2.  No single definition  Usually defined as- “A group of people with common ties of affection and responsibility who live in proximity to one another”

3. Types of Family NuclearJointExtendedElected

4. Drug use by client Poor family interactions/ behaviors

5.  Each family has its own pattern on communication (verbal as well as non-verbal) ◦ IDU threatens to run away from home- family members get him injections or ◦ Family members beat up client for using injections  Each family tries to reach a balance ◦ Family covers up drug use and act normally

6. Psychological Health Economic Impact on minor children

7. Psychological

8. Health

9. Economic

10. Impact on minor children

11.  Why is it important to include family in treatment process?

12.  Approaches that include assessment and intervention at the family’s level  Important to consider “family” from client’s point of view

13. Co- dependency EnablingBoundaries Sub-system Adjustment to abstinence Triangulation

14. Co-dependency Being overly concerned with problems of IDU while neglecting one’s own needs

15. Enabling Process of encouraging drug use by un-intentional behaviors It diffuses impact of drug-use and does not allow the client to realize his problem

16. Boundaries Separates one family member from another Dysfunctional patterns in families of IDUs: Over-involved and interfering Completely aloof

17. Sub-system Clusters of family members separated by clear boundaries. E.g. parental sub-system or sibling sub-system

18. Adjustment to abstinence Families may show negative reactions to abstinence as hidden conflicts come to surface

19. Triangulation Occurs when the IDU becomes the scapegoat for two family members who do not want to discuss their conflictual issues

22.  Important to address needs, expectations and wants of family members  Make the family feel comfortable  Identify each family member by name  Assure them of confidentiality

24.  Very important to facilitate the “un-burdening of family’s emotions  Use active listening skills  Let family members decide what they want to discuss

26.  Includes following areas: ◦ Family member’s knowledge about drugs ◦ Impact of drug use on financial status ◦ Available social support to the family ◦ Maintaining factors for drug use (eg. Peer pressure, withdrawal etc.) ◦ Health status (e.g. screening spouse for HIV) ◦ Quality of relationship of IDU with his family members ◦ Communication patterns in the family

28. Craving and withdrawal Risk associated with injection use Safe sexual practices Reproductive health Process of change Treatment process Harm-reduction process

29.  Lack of will-power not sole determinant of relapse  Elaborate phenomenon of craving and withdrawal- as predictors of relapse

30.  Family member need to be told about various health risks associated with injection use  Also should be told where to get medical/legal aid as and when required

31.  IDUs is a high risk group for getting sexually transmitted infections/diseases  Wife needs to be taught: ◦ Importance of regular condom use ◦ Condom negotiation skills ◦ Taking care of personal hygiene ◦ Common symptoms of infections (e.g. itching in vaginal area, excessive/smelly white discharge) ◦ Getting regular check-ups done

32.  Wife should also be counseled regarding: ◦ Maintaining reproductive health ◦ Spacing between children

33.  Family goes through cycle of hope (when patient abstains/reduces drug use)  despair (when previous patterns of use are resumed  Family needs to be made aware of “process of change” in addiction

35. Drug use as chronic, relapsing condition Need for regular, long-term follow-up Family should also keep in touch with counselor

36.  Family may often blame counselor- “You are supposed to make him quit, why are you giving him needles?”  Important to make family aware of Harm reduction concept

38.  Triggers (internal/external) can lead to relapse

39.  Family’s role as a trigger should be identified using A-B-C charting* DateAntecedent (What was the situation at that time? What were you thinking/feeling?) Behavior (What did you do?) Consequence (What happened after that? Family should be taught appropriate coping method

41. Managing roles and responsibilities Managing finances Managing time

42.  Family to be considered from client’s point of view  Families may resist treatment process as they have become hopeless- the counselor should not give up  Be non-judgmental.  Remember the issue of confidentiality  When in doubt, remember, the IDU is the index client, not family members

43.  Family has important role in IDUs life  Can be a protective factor or a risk factor  Important to address family’s needs, myths and expectations- from client and treatment process  Involving family in treatment  positive outcome