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Breaking the Intergenerational Cycle of Substance Abuse

National Rx Drug Abuse Summit, Atlanta, GA, April 6th 2015Robert L. Neri, LMHC, CAP - Senior Vice President, Chief Program / Service

Officer WestCare Foundation, Inc.

A Historical Perspective A Historical Perspective of the Problemof the Problem

The Study of “Epigenetics”The Study of “Epigenetics”

How the environment actually turns certain genes…

On or Off

Healthy Family ExpansionHealthy Family Expansion

CommunicationCommunication RolesRoles Emotional InvolvementEmotional Involvement Behavior ManagementBehavior Management

World of Abnormal RearingWorld of Abnormal Rearing

DeprivationDeprivation SurvivalSurvival Dependency NeedsDependency Needs

““De·pend·ent”De·pend·ent” Dependent (adj):Dependent (adj): relying on someone or relying on someone or

something else for aid, support, etc.something else for aid, support, etc.

Dependent (n):Dependent (n): a person who depends on or a person who depends on or

needs someone or something for aid, needs someone or something for aid,

support, favor, etc. support, favor, etc.

Controlled by a variableControlled by a variable

Based on the Random House Unabridged Dictionary, © Random House, Inc. 2006.

Causes of DependencyCauses of Dependency

An inability to fulfill An inability to fulfill

one’s needs independentlyone’s needs independently

Core Core Healthy FamilyHealthy Family Themes Themes

Nurturance & Trust


Nurturance & Trust

Expectations & Control


Nurturance & Trust


Relationships & Self Esteem


Nurturance & Trust Support



UnderstandingUnderstanding

The W.A.R. CycleThe W.A.R. Cycle““World of Abnormal Rearing”World of Abnormal Rearing”

Reasons for Having ChildrenReasons for Having Children

Planned/UnplannedPlanned/Unplanned

Stages of the WAR CycleStages of the WAR Cycle

ConceptionConception



Wanted/ Wanted/ UnwantedUnwanted

PregnancyPregnancy



Wanted/Wanted/ UnwantedUnwanted

PregnancyPregnancy

Unrealistic Unrealistic ExpectationsExpectations

Parental Attachment Parental Attachment and Attunementand Attunement

ATTACHMENTATTACHMENT is the drive is the drive to be Close to be Close

and and Cared AboutCared About

Attachment RelationshipsAttachment Relationships give us our concept of the world:give us our concept of the world:

Hostile Hostile FriendlyFriendly

NurturingNurturing

ATTUNEMENT ATTUNEMENT

is about being in tune emotionally is about being in tune emotionally with the child with the child

PARENTING PARENTING

is more about theis more about the

Relationship Relationship than than TechniquesTechniques

SAFETYSAFETY

is a learned behavioris a learned behavior




PregnancyPregnancy


Role ReversalRole Reversal

CChildren learn to behildren learn to be

stress absorbers –stress absorbers –

““Soaking up the worries Soaking up the worries

of their parentsof their parents.”.”

Living in a constantLiving in a constantenvironment of stress environment of stress

means thatmeans that high-stress becomes high-stress becomes

my “Baseline”my “Baseline”

II will seek outwill seek out

Stress and CrisisStress and Crisis

as my “Comfort Zone”as my “Comfort Zone”



Wanted/ Wanted/ Unwanted Unwanted

PregnancyPregnancy



ComplianceCompliance

Must be taught Must be taught

Healthy Survival SkillsHealthy Survival Skills

COMPETENCY BASED COMPETENCY BASED

APPROACH TO LEARNINGAPPROACH TO LEARNING

Competency Mastery Requires:Competency Mastery Requires:

o Information knowledgeInformation knowledge

o Implementation knowledgeImplementation knowledge

Both are Both are Internalization ProcessesInternalization Processes needed to achieve Recoveryneeded to achieve Recovery

Internalization is checking for Internalization is checking for UnderstandingUnderstanding

Taking ownership of new Taking ownership of new KnowledgeKnowledge

InternalizationInternalization is about making is about making learning Relevantlearning Relevant

Making associations between Making associations between characters and situations that characters and situations that

can shape their decisionscan shape their decisions




PregnancyPregnancy




IsolationIsolation

Adults who had Adults who had predictable, predictable, nurturingnurturing parents are comfortable parents are comfortable::

o Being close and aloneBeing close and aloneo Have a secure attachment styleHave a secure attachment style

Adults who had Adults who had inconsistentinconsistent, , emotionally unavailableemotionally unavailable parents: parents:

o Often have an anxious attachment style

o Crave closeness and fear abandonment

o Want and need less space and are

more smothering

Adults who had parents who were Adults who had parents who were

rejectingrejecting often have an: often have an:

o Avoidance attachment styleo Resisting closeness o Seeking spaceo Fear of being hurt

““Adults are Adults are unpredictableunpredictable People” People”

