A Guide Book for Addiction Treatment Practioners
Helping Families Of Drug Abusers
By Riffat Sadiq Ph.D
A Publication Of Drug Free Nation www.drugfreenation.org
Dedicated to All family members of drug abusers with great sympathy and sincere feelings
Drug Free Nation Š 2013-2014
Contributors
Bill Cameron President, Drug Free Scotland Grainne Kenny Hon. President, Europe Against Drug Abuse Haider Ali President Drug Free Nation Safia Umer Program Manager, Drug Free Nation Rabia Riaz Ph.D. Assistant Professor, Department of Psychology, University of Karachi
Preface Family members of drug abuser are kept hanging for unlimited time along with their addicted patients. Entire family environment, especially in South Asian Societies, becomes a torture cell for nonaddicted members. Associated behavioral problems of drug or substance abuse do not let rest of the family members take sigh of relief until addicted family member recovers. Entire family falls in the swamp and undergoes the severe stress. They are vulnerable to various psychological problems. With impaired mental health, they could not help their patients as they must. Codependency, social stigma and economic destruction, in turn, make them dysfunctional members of society. Mental health and other professionals treating drug abusers must be equally attentive towards the psychological issues of all family members of their patients. Only conducting family support group and few sessions of family counseling can never be effective. A comprehensive treatment program needs to be followed in order to make the entire family psychologically healthy enough to be effective supporter of their drug abuse family member. The current book has been written to guide the professionals affiliated with drug abuse treatment and rehabilitation centres. Therapeutic techniques have not been described in details. Only purpose is to make professional aware of preparing comprehensive treatment plan exclusively for families of drug abusers. Riffat Sadiq
Content
S.No 1.
Content
Chapter 1 Introduction Drug Abuse Scenario in South Asian Countries Impact of drug abuse on families 2. Chapter 2 Family and its Functions 3. Chapter 3 Impact of Drug Abuse Problems on Family Functions 4. Chapter 4 Professional Services for the Families of Drug Abusers 5. Chapter 5 Individual Psychological Counseling 6. Chapter 6 Family Counseling 7. Chapter 7 Life Skills Training 8. Chapter 8 Conducting Family Support 9. Conclusion 10. References
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35 40 44 48 54 55
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Chapter 1 Introduction Drug Abuse Scenario in South Asian Countries Impact of drug abuse on families
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Chapter 1
Introduction Drug Abuse Scenario in South Asia Countries The term “drug abuse” has been known to all of us for centuries and people have been abusing drugs since ancient times. With the passing of time, a variety of drugs along with their modes of intake have been variously introduced. Culturally, people define drug abuse differently. For instance; some communities use alcohol as a part of recreational activity; smoking of opium is still treated as a traditional practice in the region of South Asia, so in different circumstances, drug abuse is given different meanings (Voses, 1982, as cited in Muhammad, 2003). Health professionals have categorized drug abuse as a separate chronic disorder due to its pernicious effects on user’s health. Drug abuse refers to a compulsive behavior of using drugs that leads to physical, psychological and as well as social problems for the users. World Health Organization defines drug abuse as, “a consumption of a drug apart from medical need or in unnecessary quantities In Diagnostic and Statistical Manual (DSM-IV) "psychoactive substance abuse" is defined as "a maladaptive pattern of use indicated by ...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use [or by] recurrent use in situations in which it is physical1y hazardous". Drug abuse has become a global concern because of its detrimental effects on the individual, family, society and economy of the country as well. The global prevalence rate estimated by United Nation Office on Drug and Crime (UNODC) pertaining to drug abuse was 3.3% to 6.1% till 2009. About 149 to 272 million people between 15 to 64 years of age in all over the world abused illicit drugs. About 153 to 300 million people used illicit drugs in the year of 2010.
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Chapter 1
South Asian countries in particular have been entangled in drug abuse problems since 1970 (Spencer & Navaratnam, 1981) with cannabis being the most common drug. According to the survey report of Pakistan Narcotic Control Board (PNCB, 1993), there were 3 million drug abusers in Pakistan and amongst them 51% were addicted to heroin. National assessment on drug abuse problems in Pakistan (2006) depicted that there were 628,000 opiate users and amongst them 482, 000 were abusing heroin. The prevalence of drug abuse in Khyber Pukhtoonkhua was 0.7%, in Punjab was 0.4%, in Sind was 0.4% and in Baluchistan was 1 %. At country level, prevalence of drug abuse was 0.7%. United Nation Office on Drug and Crime (UNODC, 2002) reported that there were 5000,000 chronic heroin users in all over Pakistan. A survey report indicated a higher prevalence of alcohol, tranquilizers and psychedelic abuse among medical students. The prevalence of these drugs among students was 5 %, whereas among doctors was 3% (Shafiq et al, 2006). In a study, Khan and Colleagues (2004) found the highest prevalence of drug abuse among people falling between the age ranges of 21 to 30 years, and married. Most of them were heroin addicts claiming to use drugs due to peer pressure. About, 5% of the population was abusing one or more than one type of drug. Drug reports in South Asian Countries (2009, as cited in INCP, 2011) revealed that in South Asia, cannabis is the most commonly abused substance. About 3.3% and 1 % population use cannabis in Bangladesh and in Sri Lanka respectively. The prevalence rate of opiate abuse in Bangladesh is 0.4 % and in Sri Lanka is 0.1%. Population of other South Asian countries such as; Bhutan, India and Nepal also have been addicted to opiates. The use of opium is highest in India. The trend of abusing drugs by injection got higher in Bangladesh, India (0.02%) and in Nepal (0.01%). In Maldives, mode of injection also has been increased. Heroin and buprenorphine are the most preferred drugs via injection in these countries. Other drugs, for example opioids or a combination of buprenorphine and antihistamines or sedatives (mostly benzodiazepines) have become choice of drugs among most of the drug abusers in this region. Furthermore, a trend of poly drug abuse has increased in South Asian countries.
