1. Family- Centered Treatment for
Women with Substance Use
Disorders
Columbus, Ohio
May 19, 2010
Deborah Werner, MA
This presentation is made possible with support
from the Substance Abuse and Mental Health
Services Administration

2. Overview
 Talk about families
 Talk about women with SUDs
 Explore a continuum of family-based
services
 Discuss a comprehensive model of
family-centered services

3. Based on SAMHSA Family
Centered Treatment Papers
Family-Centered Treatment for Women with
Substance Use Disorders: History, Key Elements
and Challenges
Funding Family-Centered Treatment for Women
with Substance Use Disorders
and NiaTX Family Engagement Process Change
Initiative
Family-Based Service Providers and Families in
Recovery

4. Public Health Approach
Problem exists when an Agent interacts
with a Host in an Environment.
 Agent Alcohol, methamphetamine, heroin,
triggers, etc.
 Host Individual who is susceptible to a problem.
Often surrounded by families.
 Environment Family, social and community
environment including media and peers.

6. Public Health Interventions
Agents
• alcohol policy (formal and informal) • interdiction •
Environments
• supportive social networks • healthy community messages •
• safe, affordable drug-free housing, school, work, recreation •
• community support services • community education • reduce stigma •
Families
• appropriate roles • parenting skills and resources • communication
and decision making • support network •
Individuals
• building protective factors • reducing risk factors • building self
efficacy • intervention • treatment of substance use disorders •
• treatment of co-occurring problems •

7. Family … what does it mean
today?

8. Family Networks
parents
siblings grandparents
spouse godparents
supportive long-
children’s fathers term friends
Families are children
significant others complex
& partners
aunts
step-sisters/
brothers
half-sibling step-parents

9. Families
 Families
 basis for household
 economic units
 provide basis for child-rearing, human interactions,
and cultural traditions
 Most cultures use a collective vision of family.
Extended family members are interdependent and
work together to raise children, provide for
economic needs, and meet family obligations.
 Families are complex in their definitions, roles,
responsibilities, and interactions.

10. Edith Schaeffer provides an analogy between a
family and a mobile:
“Each member is connected to the others
through invisible strings. When the wind blows,
all parts move individually and harmoniously.
Mobiles are delicate. If one piece breaks, if a
string is severed or becomes knotted, the whole
mobile is affected. Similarly, the actions of one
family member affect the entire family.”

11. Prevalence of Substance Abuse
in Families with Children
 6 million children under the age of 18 live with at least
one alcohol or drug dependent parent (OAS, 2003).
 5.5% of women ages 18 to 49 who have one or more
children living with them are dependent on alcohol or
illicit drugs (OAS, 2005).
 70% of women and 50% of
men entering substance use
treatment report having
children (Brady & Ashley,
2005).

12. Inter-Generational Cycle of
Substance Abuse
 Substance use disorders affect the entire family
unit and all the individual members.
 Parental substance abuse increases the likelihood
that a family will experience:
 financial problems
 shifting of adult roles onto children
 child abuse and neglect, inconsistent parenting
 violence and disrupted environments
 Children of parents with substance use disorders
have a significantly higher likelihood of developing
substance use problems themselves.

13. Alcoholism and addiction have
long been described as a “family
disease.”
BUT
Treatment has
remained focused on
helping the
individual.

14. Women are often the glue that
holds the family together.
 For women connections – family –
is the priority and life motivator.
 For many women – being a
mother is the most important
identity.
 Women often have other family
care-taking responsibilities.
 Women are relational. Supportive
relationships are essential.

15. And yet
 Women, compared to men, are:
 More likely to report that their spouse/partners
encouraged initial and current drug use and are
less likely to pressure them to enter treatment
 Less likely to report help/support from family or
friends
 More likely to report that family or friends used
drugs in the past year (Grella & Joshi, 1999)

16. Family Centered
Treatment Evolution
 Family-centered treatment for pregnant and
parenting mothers with substance use
disorders
 Family-centered treatment for adolescents
 Family-centered approaches in other service
systems (e.g., dependency drug courts,
children’s system of care, mental health)
 Recovery oriented systems of care

17. Adopting a Family-Centered
Approach Requires a Paradigm
Shift

18. Initial Assumptions
 Family is important
 Family members can help and be helped
 Empowering women can occur while
they are in relationships. (Not all women need
or want to leave the men in their lives.)

