Presented by Mike Juarez, M.S, Executive Director, Alternative Action Programs 1

Transcription

1 Re-Entry Father s SUBSTANCE ABUSE AS RELATED TO CHILD ABUSE & NEGLECT MIKE JUAREZ, M.S. ALTERNATIVE ACTION PROGRAMS Webinar sponsored by: Webinar Presentation Presenter: Mike Juarez, M.S. Executive Director, Alternative action Programs Moderator: Kirsti Thompson Project Manager, Strategies Central Region Technical Support: Laura Everest Event Coordinator, Strategies Central Region Programs 1

2 Presentation Overview Part I: Substance Abuse and Recovery Defining Acronyms Overview of Substance Abuse/Dependence Overview of Recovery Re-entry Father s: SAO s, families, children (A Snapshot) Presentation Overview Part II: The Effects on the Family System How Parental SAO s Affect the Family System The Prevalence and Correlation of AOD, IPV, and Child Maltreatment (Abuse and/or Neglect) Families of Recovery/Re-entry Father s (support, tools, working toward healthier lifestyle, children s and mother s experiences and expectations Presentation Overview Part III: Solution Strategies, Treatment, CBO s Intimate Partner Violence Prevention/Challenges Child Abuse Prevention/Challenges Preventative Strategies Overcoming Challenges Community Based Organizations Programs 2

3 Part I SUBSTANCE ABUSE AND RECOVERY Defining Acronyms ** Operationally Defined AOD: Alcohol and Other Drugs SAO: Substance Abuse/Dependence Offender SA: Substance Abuse IPV: Intimate Partner Violence DV: Domestic Violence CBO: Community Based Organization Overview of Substance Abuse/Dependence Historically, abuse and dependence have been a separation between abuse and dependence. DSM V has moved to diagnosing according to severity (e.g., mild, moderate, severe). A major factor in diagnosing in accordance with the DSM V: Is the use of substance causing significant clinical distress For the purpose of this presentation, we will use substance abuse to cover both abuse and dependence, mild, moderate, and severe Programs 3

4 Overview of Substance Abuse Qualitative: Structured clinical interview, TWEAK, CAGE enmeshed. Quantitative: Evidenced-based measures used to inform the diagnosis: ASI, SASSI, MHSF, MAST AUDIT Assessment tools ml Alcohol and other drug screening questions and assessment tools can be located at the link listed above Screening (CAGE, TWEAK) Assessment tools (ASI, SASSI) Screening with CAGE and TWEAK (Alcohol) Brief and simple screen Can be incorporated into the interview Self-report form Can be used in an intake history form with questions interwoven Programs 4

5 Screening with CAGE (Alcohol) C A G E Have you ever felt you ought to cut down on your drinking or drug use? Y N Have people annoyed you by criticizing your drinking or drug use? Y N Have you ever felt bad or guilty about your drinking or drug use? Y N Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover? Y N Screening with TWEAK (Alcohol) T Tolerance: A: How many drinks can you hold (6 or more indicates tolerance) or B: How many drinks does it take before you begin to feel the first effect of the alcohol (3 or more drinks indicates tolerance)? A: B: W Worried: Have close friends or relatives worried or complained about your drinking in the past year? E Eye openers: Do you sometimes take a drink in the morning when you first get up? A Amnesia: Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember? K Kut Down: Do you sometimes feel the need to cut down your drinking? Y N Addiction Severity Index (ASI) Seven Domains of Assessment 1) Medical 2) Employment 3) Alcohol 4) Drugs 5) Legal 6) Family/Social 7) Psychiatric/Psychological Programs 5

6 Addiction Severity Index (ASI) Not public domain Gold standard assessment for substance use Allows for depth in each domain (probing and comments) Explores current use and history Determines need for treatment from both the client s perspective and the clinicians perspective Provides an composite graph for easy comparison Has a used for initial intake/assessment and a brief version used for exit/assessment Substance Abuse Subtle Screening Inventory 3 (SASSI-3) Not public domain The stealth assessment Can be used to determine high or low probability of dependence for both alcohol and other drugs Assesses 9 Subscales related to substance dependence Measured in t-score or percentile ** The following information is not true of all high scores. These are just some indicators. You need a scoring manual to help you determine outcomes SASSI-3: Subscales Face-Valid Alcohol (FVA) Face-Valid Other Drugs (FVOD) Symptoms (SYM) Obvious Attributes (OAT) Subtle Attributes (SAT) Defensiveness (DEF) Supplemental Addiction Measures (SAM) Family vs. Controls (FAM) Correctional (COR) Programs 6

