Empowering Women Toward Long-Term Recovery

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Empowering Women Toward Long-Term Recovery


Kathleen Tavenner Mitchell, MHS, LCADC Vice
President and International Spokesperson National
Organization on Fetal Alcohol Syndrome (NOFAS)
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• 2 Things Necessary for Life
• water
• women

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FASD AN UNEXAMINED CAUSE OF RELAPSE IN WOMEN

• Women that have used during pregnancy have severe
  guilt and shame that needs to be addressed in
  order to prevent relapse
• Women that have children with unidentified FASD
  are at high risk for relapse due to the behaviors
  of their children and the belief that they are
  poor parents
• Women that were exposed to alcohol prenatally may
  have FASD putting them at high risk for relapse

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Key Clinical Practices

• Ask
• All women of childbearing age about alcohol use
• All pregnant women about alcohol use
• Advise
• All women planning a pregnancy that no alcohol is
  the safest choice
• All pregnant women that no alcohol is the safest
  choice
• women who consumed alcohol during their pregnancy
  to contact local resources and services
• Assist
• assist women to stop drinking through
  information, counseling, care and referral to
  appropriate programs and services

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Opportunity

• Pregnancy is an opportunity for change
• Women who are pregnant are more receptive to
  intervention programs and treatment than women
  who are not currently pregnant

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Discuss Birth Experiences with Women

• Red Flags
• Two or more miscarriages?
• Stillbirths?
• Infant/child deaths (SIDS)?
• Children with LD, ADHD, MH or behavioral
  disorders ?
• Children diagnosed with FASD?
• Positive response to any of the above questions
  should warrant a screening of all children for
  possible FASD (where substance use is known or
  suspected)
• 
  
• 
  
  
  K Mitchell,
  2004

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During Screening

• Follow up the screening questions with probes
• Be non-judgmental
• Listen attentively to her concerns
• Refrain from negative comments or reactions
• Focus on your patient as well as her baby
• Be sensitive to broader issues and contexts such
  as poverty or abuse
• Make positive statements about the woman seeking
  prenatal care
• Make positive statements about progress during
  each visit

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• Refer to Treatment!

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Locate Treatment that provides Feminine Focused
Recovery

• Address the unthinkable
• Sexuality
• Biological differences
• Menstruation
• Abuse
• Substance use during pregnancy and possible
  consequences
• Secrets
• Desires, dreams and fantasies

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3 Things that Keep and Addict Using

1. Stigma
2. Family Enabling (Guilt)
3. Defense Mechanisms

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Women and Addiction

• The center of the addicts life is no longer God,
  the family, and/or her job/career, it is her
  addiction
• All of her behavior has the ultimate goal of
  feeding the addiction
• The family members become objects, means to an
  end, rather than real people
• This causes the alcoholic to become their entire
  focus and center, or they abandon her

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Progression of Alcoholism
Stage 1 Tolerance Stage 2 Physical Dependency Stage 3 Major Organ Change
high tolerance with occasional use increased tolerance/possible a.m. use possible daily or maintenance use (reduced tolerance)
occasional hangovers withdrawal headaches/nausea (anorexia, high BP, loss of concentration, weakness) migraines Vomiting rapid pulse, BP disorientation
disrupted sleep patterns sleeplessness insomnia
Colds/ infections disease pathology developing major organ damage
Irritability-mood swings-mild depression-isolation MH diagnosis (depression, anxiety, panic) institutions and rx suicidal ideation or attempts K. Mitchell, 2004
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Stage 1 Tolerance Stage 2 Physical Dependency Stage 3 Major Organ Change
memories of how nice use was preoccupation/ craving use despite consequences
one-two gateway drugs variety of drug use multiple drug addictions
mild tremors intentional tremors seizures or D.Ts
sexual pleasure sexual problems impotence
family problems school work problems loss of family, job school
trouble with the law (close calls) DWI-DUI / possession incarcerations K. Mitchell, 2004
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Empowering and Honoring the Feminine

• Intuitive wisdom
• Motherhood / life-giving
• Healers
• Caretakers
• Artisans
• Visionaries

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The Natural Order of the Universe

• To live in tune with the Earth we need to
  remember that we too are a precious natural
  resource to be cared for and valued just as we
  value the trees or the sea. Like them we live in
  the rhythms of the seasons and the days.
• Addiction is a hurricane an earthquake These
  events can bring balance to Mother Nature

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Feminine and Masculine Balance

• Yin and Yang
• Shakti and Shiva
• The basis for harmony in all of life.