19. So Why Change?

20. Why Change?
 Improve outcomes for women
 Women recover in supportive relationships.
 Retention improves
 May leave or not enter treatment without
children
 Builds a support system
 Improve outcomes for families
 Children’s needs
 Family system and family support

21. Outcomes
Individual outcomes for parent, child and other
family members (e.g., changes in substance use,
employment, health or mental health status, developmental
progress, educational performance, improved resiliency)
Relational outcomes for whole families and between
members (e.g., parent-child relationship, family stability,
attachment, relationship satisfaction, reunification, reduced
violence, communication and parenting improvement)
System or societal outcomes for the community (cost
savings from improved employment, reduced criminal
recidivism, improved prenatal and birth outcomes, reduced
school problems, future health costs)

22. A Continuum of Family-
Centered Services

23. Continuum of Family Services
Level 0
Individually focused, no meaningful consideration of family

24. Continuum of Family Services
Level 1
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family

25. Continuum of Family Services
Level 2
Programs for woman with child care, parent education
and periodic family sessions
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family

26. Continuum of Family Services
Level 3
Programs for women and their children
Programs for woman with child care, parent education
and periodic family sessions
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family

27. Continuum of Family Services
Level 4
Programs for women and children;
some services for immediate family
Programs for women and their children
Programs for woman with child care, parent education
and periodic family sessions
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family

28. Continuum of Family Services
Level 5
Family-based treatment
Programs for women and children;
some services for immediate family
Programs for women and their children
Programs for woman with child care, parent
education and periodic family sessions
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family

29. Continuum of Family-Based Services

30. Components of Family-
Centered Treatment

31. CSAT Model of
Comprehensive
Services
for Women & Children
 Components
 Clinical treatment services for women
 Clinical support services for women
 Community support services for women
 Clinical treatment services for children
 Clinical support services for children
 Community support services for children
 Cultural Competence, Gender Competence and
Developmentally Appropriate

32. Clinical Treatment Services
FOR WOMEN FOR CHILDREN
 Outreach and engagement  Intake
 Continuing care  Screening
 Screening  Medical Care and Services
 Pharmocotherapies  Therapeutic Child Care
 Drug monitoring  Development Services
 Treatment planning mental health  Mental Health and Trauma
services Services
 Detoxification  Assessment
 Medical Care and Services  Residential Care in Residential
 Assessment Settings
 Trauma Informed and Trauma-  Case Management
Specific Services  Substance Abuse Education &
 Case Management Prevention
 Substance Abuse Counseling and  Care Planning
Education
 Crisis Intervention

33. Clinical Support Services
FOR WOMEN FOR CHILDREN
 Life skills  Primary health care services
 Advocacy
 Onsite or healthy child care
 Primary health care services
 Family programs  Recovery community support
services
 Parenting and child development
education  Advocacy
 Housing support  Educational services
 Education remediation and  Recreational services
support
 Employment readiness services  Prevention services
 Linkages with legal system and  Mental health and remediation
child welfare systems services
 Recovery community support
services
 Life skills

34. Community Support
Services
 Transportation
 Child care
 Housing services
 Family strengthening
 Recovery community support services
 Employer support services
 TANF linkages
 Vocational and academic education services
 Faith based organization support
 Recovery management

35. Woman Responsive Treatment
 Relational
 Strength-based, motivational
 Comprehensive
 Trauma informed
 Addresses the different pathways to use,
consequences of use, motivation for treatment,
treatment issues and relapse prevention needs
 Provided in an environment in which women feel
safe and comfortable.

36. Culturally Relevant Treatment
 Cultural competent staff
 Honors traditions and values
 Acknowledges cultural pain and racism
 Builds appropriate efficacy and support
 Reflective staff, management and Board
 Respects individuals
 Differentiates drug culture from culture
 Helps interested people learn or rekindle cultural
traditions
 Relational
Deborah Werner 2006

37. Components of Family-
Centered Treatment

38. Identifying Family
 Factors to Consider
 Household
 Relationships of children
 Blood
 Emergency responders
 Historical family
 Lifetime relationships
Family as she defines them. Women often need support and tools to
identify who to involve, and how much. Sometimes women and their
children have different families.

