Ask the Expert
The Social Services System: Supporting Treatment and Recovery for Individuals and Families
View the Webcast "The Social Services System"
Ask the Expert:
Nachson Zohari, LCSW, Program Administrator for Substance Abuse Treatment, Denver Department of Human Services
- I like the idea of a family focused approach to providing recovery and treatment services to the entire family, however I am nervous about privacy and confidentiality, especially for my children in their school and social networks. Can you tell me what kind of protocols would be in place to protect my family’s privacy? How can I find out if my children’s school staff have had any training on recovery?
The family-centered treatment I discussed on the program is confined to a clinical setting where there are already many confidentiality polices in place to protect clients and their families. Of course, individuals involved in family therapy can always go against directives and discuss matters with who ever they want. However, because so much of the clinical work is about creating appropriate boundaries any communication of this sort would be addressed in family therapy and could be used as a teaching moment.
It should be pointed out that family therapy involving such a heavy issue as substance abuse is not appropriate for small children – the appropriate age is dependent on the emotional maturity of the child involved (we use 13 years old as our general cut-off). Small children attend the daycare facilities at our family sites and benefit from our trained staff who attempt to model and nurture healthy group/family dynamics for the kids. The staff is also available to listen to any problems they might want to talk about.
The central benefit of family work in recovery is to address any dynamics that might be underlying the substance abuse of individual members while also identifying inherent family strengths that can be used to support a drug-free lifestyle. Creating and maintaining healthy attachments and relationships (especially within the family) are a person’s best bet on staying clean and sober.
In terms of finding out about the clinical capabilities of a school’s staff I would contact the school social worker and just ask about the staff’s experiences and expertise.
There is a long history of alcoholism and substance abuse in my family, and my husband is in recovery. We haven’t talked about it with our children yet. How do we begin that conversation, and what kind of resources are available to help us prepare for it?
It depends on the ages and emotional maturity of your children. Obviously, we would approach the subject very differently for small children vs. teenagers. As I mentioned above, we’ve found that teenagers are generally able to participate in family therapy sessions discussing addiction and recovery. Therefore, bringing up this topic would probably work well in a "family discussion" setting. If your family communicates well and your relationships are solid, you can probably handle the discussion yourselves. But if relationships are strained in your family and communication difficult then you might think about having a family therapist with substance abuse treatment experience facilitate the meeting.
In either case, you should communicate that you accept responsibility for your own actions, helping your children understand that it’s not their fault, and that you are working seriously on staying clean and sober.
This can lead to a broader discussion of addiction in general and how it affects all types of people – including your own family. You’ll want to do your homework to understand addiction yourself so you can help them understand what’s going on.
In terms of small children, you must be careful to communicate in a way that is appropriate for their levels of emotional and cognitive maturity. As long as they are safe and being nurtured appropriately, they probably don’t need too many details. If they are aware that something not good is happening then you might say something like, "Daddy is not feeling well and needs to see a doctor to feel better again."
To start, a couple of good resources for these issues would be the National Association for Children of Alcoholics http://www.nacoa.net/newsearch.aspx and Al-anon/Alateen http://www.al-anon.alateen.org/english.html .
What is the greatest challenge or barrier in a community to creating the kind of systems of care discussed in the webcast? How can a citizen in a community help to try and implement this kind of system?
Honestly, I think the biggest barrier is the simple fact that treatment has never been done in this way before (at least not on a large scale). The focus has traditionally been on the addict and his or her problems, not on understanding the context of the addiction and bringing in family members and other community resources to participate in the work of recovery. Systems do not change easily and even good ideas take a while to gain momentum and find their way into "business as usual."
One of the best ways to influence change in the recovery system is to press the public payers of treatment to encourage this type of work. If agencies that spend millions of dollars a year on substance abuse treatment (e.g., Child Welfare, TANF, Probation, or Medicaid) stipulate that this is the kind of treatment they want then change can happen pretty quickly.
Many people in recovery have more than one substance use disorder that they are trying to recover from. Cigarette smoking and caffeine can be substitutes for more serious substance use problems. Is recovery enhanced by treating all substance use problems at the same time? Is it necessary to treat all of them at once?
It’s my understanding that there is not much research looking at the effect of nicotine and caffeine use on recovery – and what is out there is conflicting. I have never worked in an agency that prohibits nicotine and/or caffeine but there is a provider in Denver that has mandated smoke-free campuses. Their director of residential treatment told me that this change has not necessary changed recovery outcomes but it has created an opportunity to work on clients’ real time cravings and help them develop healthier coping skills – as well as increasing their awareness of physical health and well-being.
Certainly tobacco use is a big public health concern (caffeine less so) but most recovery programs choose to address only the drug use that is currently getting in the way of an individual’s functioning – his or her maintaining relationships, income, and housing, staying out of jail, etc.
Perhaps there are faith-based recovery programs that prohibit the use of tobacco and caffeine because they go against their religious doctrine. In the context of this type of treatment, developing a lifestyle that conforms to the mores of the larger religious community may have a beneficial effect on recovery – but that’s just speculation on my part. This would be an interesting question for researchers.
I work at a Wellness Community Center. We are looking for innovative ways to work with youth and adults recently released from incarceration, who are drinking and smoking marijuana. We are also looking for innovative ways to work with HIV+ clients who are actively using crystal meth and cocaine. Do you have any suggestions?
First, I would definitely suggest doing some family-based recovery work with any population, but especially with youth. Please see answer #1 for more details.
Second, you would do well to create a collaborative program that teams the various systems involved in these clients’ lives: substance abuse treatment providers, mental health providers, probation and parole, youth outreach programs, public health officials, etc. You will then have access to the synergistic creative energies of a broad spectrum of experts. The ideas that you come up with through an approach like this will meet the needs of your particular population and tap into the resources of your community better than anything I could come up with.