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Alcohol and Drug Alcohol and Drug Dependence and Its Impact Dependence and Its Impact on Family and Community:on Family and Community:

Seizing the OpportunitySeizing the Opportunity

Supporting Families and Supporting Families and Promoting RecoveryPromoting Recovery

Steve Hornberger and Doug RonsheimSteve Hornberger and Doug RonsheimBloomfield, CTBloomfield, CTJune 2, 2010June 2, 2010

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Supporting Families and Supporting Families and Promoting RecoveryPromoting Recovery

Why in the Faith Why in the Faith Community?Community?

33

So Help Me God:So Help Me God:Substance Abuse, Religion and SpiritualitySubstance Abuse, Religion and Spirituality

CASA’s Surveys of Clergy and Schools of CASA’s Surveys of Clergy and Schools of TheologyTheology

Presidents of 230 multi-denominational Christian seminaries and 6 Rabbinical Schools

Sample of 1,200 clergy from New York, Florida, Iowa, Washington

Denomination groups: Catholic, Protestant, Jewish, Christian, Orthodox, other (independent and non-denominational)

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So Help Me God:So Help Me God:Substance Abuse, Religion and SpiritualitySubstance Abuse, Religion and Spirituality

The Great DisconnectsThe Great Disconnects

- Clergy’s recognition of problem of substance - Clergy’s recognition of problem of substance abuse in their congregations vs. lack of training on abuse in their congregations vs. lack of training on how to deal with ithow to deal with it

- Importance of spirituality and religion to - Importance of spirituality and religion to substance abuse prevention and treatment vs. substance abuse prevention and treatment vs. failure of healthcare providers to take advantage failure of healthcare providers to take advantage of thisof this

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So Help Me God:So Help Me God:Substance Abuse, Religion and SpiritualitySubstance Abuse, Religion and Spirituality

The Clergy DisconnectThe Clergy Disconnect

- 94.4 percent of clergy and 97.6 percent of - 94.4 percent of clergy and 97.6 percent of theology school presidents consider substance theology school presidents consider substance abuse an important problem in congregationsabuse an important problem in congregations

- Only 12.5 percent of clergy get any substance - Only 12.5 percent of clergy get any substance abuse trainingabuse training

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So Help Me God:So Help Me God:Substance Abuse, Religion and SpiritualitySubstance Abuse, Religion and Spirituality

Engage the ClergyEngage the ClergySchools of Theology should:Schools of Theology should: Train clergy to recognize substance abuse and know Train clergy to recognize substance abuse and know

how to respondhow to respond

Clergy should:Clergy should: Address substance abuse in their ministriesAddress substance abuse in their ministries Develop relationships with treatment professionalsDevelop relationships with treatment professionals Connect members of congregations to treatmentConnect members of congregations to treatment

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The Clergy Education and The Clergy Education and Training ProjectTraining Project®®

Phase I – Seminary Training Expert PanelPhase I – Seminary Training Expert Panel November, 2001November, 2001

Phase II – Development of Core Competencies Phase II – Development of Core Competencies February, 2003February, 2003

Phase III – Dissemination Phase III – Dissemination Step One: Release at CADCA, January 2004Step One: Release at CADCA, January 2004 Step Two: Publication of articles in journals Step Two: Publication of articles in journals Step Three: Incorporate into AAPC and ACPE credentials,Step Three: Incorporate into AAPC and ACPE credentials,

standards, and trainingstandards, and training Step Four: Engaging the Faith Communities to helpStep Four: Engaging the Faith Communities to help Step Five: Developing Seminary Curricula ModulesStep Five: Developing Seminary Curricula Modules

Phase IV – Implementation of Clergy and Pastoral Phase IV – Implementation of Clergy and Pastoral Minister Training – Pre- and Post- Ordination Minister Training – Pre- and Post- Ordination

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Core Competencies for ClergyCore Competencies for Clergy