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Chapter 1
According to United Nation Office on Drug and Crimes (UNODC, 2009) the prevalence of opiate abuse in Afghanistan was among the highest in the region where prevalence of drug abuse reached to 53 %, 230,000 during four years. There are 120, 000 were heroin addicts. The annual prevalence of opiate use was estimated to be 2.7% of adult population. The estimated prevalence of opium use was 1.9% of adult population. Heroin prevalence was 1.0% of adult population, the prevalence of adult drug users was equal 1 million (940,000). They all were falling between the age ranges of 15 to 64. Opium, cannabis and heroin were was most common drug abuse among men and young users. About 60 % drug abusers used opium in their life. Opium, cannabis and heroin were commonly used by young women, opium, cannabis and tranquilizers (painkiller) used by women, whereas cannabis, opium and heroin were most commonly used by adolescents. Opium, cannabis and tranquilizers were used by children. Drug abusers spend 300 million dollars on their drug habit every year.
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Chapter 1
Drug Abusers and their Families Drug abuse has significant effects on the health and happiness of individuals, families and communities (Muhammad, 2003). And these effects carry severe penalties in economy, politics and international relations. Poor health, decline in income and social isolation further damage the individual functioning and as well as impede the family’s growth. The annual estimated rate of drug abusers is equivalent to 100,000 in Pakistan that bring psychological, social and economic harm to 20 million abusers and their family members. In India, a drug dependent expends 13 dollar per week on buying drugs and total expense are 250 to 25,000 dollars. That leads to poverty and other family problems (as cited in Sharma, 2009). About 58% of family members of drug abusers reported bad feelings; 2/5 reported anger and annoyance, whereas 22% reported to have the feelings of hopelessness, shame and non-supportive attitude for their drug abuse family member. Unwanted behaviors were observed in 36% drug abusers, whereas domestic violence was reported among more than 80% drug abusers. There was a strong association between drug abuse and disintegration of family. The consumption of heroin and psychotropic substances leads to breakdown in family cohesion (Spielmann, 1994) in Thailand. Drug abuse destroys the family functions (Sadiq & Umer, 2013). Families of drug abusers suffer from financial constraints, lack of protection and affection. Family prestige is also at great risk of severe destruction. Eventually, family reacts to drug abuse by denying, blaming, suppressing anger, depression and co-dependency (Sharma, 2009). Drug abuse family member becomes the source of pain and stress for rest of the family members. Eventually, family becomes emotionally dependent on drug abusers. In such situation, the family gratifies the abuser’s need for drugs in order to overcome pains associated with drug abusive behavior and to protect the entire family from further harm. Family itself becomes dysfunctional and co-dependent. A significant distress has been observed among parents, specifically mothers of drug abusers (Andrade, Sarmah & Channabasavanna, 1989).
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Wives of alcoholics reported the coping behaviors of avoidance, indulgence and fearful withdrawal in response of drug abuse problems in their partner (Chandrasekaran & Chitraleka, 1998). Delusional jealousy and violent behavior on the part of drug abusers are causing factors of suicidal attempts among spouses (Ponnudurai, Uma, Rajarathinam & Krishnan, 2001 ). Families of alcoholics suffer from guilt, stigma and emotional withdrawal (Nace et al, 1982). Family finances, gatherings, communication, roles and social life are spoiled due to alcoholic behaviors (Velleman, 1992). Family relationships are also impaired due to the drug-related crimes and accidents (Coleman & Strauss, 1983). United Nation Office on Drug and Crime (UNODC, 2002) has reported that family members provide money to drug abuse family member due to coercion and desperation. Some of them had to pay loans on behalf of their drug abusing family member. Female family member face a huge burden of bearing household expenses along with burden of blame. She herself becomes the victim of both drug abuser and society. All these factors result in feelings of guilt, shame, embarrassment, depression, anxiety, isolation and suicidal thoughts. At this stage, family members of drug abusers themselves need professional help to be come out from their own psychological problems and extreme emotional dependency on drug abuse family members.
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Chapter 2 Family and its Functions
Economics Affection and Procreation
Prestige and Status
Functions Of Family Recreation
Education
Religion
Protection
Chapter 2
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Family and its Functions Defining Family Family is described as a basic unit of society. From biological perspective, a man and woman come into a legal sexual relation to produce future generation. Formally, a family comprised of father, mother and a child. Sociological perspective takes into account the social needs of family and its role in running social institution. Family, for sociologists, refers to a social group, social institution and social system. The function of family is beyond the production of children and including upbringing the children with the aim of developing a sense of socialization so that they benefit the social system or vice versa. Different families make a social system giving various flavors in form of race, class etc. Benekraitis (1996) has defined family in traditional way. Two or more persons make family based on blood relation, marriage or adaptation. They live together being an economic unit besides raising children. In the view of Nimkoff and Ogbum (1985), “family is a socially sanctioned group of persons united by kinship, marriage or adaptation ties that generally share a common habitat and interact according to well-defined roles�. Functional Perspective (Doherty et al., 1993) deems family as a subsystem of society because society’s growth largely depends on family. Religious perspective of family discusses the combination of both biological and social need of the family. Two persons make the foundation of family by tying the knot following their cultural and religious norms. In all religions, family is deemed as a source of personal and social satisfaction. Each religion discourages the involvement in illicit sexual activities and family violence. Religion bounds all family members to fulfill the basic needs of each other. Family members are also responsible to exhibit care, love and affection in order to create a healthy family environment.
