Support Groups 2014 Webinar 1 Final · From Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs, 5th Edition by Daryl S. Inaba, Pharm.D Substance Use

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© National Center on Domestic Violence, Trauma & Mental Health 1

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Support Groups for Women Experiencing Substance Abuse in the Context of DV, Sexual Assault, Trauma & Oppression

Patricia J. Bland, M.A. CDP National Center on Domestic Violence, Trauma and Mental Health DV, Trauma, and Substance Abuse: A Webinar Series for Substance Abuse Counselors and Other Allied Behavioral Health Professionals Working with Women August 25, 2014 1

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Please Note: §  Hearing discussion about domestic

violence, sexual assault, substance abuse, and oppression can bring up unexpected feelings and responses.

§  Webinar participants are encouraged to turn down the volume or take a break if you need to.

§  If additional help is needed, we encourage you to debrief with a trusted individual.

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Our Work on Substance Use and Substance Abuse Coercion is Informed by…

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Goals and Objectives

§  Identify strategies to provide trauma-informed support groups for women experiencing multiple forms of abuse

§  Better understand how to respond to safety and recovery needs of women affected by substances in the context of DV/SA

§  Increase knowledge, reciprocal tools, and strategies when substance use, DV/SA, and oppression increase risk for women

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Support Group: Format and Topics

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It’s all about the relationship…

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Confidentiality Requirements: 42 CFR and VAWA

•  Know federal, state, local, and program confidentiality requirements for substance abuse treatment and DV/SA records keeping

•  See 42 CFR Regulations: –  http://www.ecfr.gov/cgi-

bin/text-idx?rgn=div5;node=42%3A1.0.1.1.2#sp42.1.2.a

•  See VAWA Regulations: –  http://www.justice.gov/sites/

default/files/ovw/legacy/2013/09/24/conf-acknowledgement.pdf

–  http://nnedv.org/policy/issues/vawaconfidentiality.html

•  When treatment programs are co-facilitating with DV/SA Programs, get a MOU or MOA

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Confidentiality Concerns

Depending on venue: §  First names only §  Limited notes (can be subpoenaed) §  Document the topic covered and

attendance only §  Require signed release of

information to disclose above information

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More on Confidentiality §  Advise group participants about what

you are mandated to report, e.g. CPS/APS issues, suicide threats, etc.

§  Some group members don’t want to be greeted or acknowledged outside of group due to safety constraints. Be sure to address this with the group. Some groups come up with a code.

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§  There is no right way to do this…be open §  Prioritize child care §  Have food, de-caffeinated coffee, and tea §  Assist with transportation §  Don’t screen out…Prepare for arrival §  Have enough staff or volunteers available

to deal with unexpected issues (2+) §  Have women create their own resource

book of referrals

Have Easy Access to Group: Don’t Create Barriers

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General Tips •  Co-facilitate: If possible one advocate,

one substance abuse counselor (the more the merrier, embrace diversity)

•  Be flexible: Think kitchen-table, have topic but be willing to change. The women own the group. –  Leave time for women to address

practical issues such as housing, legal, or children’s issues

– Allow people to use the copy machine, telephone, fax etc.

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Things to Keep in Mind §  Treatment settings can more easily build on

prior group work and tend to be more structured and consistent

§  In a drop-in setting, you may only see a group member once or you may have the member for 3 or more years…be solution based and friendly §  Make the most of your interaction because it may

be the only one you get §  For our drop-in groups, the average member

comes about 12 times; all are welcome to return §  Stage 2 groups can be led by the women

themselves and are good options for long term group members

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General Goals •  Safety and Sobriety

–  Safe place to tell story without judgment and to be believed

•  Opportunity for connection –  Foster notion of recovery partners. Does

she have or has she had in the past a sponsor, mentor? Encourage women to support each other, develop phone lists, etc. when safe to do so

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Adjust Group Guidelines and Topics Depending on Setting

§  In-patient or Out-patient Treatment Facility, Methadone Clinic, etc.

§  Information/Education, Peer, Self-Help, or Clinical Settings

§  DV/SA, Homeless Shelter, or Transitional Housing Program

§  Community Based DV/SA Program §  Pre-treatment services, Detox, Outreach,

Needle Exchange, Aftercare §  Other Settings

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Overall Format For Groups

§ Check In §  Identification of Problems,

Challenges or Goals, and Resources § Educational Component § Closure

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Check In §  Begin group with discussion of

confidentiality and group guidelines for safety and sobriety.

§  Open the session by asking each group member to briefly state one thing she did right or was proud of achieving during the previous week.

