Therese s Family of Origin Issues. Protective Factors. Trauma and Addicted Family Systems: A Multi-dimensional Perspective

Transcription

1 Trauma and Addicted Family Systems: A Multi-dimensional Perspective with Claudia Black, MSW, Ph.D. and Shelley Uram, M.D. Senior Fellows The Meadows Protective Factors Had a special relationship with an adult who was caring and nurturing. Had somewhere other than home they felt they belonged. Had activities that were easy to participate in outside the home. Had a sense of mastery or feelings of success in at least one area of their lives. Could distance themselves from unhealthy family behavior. Had a sense of purpose and future. Therese s Family of Origin Issues Overlook (deny, rationalize, minimize) behavior which hurt deeply Appear cheerful when hurting Make excuses for the hurtful behavior Avoid conflict to minimize further anger Tolerate inappropriate and hurtful behavior Prioritize the needs of other over own Caretake others Fault self for family s problems Discount own perceptions, give others benefit of the doubt Believe no options are available Believe she is at fault, it is her job to find the answers Not ask for help Accommodate 1

2 Grandfather Chronic poverty Grandmother Died shortly after birth of father Grandfather Alcoholic gambler Grandmother Compulsive overeater Rageful Family poor Father absent/alcoholic Mother chronically ill Rageful Father Emotionally needy Mother Father Violent Alcoholic Depression Mother Codependent Anxiety Brother Compulsive Overeater Sister Died age 9 Husband #1 Alcoholic Husband #2 Alcohol & Drug addict Son Age 7 Daughter Age 10 Healthy Parenting Practices Basic needs of safety, food, shelter Appropriate role modeling Warm and supportive relationship between the parent and child Parental monitoring and supervision Maintaining awareness of the child s peer relationships Understanding the child s individual risk level Establishing appropriate parent child communication Amelia Arria, Ph.D. Children of addiction are 2 to 4 times more likely to be sexually abused. They are prime for victimization as they 1. Are often starving for attention 2. Are less apt to speak up because of fear of not being believed. 3. Give others the benefit of the doubt. 4. Don t trust their own perceptions. 5. Don t know what they feel and can t use feelings and cues as signals. 6. Are confused about appropriate boundaries. 7. Experience shame upon shame which fuels powerlessness. 2

3 In the United States these children Are at higher risk for placement outside of the home. Are more likely to enter foster care and remain there longer than do other children. Exhibit signs of depression and anxiety more than do other children. The rate of total health care costs for children of alcoholics is 32% greater than for children of non-alcoholics. Admission rates to hospitals are 24% greater and hospital stays are on average 20% longer. In general, children of alcoholic families do less well on academic measures. They have a higher rate of school absenteeism and are more likely to leave school. Dear Lord Be good to me, the sea is so wide and my boat so small. Epigram for the National Children s Defense Fund Types of Stress Positive associated with moderate short-lived physiological responses Tolerable more severe physiological responses but tolerable when occurs over limited time and relieved by supportive relationships Toxic associated with strong and prolonged activation of the body s stress management system in the absence of buffering protection 3

4 Psychological effects are likely to be most severe if the trauma is: Human caused Repeated Unpredictable Undergone in childhood Perpetrated by a caregiver Two Facts Addiction increases the likelihood of trauma Trauma increases the likelihood of addiction Trauma Repetition 1. Doing something self destructive over and over again, usually something that took place in childhood and started with a trauma 2. Reliving a story from the past 3. Engaging in abusive relationships repeatedly 4. Repeating painful experiences, including specific behaviors, scenes, persons and feelings 4

5 The Adverse Childhood Experiences (ACE) Study Principal Investigators: Vincent Felitti MD, FACP & Robert Anda MD, MS The ACE score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACEs increase, the risk for the following health problems increases in a strong and graded fashion. Alcoholism & alcohol abuse Chronic obstructive pulmonary disease (COPD) Depression Fetal death Health-related quality of life Illicit drug use Ischemic heart disease(ihd) Liver disease Risk for intimate partner violence Multiple sexual partners Sexually transmitted diseases (STDs) Smoking Suicide attempts Unintended pregnancies In addition, the ACE Study has also demonstrated that the ACE Score has a strong and graded relationship to health-related behaviors and outcomes during childhood and adolescence including early initiation of smoking, sexual activity, illicit drug use, adolescent pregnancies, and suicide attempts. Finally, as the number of ACEs increases the number of co-occurring or co-morbid conditions increases. American Journal of Preventative Medicine Volume 14 - Issue 4 - Pages (May 1998) 5

6 Possibility for Recovery Identify primary disorders Potential for co-occurring disorders and multiple addictions Prioritize treatment of intergenerational family dynamics Ask clients about their original family history Ask pointed questions about the use of alcohol and other drugs Ask about the possibility of other addictive disorders Ask about possibility of physical or sexual abuse Recognize impact of chronic loss and stress as trauma factor Realistic & Important Goals Lessen emotional reactivity, calm part of brain that keeps person in fight, flight or freeze state Tolerate uncomfortable feelings without engaging in self defeating behavior Stay in the present Define boundaries that offer safety Set appropriate limits that honor those boundaries Recognize and disrupt shame based thinking and behavior 6