Guide to the core knowledge, attitudes, and skills Guide to the core knowledge, attitudes, and skills essential to the ability of clergy and pastoral ministers to essential to the ability of clergy and pastoral ministers to

meet the needs of persons with alcohol or drug meet the needs of persons with alcohol or drug dependencedependence

and their family membersand their family members

Focus on:Focus on:Addicted personAddicted personFamily systemFamily system

Affected childrenAffected children

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Clergy Core CompetenciesClergy Core Competencies1. Be aware of the:1. Be aware of the:

– Generally accepted definition of alcohol and other Generally accepted definition of alcohol and other drug dependencedrug dependence

– Societal stigma attached to alcohol and other drug Societal stigma attached to alcohol and other drug dependencedependence

2. Be knowledgeable about the:2. Be knowledgeable about the:– Signs of alcohol and drug dependenceSigns of alcohol and drug dependence– Characteristics of withdrawalCharacteristics of withdrawal– Effects on the individual and the familyEffects on the individual and the family– Characteristics of the stages of recovery Characteristics of the stages of recovery

3. Be aware that possible indicator of the disease my 3. Be aware that possible indicator of the disease my include, among others:include, among others:

marital conflict, suicide, family violence (physical, marital conflict, suicide, family violence (physical, emotional, and verbal), hospitalization , or encounters emotional, and verbal), hospitalization , or encounters with criminal justice system.with criminal justice system.

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Clergy Core CompetenciesClergy Core Competencies4. Understand that addiction erodes and blocks religious and 4. Understand that addiction erodes and blocks religious and

spiritual development; and be able to effectively spiritual development; and be able to effectively communicate the importance of spirituality and the practice of communicate the importance of spirituality and the practice of religion in recovery, using scripture, traditions, and rituals of religion in recovery, using scripture, traditions, and rituals of the faith community.the faith community.

5. Be aware of the potential benefits of early intervention to the:5. Be aware of the potential benefits of early intervention to the: Addicted personAddicted person Family system Family system Affected childrenAffected children

6. Be aware of appropriate interactions with the:6. Be aware of appropriate interactions with the: Addicted personAddicted person Family systemFamily system Affected childrenAffected children

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Clergy Core CompetenciesClergy Core Competencies7. Be able to communicate and sustain:7. Be able to communicate and sustain: An appropriate level of concernAn appropriate level of concern Messages of hope and caringMessages of hope and caring

8. Be familiar with and utilize available community resources 8. Be familiar with and utilize available community resources to ensure continuum of care for the:to ensure continuum of care for the:

Addicted personAddicted person Family systemFamily system

Affected children Affected children

9. Have a general knowledge of and, where possible, 9. Have a general knowledge of and, where possible, exposure to:exposure to:

12 Step Programs: AA, NA, Al-Anon, Nar-Anon, 12 Step Programs: AA, NA, Al-Anon, Nar-Anon, Alateen, ACOA, etc. Alateen, ACOA, etc. Other groups Other groups

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Clergy Core CompetenciesClergy Core Competencies10. Be able to acknowledge and address values, issues, and 10. Be able to acknowledge and address values, issues, and

attitudes regarding alcohol and other drug use and attitudes regarding alcohol and other drug use and dependence in: dependence in:

Oneself Oneself One’s Own FamilyOne’s Own Family

11. Be able to shape, form, and educate a caring 11. Be able to shape, form, and educate a caring congregation that welcomes and supports persons and congregation that welcomes and supports persons and families affected by alcohol and drug dependence.families affected by alcohol and drug dependence.

12. Be aware of how prevention strategies can benefit the 12. Be aware of how prevention strategies can benefit the larger community.larger community.

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AOD 101 – Basic InformationAOD 101 – Basic Information

To understand how to help congregants To understand how to help congregants affected by alcohol and drug problems affected by alcohol and drug problems requires that we must understand the requires that we must understand the

disease and its impact on family membersdisease and its impact on family members..