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Chapter 2
Psychologists put reflection on those factors that may positively or negatively affect the family environment. Besides investigating the determinants of family wellbeing, the significant effects of family environment on individual also have been under their debate. Parental attitude, socioeconomic factors, family structure, process and life style play vital role in developing psychopathologies and delinquent behaviors among family members. Axiomatically, family is a combination of sexual, social and psychological needs of a person. Healthy family provides physical, mental and sexual satisfaction which diminishes the probability of delinquent behaviors towards the promotion of a civilized society.
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Seven Functions of Family William Ogburn in 1930 suggested seven functions of a family which are as follow;
1. Economics: The first and essential function of family is to produce economic sources to gratify basic needs of the all of the family members.
2. Prestige and Status: Each member of family is recognized by his family name in the society. A person is valued or devalued on the basis of his or her family’s reputation in the community. Therefore, family must provide prestige and status to its all members.
3 Education: The family is also responsible for providing education regarding domestic services, needs and as well as searching educational opportunities for family members especially children which are needed to compete the society.
4. Protection: The forth function of the family is to gratify the need of security. Elders are responsible to provide physical, social and as well as economic protection to younger family members.
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5. Religion: A family must follow the religious values by arranging religious gathering, arranging religious prayer along with acquiring religious education through the use of Holy books and other scriptures.
6. Recreation: A family also needs to arrange recreational activities within family not merely relying on the community and schools etc.
7. Affection and Procreation: The family members also need affection from each other. The family provides adequate affection to family members besides emphasizing on procreation.
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Chapter 2
Winto (1995) had examined following functions of the family
To provide replacements for dying members of society: All human beings coming into the world have to go back. Human beings are being replaced by one and other. Therefore, family is basically formed to reproduce human beings to continue the system given by nature. A couple is blessed with a child as a member of society. Later on, he or she makes his family, gets married and produces a child. At a stage, his parents go back to eternal place. The entire world is based on this life cycle
To produce and distribute goods and services: Provide goods and services for the support of the members of the society is the second function of the family. Family puts effort to meet the basic needs of its members as good as possible.
To accommodate conflicts and maintain order internally and externally: Certain conflicts are expected to occur within family and between family members and society. Function of family is to resolve the conflicts, to reduce internal and external problems and to build the potentials among family members so that they could resolve the conflicts themselves
Provide Replacements
Family Function Accommodate Conflicts And Maintain Order
Produce And Distribute Goods And Services
Chapter 2
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Ghani (2000) also discussed various functions of family which are more or less similar to the seven functions proposed by Ogyum (1930). Following are the eight functions of family;
1. Reproduction of perpetuation of human race: Family is responsible for the reproduction of humanity as nature demands from all human beings.
2. Sexual Regulation: Family promotes legal way to satisfy sexual needs and regulate the sexual behavior.
3. Imparting religion and values: Each family and society has its own values and religious norms. Family is responsible to impart religious education and social values/norms to the all family members.
4. Socialization: Family also strives to be socialized by producing socially adaptable family members. Family makes tie with other families in the society.
5. Economic Function: Family has to explore economic opportunities available in the society, to plunge into competitive environment and to utilize all capabilities to be economically flourished.
Chapter 2
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6. Affectional and emotional security: Family provides affection and emotional security to all family members. Gratification of needs for love and care are first take place in the home.
7. Education: Making family members educated and knowledgeable to survive in the community is another important function of the family. Religious and other educational opportunities need to be provided to entire family.
8. Recreation: Family also needs to be involved in re-creational activities apart from striving for economical and educational resources. Recreation contributes to healthy growth of family.
Recreation
Education
Affectional And Emotional Security
Reproduction Of Perpetuation Of Human Race
Sexual Regulation
Family Functions
Imparting Religion And Values
Socialization: Economic Function
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Chapter 3 Impact of Drug Abuse Problems on Family Functions
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Chapter 3
Impact of Drug Abuse Problems on Family Functions
Destruction of Family Functions 1. Destruction of Economic Resources: Drug abuse, at first, results in destruction of family economy. When earning member of family get involved in delinquent behaviors such as; they become unable to produce sufficient economic resources that lead to deprivation of basic needs. According to Dean (1984), when an earning member of a family indulges in addictive behavior, his wife and children have to be dependent on others, such as their parents and grandparents for the gratification of their basic needs. As a result, they deprived of food and good education. In last, they feel no sympathy and emotional attachment for drug abuse family member and consider him responsible for this worst situation. Lower and middle class families suffer a lot. Drug abusers sell home appliance and other needy materials. Sometimes, families have to pay others for things stolen by their drug abuse family members for buying drugs. Many children of drug abusers have to work in factories and shops to bear household expenses. Mothers in old age, wives and even young sisters have to go out to earn money. Drug abuse, instead of providing economic resources to family, himself becomes dependent on them. He also destroys family’s wealth for drugs (Sadiq & Umer, 2013).
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Chapter 3
Case Study Razia is a mother of three addicted sons. Two of them are married and having children. Razia’s husband has passed away and she is fully dependent on their sons who are chronic drug abusers. They have been rehabilitated many times but got relapsed. Their indulgence drug destroyed family finances. As a result, Razia in her old age has to work to meet household expenses. She also used to beg for money under severe economic crises. All of the responsibilities of grandchildren and daughters-in-law are on her shoulders. She keeps weeping and says nothing.
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Chapter 3
2. Destruction of Prestige and Status: Drug abuse brings harm to family’s prestige and status. A large body of research evidences reveals the association of drug abuse problems with criminal behavior. Robbery, pick pocketing, stealing are drug abuse related crimes (Sadiq, Umer & Ali, 2013). Involvement of drug abuse family member in such crimes, has detrimental effects on family’s reputation. According to Ogyum (1983), each member of family is recognized by his family name in the society. Unfortunately, family members of drug abusers develop feelings of shame and guilt because of drug abuse family members. They also perceive rejection from society; as a result, they socially restrict themselves. Even, in sub-continent, people do not like to tie the knot with the girl belonging to drug abuse family members.
