Live Chat With Steve Hornberger

Views and opinions expressed by non-CSAT staff members in the Web chats and Web casts should not be interpreted as official CSAT policy, but as the views and opinions of the individuals participating in these events.

Live Chat With Steve Hornberger, Director of Behavioral Health, Child Welfare League of America

MODERATOR: Welcome to the Recovery Month Live Chat. Today we have Steve Hornberger, Director of Behavioral Health, Child Welfare League of America in Washington DC. The topic of today's discussion is: Social Service Approaches to Addiction/Treatment.

MODERATOR:Welcome Mr. Hornberger. We will begin now with questions submitted earlier.

MODERATOR: What are the advantages and disadvantages of methodone programs?

Mr. Hornberger:

• Client avoids the discomfort of withdrawal.
• Allow the client to make accomplishments i.e. obtaining and maintaining their job and family responsibilities.
• Reduce crime activities associated with opioid addiction. (In particular theft)
• Improvement in general health
• Avoids relapse and offers the possibility of engaging in the treatment process.

Disadvantages:

• Often the patient is poly substance dependence and the program is not always able to respond to this issue.
• Lack comprehensive care.
• Some clients lack motivated to become drug-free after prolong period of maintenance
• Social stigma attached to methadone maintenance users.

MODERATOR: Another earlier question: At our worksite, several people who have tested positive for illicit drugs who are clean cut, family oriented, and long-term employees with good work performance- not the typical profile. Can you explain?

Mr. Hornberger: We have preconceived notions about the face and behaviors of an addict. The media and the entertainment industry we encounter on a daily basis validate stereotypes. Illegal drug use/abuse crosses every socio-economic boundaries. There is not a typical profile of what a drug addict or someone with a drinking problem looks like. That is a myth! The abuse of AOD cuts across all races, ethnicities, and socioeconomic statuses.

MODERATOR: PREVLINE has a fact sheet that may provide useful information on this topic: See-- http://ncadi.samhsa.gov/govpubs/ph317/

MODERATOR: Help! I don't not know what to do. My son, 19 yrs. old, is a heroin addict. He has OD three times in the past four months. I've tried to get him in treatment. He says he's okay. But he's not. We can't just stand by and watch him kill himself. What can we do?

Mr. Hornberger: One way to address this issue is through a non-threatening family intervention in a non-threatening environment. Although emotions sometimes run high in family intervention, certain rules can be established before the intervention begins. Make it formal but informal. Have him discuss how he feels his drug behavior might have cause harm to himself and the consequences that can occur if he continues using. Be ready to site examples (a few not his whole history) if he gets stuck.

One of the first things you can do is to educate yourself about AOD, treatment, and the process of recovery. Understanding that addiction has such a biological component may explain an individual's difficulty in achieving or maintaining abstinence. Understanding this may help you gain a better understanding of his disease and how he perceives his addiction and the biological effects that occur when someone stops using drugs that cause him to crave or seek out drugs. This may help alleviate some of your frustration, but I encourage you to seek out support from others who are experiencing the same issue. I would encourage you to contact well-known organizations called Al-Anon or Nar-Anon. Both groups are support programs that offer help to families and friends who are living with the effects of someone who is currently abusing AOD or has in the past. There are local chapters in almost every city and state across the country.

In addition to educating yourself and your family, you can reassure your son that you are available to provide support and encouragement to him as he considers his treatment options. Because families can and do play a critical role in motivating a substance abuser to enter treatment, stay in it, and maintain sobriety. I can not emphasize this point enough. Once a person goes into treatment, it is not realistic to expect this person to be well overnight. Recovery in itself is a process that can require multiple episodes of treatment and it takes place over time, in specific stages.

MODERATOR: Welcome chatters, please ask away!

MODERATOR: How do we as citizens become an active deterrent to drug activity in our community?

Mr. Hornberger: Establishment of citizen patrol group (neighborhood block watch), reporting of drug activities to law enforcement agencies, organizing neighborhood pride activities, sponsoring town hall meeting, and providing structured activities for the young adults in the community are just a couple of things that can be done. If we want to deter drug activity in our community, we have to help those who need treatment to get into treatment. In order to do this we as individuals must get past the stigma of associating ourselves with these kind of people. Keep in mind, these kind of people may be our brother, mother, or best friend. Offering our support and encouragement to those individuals we know who may suffer from AOD abuse can be vital to their recovery.

