CHAPTER 11: Working with Selected Populations: Treatment Issues and Characteristics Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

Overview of Chapter Children and Adolescents Women The Gay/Lesbian/Bisexual/Transgender Community People with Disabilities Older Adults Homelessness

Children and Adolescents Key risk periods for drug abuse occur during major transitions Vulnerable life periods are transitions Moving from one developmental stage to another First major transition for children is when they leave the security of the family and enter school Next is when they advance from elementary to middle school It is at this stage (early adolescence) that children are likely to encounter drug use for the first time Next is entering high school Greater exposure to available drugs, drug users, and social activities involving drugs Life changes Moving Parents divorcing

Children and Adolescents Research indicates that signs of risk can be seen as early as infancy or early childhood, including: Aggressive behavior Lack of self control Difficult temperament Family situations also increase a child’s risk for later drug abuse when there is: A lack of attachment and nurturing by parents and caregivers Ineffective parenting A caregiver who abuses drugs

Children and Adolescents Research suggests that conduct disorders and other behavioral and temperament traits that increase a youth’s vulnerability to drug use develop as a fairly stable pattern as early as 5 years of age. Characteristics of these children Impulsivity Attention Deficit Disorder Difficult temperament Below-average verbal IQ Academic underachievement Negative affect Difficulties with emotional regulation Social incompetence Aggression

Children and Adolescents Risk Factors Community School Peer Family Individual

Children and Adolescents Individual Risk Factors: Early and persistent behavior problems such as stealing, vandalism, conduct disorder, atttention-deficit hyperactivity disorder (ADHD), rebelliousness, and aggressiveness, particularly in boys High-risk personality factors such as sensation seeking, low harm avoidance, and poor impulse control Low self-esteem Deficits in behavioral-affective regulation Antisocial behaviors Alienation High tolerance for deviance and strong need for independence Psychopathology Attitudes favorable to drug use

Children and Adolescents Family Risk Factors Low parental involvement Family history of alcohol or drug use Poverty Parental substance use and modeling Poor family management and parenting practices Poor parent-child relationships Family conflict Physical and sexual abuse Peer Risk Factors Negative peer influence Peer influence; peer rejection or low acceptance

Children and Adolescents School Risk Factors Low commitment to school/lack of school bonding School failure Failure to achieve in school Low school involvement Negative school involvement Community Risk Factors Lack of social competence Community and interpersonal violence Deficient cultural and social norms Neighborhood disorganization that reduces the sense of community

Children and Adolescents Important goal of prevention is to change the balance between risk and protective factors. Most frequently identified protective processes Parent-child attachment Parental supervision Communication of family values Second-most important socializing agent for children, after the family, is the school. School-bonding and achievement are critical protective factors.

Children and Adolescents Factors which were found to increase resiliency: Optimism and hope Self-efficacy Strong self-regulation skills Problem-solving skills Adaptability Self-regulation Sense of humor Easy temperament Close relationship among family members Low discord between parents Warm and structured parenting style

Children and Adolescents Prevention and Intervention Family support programs that encourage involvement of the parents in their children’s lives Prevention programs designed to increase positive peer relationships School Prevention Programs should be integrated within the school’s own goals of increasing academic performance and should focus on: Improving academic and social-emotional learning to address risk factors for drug abuse Support for positive peer relationships Education component designed to correct the mispercetion that most students are using drugs

Children and Adolescents Meeting adolescent specific needs Steps Initial screening In-depth assessment covering: Psychological and medical problems Learning disabilities Family functioning Other aspects of youths’ lives Treatment program

Women Risk Factors Agrawl reports that women (18-49 years of age) who are married have a lower rate of substance abuse or dependence than unmarried women History of divorce is positively associated with illicit drug use, not dependence. Partners can influence each other’s drinking and drug use. Women are more likely than men to have co-occurring mental and substance use disorders. Affects on pregnant women Alcohol is the most common cause of malformation to the embryo or fetus in pregnancy.

Women Prevention and Intervention Reports concerning treatment of women have shown: Women experience a number of barriers to receiving treatment, including: Child Care Stigmatization Inability to pay for treatment Women are more vulnerable than men to some of the physiological effects of substance abuse Substance abuse among women is more often rooted in psychosocial problems and traumatic life events

Women Protective Factors Parental Warmth Spousal or Partner Support Spiritual Presence Coping Skills

The Gay/Lesbian/Bisexual/ Transgender Community Gay/Lesbian/Bisexual/Transgender Identity Development “Coming Out” Assumptions of Cass’s Model Identity is acquired through a developmental process Change in behavior stems from the interaction between individuals and their environment Stages of Identity Development Identity confusion Identity comparison Identity tolerance Identity acceptance Identity pride Identity synthesis

The Gay/Lesbian/Bisexual/ Transgender Community Risk Factors Prejudice and discrimination Cultural issues Legal issues Accessibility Families of origin Health issues Gay bars Treatment is the same as that for other individuals However, some GLBT clients will need to address their feelings about their sexual orientation as a part of their recovery

People with Disabilities Risk Factors Substance abuse behaviors need to be identified as to whether they are a consequence of, or a response to, the disabling event. Contributing factors Stress Crisis Loss and Grief Body Image Sigma

People with Disabilities Risk Factors cont. Most frequently experienced psychosocial reactions to a disability that affect one’s ability to cope: Shock Anxiety Denial Depression Anger/Hostility

People with Disabilities Prevention and Intervention Substance abuse treatment for people with disabilities should include the following: Family psychoeducation Disability and medication management and education Independent living skills education Anger and stress management HIV risk reduction, counseling, and testing STD and infectious disease education Interpreted self-help meetings for the deaf and hard of hearing Health and wellness education Case management and crisis intervention Educational, Vocational, and residential referrals Medical and psychiatric services Domestic violence and victim assistance counseling Development of social support networks Self-esteem and body image

Older Adults Risk Factors Various biological, psychological, and social that accompany aging make older adults uniquely vulnerable to problems associated with substance abuse, including: Loneliness Diminished mobility Impaired sensory abilities Chronic pain Poor physical health Poor economic and social supports Social stigma Change in social support and work-related activities Loss One in four older adults have a significant mental disorder.

Older Adults Prevention and Intervention Research supports including the following into substance abuse treatment for older adults: Age-specific group treatment that is supportive and nonconfrontational with focus on self-esteem building Coping with depression, loneliness, and loss Rebuilding the client’s social support network Pace and content of treatment appropriate for the older person Staff members who are interested and experienced in working with older adults Linkages with medical services, services for the aging, institutions for treatment, and case management Kinney stresses the importance of groups in substance abuse treatment for older adults.

Homelessness An estimated 20%-25% of homeless people have a serious mental illness One-half has an alcohol or drug problem. Cause/Effect debate Risk Factors Four main groups that often suffer from homelessness and its effects: Families Youth Veterans Chronic Homelessness

Homelessness Treatment When homeless individuals feel humanized and treated with respect, they are more receptive to treatment services. Another important factor in successful abuse treatment is housing.