Case Study Saima’s brother is a heroin addict. He is also involved in crimes and has been arrested twice. Saima is 24 years old and her parents want her to be married as soon as possible. But, they have no suitable proposal for their daughter because of their addicted son and his involvement in drug related immoral activities. Even, Saima’s paternal aunt did not like to make her daughter-in-law. Saima has developed feelings of rejection and inferiority. All of her age fellow in family and community got married. She blames her brother for her misfortune..
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Chapter 3
3. Destruction of Education: As mentioned earlier that family is also responsible to provide educational opportunities for family members specially children to be survived. Drug abusers do not remain capable for arranging educational resources to their children and other family members. The most pitiful aspect is that children of drug abusers have to go to work and jettison their dreams to be educated. The drop out of children of drug abusers from school is common (especially in lower class). When elder family member spends all of family’s wealth on drugs leaving nothing behind for any one then, children and younger family members have to sacrifice their needs. Many children of drug abusers have been seen doing labor work.
Case Study Ali’s father is a drug abuser and involved in gambling. He needs more money for gambling and taking drugs. Ali used to study but he had to give up his studies since his father became drug abuser. Ali’s mother is not educated enough to do a job. She sells vegetables but could not earn sufficient amount to run her kitchen. Ali is 14 years old and eldest among four siblings. He started working as a mechanic in an auto repair shop. He works for more than 7 hours and do not find time to study. He and her mother are working hard to be survived. Ali’s father addiction shattered Ali’s dream of becoming educated person.
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Chapter 3
4. Destruction of Protection: Head of the family is responsible for providing physical, social, emotional and economical protection to children and younger family members. Drug abusers could not provide emotional, social and physical security to their family members. The need for love and affection remains ungratified - this impedes the process of smooth emotional growth of children. Moreover, they have to face rejection from society. Feelings of guilt, shame and deprivation result in psychological problems family members.
Case Study Rukhsana’s husband is an alcoholic. She is mother of two children. Rukhsana is a school teacher in a government sector. Although, she is not having financial problems but her husband’s alcoholism disturbs the family environment. Being intoxicated, he quarrels and uses abusive languages with family members. He also beats Rukhsana in front of his children. Due to this, Rukhsana and her both children remain fearful. Many times, she decided to break her marital relation but due to some family obligations, she did not take any step. In normal condition, Rukhsana’s husband behaves well with her and children as if he is very caring and loving. Every time, he justifies his misbehavior. He brings gifts for children and wife. Despite that Rukhsana and her both children do not feel to be secured in their own home.
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Chapter 3
5. Destruction of Religious Rituals Another adverse impact of drug abuse is on the religious functioning of the family. Though, family is responsible for providing religious education, teaching religious values to be followed but drug abuse problems impair spiritual health of people. Drug abusers themselves could not perform religious rituals properly that may affect the other family members in terms of their daily routines. Family members become co-dependents, developed psychological problems which further impair their daily functioning, even their ability to perform religious values. They remain disturbed all the day because of drug abuser family members.
Case Study Khalid belongs to a religious family. After becoming drug abuser, he deviated from religious and social norms. All of his attention is on drug intake. He frequently tells a lie and cheats family members. Drug abuse has destroyed his sense of right and wrong. His misbehavior and drug related acts have made his wife depressed and hopeless to the extent that she attempted suicide twice. She seems to be cursing her fate and prefers death over life. She is compelled to go out to work to run her kitchen. She does not have sufficient time to teach her children religious rituals. She and her children also avoid social gatherings including religious and recreational activities.
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Chapter 3
6. Destruction of Recreational Activities Recreational activities are essential to grow healthy family. Involvement in recreational activities provides sound effects, release tension and make mentally and emotionally healthy. Families of drug abusers are usually deprived of recreational activities. The entire family environment becomes stressful. Due to the destruction of economic resources, their interest is limited to meet household expenses. Indulgence of one family member in addiction makes rest of the family members frustrated and hopeless. These feelings further diminish the desire for participating in recreational activities.
Case Study Usman is 15 years old school going boy. His father is a heroin abuser. He is having two younger daughters who also study in the same school. His mother is a factory worker and is working hard to make their children educated despite her husband’s addiction. Whatever she earns is spent within a month. Her income merely meets household expenses and her children education. No extra amount is available for recreational activities. Usman’s mother goes out of her home early in the morning and come back in the evening. At home, she has a lot of work to do such as; preparing meal for children and herself, cleaning and dusting etc. Usman, his mother and both sisters are leading a life as a machine.
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Chapter 3
7. Destruction of Affection and Procreation: The seventh function of the family is to fulfill the need of affection and love of family members. All family members are dependent on each other for the gratification of their need for love. If need for love and affection remain ungratified that will impede the process of smooth emotional growth of children. Not only children but adult also need love being part of family. Drug abusers need drugs at any cost. Their craving for drugs does not let them to pay attention to what their family members need from them. Procreation does not seem to be influenced too much but emotional growth remains at great risk due to drug abuse. Drug intake during pregnancy may affect the smooth process of procreation.
Case Study Jamila’s husband is taking drugs for last 6 years. She is having two children. She belongs to lower class. She prepares meal at home and supplies to factory workers. She earns enough money to fulfill basic needs of her family. Due to her husband’s addiction and drug related activities, she deliberately underwent the surgery of removing her uterus. On inquiring, she justified that she had to do it because of her husband. He is addict and could not fulfill his responsibilities. She did not want to deliver more babies of an addicted man who is unable to support his family.
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Chapter 3
Consequences of Family Dysfunction Destruction of seven functions of family of drug abusers brings dire consequences in terms of psychological and social problems.