MODERATOR: Another supplemental fact sheet can be at http://ncadi.samhsa.gov/govpubs/mpw011/index.htm

susan: Once an individual with children is deemed to be addicted to alcohol or drugs, what is the next step by the Child Welfare League?

Mr. Hornberger: CWLA is the nation's oldest membership organization that works with both public and private agencies to protect against child abuse and neglect and to improve the well being of children and families. However, if the parent or other caregiver has an AOD problem, that puts the child at risk for harm or neglect. Professionals and community members where they live, call in the state hotline. Depending on the allegations for what the caller alleges, child protective services in that locality can come to the families and investigate. Depending on what is discovered, the allegations might be false, the family may be recommended to get family support services or the children may be removed because of the severity of the risks. Nationally, 60 to 80 percent of all children in the child welfare system, 1 or more of the caregivers has an AOD problem that has been untreated. If you need more information, you can call the SAMHSA locator to find treatment facilities in your community. Women and mothers with children report possible loss of children as one of the prime motivators for them to go into treatment. To See the CWLA's website visit: http://www.cwla.org/. The SAMHSA Treatment Facility Locator Web address: http://findtreatment.samhsa.gov/facilitylocatordoc.htm.

thegube: You may have already answered this kind of question today, but I am wondering, what kinds of signs of substance abuse should one be looking for in a young adult (age 12-15 y/o). My mother is suspcious of my younger brother, and I am not around to witness my little brother's actions. She thinks he is involved with drugs and alcohol. Is there anything I can tell her or information I can give her to "spot" any evidence of problems she finds in my younger brother?

MODERATOR: Some usefull website for young adults: http://www.theantidrug.com/.

amina88: What approach do you feel a new therapist should use relating to male teens with a hx of (alcohol, pot and ecstasy) use. Do you have any literature or web sites?

Mr. Hornberger: Any new therapist should be well rounded in his theraputic approach in understanding of adolescent's development and behavior, issues and resources in the local community, and the process of substance use and abuse. However, the most important thing is building a strong, supportive relationship with a young person, unless he has reasons to believe he has serious medical concerns. He should be trying to learn what the young person's strengths and interests are, and helping the young person to have positive activities and success in his daily life.

MODERATOR: To see CSAT's Treatment Improvement Protocol Series for additional information: http://ncadi.samhsa.gov/catalog/catalognew.asp?Topic=103. Also, see Cannabis Youth Treatment Series, Vol. 1: Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users: 5 Sessions. The latter publication's address is: http://ncadi.samhsa.gov/govpubs/bkd384/index.htm.

molly: I use to do drugs heavily in the past, but now I want to have children. Will my previous drug use have an affect on my child/children?

Mr. Hornberger: Obviously it depends on the type of drugs and duration of use. Get a thorough exam so you will know your physical condition. Be very proud of stopping and building a strong enough relationship with a loved one so that you are thinking of children.

thegube: I am curious if Mr Hornberger has an opinion on who's fault it is that young adults use drugs. Is it the parents fault, society's fault, music the kids listen too? Do you have an opinion on this?

Mr. Hornberger: The reasons why an individual uses or does not use are very complex. Certainly if someone is a child of a substance user or alcoholic they are more biological predisposed. The child's ability and success growing up, the conditions in the local area, and the environment and the availability of drugs. Also, the local community norms about drug use. All of these play a part in why children use or do not use. Unfortunatly in our society it's almost as if there's an adolescent developmental task to making a choice about using or not using drugs. It's a societal issue with no simple answers on who is to blame.

guest: Can you recommend any community support programs for people who are re-entering society after a long stint at a drug rehab center?

Mr. Hornberger: Certainly in every community there are 12 step programs. More and more there's a growing recovery movement that is speaking out and more identifiable for people who are going through such a transition. Go to the telephone book or Internet to find more resources.

MODERATOR: PREVLINE has a useful list of referrals that meet this user's needs: http://ncadi.samhsa.gov/referrals/results.asp?Category=83.

MODERATOR: Another PREVLINE visitor submitted this question early: What are some of the reasons why people turn to drugs, when they see the effect it has on others?

