FIRE AND FIREWATER The Clinical Relationship between Substance Abuse & Domestic Violence REVIEW OF THE LITERATURE b 50% of men in BIP appear to have SA issues (Gandolf, 1999) & are 8X likely to batter on the day they were drinking (Fal- Stewart,2003) b Approx 50% of partnered men entering AOD svc have battered in the past year (Chermack, Fuller & Blow, 2000; Fals- Stewart & Kennedy, 2005) b 25% to 50% of women receiving victim svc for IPV have SA issues (Bennett & Lawson, 1994; Downs, 2001; Ogle & Baer, 2003) b Between 55 & 90% of women who have SA issues have been victimized at some point in their lives (Moses, et a, 2003) and between 67 & 80% of women in SA tx are IPV victims. b Women in recovery are likely to have a history of violent trauma and are at high risk for having PTSD (Fullilove, et al, 1993) b Higher rates of substance abuse in offending populations and poor outcome in tx with victims whom are substance abusing if trauma is not addressed. b High rates of child abuse protection reports and homicides in the home when both SA & DV exist. Wife Assault in Latino Families Wife assault prevalence rates were higher among Mexican American and Puerto Rican families than among Mexican and Anglo-American families (Aldarondo et al. 2002). Husband to Wife Violence by Gender and Ethnicity of Respondent Mexican American 26% Mexican American 26% Puerto Rican 21% Puerto Rican 21% Mexican 17.6% Mexican 17.6% (Aldarondo et al. 2002) National Alcohol Family Life Survey, 1994 & 2002 Puerto Rican couples:20.4% prevalence Puerto Rican couples:20.4% prevalence Mexican American:17.9% Mexican American:17.9% Mexican:10.5% Mexican:10.5% Cuban American:2.5% Cuban American:2.5% White:9.9% White:9.9% Regional and Cultural Utility of Conventional Batterer Counseling Variations in the intervention systems, may help adapt batterer programs to different regions, and specialized counseling may be beneficial for men with high cultural identification (Gondolf 2004) Men of Color Americans of color are at greater risk of victimization by violent crime regardless of gender. Americans of color are at greater risk of victimization by violent crime regardless of gender. Black Males are disproportionately victims of homicide. Black Males are disproportionately victims of homicide. Maori men are 15% of the total population, yet make up 50% of the prison population in New Zealand. Maori men are 15% of the total population, yet make up 50% of the prison population in New Zealand. Cultural Variables Migration Migration Acculturation Acculturation Language and cultural world view Language and cultural world view Values: personalismo, familialismo, group vs individual; cooperation vs competition; spiritual vs material; youth oriented vs eldership Values: personalismo, familialismo, group vs individual; cooperation vs competition; spiritual vs material; youth oriented vs eldership Cara y Corazon Cara y Corazon LESSONS LEARNED d Modeling d Moral Correction d Love and Pain d Spirit (Soul) Wound d Internalized Oppression NEUROBIOLOGY OF ATTACHMENT Structure and function of the brain are directly shaped by interpersonal experience. Human connections create neuronal connections (Siegal, 1999) It is these connections and the developing brain that allow for the regulation of affect, thus establishing the context for relationships allow for the regulation of affect, thus establishing the context for relationships ATTACHMENT Adverse social experience during early critical periods such as neglect, abuse, abandonment, violence and chaotic chemically dependent behavior seriously impair the functioning of the LIMBIC SYSTEM. Adverse social experience during early critical periods such as neglect, abuse, abandonment, violence and chaotic chemically dependent behavior seriously impair the functioning of the LIMBIC SYSTEM. IMPAIRED LIMBIC SYSTEM ^ Hypothalamic Pituitary- Adrenal Axis. ^ Stress results in the release of CRH. ^ Excessive HPA is maladaptive. ^ Extended exposure to Cortisol is toxic and the Adrenal switch cannot be turned off. Impaired Central Nervous System m Impaired judgment: frontal lobe m Short fuse: temporal lobe m Obsessive thoughts: cingulate gyrus m Melancholic Depression. m Victim / Perpetrator of Violence. m Obsessive-Compulsive. m Panic. m Genrealized Anxiety. m Alcoholism. m Substance Abuse. m PTSD Effects of Trauma on Neurobiology Frozen memory Frozen memory Increased