1. Psychological Consequences: Psychological health of family members of drug abusers is at great risk. Research based evidences proved that drug abuse affects the psychological health of family members because of their drug abuse family members. Wives of substance/drug abusers suffer from somatic complaints, anxiety, social dysfunction, depression, anxiety and hostility (Ali & Sadiq, 2011), chronic cough, weight loss, depression, anxiety, aches, pain and irritability (Mehra, 2002, as cited in UNODC, 2002) and suicidal risk (Manohar & Kannappan, 2010). In a study, Farhat (2003) found that adult children of substance abuse fathers were suffering from depression, psychasthenia, paranoia, hypomania and psychopathic personality disorders. They also appeared to be more socially introvert and aggressive than adults children of non addicts. Alcoholic problems in parents lead to cognitive, behavioral and emotional problems in children. They, in later life, suffer from adjustment problems, violence, depression, anxiety and low self-esteem and substance abuse problems (Johnson & Leff, 1999).
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2. Social Consequences: Social problems are integral part of drug abuse problems. Family has to pay a huge cost because of their drug abusing family member in terms of social problems. Family members develop feelings of abandonment, fear, embarrassment and guilt. In South Asian countries; Pakistan, India, Bangladesh, it is not easy to cut ties with drug abusing family members. Parents go a long way to save their addicted children. Sometimes, they embrace their death taking the pain of addicted children. At social level, families of drug abusers are rejected and devalued. Most of the sisters and daughters of drug abusers seem to be complaining of not having suitable marriage proposal because of social stigma. They are labeled as sisters/daughters of drug abuser. Even, close relatives do not like to accept them for their sons. Sometimes, family has to hide or lie about the abusing patterns of addicted member so that they could arrange their daughter’s marriage. The situation becomes more pathetic in case of alcoholics. Families of alcoholics are disliked at community level due to religious and social norms. Usually, neighbors and relatives do not like to visit these families. Parents and elder brothers do not allow their girls to make friendships with the girls whose family member drinks.
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Chapter 3
3. Family Abuse Family has to counter abuse as a consequence of drug abusive behavior of one of the family member. Variety of family abuse has been committed at the hands of drug abusers such as; stealing money and things, snatching money from family members, using abusive language, beating and quarrelling with family members. Alcoholics were found to be involved in domestic violence (Kahler, McCrady & Epstein, 2003). Approximately, 87% drug addicts violently behaved with their family members (Shankardass, 1998, as cited in UNODC, 2002). Drinking problems among husbands results in death of female partner (Sharp et al, 2001). Drug abusers were more involved in quarrelling, threatening and using abusive language with their family members (Sadiq & Umer, 2013). Alcoholism predicts physical and emotional violence within family environment (Guebaly & Offord, 1997).
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Chapter 4 Professional Services for the Families of Drug Abusers
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Chapter 4
Professional Services for the Families of Drug Abusers Need of Professional Services for Families Families of drug abusers also need similar attention as drug abusers are given. Families become co-dependent due to their drug abusing family members. Drug abuse is associated with social problems such as; crime, unemployment, violence, family abuse, social rejection and stigma. Feelings of shame, guilt and social isolation make them mentally sick; as a result, they remain unable to support the addicted family member. The treatment of drug abusers requires long term support and cooperation on the part of families in order to keep the drug abuser in recovery. Many times, families have been found to be the cause of relapse. It all happens unconsciously, because the family also is suffering from emotional and behavior problems. In order to avoid further harm, they give money to the drug abuser for buying drugs. Under the shadow of multiple problems, they incorporated dysfunctional personality patterns. These patterns further make the environment stressful in which the entire family feels insecure, deprived and helpless. Specifically, intense feelings of insecurity are developed in children. Therefore, the family itself requires equal attention from health professionals along with the drug abusing family members. Family members must be alive with mental harmony whether their addicted family member recovers from drugs or not. There are four ways to provide professional services to the families; 1) individual psychological counseling, 2) life skill training, 3) family counseling, 4) family support group. Effective treatment is the mixture of all of the four services.
Chapter 4
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Individual Counseling
Family Support Group
Professional Services
Family Counseling
Life Skills Training
Individual Psychological Counseling Individual psychological counseling involves one to one session to directly direct the psychological problems family members are suffering from. The number of sessions depends on the severity of problems. Variety of therapeutic techniques can be applied with patients like; supportive techniques, client- centered therapeutic techniques, crises intervention and cognitive-behavioral interventions. Individual needs of family members of drug abusers are attended in individual psychological counseling. Family member learns to shift from negative behavioral and communication patterns to positive one. He or she also learns to rebuild his or her coping skills to combat environmental problems. His or her coping skills and sense of positive self-image also help in the treatment and rehabilitation of drug addict family member.
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Family Counseling Family counseling is conducted to empower the family members of drug abusers who are affected by drug related issues. Treatment plan is followed with the collaboration and mutual understanding of both families and their patients. Therefore, family counseling is an integral part of drug treatment and rehabilitation. Family therapy/counseling gave better results as compare to family education groups and other family services in the context of substance abuse disorders (Stanton & Shadish, 1997). Family counseling helps family members to evaluate their own dysfunctional patters and nature of co-dependency which, somehow, contribute to drug abuse problems and relapse. They also learn to communicate with each other in a positive way and develop functional behavioral patterns. A collaborative attitude is developed in the entire family towards the solution of drug-related problems. Sessions go side by side with the treatment of their addicted family member.
