1. Coping

2. Stress – strain – coping – support model
Stress-Strain-Coping-Support model as it applies to having a whanau member with a substance abuse problem
What it shows us is the relationship between our whanau member’s substance abuse problem and the amount of strain we experience.
In this program we will today look at coping and in a later session explore social supports.
Stress:
The relationship has become disagreeable, and sometimes aggressive
There is conflict
Family members experience uncertainty
Family members are worried
Home and family life are threatened
Strain:
Feeling worried and anxious,
helpless and despairing,
low and depressed,
guilty and devalued,
angry and resentful,
(often they feel guilty about these feelings)
sometimes frightened
and often feeling alone
Coping – family members choose how to respond, what they do, what they say to the family member with the substance abuse use problem – they tolerate it, engage with it or withdraw from it
Support – what resources does a person have – are they positive or negative (e.g. you should do this, why don’t you do that... Judgemental or they just don’t know what it is like)

3. Coping responses Tolerant Engaged Withdrawn
Styles identified through research in the UK.
People here in NZ who have come through the group identify with these
Whanau have a choice in how they respond to their drug using whanau’s behaviours.
Often they get stuck in pattern of responding in ways that increase the strain they experience.
The point here is to realise that you have different ways to respond to their behaviour and there are advantages and disadvantages to each one.
To identify the advantages and disadvantages of your different responses can help you change the stress and strain from their behaviours.

4. Tolerant What is it? Putting up with it
Actions that remove the negative consequences for the user
Advantages:
Disadvantages:
This can be about keeping the peace

5. Engaged What is it? Standing up to it
Actively engaging to help them make changes
Advantages:
Disadvantages:

6. Withdrawn What is it? Withdrawing and gaining independence
Putting distance between self and user, either due to uncertainty or wanting to care for self
Advantages:
Disadvantages:

7. Stages of change Understanding the stages of change.
You are here probably because you want your family, whānau member, or friend to make changes to their alcohol and other drug use.
Change is a challenging process for families and whānau. It can feel uncomfortable.
It is really helpful to understand that change is a process, not a straight line. People making changes usually go backwards and forwards before eventually getting there. This process of change is also similar for family, whānau and friends. Understanding the process of change that your family, whānau member or friend may go through can be really helpful to maintain realistic expectations.

8. Stages of Change Hasn’t even thought about it (pre-contemplation)
Starting to think about it (contemplation)
Getting ready to make changes (decision)
Doing it (action)
Sticking with it (maintenance)
Slipping back (lapse/relapse)
Stage One: Hasn’t even thought about it/Pre-Contemplation
Unaware or ignores the negative consequences of their alcohol and other drug use.
Often at this stage a person is not aware or concerned that their drug use is an issue. It would appear to them to be under control or purely for recreation. This might not be the case for others – usually their families who might see the use of drugs as too heavy or the use of any drugs as unacceptable.
Stage Two: Starting to think about it/Contemplation
Aware of the problems substance use is causing but continues to enjoy using alcohol and other drugs.
Something often happens which forces a person to think about their drug use. It could be a fight with a partner or friend, or a problem at work, which has come about because of their drug use. It could simply be a new year’s resolution or a decision to give something up for Lent. The drug is not yet seen as a serious problem for them.
Stage Three: Getting ready to make changes/Decision/determination
Realises the negative consequences of continuing to use alcohol and other drugs are worse than changing.
This is when the person decides to do something and makes the appropriate plans. They might tell a friend they are going to stop or reduce consumption. A word of warning to family members – the drug user may use this stage just to get you off their back.
Stage Four: Doing it/Action
Makes attempts at change, avoids using friends, attends self-help groups, seeks professional help.
The person decides to do what he/she has decided. This may involve contact with a local community group responding to the drug problem or a statutory service provider such as the Health Service Executive. It is important for the family to note that while drug users must do this for themselves they do need as much support as the family can give.
Stage Five: Sticking with it/Maintaining the Action
Maintains and sticks to goals
They keep up the action for as long as they can. This is often when the family can have an input into the care of children/child. They have seen a positive move and can support it by understanding the problems their family member is going through and helping to come up with solutions.

9. Cognitive Process Beginning Stages of Addiction
In first stage - only positives, and only when a person moves to second stage do they start to realise negatives.
Positives
Relief from:- Depression, Anxiety, Loneliness, Insomnia
Euphoria
Increased status
Increased energy
Increased sexual/social confidence
Increased work output
Increased thinking ability
As it progresses
Depression relief
Confidence boost
Boredom relief
Sexual enhancement
Social lubricant
Negatives
May be illegal
May be expensive
May cause missing work
(sleep; recovery)
Employment/school disruptions
Relationship concerns
Financial problems
Beginnings of physiological dependence
The balance begins to tip
Prior to it tipping this is where someone between pre-contemplation to contemplation is.