emotional triggers Increased emotional triggers No context for prior trauma memory No context for prior trauma memory Hyperaroused limbic system Hyperaroused limbic system Speechlessness Speechlessness Retraumatization Retraumatization Avoidance Avoidance Physiological conditioning (Van der Kolk) Physiological conditioning (Van der Kolk) Attachment Theory Secure. Anxious-avoidant: Dismissing. Anxious-ambivalent: Preoccupied. Disorganized: Fearful. Assessment of Lethality ; History of Violence: frequency and severity increased over time. ; Rule out Mental Illness and Organic Conditions. ; Substance Abuse. ; Criminal Justice Involvement. ; Weapons & Threats of Weapons. ; Relationship is ending. IMAGE OF VIOLENCE Normal Underside surface view. Arachnoid Cyst occupying the space of the left temporal lobe in a violent 9 year old boy. Images of Alcohol and Drug Abuse Heroin & Methadone Normal View 39 y/o - 25 yr. hx of frequent heroin use Active side view on high dose methamphetamine Active side view off methamphetamine Underside active view Hot area deep left temporal lobe Top-down surface view Multiple hole across cortex Hope for Healing Alcohol Cocaine & Meth On and Off Drugs Top-down surface view During substance abuse Top-down surface view A year drug and alcohol free Underside surface view During substance abuse Underside surface view A year drug and alcohol free * Holes and shriveled appearance during abuse TREATMENT CONSIDERATIONS v Solid Clinical Assessment. v Rule Out Lethal Situations. v Assess Level of Substance Abuse expect Sobriety. v Assess Neurochemical Impairment. v Motivational Enhancement Initially. v Deep Psychotherapeutic Episode to deal with Living Clean, Sober & Violence Free STAGES OF CHANGE s Precontemplation-Denial. s Contemplation-Exploration Preparation. s Prevent Tarzan-Swing Action. s Maintenance-Relapse Prevention. s Balance, Rhythm & Harmony. Intake Process Intake Process Conocimiento Conocimiento Family History Family History Cultural History Cultural History Community History Community History What behaviors were learned. What behaviors were learned. Lugar: Place Lugar: Place Machismo Machismo Parenting: how they Parenting: how they Were parented Were parented How do they want to parent How do they want to parent Relationships Relationships Healing Healing Compadres Network Compadres Network Domesticated Violence It takes a nation to raise children to become violent men. It takes a nation to raise children to become violent men. Violence is learned behavior that has been reinforced nationally & internationally. Violence is learned behavior that has been reinforced nationally & internationally. This is a historical correlation between oppression and the domestication of violence. This is a historical correlation between oppression and the domestication of violence. La Cultura Cura La Cultura Cura Domesticated Violence Oppression is a spirit breaking process of objectifying people. Oppression is a spirit breaking process of objectifying people. Oppression has an inherent pathology of addiction: the Land Rush, Gold Rush, and Oil Rush. Oppression has an inherent pathology of addiction: the Land Rush, Gold Rush, and Oil Rush. Domesticated violence is a Human Induced Disaster. Domesticated violence is a Human Induced Disaster. Goal: to learn to Honor all sacred relations. Goal: to learn to Honor all sacred relations. The Altar Curriculum Conocimiento Conocimiento Palabra Palabra History of family History of family History of colonialization History of colonialization Migration Migration Acculturation Acculturation Cargas y Regalos Cargas y Regalos Differential Diagnosis Differential Diagnosis Entendimiento Cultural Cura Cultural Cura La Conquista La Conquista Machishmo: True vs False Teachings Machishmo: True vs False Teachings Patriarchy Patriarchy Erosion of Cultural values Erosion of Cultural values Palabra Palabra Maleness to Manhood Maleness to Manhood Integracion Tortilla de la Vida Tortilla de la Vida Mascara Mascara Cara y Corazon Cara y Corazon Altar Altar Mi Familia, Mi Corazon Mi Familia, Mi Corazon Sacredness of Relations Sacredness of Relations Fire & Water Fire & Water Movimiento Perdon Perdon Family Preparation: Cultural congelada Family Preparation: Cultural congelada Dando Palabra Dando Palabra Despedida Despedida Compadres Network Compadres Network Mentoring Mentoring Peace Keepers: Jaguares