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Life Skills Training Life skill training is provided to enhance the skills of people to cope with daily life problems. Families of drug abusers need to be skilled enough to combat with social and psychological problems along with seeking treatment for the drug abusing family members. Life skills make them able to handle stressful situations and find alternative ways for a particular problem. Though, drug addiction is not a problem of an individual but of the entire family, therefore, several problems are expected to be destroying the entire family environment. Stressful family environments make family members co-dependents in terms of emotional and behavioral problems and deteriorated coping skills. Through life skills training, their deteriorated skills are rehabilitated such as; skills to manage stress and anger, skills to solve problems and skills to communicate and socialize with others.
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Family Support Group Family support groups are held to provide a platform for family members of drug abusers where they express their feelings, share experiences and learn from other families of drug abusers. They gain relevant information, learn from other experiences and develop skills to listen to others as well as contributing in making social networks. Family support groups provide supportive and sympathetic environment to family members to express their feelings of shame, guilt and resentment. Each member in the group carefully and sympathetically listens to person sharing his or her emotional pain. The rest of the members give suitable advice and recommend strategies to overcome emotional pain and problematic situation.
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Stages of Providing Services to Families Professional services are provided to families in sequences to have long lasting benefits. Individual counseling is essential if a family member is suffering from psychological disorder. He or she must be attended as an individual client rather than a relative of a drug abuser. Drug related psychological issues appear in form of hopelessness, aggression and feelings of guilt and shame. At this point, merely advice will not be effective. A Counselor, being an empathetic, supportive and good listener, will remove the blockage existing in expressions of their feelings and emotions. Having attended individual counseling sessions, family members come out of their own psychological problems and start realizing the reality of drug abuse problems. Then, they move to the second stage of their treatment, that is family counseling along with life skill training. In family counseling sessions, he or she is given awareness of dysfunctional family patterns that cause a gap among family members. He or she also learns to play a positive role in the treatment of the drug abuse family member. In family counseling, joint sessions are also conducted. After individual and family counseling sessions, life skills training can be given to them so that they rebuild their coping skills to fight in the battle of daily life stress created by drug abusing family members. Problem solving abilities, improved selfesteem and communicative skills make them able to handle not only drug abusing family members but also their own self. At the third stage, they are referred to family support group. Where, they are exposed to others suffering from similar kinds of problems. They are ready to learn from other experiences. They come to know that there are many others who are facing the problems like them. Family support group also helps in building a sense of socialization. Their need for being socialized deteriorated due to the drug abusing family members. But they are given an opportunity to relive again with enthusiasm.
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Stage 1
Stage 2
Stage 3
• Providing psychological counseling sessions to family members (individual or family counseling sessions or both)
• Arranging life skill training for family members
• Conducting family support group
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Chapter 5 Individual Psychological Counseling
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Individual Psychological Counseling Description Individual psychological counseling is one to one relationship between counselor and client. A supportive and positive environment is provided to a person suffering from any kind of emotional pain or stress. In individual setting, a psychological counselor, by applying therapeutic interventions, helps the family member of drug abusers in dealing with stress and pain associated with drug abusing family member. Psychological counseling also helps in increasing the sense of well-being. Different therapeutic techniques can be used to treat the emotional and behavioral problems among family members of drug abusers such as; supportive therapy, cognitive-behavioral therapy, crises intervention etc.
Objectives of Individual Psychological Counseling To provide the opportunity to family members to express their feelings associated with drug abuse family members To target their psychological problems (i.e, anger, depression, anxiety and so forth) To get them back from co-dependency To develop coping skills to handle drug abuse related problems To improve their psychological health so that they perform their role positively in the treatment and recovery of their drug abuse family members
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Qualities of Psychological Counselor Following are the qualities to be a good psychological counselor
Good listener Empathic Non-judgmental Open-mind Flexible Genuineness Discipline and Firmness Fortitude and Sensitivity Caring of professional ethics
Phases of Individual Psychological Counseling There are three phases of psychological counseling for families of drug abusers
Phase I: Rapport building and catharsis Initially, Psychological counselor needs to build rapport with the clients by providing them with the opportunity to express their feelings and emotions associated with their drug abusing family member. A supportive and positive environment is provided for catharsis. This phase facilitates the assessment of the nature of the problem. Techniques from supportive therapy and client-centered therapy are useful for rapport building and catharsis.
Phase II: Assessing the problem Psychological counselors needs to examine the nature of the problem Through probing and using structured questionnaires, counselor assess the impact of drug abuse problems on the psychological and social health of the family member with whom he or she is sitting right now. Type of problem, factors involved in the problems will be thoroughly examined. The counselor may also use questionnaire or projective techniques to determine the type and level of psychological, social and family problems. After in-depth analysis of the problem, a treatment plan is prepared to treat targeted symptoms.
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Treatment Plan Name:_______________ Gender:______________ Age:_________ Educational level:_____________ Relation To Drug Abusers:____________ _____________________________________ Diagnosis: Date:__________ Identified Problems
Targeted Symptoms
Interventions
Number Of Sessions Required
Prognosis: Note: This is a sample of treatment plan. Counselor can make treatment plan according to need
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Phase III: Using Appropriate Interventions After making diagnosis, family counselor uses different therapeutic interventions to treat psychological problems of family members. Supportive therapy, cognitive-behavioral therapy, crises interventions can be applied with them. Homework assignments can also be given to the clients. Selection of therapeutic techniques depends on the diagnosis, its etiological factors and client’s variable (demographic characteristics, family background, social and religious values/beliefs, personality traits etc). Number of sessions also depends on the intensity and duration of the problem.
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Chapter 6 Family Counseling
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Family Counseling Description The core objective of family counseling is to strengthen relationships among family members in order to promote healthy family environment. The family environment of a drug abuser is stressful and causes detrimental effects on the mental health of all family members. Anger, frustration and other psychological problems are obvious among them. As a result, relationships among the rest of the family members of drug abusers also get impaired. Family counseling not only removes the hurdles between drug abuser (under treatment and rehabilitation) and their families but also works on interaction patterns existing among family members. Family counselors may take into account the problems of the entire family, specifically the effects of drug abuse. Communication patterns also are improved. Family members learn to use more positive ways of communication to handle family problems.
