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Involvement of the Family in the Recovery Process
Involvement in the recovery activities is beneficial to the family in more than just providing support to the substance-affected family member. Other members of the family benefit when they have the opportunity to learn about addiction and its physical, psychological, and emotional effect. Family participation in the recovery plan helps them identify relapse warning signs, support efforts to remain abstinent, and achieve some control over the recovery process (Daley & Raskin, 1991). Participation in the process gives family members the opportunity to heal any emotional pain they may have experienced as a result of the addict's substance abuse history (Daley & Marlatt, 1992).
Effect of Substance Abuse on Children
Psychological, cognitive-behavioral, and behavioral risks to children of substance-abusing parents are well-established (Aktan, Kumpfer, & Turner, 1996; Curtis & McCullough, 1993; Dore, Doris, & Wright, 1995; Julianna & Goodman, 1992; Sheridan, 1995). Dore, Doris, and Wright, in a review of how substance abuse affects children, reported that studies of psychosocial functioning have found that children from substance-abusing families are prone to behavior problems involving hyperactivity and conduct disorder, drug and alcohol use, impaired intellectual and academic functioning, clinical levels of anxiety and depression, low levels of self-esteem, and perceived lack of environmental control. Aktan, Kumpfer, and Turner reported that children in families of substance abusers are inclined to have ability deficits that impair their ability to solve problems, cope with stress, tolerate drugs, communicate effectively, consistently apply good standards, hold reasonable expectation, and be sufficiently interactive and supportive with others.
Effect of Substance Abuse on Parenting
Assistance to Substance-Affected Families
Tracy (1994) noted a reluctance on the part of social workers to address substance abuse problems adequately. Moreover, even when the social worker appropriately recognizes these family issues, the case management plan may be inadequate because of limited treatment sources and lack of preparation for addressing the effect of drug and alcohol use. Few programs have the comprehensive range of services to address the diverse needs of substance-affected parents, which include special and developmental needs of children, child care and parenting skills, housing and vocational assistance, and counseling directed at the emotional consequences (for example, guilt and shame) of substance abuse.
The Child Welfare League of America's North American Commission on Chemical Dependency and Child Welfare (1992) has recommended that child welfare agencies recognize that parental alcohol and drug dependency places children at risk of abuse and neglect and provide services to undo the effects of abuse and neglect, stabilize the family, improve parenting skills, and prevent maltreatment. According to the Child Welfare League of America, "Chemically dependent families need intensive immediate and ongoing assistance to resolve AOD dependency, improve family functioning, and remedy the problems that chemical dependency creates for children" (p. 20). The report asserts that services must be provided to help parents improve their ability to perceive, understand, and respond appropriately to their children's needs. Also, it is important to consider the larger context of alcohol and drug use and how it might affect family needs such as housing, employment, medical care, sufficiency of social network, and contact and integration with the community.
Intervention Domains: The Bridges Program
The four domains are
Achievement in each domains is measured through a series of assessment questions at case opening, case closure, and six weeks after closure of the case. Four levels of progress are depicted on a pictograph of the components of each domain (see Figure 1):
Components are scaled on a motivation to change or achievement of change dimension fashioned after the preparation stages of the change model of Prochaska and his colleagues (Prochaska, DiClemente, & Norcross, 1992). The domains and their components are used to develop and implement the treatment plan, which addresses family functioning and relapse prevention issues. Level of functioning within each domain is addressed so that the focus on the work with the family is to establish a strong link between family behavior and support actions and the substance-affected parent's functioning and recovery actions. The resulting picture that is created on the pictograph shows the individual and family movement toward recovery functioning and what specific domain components may need further work. (Examples of the intervention strategies derived from the model are presented in Gruber, Fleetwood, and Herring, 1998, which is available from the authors.)
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