Title: The family affected by substance use disorders: What we know and why we should intervene
1The family affected by substance use disorders
What we know and why we should intervene
- Robert A. Zucker, Ph.D.
- Addiction Research Center and
- Substance Abuse Section
- Department of Psychiatry
- University of Michigan Medical Center
2I. My background as an introduction to this
presentation
3Goals of this talk
- To increase understanding of the role that the
social environment plays in creating and
maintaining addiction problems - To increase understanding of the special role of
the family as an influence in the substance
abusers life - To describe new research on early child
functioning and its connection to adult substance
use disorders
4Goals of this talk (continued)
- To discuss barriers to change in current
treatment models that need to be overcome - e. To describe methods of reducing child risk
- To describe a manualized family treatment program
to reduce child risk - To discuss what you can do to apply these
findings in your own clinics.
5II. Diagnosis and the person
- a. Review our current DSM-IV diagnostic scheme
- b. Diagnosis and the person where is the
person? - Is diagnosis stable over time?
- Does diagnosis ever go away? If so, under what
conditions?
6III. Addiction varies with context
- a. Is the disorder within the person?
- b. Drug availability and addiction
- Friends use and addiction
- Conflict
- Loss
- Stress
7IV. The family as context
- Why is the family important?
8V. The role of the family in the substance
abusers functioning
- Assortment (Birds of a feather)
- Partner relationships and relapse
- Child difficulties and parent effects
9VI. Now for the child in the substance abusing
family The role of the family in the childs
functioning
- Is the family relevant?
- c. The special problem of nested risk
- d. Long term outcomes what the actuarial
tables tell us
10VII. New research on long term outcomes
- Problems with actuarial data
- High risk studies
- c. How far back should we look?
- d. 2 studies starting in preschool 4 in the
early school years
11VIII. How early can risk be identified?
- Risk for what?
- Findings about externalizing problems
12VIII. How early can risk be identified?
(Continued)
- Risk for what?
- Findings about internalizing problems
13VIII. How early can risk be identified?
(Continued)
- Risk for what?
- Findings about sleep problems
14VIII. How early can risk be identified?
(Continued)
- Risk for what?
- Findings about early onset of drug use and later
substance use disorder outcomes
15IX. Does the knowledge of early risk have
anything to do with what treatment agencies
should be doing?
- Why dont we know about this work?
- What the clinical problem is.
16X. The social and political barriers to doing
prevention work at the same time as treatment
- Managed care and long term outcomes
- The problem of the heaviest care users
- c. The Washtenaw Community Project as a possible
example
17XI. The history of prevention work with children
- Dealing with children separate from families
- Shifting the problem to schools and general
population programs - c. What long term studies tell us
18XII. Treatment as prevention
- Marital therapy findings impact on children
- The delicacy of dealing with the families of
patients Fals-Stewarts work and Luthars - Karol Kumpfers Strengthening Families Program
19XIII. The Strengthening Families Program
- Manualized 14 sessions
- Involving children and parents, but separately
first, then together - Program content deliberately changes over the
course of treatment - d. Addiction as a chronic disorder when do you
stop?
20XIV. What can your program do?
- How are you going to pay for the work?
- What places might assessment be carried out?
- Developmental assessments rather than current
and immediate past -
- Manualized, family focused treatments
21XIV. What can your program do? (continued)
- e. Is follow-up, semi-annual check-up,
possible? - f. Potential for impact on the patient as
well as the family A double impact program
22Family attachments and refusal skills as
protective factors
- Famous Jazz Pianist Oscar Peterson, on his life
- Interviewer Heroin was a big thing in those
days (the late 40s and early 50s) , and a lot
of musicians around you were doing it. How did
you stay clean? -
23Family attachments and refusal skills as
protective factors
- Peterson It wasnt easy because the guys would
be going out to do it, and theyd say, hey man,
comeon along. Of course it was hard to refuse
them, you wanted to belong, to be with the group,
but I had two things I would always tell them - One was, Hey man, I promised my mother that I
would never do that, and if she heard about it,
it would kill her. I couldnt do that. - And the other thing Id say is If I were
ever to get busted, they wouldnt let me leave
the country, and I need that for my music. - Those two things together seemed to do the
job, and theyd leave me alone. - Interview with Bob Edwards on National Public
Radio, - February 21, 2003.
24- There are now ways to make a difference
- Early screening
- Early intervention
- The chronic disease model
25Goals Review
- To increase understanding of the role that the
social environment plays in creating and
maintaining addiction problems - To increase understanding of the special role of
the family as an influence in the substance
abusers life - To describe new research on early child
functioning and its connection to adult substance
use disorders
26Goals Review, II
- To discuss barriers to change in current
treatment models that need to be overcome - e. To describe methods of reducing child risk
- To describe a manualized family treatment program
to reduce child risk - To discuss what you can do to apply these
findings in your own clinics.
27The work reported here was supported by
National Institute on Alcohol Abuse and
Alcoholism grants R37 AA 07065,R01 AA 12217, T32
AA 07477, and National Institute on Drug Abuse
grant U10 DA13710