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Terminology Can Provide Hope or Terminology Can Provide Hope or Deepen Misunderstanding and ShameDeepen Misunderstanding and Shame

AlcoholismAlcoholism AddictionAddiction Chemical DependencyChemical Dependency Brain-Based IllnessBrain-Based Illness Substance Use DisorderSubstance Use Disorder ““Substance Abuse” Substance Abuse”

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Learning about addiction includes Learning about addiction includes learning about its childrenlearning about its children

1 in 4 children under the age of 18 has a family 1 in 4 children under the age of 18 has a family member who abuses alcohol or has alcoholism. member who abuses alcohol or has alcoholism. Countless others live with parental drug use. Countless others live with parental drug use.

Addiction is a treatable disease, not a moral Addiction is a treatable disease, not a moral weakness, and living with it is emotionally and weakness, and living with it is emotionally and developmentally harmful to children.developmentally harmful to children.

Clergy and other pastoral ministers can offer Clergy and other pastoral ministers can offer hope and help to addicted individuals and hope and help to addicted individuals and affected children and spouses in their affected children and spouses in their congregations.congregations.

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Why Include an Emphasis on the Why Include an Emphasis on the Children?Children?

Numbers are so greatNumbers are so great Chronic confusion, fear, stress, emotional Chronic confusion, fear, stress, emotional

and - sometimes - physical abuseand - sometimes - physical abuse Developmental and emotional impact from Developmental and emotional impact from

the toxic family environment the toxic family environment Greater risk for neglect, for mental health Greater risk for neglect, for mental health

problems, for addiction and for entering the problems, for addiction and for entering the juvenile justice systemjuvenile justice system

Family interaction is defined by Family interaction is defined by alcoholism or addiction. alcoholism or addiction.

Problems clergy see that are frequently associated with Problems clergy see that are frequently associated with addiction in the family: addiction in the family:

Increased… Decreased…Increased… Decreased…Family conflict Family cohesionFamily conflict Family cohesionEmotional or physical violence Family organizationEmotional or physical violence Family organizationFamily isolationFamily isolationFamily stress, e.g.: work problems,Family stress, e.g.: work problems, illness, marital strain, finances, illness, marital strain, finances, and frequent relocationsand frequent relocations

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What Makes the Family Toxic?What Makes the Family Toxic?

Don’t talkDon’t talk Don’t feelDon’t feel Don’t trustDon’t trust

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Addicted Family Defense Addicted Family Defense MechanismsMechanisms

DelusionDelusion DenialDenial MinimizingMinimizing ProjectionProjection RationalizationRationalization

2020

A Parent who is abusing alcohol A Parent who is abusing alcohol or other drugsor other drugs

May be less attentive to the child while May be less attentive to the child while drunk or highdrunk or high

May be unable to fulfill their role as a parent, May be unable to fulfill their role as a parent, including providing medical treatmentincluding providing medical treatment

Is more likely to be diagnosed with a co- Is more likely to be diagnosed with a co- morbid psychological problemmorbid psychological problem

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A Parent who is abusing alcohol A Parent who is abusing alcohol or other drugsor other drugs

May be chronically physically ill from using May be chronically physically ill from using drugs or alcoholdrugs or alcohol

Spends times procuring, using, and Spends times procuring, using, and recovering from the alcohol or drug use recovering from the alcohol or drug use instead of parentinginstead of parenting

May be engaged in illegal activitiesMay be engaged in illegal activities Places financial stress on the family systemPlaces financial stress on the family system

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• More absenteeism from school, less help with homework

• Daughters more likely to connect to/marry addicted men

• More depression and suicide in adolescents

• More illness, injuries, poisonings, substance abuse, hospitalizations

Consequences for Children of Consequences for Children of Addicted ParentsAddicted Parents

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Children of Addicted ParentsChildren of Addicted Parents Often lack consistency, stability, and Often lack consistency, stability, and

needed emotional support due to the needed emotional support due to the chaotic family environmentchaotic family environment

May be physically and emotionally May be physically and emotionally traumatized by accidental injury or verbal, traumatized by accidental injury or verbal, physical or sexual abuse due to parental physical or sexual abuse due to parental drinking/drug usedrinking/drug use