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Identification of Problems, Challenges, Goals, and Resources

§  Ask participants if anyone is facing a special challenge or has a particular goal she’d like to achieve

§  Identify resources currently utilized by group members

§  Develop additional options to resolve problems, meet challenges, and achieve goals.

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Educational Component

§  Use a portion of the session to educate participants about aspects of substance abuse in context of IPV.

§  Topics may include power and control dynamics, safety issues, sobriety issues, children’s issues, healthy boundaries, coping skills, etc.

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Closure §  Close by asking

each person to name one thing she can do to keep safe and sober for the coming week

§  Include an evaluation component

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Sample Topics For Educational Component

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Topics and Handouts

§  Each of these topics can stand alone.

§  Topics may be used in any order. §  These are examples only! Nothing

here is carved in stone – feel free to be creative with these topics and come up with some of your own.

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Intro - Who Can We Trust? §  To heal and function in the world, we need

to be able to trust somebody. §  A woman’s past experiences may make this

difficult if this experience includes: IPV, a substance use disorder, trauma, psychiatric disability, or other forms of oppression.

§  Discuss some of these experiences and how they might affect ability to trust others.

§  Explore how to determine who is trustworthy and who is not and point out it’s okay to require people to earn our trust.

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Intro - Handouts

•  Who Can We Trust?

•  Gaining Trust •  Trust Isn’t Always Easy

Additional webinar resource available on our website: Building Trust: Trauma-Informed Advocacy with Survivors of DV/SA Experiencing Addiction (Webinar 2)

http://www.nationalcenterdvtraumamh.org/trainingta/webinars-seminars/2013-8-part-series-substance-abuse-trauma-and-domestic-violence/ 23

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1 - The Relationship between Substance Abuse and Violence

§  Discuss relationship between substance use and DV. Does substance abuse cause violence? Will treatment stop it?

§  Are victims who abuse substances asking for trouble? Does abuse cause development of AOD problems?

§  Discuss tools to address both problems.

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1 - Handouts

• Woman Abuse, Substance Abuse: What is the Relationship?

• Survivors of Chemical Dependence, Domestic Violence and Sexual Assault

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2 - Naming the Problem

§  Discuss definitions of a substance use disorder, DV, sexual assault/sexual abuse, and other related concerns.

§  Encourage women to discuss signs or indicators they’ve experienced.

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2 - Handouts

•  Naming the Problem

•  Manifestations of Violence

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Definitions

Domestic Violence is a pattern of assaultive and coercive behaviors, including physical, sexual, and psychological attacks, as well as economic coercion, that adults or adolescents use against their intimate partners to gain or maintain power and control. (Ann Ganley, Ph.D, 1998)

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Definitions

Substance use disorder - a destructive pattern of drug use, including alcohol, which leads to clinically significant impairment or distress. Often the substance abuse continues despite significant life problems (Definitions developed by APA & ASAM adapted by DV/SA Task Force of IL DHS, 7/2000)

– Tolerance and withdrawal are often present when a person’s substance use progresses to an advanced Substance Use Disorder

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http://www.asam.org/publications/the-asam-criteria http://addictions.about.com/od/aboutaddiction/a/Dsm-5-Criteria-For-Substance-Use-Disorders.htm

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From Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs, 5th Edition by Daryl S. Inaba, Pharm.D

Substance Use Disorder (Addiction)

Tolerance

Loss of Control

Continued use despite adverse consequences

Withdrawal Symptoms

(Has altered brain chemistry, which leads to stress, craving, denial and relapse potential)

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Substance Use Disorder (Chemical Dependence or Addiction in Lay terms)

§  Characterized by continuous or periodic impaired control over drinking alcohol or using other drugs, preoccupation with use, use despite adverse consequences and distortions in thinking (e.g. denial)

§  The neuro-chemical function dysfunction is best described as a chemical deficiency in pathways of the brain. See also websites below: §  http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact

%20Sheet.pdf §  http://addictions.about.com/od/aboutaddiction/a/Dsm-5-Criteria-For-

Substance-Use-Disorders.htm 31

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Tolerance and Withdrawal

§  Tolerance - the need for significantly larger amounts of substance to achieve intoxication

§  Withdrawal - adverse reaction after a reduction of substance

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The Liver

From Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs, 5th Edition by Daryl S. Inaba, Pharm.D

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Distortions in Perception Defined

§  Euphoric recall - memories formed under the influence (Johnson, 1980)

§ May be used as inappropriate excuse to minimize, rationalize or deny behavior

§  Blackout - an amnesia like period often associated with heavy drinking § While blackouts impact memory, there

is no evidence to support contention that blackouts alter judgment or behavior at the time of occurrence (Kinney & Leaton, 1991)