Mr. Hornberger: Peer pressure, curiosity, low self-esteem, insecurity, loneliness, depression, rejection, loss of a loved one, learned behavior and chronic medical conditions medical conditions are some of the reasons people turn to drugs. In many cases, people use AOD as a way to mask their feelings about life's circumstances. In many instances, people do not have a strong set of something called coping skills. The concept of coping skills is something the average person may take for granted. For example, for the average person, when they experience stress, they may do some kind of activity, such as exercise to help combat their feelings. Their ability to make the decision to go for a walk, a movie, talk to a friend is a coping skill. For someone who uses drugs, their coping skills are not fully developed and when they face a stressful situation, they may react in another manner, and their instincts will face a stressful situation, they may react in another manner, and their instincts will draw them to the immediate quick fix to use the drugs to make them feel better about the situation.

guest: Is it okay to have alcohol at social events where you know there will be people in recovery?

Mr. Hornberger: This is certainly a controversial issue. Certainly 12 step programs believe in total absinence therefore alcohol should not be available or on the premises. However, a book was just published about 212 ways to sobriety and pointed out at least two thirds of the people remained sober and lead drug free lives though they did acknowledge situational uses such as a toast at a child's wedding. Obviously when in doubt no temptation helps sober and drug free living, but I think we're just beginning to learn more information about that.

MODERATOR: Views and opinions expressed by non-CSAT staff members in the Web chats and Web casts should not be interpreted as official CSAT policy, but as the views and opinions of the individuals participating in these events.

janie: When is someone considered an alcoholic? Does it mean that they are dependent on alcohol?

Mr. Hornberger: Yes. They are an alcoholic and dependant on alcohol.

janie: Are you seeing a lot of oxycontin use or the use of ecstasy?

Mr. Hornberger: It is certainly increasing. NIDA has some good links and point on this as well as CSAT.

MODERATOR: See PREVLINE's speacial feature area on Oxycontin: http://ncadi.samhsa.gov/features/oxy/.

MODERATOR: This question was put forth earlier today: Can child welfare require that a teenager in custody enter residential substance abuse treatment against their own will? And if so, how can they be forced to engage?

Mr. Hornberger: A child who is in the child welfare system can not be forced to enter substance abuse treatment or made to stay once they are admitted. Treatment facilities are overall voluntary (except those who have a correction option component or DWI facility). It will be helpful upon the court's case review, to have the judge address it in the court order. If the child has DJJ involvement, you may use this as leverage. Adolescent addiction is difficult to address because of the high incident of relapse and the lack of personal maturity to address a chronic disease/condition. For the child welfare system, it truly presents placement difficulties. There are substance abuse treatment techniques for adolescents that can help motivate a youth to seek/stay in treatment, but ultimately, it is the youth's decision whether or not he will engage in the process.

DrugsRBad: When I was growing up, it was simple, "drugs were bad," "those who sold drugs were bad," and "those who used drugs were bad." If you did drugs or had drugs, you could get in trouble and go to jail. Now we are in an age of not wanting to make people feel they have done wrong and it is more of a 'sickness' than a 'crime' to do drugs and that the users themelves shouldn't feel bad about it. There seem to be no real deterants or consequences to those who do drugs (besides the fact they are harmful too).

Mr. Hornberger: Clearly just a moral view of drugs offers some insight and help for people to stay drug free. However since so many people have used we have a biopsychosocial understanding of this behavior. This isn't that simple that bad people do bad things. And in fact, substance abuse treatment when successful, has a greater successful than comparable kinds of diseases such as asthma.

monica: My daughter is currently rehab and about to be released. I am concerned that she will go back to her old ways because of the neighborhood that we live in. What can I do?

Mr. Hornberger: Become active as possible in her discharge planning and her re-entry phase of her rehab program. Understand the signs and symptoms of relapse, work with your daughter, the treatment staff and other community resource people to bear positive life goals and activities for your child. Even though she is being discharged from drug rehab, your daughter needs you to be involved in her socialization and life.

MODERATOR: Chatters, we are nearing the end of our conversation. Mr. Hornberger has some concluding comments he would like to share.

Mr. Hornberger: We're still learning how to identify and engage people with AOD problems. Unfortunately in the child welfare system when we can identify people with the problem, too often there's not capacity to access appropriate services quickly. Some large issues for the AOD system and the child welfare system is how to expand the role of the consumer and the demand and delivery process, how to bridge formal and informal systems of care, and how to develop culture based community services. In short, different populations have different treatment needs and we're at the beginning of learning them and knowing how to intervene. We at the Child Welfare League look forward to working on this issue and erradicating this problem.

MODERATOR: Mr. Hornberger, thank you for taking the time to share your knowledge. Audience, thank you for your great questions. To learn more about Recovery Month visit: http://ncadi.samhsa.gov/2001/.