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Change Perception linear to circular
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Yin Energy

• Taoist term for the Feminine force.
• The receptive, the watery, the earth.
• Associated with the negative magnetic pole, with
  the moon, with coolness, with attraction rather
  than assertion.
• The power of Yin comes from natural
  responsiveness, nurturing and support not direct
  independent action.
• The receptive force is sensual, flowing,
  accepting and allowing.
• Yin energy moves through feelings rather than
  thoughts, it is diffuse, spacious, and open.

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The Feminine represents fertility, and is often
seen symbolically as a chalice, cup, container,
valley or womb.

• She is the earth, the ground, the mother, the
  maiden, and the crone.

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Honoring the Feminine

• The essence of the Feminine is Love.
• The pure white light of the Divine Mothers
  unconditional love for all her children.
• The Feminine is also the power of unity, of
  connection, of relatedness, which weaves all of
  creation together.
• The Feminine emphasizes togetherness,
  similarities, correspondences, and Oneness.

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Biological Differences

• Womens bodies have less body water than men of
  similar body weight
• Achieve higher concentrations of alcohol in the
  blood with equivalent amounts of alcohol
• NIAAA Alcohol Alert 1999

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Biological Differences

• Women experience major organ complications more
  rapidly than men

• Liver damage
• Cirrhosis
• Brain damage
• Heart disease
• High blood pressure
• Stroke
• Breast cancer
• Gastrointestinal hemorrhage
• Anemia
• Malnutrition
• Colon cancer
• NIAAA, Alcohol Alert 1999

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Menstrual Cycle

• Calendar to chart bleeding, cravings, moods,
  behavioral reactions, depression
• Discuss ovulation
• Half-way through cycle
• Increase in vaginal discharge
• Slight cramping in abdomen
• May augment moods

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PMS Emotional Symptoms(Relapse Vulnerability)

• Mood swings
• Critical of loved ones
• Negative thinking
• Crying spells
• Depression
• Controlling attitudes/behaviors
• Forgetfulness
• Indecision
• Panic attacks-Suicidal ideation

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PMS Wellness

• Reduce sugar salt (diet sodas)
• Reduce or eliminate caffeine
• Increase soy
• Consider natural hormones (perimenapause or
  menopause)
• Good Quality Multi-vitamin
• Vitamin B compound vitamin E
• Calcium with magnesium
• Limit dairy/increase green leafy vegetables
• More AA, naps, relaxation, yoga

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Honoring our cycle

• Let others know what your needs are.
• Indulge your creativity it is keenest now.
• Take a nap. 
• Have a piece of chocolate.
• Cook if you want to, or dont.
• If you need to crygo ahead (set a time limit
  though, no all night pity parties allowed!)
• Wear loose comfortable clothes.
• Listen to your body, your inner wisdom knows best.

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Honor Thy Bitch!

• All women have a dark goddess she holds the
  power of the feminine!
• The dark goddess is the creator and the
  destroyer. She is depicted as one who cuts off
  the heads of men. This is a symbolic
  representation of her challenging the Ego.
• Embrace her POWER.She will lead her to
  Healing.to Recovery!

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Menapause The Crone

• Wisdom
• Knowing arises from direct experiences
• This is a valuable natural resource a teachera
  healer
• Brings balance to the family

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Women with Addictive Disease

• Many have lost their voice have turned off
  their inner wisdom
• Have low self-esteem
• Have little self-confidence
• Feel powerless
• Majority have been physically and/or sexually
  abused
• Are codependent
• Have been living in secrecy

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Traits of Codependency

• Over developed sense of responsibility
• Stuff feelings from traumatic childhood
• Lost ability to express feelings
• Isolated/afraid people and authority figures
• Addicted to approval/excitement (crisis)
• Frightened by angry people or personal criticism
  
• See themselves as victims
• Judge themselves harshly

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Traits of Codependency

• Abandonment issues
• Feelings of guilt when they stand up for selves
• Confuse love and pity, love people they pity
  (rescuers)

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Ways to Destroy the Culprit ( Codependency)

• Perfectionism
• 3 Ps (perfectionism, procrastination, paralysis)
• Vocabulary
• Change I cant to I choose not to or I
  wont
• Decision making
• Make everyday decisions
• Choices
• Every action is a chosen action

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Other Methods to Rescue Women from Addiction