39. Who is the Family?
Elderly Auntie
Cheryl Stable. Parents Susan
Does not trust Partner, and Kyle –
niece. concerned but periodically
feels abandoned raising children.
Actively using Angry and Long lost God
spouse skeptical. Parent
children’s fathers –
want no contact Michael age 7
Families are with behavioral
Celia – old complex problems.
girlfriend/partner
and co-parent of John, I met him at
children the AA meeting last
Best friend Thursday
from high Baby in
school, 2 years fostercare
sober with 2 Skeptical siblings
Mother, married to
jobs and 3 kids
man who molested.

40. Involvement of Children
 Children are both an incentive and a barrier to
participating in treatment
 Multiple studies have demonstrated that
better outcomes are achieved by women who
have all of their children with them
 Children often have their own treatment needs
 Parenting support allows for improved
parenting, esteem and reduced stress

41. Involvement of Teen/Adult
Family Members
 Family members often have their own service
needs
 Need for engagement – they may not want to
participate or change
 Assessing relationship dynamics, violence, safety
and how to counsel members
 Multiple individuals, with differing treatment plans –
priorities and family decision-making
 Balancing women’s need for identity development
and family involvement

42. Types of Services -
Engagement not
Involvement
 Initial Engagement
 “if you just build it – they won’t come”
 Conocimiento and Assessment
 Listening and Respecting
 Supporting Connection
 Promoting Healing

43. When family is engaged: a
NIATx view of engagement
Tommie Ann Bower, Chief Clinical
Officer, Gosnold, Inc.

44. Addressing Challenging
Family Members
 Violent Children
 Resistant Children
 Angry and Cynical Family Members
 Abusive Family Members
 Uncommitted Family Members
 Different Stages of Change

45. How to Involve Family
Members
 Dynamic – different members may come at
different times
 Requires a new way of looking at clients
 Collaboration (and funding) across service
systems
 Safety comes First
 Maintaining cohesive program structure and
individualized, family-services

46. Treatment plans, case plans
and action plans
 Women’s services
 Children’s services
 Family member services
 Parenting support
 Family and relationship counseling
and decision making
 Community/Recovery support

47. Elements of Treatment
 Detoxification and Stabilization (includes pharmacology)
 Motivation and Engagement
 Assessment, Placement & Treatment Planning (co-occurring)
 Skill Building Programming
 Drug Resistance Skills  Avoid Triggers & Cravings 
 Problem Solving Skills  Assertiveness Skills 
 Life Style and Support
 Interpersonal Relationships  Replace Drug Activities 
 Safe and Health Environments  Family Recovery 
 Case Management
 Child Welfare  Criminal Justice  Family Support  Housing 
 Community & Recovery Support  Economic Needs 

48. Types of Services
 Services for Individual  Groups
Family Members  Family Education
 Counseling  Parenting Support
 Individual Family  Multi-Family
 Significant Persons
 Relationship-based
 Special Topics
 Couples
 Reunification Support
 Parenting Education  Wrap around
 Coaching  Case Management/
 Holidays, Recreation & Community Support
Leisure Adapted from East Bay Community Recovery Program

49. Whole Family Approach
 Celebration/Reconnection Approaches
 Processing Tools for Families
 Communication Skills
 Reducing Stress Burden
 Mutual Support & Integrated Treatment Plans
 Mutual Priorities and Community Support Plan
 Building Family Strengths, Identity and
Cohesiveness
 Holidays, Recreation & Leisure
 We’re Changing; so much to Change

50. Managing a Dynamic
Program
 Individualized services
 Offering an array of services
 Strength-based, motivational approach
 Flexibility and collaboration
 Family members changing
 Multiple people, multiple treatment
plans, multiple agencies
 Maintaining safety, harmony and community
 Visible structure and guidelines
 Diversity and respect

51. Transformation in the
world happens when
people are healed and
start investing in other
people.
Michael W. Smith

53. Thank You.
Deborah Werner
Advocates for Human Potential, Inc.
PO Box 267 * Topanga, CA 90290
818/999-6985
dwerner@ahpnet.com