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Download FAMILY GROUP - Hamilton Family Health Team
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FAMILY SUPPORT GROUP Purpose of Today Provide Education Discuss Family Impact Gain support and share experiences Group Facilitators John – Hamilton Family Health Team Adrienne – Alcohol, Drug & Gambling Services Group Rules/Norms Confidentiality for: Group leaders Group members Your family member/loved one Introductions First Name Relationship with family member/loved one What would you like to gain from today’s session? Outline Part 1: Understanding Substance Use and Problem Gambling Continuum of Use and Problem Gambling Substance Misuse and Problem Gambling: Challenges for the family Ways of Coping Stages of Change Treatment options for your family member Outline Part 2: Boundaries, Self Care, and Strategies What can you do and what can you control? Taking care of yourself Setting your own Boundaries and Limits Communication Strategies Treatment options for Family Part 1: Understanding Substance Use and Problem Gambling Substance Use Continuum Experimental (First Use) Social Use Abuse Dependence Experimental Use Triggered by curiosity Use is usually approached with caution Removes much of the normal fear connected with substance use Experience is usually positively reinforcing at this stage Positive experience often leads to using again Social Use Triggered by social norms/peer influence Offers the users a sense of inclusion, acceptance and belonging Use is still within the individual’s control (can take it or leave it) Use is viewed as enhancing a social activity Abuse Use is now triggered by certain emotional and environmental factors Individual feels the “need” to use when confronted with a trigger Individual has progressed to depending on the substance to help manage/function in certain situations There is some form of regular pattern to the substance use The individual has lost some ability to choose and/or control their use Dependence Triggers for using are becoming more numerous The individual feels the “need” to use the substance in a wide variety of normal daily situations There is a component of both physical and psychological dependence The individual is experiencing an increase in both the number and severity of consequences from use Defenses such as denial, avoidance and rationalization develop to protect the habit Tolerance Develops with continuous use of a substance This means that as time goes on, the body needs more and more of the drug to produce the desired effect. Tolerance is a strong indicator of dependence Withdrawal Is a group of symptoms that occur upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and/or alcohol to which one has developed tolerance Symptoms can include: Sweating Shaking Nausea In extreme cases, hallucinations Cycle of Dependency MAY START HERE Difficulty Managing Experiences & Emotions Skills Erode (Not Used) Decrease Time Using Skills To Manage Use DRUG MAY START HERE Quick Easy Effects (Short Term) Increase Time Using Drug What is Gambling? Gambling means risking something of value when there is an element of chance associated with the outcome 63.3% of Ontarians gambled in the last year You know you’re gambling when: You risk something of value Once the bet is made, it’s irreversible The outcome of the game is largely determined by chance Problem Gambling Problem gambling is defined as a pattern or gambling behaviour that may compromise, disrupt, or damage family, personal, or vocational pursuits Problem Gambling Continuum No Involvement No involvement means exactly what it says – absolutely no gambling activity at all. Approximately 36% of the population in Ontario are ‘non-gamblers.’ Casual Social Gamblers Occasional Part of a larger leisure life Not the only form of recreation Gamble for recreation and excitement Losses are accepted Does not interfere with life or selfesteem Would not miss gambling Serious Social Gamblers Main form of entertainment Regular gambling Serious pastime, but does not interfere with life Unlikely to progress if pattern is longstanding Would miss gambling Harmful Involvement Gambling to escape and to experience relief from problems and anxiety Gambling is having a negative impact on life 2.6% of the population are harmfully involved with gambling Pathological Gambling DSM IV diagnosis 10 possible symptoms .8% of the population meet the DSM IV criteria for Pathological Gambling SIGNS OF A GAMBLING PROBLEM How do you know that someone has a gambling problem? Financial cues Emotional cues Time cues Behavioural cues Signs and Symptoms Financial cues: Placing larger and more frequent bets in order to get the same level of excitement “Chasing” losses Watching debts grow, borrowing money, not paying bills Cashing in RRSPs, savings bonds, insurance Money or valuables missing Changes in spending priorities Defensiveness or secrecy about money Signs and Symptoms Emotional Cues Pinning hopes on a ‘big win’ to solve problems Feeling frequent highs and lows, on edge, moody, irritable ‘Spacing out’, dissociating, or withdrawing Feeling ‘like a different person’ or feeling cold, closed off, or unemotional Signs and Symptoms Time Cues: Increased time spent on reading race scores, the stock market, or sports statistics (“handicapping”) Arriving late for work, family events or other commitments Large blocks of time unaccounted for Prefer gambling to anything else Signs and Symptoms Behavioural Cues Decreased attendance at family functions Neglecting responsibilities/preoccupied Changes in sleep, eating, sexual behaviour Being on edge, reactive, defensive, bored easily Deception, secrecy Partial confessions How Have You Been Affected? How Has Your Family Been Affected? Substance Misuse/ Problem Gambling: Challenges For The Family Sadness Unpredictability Anxiety and fear Safety concerns Anger Guilt and shame Relational Conflict Role imbalances Children “acting out” Stigma Secrecy/Isolation Stress-related illness Poor Communication Financial Difficulties Impact Of Substance Abuse/Problem Gambling on Family Members In the Early Stage: Denial Arguments Believing excuses as reasons Confusion and ambivalence Anxiety and concern Rescuing, protecting, covering up for family member In the Middle Stage: Vague, unclear communication – “Don’t Trust. Don’t Talk. Don’t Feel” Unresolved conflict – deterioration of relationship Gradual shift in role and responsibility Decreased sociability ATTEMPT TO CONTROL Nagging, threatening Reporting on use and user Counting drinks, marking bottles, checking on amount of drugs consumed In the Late Stage: Attempts to control the user or the use become more extreme until… Eventually: Self neglect – physical, social and emotional May increase own use of drugs or alcohol Anger, rage Depression Burnout What Have You Tried ? Family Members Try Less Helpful Ways of Coping Nagging Controlling Investigating Fixing Protecting Some suggested responses Instead of…….. Nagging: speak to family member when he/she is sober/straight to set limits & consequences and follow through – try to avoid being repetitive Controlling: try to let go, and give the responsibility for recovery over to the substance abuser Investigating: identify what you are & aren’t responsible for; set limits Instead of…….. Fixing: allow family member to fix their own issues/problems Protecting: Allow family member to experience the consequences of drinking/using All of these behaviours take time to understand and learn, so be patient Strategies for Problem Gambler’s family If your loved one has a gambling problem and wants to make changes OR If your loved one has a gambling problem but does not want to make changes at this time The Three C’s 1. You did not CAUSE the substance abuse or problem gambling 2. You cannot CONTROL the substance abuse or problem gambling 3. You cannot CURE the substance abuse or problem gambling The Stages Of Change (Prochaska, Norcross & DiClemente, 1994) Precontemplation Contemplation Determination/Preparation Action Maintenance Tasks Of Each Stage Of Change Tasks for User: Tasks for Family Member: Precontemplation Acknowledge the existence of a problem •Education about substance use and/or problem gambling •Allow the family member to experience the consequences of his/her use or behaviour Contemplation •Resolve ambivalence about behaviour •Weigh the pros and cons of behaviour •Realize need to change • Support family member when leaning towards change •Support any engagement with the treatment system Determination/Preparation • Learn about recovery •Develop action plan to change • Support realistic expectations and goals • Support non-using behavior • Practice self-care throughout Tasks Of Each Stage Of Change Tasks for User: Tasks for Family Member: Action Prevent relapses and deal with lapses: • Learn about triggers • Resist urges • Develop new ways of behaving /coping Take steps toward goals: • View lapses as opportunities for learning • Get back on track quickly after lapses • Reinforce positive steps • Support User’s efforts to care for self • Express understanding of the difficulty of the process • Encourage person to get support if a lapse happens Tasks Of Each Stage Of Change Tasks for User: Tasks for Family Member: Maintenance • Continue to do what works • Prevent relapses and deal with lapses • Reinforce healthy behavior • Support and encourage regular attention to goals set for recovery – are you both on track? Recovery and Treatment Recovery: What To Expect is a process that is unique to everyone. takes time. may require treatment of co-occurring mental health problems. involves learning new ways of coping and behaving. maintenance Achieving Goals often involves lapses and relapses. stressor lapse relapse Time Harm Reduction Assumptions: Not all substance use or gambling is necessarily harmful. There will always be individuals who misuse substances or gambling harmfully Not all individuals are willing or able to achieve abstinence. Individuals can learn to decrease the harms associated with their substance use or gambling Some individuals are more likely to seek treatment if it does not require abstinence. There is value to treatment at all stages of change. Treatment System for Men and Women for substances To access addiction treatment in Ontario Drug and Alcohol Registry of Treatment (DART): www.dart.on.ca OR 1-800-565-8603 SUBSTANCE ABUSE TREATMENT OPTIONS FOR MEN IN HAMILTON Self Help AA NA CA GA Men for Sobriety Location: Various Meeting Sites across Hamilton Withdrawal Management Location: Men’s Withdrawal Management Centre