Objectives of Family Counseling To help family members to understand each other’s feelings To convert dysfunctional family patterns into functional one To enable them to handle family issues To enhance their communicative skills/patterns To reduce gap among family members
Qualities of a Good Family Counselor Empathic Good listener Compassionate Flexible Non-judgmental Organized
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Steps involved in Family Counseling 1. 2. 3. 4. 5. 6.
Rapport building and Catharsis Assessing the nature of the problems Using therapeutic techniques Providing psycho-education in the context of drug abuse Providing information about relapse prevention Providing information about the maintenance of drug free life style
1. Rapport building and Catharsis Initially, the family counselor builds rapport with client by attentive listening and showing empathy. Rapport building is indeed a way of catharsis. Family members are encouraged to express their suppressed emotions and feelings. Rapport building and catharsis build a long term trustworthy relationship between counselor and client that helps in assessing the nature of problem.
2. Assessing the nature of the problems A Family counselor tries to assess the problems in detail in the context of a drug abusing problem. Causes and effects of drug abuse problems are thoroughly analyzed. More than one family member can be taken into session. Sometimes, the entire family may attend along with the drug abuser in order to make connection in obtaining information. The family counselor can use assessing tools, psychological/personality tests to diagnose the problem. 3. Using therapeutic techniques In case of identifying a psychological disorder, the family member is referred for individual counseling. Family members with mild depression, helplessness, anger and worries are treated by applying different therapeutic techniques in family counseling. Techniques from client-centered therapy, cognitive-behavior therapy, supportive therapy and reality therapy can be used. Selection of techniques depends upon nature, intensity and duration of the problem, client’s variable (age, educational level, personality traits and relation with drug abuser). Joint sessions are also held.
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4. Providing Psycho-Education In The Context Of Drug
Abuse After assessing the problem, psycho-education is provided to family members regarding drug abuse and its impact on mental health on drug users and their family. Counselor explains the way family’s well-being is impaired and how drugs make the family dysfunction. Family members develop psychopathologies and social problems. Co-dependency and its role in drug abuse problem are also explained to them. The family counselor explains the dynamics of co-dependent behaviors in relation to drug abuse problems.
5. Providing Information About Relapse Prevention
Very few know that relapse is a part of treatment. Families usually lose their heart when their patient relapses immediately after treatment. Relapsing again and again increases hopelessness in family. It is a common belief of people in South Asian countries that drug abuse is an incurable disease. The family counselor makes them aware of the reality that drug abuse is difficult to be treated but it is curable. Chances of relapses are always there. Information regarding warning signs of relapse and factors responsible for relapse is provided to them.
6. Providing information about the maintenance of drug free life style Sustaining recovery demands life time abstinence from drugs. Abstinence is not possible without healthy life style. Healthy life styles means proper sleeping and eating habits, engaging self in creative activities, taking occupational responsibilities and attending the meetings of Narcotic Anonymous (NA). The family counselor provides information to families about the maintenance of recovery. Only treatment is not enough to keep the patient away from drugs. The family needs to prepare daily plans and encourage the patient to change life style. Daily plans are prepared sitting with family counselor. Both patient and his family take part in deciding which activities are suitable for leading a sober life.
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Chapter 7 Life Skills Training
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Life Skills Training Description
A life skills training program should also be conducted in order to enhance coping skills among family members to deal with stress and other problems in daily life. Families go through continuous stress due to drug abusing family member and gradually they become co-dependent. Their ability to solve problem, managing stress and anger is also adversely affected. For these reasons, besides providing individual counseling sessions, they must be provided with proper training to build coping skills. The core objective of life skills is to promote healthy life styles rather just focusing on present symptoms. Activities should be done considering cultural differences, family, social and religious values and as well as demographic characteristics of the participants. Socioeconomic status and education count a lot. Going for jogging is not as easy for a person belonging to lower or middle class than a person coming from upper class. Activities should be modified taking into account above mentioned factors
Following Skills Can Be Taught To Them Via Training; Stress management Anger management Problem solving skills Communicative skills
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Standards for Conducting Life Skill Training Program The group size will be between 5 to 10 The duration should not exceed from 90 minutes Frequency of training sessions will depend on the nature of the problem. It can be conducted on a daily basis. A comfortable and well-equipped room with adequate light, proper ventilation, required stationeries should be available
Characteristics of a Group Facilitator A good leader Supportive Honest Non-judgmental Keen observer Firm Goal directed
Steps Involved in Conducting Life Skill Training Program 1. 2. 3. 4. 5. 6. 7. 8.
Arrange the comfortable room with all needed stationeries Arrange chairs in circles for the participants Decide the type of skill that is to be taught Determine the duration of activity and group size Determine the frequency of activities to teach a skill Brief the rules of participation in the activity Do the activity with the help of participants Use process questions in the end
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Skill # Personal Skill Time: 30 minutes Additional Resources: Flipchart and pens Objectives For Participants Knowledge Learn new methods of coping with stress Attitudes/Values Reduction of stress through conscious efforts Skills Identifying specific method to deal with individual stressors
Group activity 1.Write the following headings on the white board o Personal o Interpersonal 2. Participants have to work individually. They have to identify methods they have tried to reduce stress o After writing a list of methods, they work with the group. Each one has to say two or three methods to reduce stress. They also have to identify which category they belong to environmental, personal and interpersonal 3. For example: Personal o Jogging o Long walks o Taking care of family members o Look good Interpersonal o Sharing problems with empathetic person o Joining social service organizations to help others
Notes This activity helps participants to identify a wide range of method to deal with stress
Process Questions? What did we do? How did we learn? Why did we do this activity? How would you use this? Note: This activity has been taken from a manual of Life Skill published by Colombo Plan, Drug Advisory Program (DAP) as a sample.