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©NCDVTMH From Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs, 5th Edition by Daryl S. Inaba, Pharm.D

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3 - Overlapping Elements: DV/SA and SUD’s

§  Help participants identify overlapping SUD’s and DV/SA in context

§  Review signs/symptoms of SUD’s and patterns of DV/SA

§  Explore coercion and compulsion §  Help develop tools to address

accountability and avoid self-blame §  Discuss other concerns affecting safety,

sobriety, wellness (e.g. psychiatric disability, poverty, oppression)

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3 - Handouts

•  Merry-Go-Round of SUD’s (Addiction in lay terms)

•  Merry-Go Round of Violence •  1 + 1 = 10 Tons of Trouble •  Other Issues: What Else Impacts

Safety and Sobriety? •  Power and Control Wheel for

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Rationalizing

Minimizing

Denial

Merry-Go-Round of SUD’s (Addiction in lay terms)

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Rationalizing

Minimizing

Denial

Merry-Go-Round of Violence

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4 - Getting Help

§  Discuss services offered by DV/sexual assault programs, substance abuse treatment providers and support groups

§  Offer resources and referrals §  Ask participants to share helpful

information/resources

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4 - Handouts

• Getting Help – Note: You may also wish to

provide brochures and meeting schedules from agencies/support groups in your community

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5 - Sorting Out Messages §  Women receiving services may hear

conflicting messages, posing risks to safety in treatment and to sobriety in DV programs.

§  Discuss ways to overcome risks and reconcile conflicting philosophies.

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5 - Handouts

• Sorting Out Messages • Safety and Sobriety: Risk

Factors in Traditional Advocacy and Treatment Programs

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6 - Using Support Groups §  Discuss benefits of support groups &

ways for women to feel comfortable using them.

§  Include safety tips. Safety planning is key when using support groups just as it is in other settings (e.g. in the home, going to work, visiting relatives, etc.).

§  Survivors may also need some extra assurance they have the right to protect their boundaries when in groups.

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6 - Handouts

•  Safety at Support Group Meetings

•  Etiquette in Groups

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7 - Using the 12 Steps §  Discuss 12 Step concepts §  Identify strengths and challenges for

survivors of DV and sexual abuse experiencing a SUD and/or substance abuse coercion

§  Know resources in your community for 12 Step groups plus alternatives such as New Beginnings, Women For Sobriety, or 16 Step Empowerment Groups, etc.

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7 - Handouts

•  Using 12 Step Groups

•  Alternative Support Groups

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8 - Safety and Sobriety Planning

§  For women experiencing substance abuse and IPV, both safety and sobriety must be priorities.

§  Review impact of safety on sobriety and sobriety on safety.

§  Discuss how participants can make relapse prevention part of their safety plan and safety part of their relapse prevention plan.

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8 - Handouts

•  Safety Plan •  Mini-Safety/Sobriety Plan

Additional webinar resource available on our website: Enhancing Safety: Safety Planning for Survivors Affected by Their Own or Another’s Substance Use, Abuse, or Addiction (Webinar 3)

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Mini-Safety/Sobriety/Wellness Plan

§  Strategize: Steps to reduce risk/use/harm §  Develop: Options to keep safe/sober/well §  Identify: Trusted allies/safe sponsors/

strengths §  Plan: Means to escape abuser/drugs/

unhealthy coping tools §  Discuss: Referral resources §  Avoid: Danger/persons, places, things/health

risks §  Tools: HALT/One-day-at-a-time/Follow-up Caution: Written materials, referrals can place survivors in danger 50

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9 - Children’s Issues §  Children may not talk about problems

they witness in the home, so it can be tempting to think they are not affected by what’s going on.

§  Help participants recognize impact of both substance abuse and violence on their children.

§  Discuss strategies to create a more positive environment for children.

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9 - Handouts

•  Children Exposed to DV and Substance Abuse •  Children Coping With

Family Violence

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9 - Children’s Issues

•  Safety Planning Interventions For Children

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10 - Power & Control Dynamics

§  Use Power and Control Wheels to illustrate various ways power is used and abused in our society and in our personal relationships to dominate and control others.

§  Discuss what equality and respect would look like, both in our personal relationships and the larger society in terms of both safety and recovery.

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10 – Handouts: Power and Control Wheels

•  Original wheel and modified versions: – Model For Women’s Substance Abuse – Lesbian/Gay – Violence Against Native Women:

Battering –  Immigrant – Children Coping With Family Violence – Three Circles – Equality Wheel – Natural Life-Supporting – Community Accountability

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11 - Creating Change §  Working for change, providing service to

others, or carrying the recovery message can foster empowerment and healing.