7 SASSI-3: Subscales Face-Valid Alcohol (FVA) Face-Valid Alcohol (FVA) FVA: Face-Valid Alcohol measures acknowledged alcohol use, motivation and consequences of usage, and loss of control. SASSI-3: SubscalesFace-Valid Other Drugs (FVOD) Face-Valid Other Drugs (FVOD) FVOD: Face-Valid Alcohol and Other Drugs measures acknowledged drug use, motivation and consequences of usage, and loss of control. SASSI-3: Subscales Symptoms (SYM) Symptoms (SYM) SYM: Symptoms of Substance Misuse measures the extent to which the client acknowledges specific problems associated with substance misuse. Programs 7

8 SASSI-3: Subscales Obvious Attributes (OAT) Obvious Attributes (OAT) Obvious Attributes measures the client s tendency to acknowledge characteristics commonly associated with substance abuse. SASSI-3: Subscales Subtle Attributes (SAT) Subtle Attributes (SAT) SAT: Subtle Attributes measures characteristics of substance dependent people which are less apparent than those measured by OAT SASSI-3: Subscales Defensiveness (DEF) Defensiveness (DEF) DEF: Defensiveness identifies defensiveness Programs 8

9 SASSI-3: Subscales Family vs. Controls (FAM) Family vs. Controls (FAM) FAM: Family vs. Control Subjects identifies individuals with characteristics common among family members of substance dependent persons. SASSI-3: Subscales Correctional (COR) Correctional (COR) COR: Correctional assesses the client s relative level of risk for legal problems. AOD Recovery vs. DV Treatment OCPD Characteristics Denial Affair with the Dysfunctionality Familiarity Submission Loss of Control Relapse No matter how much treatment I always go back to the same kind of guy/girl/friends! WHY? Society gives up on them because they do. Programs 9

10 Why is the Prevalence Between AOD and DV so high? Why do AOD make Violence ok? Lifestyle Risky Behavior Poor Decisions (intoxicated) Effects of AOD i.e. aggressiveness Image to Lifestyle Perpetraitor s Own Repressed Abuse The Cycle Continues Cluster B and the SAO A pattern of traits can be found across the diagnostic criterion of: Antisocial Personality Disorder (ASPD) Borderline Personality Disorder (BPD) Histrionic Personality Disorder (HPD) Narcissistic Personality Disorder (NPD) Obsessive-Compulsive Disorder (OCD) Antisocial Personality Disorder (ASPD) DSM-IV-TR Diagnostic Criterion A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since the age 15 years, as indicated by three (or more) of the following: 1) Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest 2) Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure 3) Impulsivity or failure to plan ahead 4) Irritability and aggressiveness, as indicated by repeated physical fights or assaults 5) Reckless disregard for safety of self or others 6) Consistent irresponsibility, as indicted by repeated failure to sustain consistent work behavior or honor financial obligations 7) Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another Programs 10

11 Borderline Personality Disorder (BPD) 1) Frantic efforts to avoid real or imagined abandonment 2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation 3) Identity disturbance: markedly and persistently unstable self-image or sense of self 4) Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) 5) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 6) Affective instability due to a marked reactivity of mood (e.g., intensive episodic dysphonia, irritability, or anxiety) Narcissistic Personality Disorder (NPD) 1) Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior or without commensurate achievements) 2) Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love 3) Believes that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions 4) Requires excessive admiration 5) Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations 6) Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends 7) Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others 8) Is often envious of others or believes others are envious of him or her 9) Shows arrogant, haughty behaviors or attitudes Erickson s Stages Psychosocial of Development 0-2 years Trust 2-4 years Autonomy 4-5 years Initiative 5-12 Years Industry years Identity years Intimacy Mistrust Shame and Doubt Guilt Inferiority Role confusion Isolation Programs 11