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Chapter 8 Conducting Family Support
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Chapter 8
Conducting Family Support Family Support Group Family Support Group is a group of concerned relatives and friends whose lives have been adversely affected by a loved one’s addiction to alcohol or drugs.
Objectives of Family Support Group To raise family awareness about drug abuse problem as an illness also it’s psychological, social and economic impact on families. To make them learn from others facing similar problems To make families of drug abuser aware of their own feelings , and reasons for being co-dependents To teach the method of dealing psychological and social problems associated with their drug abusing family member through discussion. To make the families of drug abusers aware of the signs of relapse and factors involved in recovery process in indirect way.
Who Can Attend Family Support Group? Any close relative of drug abuser who has been affected in terms of economical, psychological, social and spiritual problems due to the drug abusing family member. Parents, siblings, spouse, children, uncle, aunts, cousins or other relatives, with whom a drug abuser is living, can attend family support group. Not only do they learn to deal their own problems but they also get information regarding the factors involved in relapse and recovery process of the addict.
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Twelve Steps Family Support Group is based on the 12 Steps which are as follows 1. We admit to ourselves that we are powerful and that we can have control over our homes when our guard member is away. 2. We know that by coming to have knowledge of our own power, we can maximize decision making, gain control and maximize peace and joy within our homes. 3. We make the decision to start now towards the path of Readiness and educate our children and other family members as to our role in a National Guard Family. 4. We will seek to gain an understanding of the overall mission of the National Guard in order to better support our guard member. 5. We will express to others, and ourselves, our fears of military separation which will allow us to gain power over them. 6. We know that by being Ready we can remove the fears that compromise the well-being of ourselves and of our family. 7. We understand that we may not always be able to handle every situation and that it is OK to ask for assistance. 8. We know to make a list of things that need to be taken care of and have a willingness to work at each one individually. 9. We know that, although we sometimes may think we cannot manage on our own, there are others who are willing to help, guide, train and support us. 10. We understand that we may make wrong decisions but will not let them hold us back in achieving our mission of READINESS. 11. We seek to improve our state of readiness by sharing our knowledge and working together as a purple program. WE will not turn a cheek to a National Guard family that is in need of our support and assistance. 12. We know that through our volunteer service to other National Guard families we can carry this message and help them be as Ready as we.
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Standards for Conducting Family Support Group Following steps should be kept in mind before conducting family support group o The group should be comprised of 8 to 12 members o Duration will be 1 ½ hours o Well-equipped room with adequate light, comfortable chairs must be arranged. o There should be no distraction such as; noise o Sitting arrangement will be U-shaped. o Participants will be selected controlling their demographics. Moreover, type of drug abuse and associated problems must also be taken into account in this regard. o Group will be conducted in native language o Topic will be selected according to the need of the participants. o Use neutral words and avoid biased, sexy language o Maintain equality among all participants ignoring their religion, ethnicity or race o Group will be conducted by a single facilitator
Process of Family Support Group o o o o o o o o o
Family support group will be conducted in the following ways First facilitator will introduce himself to the group Facilitator will encourage the participants to join him in Serenity Prayer Facilitator will brief some rules for participating in family support group Will introduce the topic of today Encourage the participants to share related to the topic Encourage the participants to share their personal experiences related to the topic Close the session by saying some positive words Again encourage the participants to join him in Serenity Prayer
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Conducting Family Support Group Following are the steps that a facilitator needs to take to conduct family support group;
Step 1: Introduce yourself to the participant o Salam/hello to all o Welcome to all for coming to attend the group o Please join me in Serenity Prayer
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Step 2: Telling Rules for Attending Family Support Group Here are some rules to attend the family support group o o o o o o
Please turn your mobile off Listen attentively to others Let others complete their words Raise your hands if you want to share something Try to avoid non-verbal communication Share only your own feelings and experiences not the addict
Note: Explain rules in positive way (i.e, please do this, rather than don’t do this)
Step 3: Explaining topic and discussion about it o o o o o o o
Topic of today is --------------. My opinion about the topic is ………………………………… Would you like to say something about this? Who would like to share personal experience/feelings? How did you handle that problem? Would any one among you like to add something to this? Now we close the today meeting with the same prayer which we read in the beginning o Please join me again in Serenity Prayer
God grant me the serenity to accept the things I cannot change Courage to change the things I can And the wisdom to know the difference between them Amen
Note:
Being a facilitator you will have to provide an opportunity to each participant of the group to share his or her personal experience and feelings. Try to find a suitable solution of the problem with the help of all participants. Sentences used above in the step 3 are examples and you can change words during discussion. Try to use neutral words so that no one gets hurt.
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Conclusion
Conclusion The essence of the information provided in the whole book is that families of drug or substance abusers suffer from unlimited miseries which profoundly impair their personalities and coping skills. Dysfunctional patterns and emotional problems further impede their adjustment in the society. Empirical evidences have confirmed that children and younger family members of drug abusers develop severe behavioral and emotional problems. Female family members, in any role, are also leading the life of silent sufferers of society due to addicted family members. Keeping all these facts in mind, exclusive treatment should be provided to entire family members of drug abusers. Families can be helped by giving quality of psychological counseling sessions (individual and joint), conducting life skill training and family support groups. They need to be aware of their emotional turmoil resulted as a consequence of drug abuse and associated problems in their family member. Enhancing their coping skills to fight with daily stress, social and economic problems they are overwhelmed with, is equally important. Families of drug abusers are in great need of help from government and non-government agencies and as well as from health professionals.
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