1. CHEMICAL DEPENDENCY & SUBSTANCE ABUSE In relation to sexually abused children and adolescents Carrie Meiners Laura Monteiro Anna Smith Mariah Snow

2. The Problem: Chemical Dependency chemical dependency - addiction to a mood-altering chemical. includes both drug addiction and alcoholism When a person is chemically dependent, they have lost the power of choice over using mood- altering chemicals. They may be able to stop for awhile, but they will return to its use again and again despite their best intentions and exertions of logic and willpower. Chemical dependency is characterized by continuous or periodic: impaired control over drinking and/or drug use (prescribed or illegal), preoccupation with the mood-altering chemical, use of the addictive substance despite adverse consequences, and distortions in thinking--most notably denial. Though the disease can't be cured, it can be arrested and treated (kept in remission). The disease is far more complex than the mere use and abuse of mood-altering chemicals and recovery is far more complex then just becoming abstinent. Anyone can become chemically dependant, starting even in children of elementary age! – As you will find out, one common population can be found among those who have been sexually abuse, physically abused or have experience traumatic stress early in life.

3. Study #1: Women in Methadone Treatment In 2008, A research study was done at the University of Chicago to study the direct and meditated relationships between childhood sexual abuse among a random sample of 416 women in methadone treatment – 59% of all women reported high rates of childhood sexual abuse – 89.7% reported intimate partner violence – 28.6% reported Posttraumatic stress disorder – 19.5% reported global psychological distress

4. Study #1 : Women in Methadone Treatment What the findings prove: – Over half of the methadone addicted women were sexually abused as children – Majority of women that were sexually abused as children and addicted to meth, continued to be abused in adult relationships – PTSD and global psychological distress are both 2 possible correlates of sexually abused children that could lead them to chemical dependency

5. Study #2: Sexually Abused Men in Treatment for Substance Abuse A retrospective chart review was performed of 222 men admitted to an outpatient chemical dependency treatment program 6 dependant variables were examined and compared among the men 1.Freq. & quantity of alcohol use 2.Freq. & quantity of use of cocaine and heroine use 3.Age of first use 4.Multiple substance abuse 5.Psychiatric co-morbidity 6.# of prior treatments

6. Study #2: Sexually Abused Men in Treatment for Substance Abuse Results: – Men who reported history of sexual abuse used cocaine more frequently, started drinking earlier, used multiple substances and had greater psychiatric co-morbidity than the control group – Men who reported history of physical abuse used cocaine more frequently, used multiple substances reported a higher number of treatment attempts, and had a greater psychiatric co- morbidity than the non-physically abused group. What the findings confirm – There is indeed a strong link between childhood sexual abuse, childhood physical abuse and substance abuse,

7. Study #3: Associations between types of maltreatment and substance use during adolescence All 10 th through 12 th graders (n=2,187) at 6 public schools in rural Oregon county filled out an anonymous survey that included questions about their experience of emotional, sexual, and physical abuse, and their use of a variety of substances. Substance use was categorized as: 1.Tobacco use 2.Alcohol use 3.Illicit drug use 4.Physical abuse 5.Sexual abuse

8. Study #3: Associations between types of maltreatment and substance use during adolescence Results: – Suggested that all types of maltreatment including emotional abuse, are related to significantly higher levels of substance abuse and should be considered serious risk factors for substance use during adolescence – strength of association between maltreatment and substance abuse use varies by the types of maltreatment Youth who have experience both physical and sexual abuse are at especially high risk of substance use!!

9. Symptoms & Manifestations of Chemical Dependency Symptoms – unable to stop drinking or taking a particular mood-altering chemical despite serious health, economic, vocational, legal, spiritual, and social consequences are become visible. – Adolescents begin to do poorly in school, stop caring about the world around them Manifestations – Loss of reality Ex) Defense Att. Ramsey – Death

10. Cultural Variation Overall A chemically dependent person is unable to stop drinking or taking a particular mood-altering chemical despite serious health, economic, vocational, legal, spiritual, and social consequences. It is a disease that does not see age, sex, race, religion, or economic status. It is progressive and chronic and if left untreated can be fatal. However some variations can be found from one culture to the next such as: – how the culture/society views chemical dependence – What is the cultural definition of dependence Could just be a way of life – What substances are deemed “legal” and “illegal”

11. Treatment Options – Intensive Outpatient Program (IOP) – Partial Hospital Program (PHP) – Residential (Inpatient) Treatment Problem Solving Techniques – The 12 Steps – Cognitive Behavior Therapy – most effective

12. The 12 Steps: Step 1 - Admit powerless over addiction Step 2 - believe that a Power greater than ourselves could restore us to sanity Step 3 – Turn life over to higher power Step 4 – Moral inventory Step 5 – Admit the exact nature of our wrongs Step 6 – Be ready and willing to have all defects of character removed Step 7 - Humbly asked God to remove our shortcomings Step 8 - Make a list of all persons we had harmed, and be willing to make amends Step 9 - Make direct amends to such people wherever possible, except when injury may be a result Step 10 - Continue to take personal inventory and promptly admit when wrong Step 11 - Sought through prayer and meditation to improve our conscious contact with God Step 12 - Having had a spiritual awakening as the result of these steps

13. Treatment Outcomes – Relapse: “Falling off the Wagon” – 58% fail to complete 12 month period of abstinence – 78% of the 58% relapse in the first 6 months – Of the remaining 22%, 77% stay clean for a whole year – Females 22% likely to relapse, males 32% Reasons for relapse – Most adolescents who use are troubled prior to addiction – Co-morbidities – Aftercare reduces risk of relapse

14. Role of Professional: Recognition & Assessment Recognition – Looking for symptoms – Receiving reports of chemical dependency – Numerous substance related violations – Different aspects of life affected by substance abuse Assessment – Chemical dependency assessments – Screening instruments – Mid-Range instruments – Comprehensive instruments

15. Role of Professional: Intervention & Referrals Intervention – Limiting their opportunities to use – Conducting an intervention – Court orders Referrals – Inpatient treatment programs – Outpatient treatment programs – Individual counseling – Group counseling – Alcoholics Anonymous or Narcotics Anonymous

16. Case Study

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