May encounter permissiveness, neglect, May encounter permissiveness, neglect, violence, poor communication, under-violence, poor communication, under-socializationsocialization

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Adverse Child Experiences StudyAdverse Child Experiences Study

Adoption of Health-risk Behaviors

Social, Emotional, & Cognitive Impairment

EarlyDeath

Adverse Childhood Experiences

Death

Disease, Disabilityand Social Problems

Conception

Scientificgaps

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Addressing Family AddictionAddressing Family Addiction Interventions need to be comprehensive Interventions need to be comprehensive

and continual – and include age-and continual – and include age-appropriate child services.appropriate child services.

Children benefit from educational support Children benefit from educational support programs, including Alateen, whether they programs, including Alateen, whether they live in birth home or in foster care, and live in birth home or in foster care, and whether or not their parents get well. whether or not their parents get well.

Spouses benefit from Al-AnonSpouses benefit from Al-Anon

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Recovery Does HappenRecovery Does Happen Intervention and treatment workIntervention and treatment work

Families healFamilies heal

Spiritual health is possible againSpiritual health is possible again

Money is savedMoney is saved

Life gets betterLife gets better

People in recovery give backPeople in recovery give back

Everyone wins!Everyone wins!

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Emerging Recovery TrendsEmerging Recovery Trends

Recovery from alcohol and drug problems is a Recovery from alcohol and drug problems is a process of changeprocess of change through which an individual through which an individual achieves abstinence and improved health, achieves abstinence and improved health, wellness, and quality of life.wellness, and quality of life.

Recovery-Oriented Systems of Care shift the Recovery-Oriented Systems of Care shift the question from question from “How do we get the client into “How do we get the client into treatment?”treatment?” to to “How do we support the process of “How do we support the process of recovery within the person’s environment?”recovery within the person’s environment?”

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Definition of Addiction in Definition of Addiction in Relationship to GodRelationship to God

Addiction is a systemic de-construction Addiction is a systemic de-construction that estranges, alienates and sedates that estranges, alienates and sedates the self-in-relation toward the Ultimate the self-in-relation toward the Ultimate with outcomes of disenchantment and with outcomes of disenchantment and loss of meaning for life-experiences. loss of meaning for life-experiences.

Paraphrased from James E. Royce, S..J., Ph.D.Paraphrased from James E. Royce, S..J., Ph.D. The Effects of Alcoholism and RecoveryThe Effects of Alcoholism and Recovery, 1995, 1995

from from Spirituality and Chemical DependencySpirituality and Chemical Dependency

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Long term effects within family system: Long term effects within family system: applications to spiritual developmentapplications to spiritual development..(McIvyn C. Raider, Ph.D. –1992, (McIvyn C. Raider, Ph.D. –1992, Assessing the role of religion in Family Functioning)Assessing the role of religion in Family Functioning)

Tangled relationshipsTangled relationships– ““God” as the image of mom or dadGod” as the image of mom or dad– Co-dependent behaviorsCo-dependent behaviors– Poor self-image Poor self-image

Instability of religious commitmentInstability of religious commitment– Underdeveloped intrinsic valuesUnderdeveloped intrinsic values– Overcompensated with rigid behaviors or beliefsOvercompensated with rigid behaviors or beliefs– Under-utilization of religious formation and support Under-utilization of religious formation and support

systemssystems– Inconsistent modeling and mentoring for childrenInconsistent modeling and mentoring for children

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COAs Need Spiritual HelpCOAs Need Spiritual Help

““I don’t know if I can ever forgive him …”I don’t know if I can ever forgive him …”

COAs must learn to walk the path of progress, not COAs must learn to walk the path of progress, not perfection.perfection.– Support by clergy and faith–community for family Support by clergy and faith–community for family

therapy or individual counseling therapy or individual counseling – Spiritual direction and mentoringSpiritual direction and mentoring

The journey of forgiveness is not made in one’s feelings but in The journey of forgiveness is not made in one’s feelings but in one’s surrender to faith. one’s surrender to faith.

