Addressing Adverse Childhood Experiences (ACEs) Through Family-Focused Services for Families Dealing with Substance Use Disorders © By Rosemary Tisch, MA, and Rivka Greenberg, Ph.D.

Addressing Adverse Childhood Experiences (ACEs) ]Through Family-Focused Services

for Families Dealing with Substance Use Disorders 
 

Rita* was a homeless, struggling Mom, using drugs with her boyfriend, who had given her children to her mom and their various fathers to parent. Children & Family Services mandated that she attend a residential treatment center for women with children to help build a relationship with her children. As part of her treatment, a family-focused service was provided for all children and their caregivers.  During group, Rita began to understand that the lack of connection with her children was due to her substance use. As the entire family attended group, the children’s multiple caregivers began to recognize how addiction had affected each of them and that healthy communication between them all was an important factor in mending a broken family.  Through the family program,Rita was able to connect with her children in healthy ways and to become an interactive, loving parent with boundaries and structure. *Composite participant

“Juanita” was struggling with her recovery, self-described as  “sober - but broken, with no hope”. Using drugs and alcohol since age 12, she was referred to a family-focused service, as part of Family Treatment Court, along with individual treatment for co-occurring disorders.  As a child, she was sexually abused and as an adult she experienced domestic violence, witnessed by her young daughter. “Juanita” felt she would soon either hurt her daughter or herself and she did not want to keep living. Attending a family-focused group, as part of her required services, “Juanita” now enjoys a much better relationship with her daughter.  The program “took me to real recovery with hope and courage to keep living and to help other single moms and families in recovery.”

Families with addiction are often dealing with multiple adverse childhood experiences: substance abuse, neglect, family violence and emotional, physical and sexual abuse.  Commonly there is parental separation or divorce and often one or both parents are dealing with mental illness and incarceration. Their children are among those at highest risk for future physical and mental health problems, having experienced many adverse childhood experiences (ACEs).  ACE authors have specifically noted this relationship:

• The ACE Study provides population-based clinical evidence that unrecognized adverse childhood experiences are a major, if not the major, determinant of who turns to psychoactive materials and becomes ‘addicted’ (Felitti, 2003).
• Growing up with alcohol abusing parents is strongly related to the risk of experiencing other categories of ACEs (Anda, 2010). 

Family-Centered Services Are Effective As Prevention & Treatment

The most effective prevention programs target the whole family, delaying initiation of substance abuse, improving youth resistance to peer pressure to use alcohol, reducing affiliation with antisocial peers, improving problem-solving and reducing levels of problem behaviors (UNODC, 2009; Ialongo, Poduska, Werthamer, & Kellam, 2001). Family programs are found to be second only to in-home family support and nearly 15 times more effective than programs working with youth only.  In addition, the effect of family skills training programs is sustained over time (Cheng, et. al, 2007; Miller-Heyl, & Fritz, 1998). 

Family Treatment Courts (FTC), also referred to as Dependency Drug Courts, are another proven, successful treatment approach for child abuse, neglect, family violence and addiction, probably due to their focus on family-centered services. Reviews of FTCs show that “manualized, structured, evidence-based family treatments…” are an essential component (Marlowe & Carey 2012).

Family-centered services are critical for healing, yet few evidence-based family-focused programs exist; fewer still focus on addiction.

Celebrating Families!™ (CF!)

“I can’t change the past, but I can make a better future.”   CF! Graduate

One such program, Celebrating Families!™(CF!), was created specifically for families in Family Treatment Courts (FTC) and is listed on SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP). Celebrating Families!™ (CF! ) is a multi-family, strength-based, skills building program serving children ages birth through 17, their parents, and caregivers.  The program consists of 16 sessions, emphasizing attachment, addiction prevention, stress/anxiety reduction, safety, and the development of a sense of hope and an expanded life view. The program gives parents needed skills to stay sober, to begin to heal, and to build healthy, non-violent relationships with their children. Long term program outcomes are to (1) Increase mental, physical, and spiritual health of youth and families, including preventing children’s future addiction; (2) Increase parental rates of recovery; and (3) successfully reunify families, when appropriate.

Each session includes a healthy meal eaten in family groups; age-appropriate, skill building groups; and a structured, related Family Activity. The curriculum directly addresses issues of addiction in every session, helping anchor families in recovery and children better understand chemical dependency. It includes information on brain chemistry, life skills, resilience and asset development. Parents’ and age-appropriate children’s sessions include skills training on: affirmations; appropriate expression of feelings, including anger management; communication; family/domestic violence (defining of healthy relationships); goal setting; how chemical dependency affects families; learning differences and Fetal Alcohol Spectrum Disorders (FASD); limit and boundary setting; nutrition; problem solving and decision making; and refusal skills.