§  Discuss simple things participants might do to make a difference in society. § Choose a group activity (such as making

T-shirts for the Clothesline Project) to engage participants in the art of “making a difference.”

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11 - Handouts

•  Personal

Change, Social Change

•  Can One Person Make a Difference?

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12 - Sharing Personal Experience, Strength and Hope

Provide venues for women to tell their story, be believed, and have opportunity connect with others.

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12 - Handouts

• Women Talk About Substance Abuse and Violence

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“They were right there for me”

“Somebody wanted to show me support, listen to me, not yell at me, not scream at me, just look at some options instead of that. Through them showing love to me, I began to love myself. I didn't deserve the punishment for all that had happened in my life. The continuous bad relationships, continuous abusing the drugs, and shame and the guilt I felt from all that. I deserved better. It was also OK to heal from all that.”

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Community Partners

§  Domestic violence advocates are your local experts

§  Refer women to your local DV/SA program!

§  CDPs and MHPs are your local experts

§  Refer women to your local Treatment and/or Mental Health programs!

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www.ispia.org/index.php

Iowa Integrated Services Project

Resources and Conclusion

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Support Group Manuals Real Tools: Responding to Multi-Abuse Trauma (2011) and Getting Safe and Sober, Real Tools You Can Use (2008) by Debi Edmund and Patti Bland for the Alaska Network on DV/SA (available in English & Spanish) http://www.andvsa.org/wp-content/uploads/2009/12/Real-Tools-Manual_08Version.pdf http://www.nationalcenterdvtraumamh.org/publications-products/real-tools-responding-to-multi-abuse-trauma-a-toolkit

For more information contact: Alaska Network on Domestic Violence and Sexual Assault www.andvsa.org 907-586-3650

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BC Society of Transition Houses

•  Reducing Barriers to Support Women Fleeing Violence: A Toolkit for Supporting Women with Varying Levels of Mental Wellness and Substance Use

•  Discussion Paper: A research-based discussion paper outlining the links between violence against women, mental wellness and substance use, barriers to service for women, barriers to providing support to women, components of best practices for supporting women

•  http://www.bcsth.ca/

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Interdisciplinary Overview

•  Safety and Sobriety, Best

Practices in Domestic Violence and Substance Abuse, DV/SA Interdisciplinary Task Force, IL DHS

•  http://www.dhs.state.il.us/page.aspx?item=38441

http://www.dhs.stahttp://

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SAMHSA

TIP 25: Substance Abuse and Mental Health Services Administration Available at: www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.46712

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Beyond Labels: Working with Abuse Survivors with

Mental Illness Symptoms or Substance Abuse Issues

© 2007 SafePlace

For more information, please visit the SafePlace

website at: www.SafePlace.org

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National Center on Domestic Violence, Trauma & Mental Health

Resources and Publications: http://www.nationalcenterdvtraumamh.org/publications-products/ Webinars: http://www.nationalcenterdvtraumamh.org/trainingta/webinars-seminars/

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Trauma Resources

•  Sidran Foundation (www.sidran.org)

•  Ohio DV Network (www.odvn.org)

•  National Center for PTSD (www.ptsd.va.gov/)

•  National Child Traumatic Stress Network (www.nctsn.org)

•  International Society for Traumatic Stress Studies (www.istss.org)

•  International Society for the Study of Trauma and Dissociation (www.isst-d.org)

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Legal Advocacy Resources

§  State DV Coalitions

§  Center for Survivor Advocacy & Justice

§  Bazelon Center for Mental Health Law

§  National Center on Domestic Violence, Trauma & Mental Health

§  NCJFCJ and BWJP

§  The Leadership Council on Child Abuse & Interpersonal Violence

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Patti Bland, MA, CDP

29 E. Madison St., Suite 800 Chicago, IL 60602 P: 312-726-7020 x2013 TTY: 312-726-4110 www.nationalcenterdvtraumamh.org [email protected]

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Thank You to Our Funders Domestic Violence, Trauma, and Substance Abuse: A Webinar Series for

Substance Abuse Counselors and Other Allied Behavioral Health Professionals Working with Women is part of the

Trauma Informed Rural Advocacy Series This project was supported by Grant No. 2011-TA-AX-

K128 awarded by the Office on Violence Against Women, US Dept. of Justice. Funding was also provided by the Administration on Children Youth and Families Administration for Children and Families, US Department of Health and Human Services. The opinions, findings, conclusions and recommendations expressed in this presentation are those of the author and do not necessarily reflect the views of the Dept. of Health and Human Services or the Dept. of Justice, Office on Violence Against Women.

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