12 Kohlberg s Six Stages of Moral Reasoning Level I: Preconventional Morality Stage 1 - Obedience and Punishment The earliest stage of moral development is especially common in young children, but adults are also capable of expressing this type of reasoning. At this stage, children see rules as fixed and absolute. Obeying the rules is important because it is a means to avoid punishment. Stage 2 - Individualism and Exchange At this stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. In the Heinz dilemma, children argued that the best course of action was the choice that best-served Heinz s needs. Reciprocity is possible at this point in moral development, but only if it serves one's own interests. Kohlberg s Six Stages of Moral Reasoning Level II: Conventional Morality Stage 3 - Interpersonal Relationships Often referred to as the "good boy-good girl" orientation, this stage of moral development is focused on living up to social expectations and roles. There is an emphasis on conformity, being "nice," and consideration of how choices influence relationships. Stage 4 - Maintaining Social Order At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one s duty and respecting authority. Kohlberg s Six Stages of Moral Reasoning Level III: Postconventional Morality Stage 5 - Social Contract and Individual Rights At this stage, people begin to account for the differing values, opinions and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards. Stage 6 - Universal Principles Kohlberg s final level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules. Programs 12

13 7 Basic Focuses of Treatment 1) Confrontation of Beliefs, Attitudes and Behaviors 2) Assessment of current relationships 3) Reinforcement of Positive Behavior and Habits 4) Positive Identity Formation 5) Enhancement of Self-Concept 6) Decrease in Hedonism and Development of Frustration Tolerance 7) Development of Higher Stages of Moral Reasoning Therapeutic Factors Installation of hope My problems are manageable Universality I m not alone Imparting information Resources, non-clinical tips Altruism Selfish becomes selfless, consideration for others The corrective recapitulation of the primary family group Family dynamics Development of socializing techniques Productive, law abiding, non-dysfunctional or healthy relationships Imitative behavior Mirroring and modeling senior group members Interpersonal learning Intrinsic, who am I, needs, identity Group cohesiveness Strong bond and relationships (functional) Catharsis About the pain and turmoil, safety, non-judgmental Existential factors - Meaning of life, isolation, and freedom Treatment Synopsis Substance abuse treatment significantly reduces the reoffending rates of substance abusing participants. The simple fact is that when treating offenders, their substance abuse is a problematic component of their overall personality. Thus, methods aiming to treat or rehabilitate offender populations must employ effective means that address the thinking patterns and underlying symptomology of their substance abusing behavior. Data from numerous sources show how ingrained substance abuse is in offenders. Drug testing of offenders has shown substance abuse rates among all offender types as high as 80% (Bureau of Justice Statistics, 1992) and Gorski (1993) states that 70% of offenders are chemically dependent while nearly all offenders abuse drugs or alcohol. Little & Robinson s (1994) monograph on antisocial behavior and substance abuse states shows that substance abuse is a symptom of underlying personality disorder centered among a cluster of criminologic factors. Thus, Treatment directly addresses these criminologic factors and thereby appears to concomitantly reduces substance use. Programs 13

14 Treatment Synopsis The specific target areas in need of and amenable to systematic remediation cluster is as follows: antisocial attitudes and thinking and behaviors must be addressed and changed; inappropriate peer associations must be eliminated followed by planning and actions to integrate more normal friendships and relationships; social relationships including family and friends must be enhanced and corrected ; antisocial behavioral patterns (e.g. lying, stealing, victimizing) must be specifically addressed and altered to prosocial behaviors and attitudes; self reliance, dependability, and reliability must be fostered. Andrews and others (Antonowicz & Ross, 1994) have shown that offender targeted cognitive skills, cognitive restructuring, and cognitive behavioral programming can favorably alter criminologic factors of participants. Treatment Synopsis Treatment has shown its effectiveness in directly confronting and favorably altering the criminologic needs of offender participants. Antisocial behaviors, beliefs, and attitudes are the initial target of the approach. Behavioral rehearsal and practice is gained in the group process as offenders must then make an overt commitment to following the rules of their custody or supervision. Relationships are then addressed, followed by appropriate goal setting, identifying additional problem areas and beliefs, and then making refinements on relationships and goals. Group process provides SAO s the opportunity to change inappropriate and selfdefeating beliefs, attitudes, and behaviors. The research and literature have consistently shown treatment successfully reduces recidivism. Components for Successful Treatment Client s are assessed to determine treatment readiness If a client is not a treatment candidate, the clinician should do a referral with a clinical recommendation Attendance Support i.e., family, social, support groups, religious organizations, community, probation, criminal justice system Programs 14

15 Part II THE EFFECTS OF THE FAMILY SYSTEM Intimate Partner Violence Intimate partner violence (IPV) is a serious, preventable public health problem that affects millions of Americans. The term "intimate partner violence" describes physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same sex couples and does not require sexual intimacy. (Center For Disease Control And Prevention, 2010) Domestic Violence (DV) Although they are used interchangeably, DV is used in contemporary research and literature as a broader definition to mean all violence related to an intimate partner or the family. Whether current or in the past i.e. child abuse, neglect, inappropriate sexual acts (usually by a trusted family member or close family friend, incest, witnessing DV, and many other forms or violence within the family system, community, or environment. (Center For Disease Control And Prevention, 2010) Programs 15

