2.7: Addressing the Substance Abuse Challenges of Homeless Families Presentation by Deborah Werner

1. Addressing the Substance
Abuse Challenges of Homeless
Families
Deborah Werner
Advocates for Human Potential, Inc,
This presentation is made possible with support from the
Substance Abuse and Mental Health Services Administration

2. Substance Use
 Abstinence
 Experimental Use
 Responsible Use
 Episodic or Situational Abuse
 Chronic Abuse
 Dependence
Responsible use = moderate, legal consumption
in low-risk settings 2

3. Not all Use is Addiction
 Use of Illicit Substances
 Heavy consumption
 Binge drinking
 Poor coping strategy
 High-Risk Settings
 Driving under influence
 While caring for child
 Episodical/Situational Abuse
 Common co-occurrence with intimate partner
violence
Interventions include: education, brief interventions, 3
harm reduction, alternative activities, coping skills

4. Addiction and Dependency
 Brain disorder
 Brain impacted
 Cravings
 Tolerance
The individual becomes controlled by the
substance at a cellular level. Use continues
despite catastrophic consequences.
– Nora Volkow, MD, paraphrased 4

5. The Substance Use and Mental
Disorders Landscape is Changing

6. Reforms
 Ensures consumer  Allows states the option of
protections in the insurance continuing Medicaid
market. coverage to former foster
care children up to the age
 Creates immediate options
of 25 years old.
for people who can’t get
insurance today.  Ensures free preventive
services.
 Expands health insurance
coverage to 32 million  Small business owners and
Americans. employees will be insured
 Adds 16 mil with incomes  Reduces uncompensated
below 133% of the federal care.
poverty level to Medicaid.

7. Impact of Reform & Parity
 Creates guaranteed access to mental health and substance use
disorder services at parity in most major public programs
including Medicaid and Qualified Health Plans (QHPs) to cover the
uninsured and small businesses.
 Provides changes to the Medicaid program to continue and
expand home and community-based services for individuals with
mental health and substance use disorders.
 Allows state Medicaid programs to establish health homes for
those with chronic illnesses. States that seek this option must
consult and coordinate with SAMHSA regarding the prevention
and treatment of mental illness and substance use disorders
among those with chronic illnesses.

8. Impact of Reform & Parity
Includes mental health and substance use disorder
services as essential health benefit services for
qualified health plans (QHPs) offered in the state-
based exchanges.
 Provides for grants to community mental health programs for co-
locating primary and specialty care.
 Creates a grant program for school-based health clinics to
provide mental health and substance abuse assessments, crisis
intervention, counseling, treatment and referrals.
Anticipate reductions in residential services over time.
Increased need for mental health and substance use
treatment agencies to collaborate with housing programs

9. While
substance use/abuse
in and of itself is
not child abuse –
behaviors
associated with
substance use/
abuse can put
children at
significant risk

10. Inter-Generational Cycle of Substance Abuse
 Substance use disorders affect the entire family unit
and all the individual members.
 Parental substance abuse increases the likelihood
that a family will experience
 financial problems
 shifting of adult roles onto children
 child abuse and neglect, inconsistent parenting
 violence and disrupted environments
 Children of parents with substance use disorders
have a significantly higher likelihood of developing 10
substance use problems themselves.

11. Families do recover!

12. Lessons from the Treatment Field
 Each family is different and their solutions are unique.
 Children often have service needs of their own.
 Developing motivation for recovery is a service not a
pre-requisite.
 Many women with SUDs experienced childhood trauma
and/or poor parenting which can significantly effect
their relationships with their own children but effective
supports and parenting programs are available.
 Relapse is common. Prognosis/relapse the same as for
hypertension or diabetes. Early intervention can end a
relapse.
12
 Recovery communities have powerful synergy.

13. Ending the Cycle
 Accessible Gender-Responsive, Trauma-Informed Behavioral
Health Services
 Children’s Assessments, Developmental Services, Education
 Comprehensive Services for Families and Family Members
 An array of safe, affordable housing options
 Recovery residences
 Supportive housing
 Service-enriched housing
 “mainstream” safe, affordable housing
 Clean/sober communities
 Accessible recovery support
 Opportunities for growth, economic and social well-being
13

14. We all want to:
 Help families access supports and resources
 Strengthen/support families and family members
 Preserve individual rights and self-determination
 Support recovery and reduce risks associated with
use
 See children thrive
 Create wellness focused
communities
14

15. Voluntary/Mandatory Continuum
Least restrictive Most restrictive
No services Service Most Services fall in here. Mandatory Mandatory
Housing Coordinator Case Plan Participation Participation
only checks in Contracts, agree to attend In Services in all
Standard regularly. certain services, contingency Relapse services.
lease client management, drug testing, addressed, Removal if
provisions decides on relapse does not necessarily may result in use alcohol
no special service or result in loss of participation discharge /drugs
rules objective
related to No
alcohol or abstinence
drugs requirements
Where are you? 15
The Werner Hartman Group, 2006

16. Approach Varies Depending on
 Agency mission, values philosophical framework
 Availability of collaborative partners and quality
community services
 Funding agency requirements/constraints
 Individual Family Needs
 Sense of urgency
What works for one family won’t
necessarily work for another. Our
villages benefit from having an array
of options.
16

17. Program Variations – depending on
population, philosophy and options
 Acknowledging alcohol or drug use may vary
depending on policies, legality of use, drug testing
policies, client service plan
 Response to alcohol or drug use may vary by type of
use, risk to children, mental health status, resources
available, “rules,” perceived risk to other residents,
 Policies on if or when to evict family when householder
is using.
 Respect parental authority and roles when you see
marginal care of children you care about.
 Focusing on strengths when needs are so visible
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18. Resources
 The Treatment Improvement Exchange
 http://www.tie.samhsa.gov/
 http://womenandchildren.treatment.org/
 Homeless Resource Center
 http://www.homeless.samhsa.gov
 National Institute on Drug Abuse
 http://www.drugabuse.gov/
 Join Together
 http://www.jointogether.org/
 Werner, D., Young, N.K., Dennis, K, & Amatetti, S.. Family-Centered Treatment
for Women with Substance Use Disorders – History, Key Elements and 18
Challenges. Department of Health and Human Services, Substance Abuse
and Mental Health Services Administration, 2008.