One day at a time …One day at a time …

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COAs Need Spiritual Help COAs Need Spiritual Help (cont.)(cont.)

COAs need to appreciate their goodness and COAs need to appreciate their goodness and individual gifts.individual gifts.

““We cannot forget but we can know where we We cannot forget but we can know where we want to be and always seek out new, fresh, holy want to be and always seek out new, fresh, holy ground as a restless pilgrim. We may not want to ground as a restless pilgrim. We may not want to go home – but we can build a new house and go home – but we can build a new house and make it our home.”make it our home.”Spiritual maxim (Ronald Rolheiser 2001: Against an Infinite Spiritual maxim (Ronald Rolheiser 2001: Against an Infinite Horizon)Horizon)

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Small Efforts Can HelpSmall Efforts Can Help

Deliver the messages that break the silenceDeliver the messages that break the silence– In sermonsIn sermons

– In “Did You Know” FactoidsIn “Did You Know” Factoids

– In casual conversationsIn casual conversations

– In your congregational education programsIn your congregational education programs

– In your youth programsIn your youth programs

– In your pamphlet racks and with posters In your pamphlet racks and with posters

Affected Spouses and Children Need a Affected Spouses and Children Need a Framework for What They are ExperiencingFramework for What They are Experiencing

- Information about addiction as a family disease- Information about addiction as a family disease

- Information about the hope of treatment and the process of - Information about the hope of treatment and the process of recoveryrecovery

- Information on community-based supports such as Al-Anon - Information on community-based supports such as Al-Anon and Alateenand Alateen

- Validation of their experiences- Validation of their experiences

- Reassurance that affected children and spouses need and - Reassurance that affected children and spouses need and deserve support and help…whether or not the addicted deserve support and help…whether or not the addicted family member recovers family member recovers 3333

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Addicted Families Need ClergyAddicted Families Need Clergy To Break the Family “no talk” rule:To Break the Family “no talk” rule:

– Use “teachable moments” in sermons to inform about Use “teachable moments” in sermons to inform about the disease and invite hurting congregants to healing.the disease and invite hurting congregants to healing.

– Include addiction and family impact information in your Include addiction and family impact information in your educational programs.educational programs.

– Leave 12-Step literature in your materials racksLeave 12-Step literature in your materials racks

– Leave this project’s free pamphlets in your counseling Leave this project’s free pamphlets in your counseling offices and youth centers for children and teens; hang offices and youth centers for children and teens; hang project poster. project poster.

– Remember: doing nothing and saying nothing is not Remember: doing nothing and saying nothing is not neutral.neutral.

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Talking Helps to Break the SilenceTalking Helps to Break the SilenceTalk TO the children of alcoholics and drug addicts and talk ABOUT them; explain the disease and 7 Cs

I didn’t Cause it

I can’t Cure it

I can’t Control it

I can take better Care of myself:

by Communicating my feelings

making healthy Choices

by Celebrating myself.

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Other Messages Children NeedOther Messages Children Need You’re Not Alone.You’re Not Alone. It’s Not Your Fault.It’s Not Your Fault. You deserve help, and there are safe You deserve help, and there are safe

people who can help you.people who can help you. Addiction is a health problem.Addiction is a health problem. It’s OK to feel our feelings.It’s OK to feel our feelings. It’s important to talk. It’s important to talk. Treatment helps, and recovery happens.Treatment helps, and recovery happens.

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There are Many Message Delivery There are Many Message Delivery SystemsSystems

Health Care SystemsHealth Care Systems Treatment SystemsTreatment Systems FAITH COMMUNITIESFAITH COMMUNITIES CourtsCourts Community CoalitionsCommunity Coalitions SchoolsSchools Workplace ProgramsWorkplace Programs Knowledgeable and caring family membersKnowledgeable and caring family members

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Help for the ChildrenHelp for the ChildrenThere is great value in educational support There is great value in educational support

group activities –group activities –– Provide beneficial education for all children and Provide beneficial education for all children and

youthyouth– Especially helpful for children living with Especially helpful for children living with

alcoholism or drug dependence in the familyalcoholism or drug dependence in the family

A tool to help:A tool to help:SAMHSA’s SAMHSA’s Children’s Program KitChildren’s Program Kit

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Kids learn they are not alone.Kids learn they are not alone.