16 Battered Wife Syndrome A pattern of signs and symptoms, such as a fear and a perceived inability to escape, appearing in women who are physically and mentally abused over an extended period by a husband or other dominate individual Stockholm Syndrome A psychological response sometimes seen in a hostage, in which the hostage exhibits loyalty to the hostage taker, in spite of the danger. In DV the victim, in this case (contrast with survivor), the victim will express empathy, sympathy and have positive feelings toward their perpetrator, to the point of defending and identifying with them. They may see their abuse as acts of kindness and love. Characteristics of an abused woman Reserved Withdrawn Depressed Anxious Low self-esteem Poorly integrated self-image General inability to cope with life s demands Shame Self-blame Hyper-startle response DMPD Programs 16

17 Depressive Masochistic Personality Defined: A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which he or she will suffer, and prevent others from helping him or her. Many victims fall into DMP and subsequent negative attachment typology beginning in childhood as a witness to DV or a victim of child abuse in all its forms. (Naud, et. al., 2013) Correlational Factors of Substance Abuse and Domestic Violence The Cycle of Addiction The Cycle of Violence The Effects of Children in the Abusive Cycle Now consider how these manipulations effect the children in this family system What messages are being sent to the child? What might future impact look like? How might this effect his or her own parenting? Programs 17

18 Characteristics of an abused child Signs and Symptomology Control Fear Humiliation Anger Criticism Mistreatment Threats Jealously Unwanted sex Physical, sexual, emotional/mental, neglect, financial Families of Recovery/Re-entry Father s Support While a vital component to a solution, this is often lacking, insincere, biased, conditioned etc. Tools Most re-entry father s receive little or no treatment. If there is treatment it is for SA. There are minimal tools provided for the family system Children s Expectations Role changes, fantasy expectations, reality Mother s Expectations Role changes, fantasy, life and interest changes Father s Expectations No changes Programs 18

19 Part III SOLUTION STRATEGIES TREATMENT COMMUNITY BASED ORGANIZATIONS Intimate Partner Violence Prevention/Challenges Child Abuse Prevention/Challenges Preventative Strategies Overcoming Challenges Community Based Organizations IPV: Prevention/Challenges Domestic violence shelters Court liasons Other CBO s Challenges: Perpetrator tactics to manipulation and DMP Programs 19

20 Perpetrator Tactics to Manipulation Dominance: controlling, only decision makers, tell you what to do, expect obedience, treats you like a servant, child or as their possession Humiliation: Goes out of his/her way to make you feel bad about yourself or like you re a defect or worthless (so you believe no one will want you). Insults, name-calling, shaming are all weapons designed to erode your self-esteem and make you feel powerless Isolation: Will cut you off from the outside world to establish your dependence on him or her (Including home and finances). Will keep you from seeing family, friends, work, school, etc. You must have permission to see anyone Perpetrator Tactics to Manipulation Cont Threats: Threatens to hurt or kill you, your children or other family members. Threatens to commit suicide, file false charges against you and turn you over to child protective services. Intimidation: Designed to scare you into submission. Threatening looks, gestures, smashing things in front of you, destroying property, putting weapons on display etc. Denial and Blame: Will blame their abusive behavior on a bad childhood (and through their master manipulation will make you feel bad for them and protect their behavior). Minimize or deny the abuse. Turn it into the abuse being your fault. Child Abuse Prevention/Challenges School: Communication with teachers and identifying signed of abuse Child Protective Services Challenges: Refer to perpetrator tactics Programs 20

21 Preventative strategies Overcoming Challenges IDDT (Between and within agency collaboration) Learn your agencies policies on mandated reporting Have interagency discussions about adding protocols for your area Have a list or referral manual for CBO s in your area Community Based Organizations: Remember, it is always best practices to refer to specialist who work in the identified area i.e., IVP, child abuse etc. It becomes an ethical question if you are practicing outside your scope. It could save a child s life! Contact Information Mike Juarez, M.S. Programs [email protected] Kirsti Thompson Project Manager, Strategies Central Region [email protected] Laura Everest Event Coordinator, Strategies Central Region [email protected] Thank you! Please complete your evaluations Programs 21