Transcript FAMILY GROUP - Hamilton Family Health Team

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
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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
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Triggered by curiosity
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Use is usually approached with caution
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Removes much of the normal fear connected
with substance use

Experience is usually positively reinforcing at
this stage
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Positive experience often leads to using again
Social Use

Triggered by social norms/peer influence
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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
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Shaking
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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
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No involvement means exactly what it
says – absolutely no gambling activity
at all.
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Approximately 36% of the population in
Ontario are ‘non-gamblers.’
Casual Social Gamblers
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Occasional
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Part of a larger leisure life
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Not the only form of recreation
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Gamble for recreation and excitement
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Losses are accepted
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Does not interfere with life or selfesteem
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Would not miss gambling
Serious Social Gamblers
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Main form of entertainment
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Regular gambling
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Serious pastime, but does not interfere
with life
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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
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Emotional cues
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Time cues
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Behavioural cues
Signs and Symptoms
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Financial cues:

Placing larger and more frequent bets in order to get the same level
of excitement
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“Chasing” losses

Watching debts grow, borrowing money, not paying bills

Cashing in RRSPs, savings bonds, insurance
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Money or valuables missing
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Changes in spending priorities
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Defensiveness or secrecy about money
Signs and Symptoms
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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
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Prefer gambling to anything else
Signs and Symptoms
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Behavioural Cues
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Decreased attendance at family functions
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Neglecting responsibilities/preoccupied
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Changes in sleep, eating, sexual behaviour
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Being on edge, reactive, defensive, bored easily
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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
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Safety concerns
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Anger
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Guilt and shame
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Relational Conflict
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Role imbalances
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Children “acting out”
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Stigma
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Secrecy/Isolation
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Stress-related illness
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Poor Communication
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Financial Difficulties
Impact Of Substance Abuse/Problem
Gambling on Family Members
In the Early Stage:
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Denial
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Arguments
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Believing excuses as reasons
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Confusion and ambivalence
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Anxiety and concern
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Rescuing, protecting, covering up for
family member
In the Middle Stage:


Vague, unclear communication –
“Don’t Trust. Don’t Talk. Don’t Feel”
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Unresolved conflict – deterioration of
relationship
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Gradual shift in role and responsibility
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Decreased sociability
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ATTEMPT TO CONTROL
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Nagging, threatening
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Reporting on use and user
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Counting drinks, marking bottles, checking
on amount of drugs consumed
In the Late Stage:
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Attempts to control the user or the
use become more extreme until…
Eventually:

Self neglect – physical, social and
emotional
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May increase own use of drugs or
alcohol
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Anger, rage
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Depression
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Burnout
What Have You Tried ?
Family Members Try Less
Helpful Ways of Coping
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Nagging
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Controlling
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Investigating
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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
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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
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Contemplation
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Determination/Preparation
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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
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often involves lapses and relapses.
stressor
lapse
relapse
Time
Harm Reduction
Assumptions:
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Not all substance use or gambling is
necessarily harmful.
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There will always be individuals who misuse
substances or gambling harmfully
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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
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www.problemgambling.ca
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Ontario Problem Gambling Helpline 1-888-230-3505
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Day and residential treatment
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GamBlock
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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