Group work increases the likelihood of breaking denial.Group work increases the likelihood of breaking denial.

Group work provides safety and protection.Group work provides safety and protection.

Kids experience healthy social interactions.Kids experience healthy social interactions.

Group work builds trust in social situations.Group work builds trust in social situations.

Group work provides opportunities for group validation.Group work provides opportunities for group validation.

Group work allows kids to try out new approaches to old Group work allows kids to try out new approaches to old problems.problems.

Group Work is the Preferred Group Work is the Preferred Strategy Because:Strategy Because:

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Let them know they are not alone!Let them know they are not alone! Validate their perceptions and interpretationsValidate their perceptions and interpretations

Help them gain some perspectiveHelp them gain some perspective

Absolve them of blameAbsolve them of blame

Help them separate parent from parental behaviorHelp them separate parent from parental behavior

Offer hope, self-care skills and help to copeOffer hope, self-care skills and help to cope

Provide a safe outlet for angerProvide a safe outlet for anger Explain risks of behavior, and how to identify safe Explain risks of behavior, and how to identify safe people in their livespeople in their lives Help build self-esteemHelp build self-esteem

COA GroupsCOA Groups

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What happens if adults don’t help? What happens if adults don’t help?

Children are at greater risk for: Children are at greater risk for:

Physical, verbal or emotional abusePhysical, verbal or emotional abuse Poor school performancePoor school performance Lacking of trust in others, including GodLacking of trust in others, including God Diminished spiritual lifeDiminished spiritual life Truancy or trouble with the lawTruancy or trouble with the law Poor choice of life partnersPoor choice of life partners Diminished economic opportunitiesDiminished economic opportunities

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Clergy Need to Understand Family Clergy Need to Understand Family InterventionIntervention

Engages the most significant people in the Engages the most significant people in the addicted person’s life to:addicted person’s life to:– present a loving, structured, supportive and present a loving, structured, supportive and

coherent message of concern to an addicted coherent message of concern to an addicted loved one;loved one;

– convince the person that alcohol/drug use is convince the person that alcohol/drug use is creating painful problems for all involved;creating painful problems for all involved;

– request that the person get help so that all can request that the person get help so that all can recover and heal.recover and heal.

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Family Intervention Is...Family Intervention Is... Carefully pre-plannedCarefully pre-planned

Facilitated by a professional interventionistFacilitated by a professional interventionist

Includes key family members – spouses, Includes key family members – spouses, children, and other significant personschildren, and other significant persons

Uses loving, supportive languageUses loving, supportive language

Includes “What if…?” bottom linesIncludes “What if…?” bottom lines

Would seldom include clergy or other Would seldom include clergy or other pastoral ministerspastoral ministers

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The VisionThe Vision A faith community environment where all A faith community environment where all

members of a family affected by addiction members of a family affected by addiction know there are knowledgeable and caring know there are knowledgeable and caring clergy and other pastoral ministers who:clergy and other pastoral ministers who:– understand what they are experiencingunderstand what they are experiencing– care about them and are available to themcare about them and are available to them– can help them find emotional and physical can help them find emotional and physical

safety andsafety and– can support their healing and spiritual growthcan support their healing and spiritual growth

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To Contact Us:To Contact Us:

National Association for Children of National Association for Children of Alcoholics Alcoholics www.nacoa.org Steve HornbergerSteve Hornbergershornberger@nacoa.org

American Association of Pastoral CounselorsAmerican Association of Pastoral Counselorswww.aapc.org Doug RonsheimDoug Ronsheimdoug@aapc.org