10. Cognitive Process Severe dependence
A person begins to make changes when the negatives begin to outweigh positives.
Positives
Sociability
Occasional euphoria
Relief from fatigue
Relief from stress
To severe dependence:
Relief from depression
Negatives
Withdrawal depression
Paranoia
Tweaking
Relationship disruptions
Family distress
Impending job loss
To severe dependence
Weight loss
(Psychosis)
Loss of family
Seizures
Severe depression
Unemployment
Bankruptcy

11. Slipping back (Lapse/relapse)
Lapse is one off, short term
An opportunity to learn
Frustration for family
Relapse – returning to old behaviours
Happens when proper supports/strategies aren't put in place after a lapse
Stage Six: Slipping back/Lapse/Relapse
May have a setback, lapse or relapse.
Often people will find it difficult to maintain an action and will use again, sometimes at an increased rate and sometimes they may use just once. This can be more devastating for the family than an initial discovery. A year of watching the harm caused to a family member by their drug use can seem like a lifetime for a family but a year is nothing in the cycle of life on drugs. Neither is a year anything in the process of recovery. As time passes and families begin the process of recovery trust is rebuilt. The drug user begins to trust the family and the family begins to trust the user. When the drug user who has stopped using for months, or years, relapses and begins again, the pain for the family is worse than first time round. They can’t get rid of the feeling of disappointment, desolation and the terrible sense of failure as a parent/partner. The mistrust, the fear, the anger and the grief are constant factors in the family home. The cycle starts over again. For everyone! Until at some point the parent/partner begins to recognise the limitations of the family.
Recognising the Limitations of the Family
The parent has to recognise their own limitations and, indeed the limitations of the family. Often it is another member of the family who says something inadvertently that will make a parent realise that he or she can do no more. Often it is total exhaustion that makes a parent realise that he or she has to give the responsibility of getting off drugs back to the user. At this stage of acceptance, the family can begin to think about how best they can support the drug user living in the home or outside the home. We in the Network have found while we are supporting the drug user we ourselves need support. We found that the best way of getting this support for ourselves was through our Family Support Group.
Permanent Exit
It is important that families have some hope when dealing with the process of addiction. While it is not within the Wheel of Change there is hope in the permanent exit. Some drug users when they receive treatment actually maintain whatever stage they are at and move on to the next stage and eventually reach the stage where they are clean of drugs. They continue to deal with their addiction and recovery through aftercare services, which many be provided by the agency that detoxed them or local groups. They also get support through self-help groups such as Narcotics Anonymous.

12. Live your life.
Regardless of what stage they are at, your first responsibility is to look after yourself.
You will hear facilitators say this more than once as it is very important!!
No matter where your family, whānau member, or friend is in the change process, you look after yourself and live your life. Remember, by doing this, you provide an example for others in your family and whānau. You are change in action.

13. How do you Cope? Advantages? Disadvantages?
Ask participants to reflect on their own ways of coping and what the advantages and disadvantages are.

14. How do you live with an Addiction
People in recovery need to learn their limits and relapse signals
A person in recovery needs to respond immediately to relapse signals
A person in recovery has to maintain a balanced lifestyle, more so than if there had been no addiction
Family members can help identifying triggers and high risk situations
Family members must understand that avoiding relapse often may take priority over family relationships and plans but that avoiding relapse is in everyone’s best interest.
Family can help with a balanced lifestyle – trying to engage them in positive healthy activities away from substances.

15. How do you live with an Addiction
Recovery is a process, and all aspects of it, including re-establishing trust, may occur slowly.
It is often difficult for family members to live without a guarantee that a relapse will not occur.
4. Families often experiencing a lack of trust in the whānau who use
5. Families need to understand that lapse and relapse are part of the process and can be learning experiences.
This is where looking at the advantages and disadvantages of the different coping styles can be helpful – always keeping in mind how can you look after yourself.

16. Who can you contact?
Police – 111 A&D Helpline – Mental Health Line – A&D Service – Supporting Families –
Local numbers
If a person is at risk of harm to self or others police
If there are physical health concerns – ambulance ED at the hospital for urgent matters or less urgent then GP or local health provider
Mental health concerns – CATT