“ “ People turn on you ”People turn on you ”

“ “ Trust only myself ”Trust only myself ”




PregnancyPregnancy




IsolationIsolation

Trust Not Trust Not LearnedLearned




PregnancyPregnancy


Role Reversal


IsolationIsolation


I’m No GoodI’m No Good




PregnancyPregnancy

UnrealisticUnrealistic ExpectationsExpectations



IsolationIsolation



Selection of Selection of Friends Friends

Social Support DeficitSocial Support Deficit

Choosing relationships with people who have “like” Choosing relationships with people who have “like” problemsproblems




PregnancyPregnancy




IsolationIsolation




Select PartnerSelect Partner

Relationships DamagedRelationships Damaged

Relationships are about Relationships are about Dependency & Dependency &

using each otherusing each other




PregnancyPregnancy




IsolationIsolation





Relationship Relationship Fails Fails

Themes & Stages of the WAR CycleThemes & Stages of the WAR Cycle


PregnancyPregnancy




IsolationIsolation





Relationship Fails

Nurturance & Trust Support



IInterventions nterventions to to

BBreak the reak the CCycleycle

WAR Cycle – Adults look back WAR Cycle – Adults look back

at what helped them:at what helped them:o One-on-one time with a loving adultOne-on-one time with a loving adult

o Informal support from a neighbor, Informal support from a neighbor, teacher, coach, ministerteacher, coach, minister

o Early insight – “It’s not about me” – Early insight – “It’s not about me” – “These people are sad and angry.”“These people are sad and angry.”

A passion for reading, musicA passion for reading, music A sense of humorA sense of humor Love for the ArtsLove for the Arts Physical activity – release from painPhysical activity – release from pain

Assess/Deprivation NeedsAssess/Deprivation Needs

Abuse HistoryAbuse History Resiliency FactorsResiliency Factors

High Pain

Low Pain

Low Hope

High Hope

Understand Role ReversalUnderstand Role Reversal

Facilitate PredictabilityFacilitate Predictability Address childhood play Address childhood play

through safe, social through safe, social activitiesactivities

Facilitate movement from Facilitate movement from compliance to internalizationcompliance to internalizationthrough gradual reduction of through gradual reduction of

structure and insight workstructure and insight work

Create a treatment culture Create a treatment culture that promotes that promotes

“Mistakes are wonderful “Mistakes are wonderful opportunities to learn.” opportunities to learn.”

Establish a therapeutic allianceEstablish a therapeutic allianceand facilitate and facilitate

transfer of trusttransfer of trust

Victims of Emotional Manipulation

Disclose “way too fast”

No small talk which is “testing talk”

Each conversation goes a little deeper (gradual)

Clients Are SkillfulClients Are Skillful

at at

ADAPTINGADAPTING

o Face Readers

o Can be Manipulative

WWe teach them by e teach them by observing us being observing us being genuinegenuine

& & authenticauthentic

= Role Modeling= Role Modeling

Relational FrictionRelational Friction – – Beats them upBeats them up

Relational Work in TherapyRelational Work in Therapy – –

Restores themRestores them

Hearing their narrative (story) as Hearing their narrative (story) as

a survivor – a survivor –

““Empowerment is Therapeutic”Empowerment is Therapeutic”

Teach social network mappingTeach social network mappingand assist clients with buildingand assist clients with building

a social support networka social support network

Teach everything you can aboutTeach everything you can aboutrelationships including patterns,relationships including patterns,

boundaries, roles, etc.boundaries, roles, etc.

Establish ConversationsEstablish Conversations

ParentingParenting Contact Comfort Contact Comfort Family ExpansionFamily Expansion

Competency Based ContinuumCompetency Based Continuum

Numbness Apathy Numbness Apathy Self Help Self Help

Learned Helplessness Learned Helplessness Mutual Help Mutual Help

IndifferenceIndifference Industrious Industrious

Arrested Development Arrested Development Social Learning Social Learning

“ “No Learning” Learning from No Learning” Learning from ExperienceExperience

Unpredictable Adults Unpredictable Adults Role ModelsRole Models

IsolationIsolation Connected to Self/Connected to Self/ Higher Power/ Higher Power/

OthersOthers

Emotional DeprivationEmotional Deprivation Contact Comfort Contact Comfort Emotional Literacy Emotional Literacy

Self Soothe Self Soothe

Displacement Displacement BelongingBelonging

Thank YouThank Youfor Your Time and for Your Time and

Attention!Attention!

Robert L. Neri, LMHC, CAP Robert L. Neri, LMHC, CAP Senior Vice President,Senior Vice President,Chief Program / Service OfficerChief Program / Service OfficerWestCare Foundation, Inc.WestCare Foundation, Inc.

Rx15 presummit mon_200_neri

Healthcare

war cycleconception

anxious attachment style

secure attachment style

unavailable parents

constantenvironment

space fear

learned behavior stages

comfort zone stages