y Aguilas Peace Keepers: Jaguares y Aguilas Las Cargas A collective sense of unresolved psychic conflicts, being highly functional addicts, relationship problems with spouses/children, enduring emotional pain related to early experience of child abuse and abandonment. The profound effect of internal oppression has caused a pervasive sense of isolation in our lives. A collective sense of unresolved psychic conflicts, being highly functional addicts, relationship problems with spouses/children, enduring emotional pain related to early experience of child abuse and abandonment. The profound effect of internal oppression has caused a pervasive sense of isolation in our lives. REGALOS Regalos can be described in terms of academic, business, and personal success. Regalos can be described in terms of academic, business, and personal success. Many members of the group had experience substantial personal status within their field of expertise. Many members of the group had experience substantial personal status within their field of expertise. Having overcome the detriments of poverty and external oppression. Having overcome the detriments of poverty and external oppression. The most impressive gain was gathering to support each other in our pursuit of personal growth and integrity; in the similar vein that may be the reason we are here. The most impressive gain was gathering to support each other in our pursuit of personal growth and integrity; in the similar vein that may be the reason we are here. Respeto-no cross talking, no interruptions, no impositions of values or judgments. Freedom to speak of ones cargas and regalos. Freedom to speak of ones cargas and regalos. Empathic listening. Empathic listening. Feedback, cario. Feedback, cario. Closing prayer and sharing. Closing prayer and sharing. El abrazo. El abrazo. The Group Circulo Process The Group Circulo Process Guiding Principle: El Hombre Noble Occepa iuhcan yez, occepa iuh tlamaniz, iiquin, in canin / Once again it shall be, once again it shall exist, sometime what existed long agowill exist again. Occepa iuhcan yez, occepa iuh tlamaniz, iiquin, in canin / Once again it shall be, once again it shall exist, sometime what existed long agowill exist again. El Hombre Noble Cumple con su Palabra / Is a man of his word. El Hombre Noble Cumple con su Palabra / Is a man of his word. El Hombre Noble... Debe de tener un sentido de responsibilidad para su propio bienestar y para otros en su circulo / Should have a sense of responsibility for his own well being and that of others in his circle. Debe de tener un sentido de responsibilidad para su propio bienestar y para otros en su circulo / Should have a sense of responsibility for his own well being and that of others in his circle. Rechaza cualquier forma de abuso...fsico, emocional, mental o espiritual asi mismo y a otras personas / Rejects any form of abusephysical, emotional, mental or spiritual, to himself and others. Rechaza cualquier forma de abuso...fsico, emocional, mental o espiritual asi mismo y a otras personas / Rejects any form of abusephysical, emotional, mental or spiritual, to himself and others. Hombre Noble Should take time to reflect, pray, and include ceremony in his life. Debe de tener tiempo para reflexionar, rezar e incluir la ceremonia en su vida / Should take time to reflect, pray, and include ceremony in his life. Should be sensitive and understanding. Debe ser sensible y comprensivo / Should be sensitive and understanding. Should be like a mirror, reflecting support and clarity to one another. Debe ser como un espejo, reflejando apoyo y claridad de uno a otros / Should be like a mirror, reflecting support and clarity to one another. Lives these values honesty, and with love. Vive estos valores honradamente y con amor / Lives these values honesty, and with love. Hombre Noble Treatment Planning a Initiate mutual clinical alliance. a Primary treatment considerations are the effect of neglect, sexual, physical, & psychological abuse. a Treatment is slow. a Trust building is crucial. a Patience on the part of the clinical team. a Behavioral skill development: a How to live without the Raging Fire a (ROCK & ROLL) RICARDO CARRILLO Ph.D. Tel (559) National Compadres NetworkNational Compadres NetworkNational Latino Alliance for the Elimination of Domestic ViolenceNational Latino Alliance for the Elimination of Domestic Violence