marijuana Prescription Abuse OTC Drugs Inhalants/ Hallucinogens Internet Pharmaceuticals Methamphetamine 1

2 What does alcohol do to the developing fetus? (80% will have some effect, NIH 2012) Fetal Alcohol Syndrome (FAS) is a life long birth defect caused by maternal consumption of alcohol during pregnancy. Diagnostic criteria include Dysmorphic facial features Growth delay Brain dysfunction Maternal history Genetic syndromes must be ruled out Pregnancy outcome depends on multiple factors Fetal Alcohol Spectrum Disorders is a descriptive term used for the broad spectrum of disorders caused by prenatal exposure to alcohol including: PFAS (Partial FAS) FAE (Fetal Alcohol Effects) ARND (Alcohol Related Neurodevelopmental Disorders) ARBD (Alcohol Related Birth Defects FAS (Fetal Alcohol Syndrome) **FASD IS NOT A DIAGNOSIS What does the Woman at Risk Look Like? Observe your own reactions Common themes: Women with alcoholism Early onset of criteria for alcohol dependence with physical consequences Multiple physical, emotional, behavioral, family, and professional consequences Denial to the death the illusion of control Multigenerational alcoholism Multiple levels of treatment Alcohol exposed pregnancies different patterns of use, different outcomes Neglect, abuse of children; loss of family connections Lifestyle includes trauma, crime, violence, untreated injuries, STDs, mental illness, hopelessness 2

3 Possible outcomes with prenatal exposure to substances Newborn withdrawal Cognition/ Executive Function/Learning disabilities ADD, hyperactivity, impulsivity, emotional deregulation Language and communication delays Sensory integration and motor dysfunction Social skills and Adaptive behavior deficits Co occurring mental health issues, substance use disorders, physical health challenges Involvement with multiple institutions as adolescents and adults; joblessness, homelessness, addiction and need for intensive recovery support, inappropriate sexual behavior Identifying addiction Addiction: a chronic, relapsing, brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences (ASAM 2011; NIDA, NIH, USDHHS Drugs, Brains and Behavior: the Science of Addiction NIH, 4/07) New DSM5 criteria include craving, tolerance/ withdrawal, preoccupation, failure to fulfill roles There may be a family history Major organ damage will result with chronic use Gender related differences influence our approach 3

4 Chronic alcohol use affects memory, judgment, reasoning, impulsivity, recovery readiness What is recovery? A process of change through which an individual achieves abstinence and improved health, wellness, and quality of life ( A Working Definition of Recovery, CSAT National Summit on Recovery, 2005) A process of change through which individuals improve their health and wellness, live a selfdirected life, and strive to reach their full potential. (SAMHSA 2011) What might it take to recover? Survival and safety needs Recovery/ 12 step meetings AA, NA, DRA Spiritual resources Husband, children, family, community Long term residential treatment and recovery community deal with shame, trauma, secrets Support system with other birth moms Child protection with kinship/ foster care Long term intensive psychotherapy with psychiatrist Ongoing addiction and internal medicine physicians Vocational support/ professional monitoring 4

5 What barriers do women have to successful recovery? Ongoing intoxication/ withdrawal Shame and denial of the problem Fear/ Confusion/ Depression/ Hopelessness Opposition of partner and/ or family; codependency Lack of social support (child care, job skills, housing) Undiagnosed trauma Undiagnosed FASD Healthcare provider barriers, including confusion about meds and alternative therapies as adjuncts The media Self-forgiveness as a barrier Approach to Recovery and Forgiveness Identify one person, place. or thing in your life that you need to forgive or be forgiven What forgiveness is and isn t Benefits/ incentives to forgive Recovery Stories Blocks to forgiveness 12 Steps as one path to forgiveness and self forgiveness especially families 5

6 Describing forgiveness Forgiveness is: to extend an attitude of respect, compassion and goodwill to an individual/ self in spite of what she has done and because of who she is. Forgiveness is: a choice; a tool; a gift only we can give ourselves; a process; a change of perception/ letting go of judgment; possible with Higher Power Forgiveness is not: giving in; forgetting/ dismissing the victim; justification; an excuse; giving up responsibility; condoning a wrong Blocks to Forgiveness Secrets in treatment and recovery Forgiveness requires discipline, imagination, persistence, patience, courage, time, mental toughness, letting go of shame and selfcenteredness Fear of vulnerability, change, our own power Attitudes/ Beliefs that block: Addiction is not a disease We don t deserve happiness We were owed a healthy childhood, pregnancy, children Blocks to Forgiveness: Frozen in shame role Keeps us connected and attached to our old lives Provides meaning, structure, direction, definition in our lives Gives us safety, comfort, familiarity, a role Is the safest and expected response to stigma and judgment ( You should be ashamed of yourself!) Hope that enough shame will change the outcome Covers a deep sense of sadness and protects us from going through the painful grief process 6

7 How long is all this going to take? I DON T KNOW. ***Say it as many different ways as you like, but NEVER give a set amount of time to answer the question How long will it take for me to forgive myself? Why talk with women about FASD? Women who drink during one pregnancy may drink more during the next FASDs are preventable Early identification and intervention can decrease lifespan challenges in affected offspring Women surviving addiction and other traumas are probably strong enough to talk about it (with support) Birth mothers will need extra support with the decision to talk to their children who were alcohol exposed or to realize they were alcohol exposed themselves. Nutrition during pregnancy and in alcohol exposed children may ameliorate some effects of alcohol FASD in women and in offspring may contribute to relapse Women that have used during pregnancy have severe guilt and shame that needs to be addressed to prevent relapse (high risk) Women that have children with undiagnosed FASD risk relapse because of the challenges behaviors of their children and belief that they are poor parents Women prenatally exposed to alcohol themselves will need extra support to engage in treatment and recovery and prevent relapse Birth Mothers Network as a major support contact Kathy Mitchell: Mitchell@nofas.org 7

8 Common themes: Families affected by FASD Child protective services/ attachment issue Delayed FASD diagnosis Multiple medical issues and physician denial Educator/ Child study team denial Late interventions and family support Crisis motivated advocacy Teen issues of sexuality, guardianship, work, crime Birth mothers at ongoing risk of relapse as new issues arise Essential interventions and strategies Early intervention and special education Speech therapy, sign language Sensory integration OT Fitness program; swimming (Special seals and Olympics) Self enclosed special education classes and high school Parent education/ advocacy training Social skills and supervised play Experiential, multisensory learning ie demo fires at Annual Fire Safety Day and practicing diner at home Ongoing interventions: Affected teens and young adults Remember the age adjustment between chronological and behavioral age Relationships, sexuality, and birth control deal with these issues openly and concretely Safety: Alcohol, drugs, driving, peers, meds. People with FASD at higher risk for addiction themselves Intensive ongoing job support applications, volunteering, drop in supervision Money, finances, banking, guardianship issues Spouses and siblings need to be educated and involved in recovery, relapse prevention and relapse contingency plans. Custody and re unification are individual 8

9 Health maintenance can assist individuals in regulating behavior Safety Sleep Oral and dental care Nutrition and fitness Sexuality and risk of sexual abuse Employment and vocational rehab Physical, mental, and spiritual health are a unit 9