Outpatient Counselling -Individual and Group Counselling -Assessment and Referrals Location : ADGS HFHT Day Treatment 2 weeks pre-treatment 6 weeks core program Evening Program 2 weeks pretreatment 8 weeks core program Location: SUNTRAC Residential Short -term 18-21 days Long term More than 21 days (ex. Wayside House) Location: within Ontario SUBSTANCE ABUSE TREATMENT OPTIONS FOR WOMEN IN HAMILTON Self Help AA NA CA GA Women for Sobriety Withdrawal Management Location: Various Meeting Sites across Hamilton Location: Womankind Addiction Services Outpatient Counselling -Individual and Group Counselling -Assessment and Referrals Location : ADGS HFHT Day Treatment Residential -Taking Steps pre treatment Short -term 18-21 days -5 week day treatment program -aftercare program Long term More than 21 days Location: Womankind Addiction Location: within Services Ontario Treatment Options for Problem Gambling Individual, Couple, Family and Group Treatment (ADGS) Gamblers Anonymous/Gam-Anon www.problemgambling.ca Ontario Problem Gambling Helpline 1-888-230-3505 Day and residential treatment GamBlock Self-Exclusion Recovery: Challenges For The Family During recovery of a loved one, family members: May experience their loved one as unavailable emotionally. May witness their loved one as having more difficulties coping. May not like the speed or focus of recovery. May feel like they are on a roller coaster. are walking on eggshells. “in the dark.” May feel discouraged, angry and hopeless. May receive little support and treatment themselves. May need to change their ways of relating to their loved one. Where is your family member in their journey of recovery? And where are you? Lunch Part 2: Boundaries, Self Care and Strategies What can you control? You CAN NOT control what someone does and how they behave You CAN only control your own actions and reaction to the other person’s behaviour What can you control? Taking Care of Yourself Taking care of yourself allows you to be: More healthy physically, emotionally, spiritually, socially and in your relationships Better able to respond to and support a relative with a substance use problem Better able to parent and support children affected by familial substance use Self Care Personal Social Professional Support What is a Boundary? Some possible definitions: The shield we put around ourselves Where one person stops and the other begins One’s physical, emotional, sexual and social safety zones Why do we have boundaries? Boundaries exist to protect yourself and others Prevent resentment and/or burnout Reduce abuse, exploitation, or control by another Overcome unhelpful and unsustainable patterns of relating Take responsibility only for what is your responsibility Boundaries and Limits If I am: Responsible FOR others, I am attempting to CONTROL Responsible TO others, I am attempting to CARE Determining your boundaries and limits In order to determine your boundaries, it is important to know what you will and will not tolerate from your family member Everyone has different limits and is in a different situation, so there is no “should” or “should not” in any particular example Group Exercise I will tolerate….. I am unsure if I will tolerate….. I will not tolerate…… How do you protect your boundaries? Determine, set and enforce limits Set limits on another person’s behaviour with respect to your boundaries Tell the person of these limits and the consequences if the limits are not respected Observe whether the person is respecting these limits Proceed by following through on the consequences if your limits have not been respected Common barriers to protecting boundaries Lack of skills Lack of awareness Feelings Expectations and beliefs Four Communication Styles 1. Passive 2. Aggressive 3. Passive-Aggressive 4. Assertive How to communicate loving limits Choose an appropriate time Choose a neutral place Demonstrate understanding Take responsibility Be positive Be firm Be specific Communication Strategies: DESC model D escribe the situation E xpress your feelings S pecify what you want C ommunicate the consequences DESC Model “When you…” (behaviour) “I feel…” (emotion) “Because…” (describe why you feel this way) “I would like / prefer…” (need/desire) “I you do……… then…” (positive payoff) “If you don’t……then…. (consequence) Setting loving limits exercise Choose a behaviour that you are not willing to tolerate, and decide how you will communicate and enforce this limit: Limit I would like to set: Where I will communicate this limit: When I will communicate this limit: Setting loving limits exercise continued How I will communicate this limit (what I will say) using the DESC model When you… I feel… Because… I would like / prefer… If you do….then… If you don’t…then… Suggestions for Family Members: Find social support Obtain encouragement & emotional support Take care of yourself Learn ways of managing stress Take breaks (vacations) Protect your boundaries Get in touch with, and work through your feelings Engage in effective problem solving Seek help or treatment for yourself Treatment Options for Family Members Suntrac – Partners in Recovery Womankind – Concurrent Disorders Support and Education Group Al-Anon Nar-Anon Gam-Anon ADGS for problem gambling individual , couples, or family counselling Thank you for attending