• Relationships
• Consider physically separating from partner
• Detachment skills
• Enabling
• Remove client from enabling family members
• Investigate love verses enabling
• ACOA issues
• Educate on effects on family
• Treat childhood issues with relapse clients

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Women need Women

• " How might your life have been different if
  there had been a place for you to go.. a place of
  women, to help you learn the ways of women, .. a
  place where you were nurtured from an ancient
  flow sustaining you and steadying you as you
  sought to become yourself. A place of women to
  help you find and trust the ancient flow already
  there within yourself. . waiting to be released.
  . How might your life be different?"
  Duerck

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Identify or Create Natural Connections

• Re-Connecting Women
• Family
• sisters, mothers, grandmothers, daughters, grand
  daughters
• AA/NA
• Womens meetings, womens retreats
• Women Circles/Clubs/Meetings
• Artist way meetings, inner child groups, quilting
• Spiritual Communities
• Social Activities
• Health Club/Physical Activities/County
  Recreation
• Art or yoga classes

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Communication SkillsSetting
BoundariesnoAssertivenessnot passive-not
aggressiveHonesty I cant to I wont
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Confrontation IS

• A challenge to both parties to stay open
• An attempt to communicate honestly
• A courageous act of good intent to state ones
  feelings and thoughts
• An effort to keep relationship growing
• Misunderstood It is not yelling, screaming, or
  guilt making
• Part of healthy intimate relationships
• An act of self-affirmation
• Sets a boundary

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Confrontation IS NOT

• An attack
• An effort to hurt
• Verbal abuse when done carefully
• A thing to fear or avoid
• The same as criticism

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Non-assertive Assertive Aggressive
Verbal Apologetic word, rambling, failure to say what you really mean Statement of wants/ needs, I messages, honest statement of feeling Loaded words, accusations, You messages, superior words
Non-verbal Hoping someone will guess what you want Active listening behavior, caring, communication and strength Flippant sarcastic style
Voice Eyes Weak, hesitate, soft Downcast, teary, pleading Firm, warm, relaxed Open, direct eye to eye contact, not staring Loud, authoritative, or deadly quiet Staring, not really seeing you
Stance Posture Lean for support, twisted Stooped, sagging, head nodding Well balanced, at ease Facing, relaxed Hands on hips, feet apart Stiff and ridged, rude, head bobbing
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Non-Assertive behavior Assertive Behavior Aggressive
Characteristics of the behavior Allows others to choose for her Permits others to infringe on her needs Chooses for self Expresses and asserts own needs Emotional honest direct Chooses for others Expresses needs at expense of others Inappropriate outburst
Feeling when you engage in behavior Hurt, anxious, disappointment, and anger Confident, self-respecting, feels good about self Angry, righteous, superior, then guilty
Outcome Payoff Doesnt achieve desired goal Avoids conflict May achieve desired goal Honest relationships Achieve desired goal by hurting others Justifies resentment
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Parenting Issues

• Guilt/shame
• Child neglect and/or abuse
• Feelings of inadequacy
• Difficult past with care-taking of family
• Legal/foster care

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Sexuality

• Promiscuity
• Prostitution
• Rape
• Fear of sex
• Incest and/or sexual abuse
• Loss of orgasm
• Painful sex
• Sexual orientation
• Value conflicts
• Sexuality as a relapse trigger

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Use Spiritual Concepts (No longer in charge)
Breathe God in and me out
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Developing a Sense of Self

• Kill the critics Whose voice is that?
• Discover the rule makers Whose rules are those?

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Meet the Committee

• Have client focus on childhood (i.e. year 0 to 3)
• Who were the people who nurtured you and
  supported you?
• Who were the people that were not kind to you,
  hurt your feelings or hurt you in other ways?
• List them, list the behaviors

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Meeting Yourself

• Investigate accomplishments Things I do really
  well list
• Long term goals- Do not let client limit
  themselves in reality
• Short term goals- achievable, measurable, simple
  
• Lists of needs/wants/likes

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Clearing Negativity Releasing Attachments

• Stuff
• Everything is borrowed, I own nothing
• People
• Its okay to love someone and celebrate
  connectedness
• Wanting to possess another misery
• The less you try to control, the closer you
  become

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Releasing Attachments

• Past
• ? living in shoulds
• ? living in what ifs?
• ? self pity
• ? criticism
• Form
• ? preoccupation with appearance

• ? guilt
• ? cant- they wont
• ? never- have to

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Releasing Attachments

• Being right
• prevents communication
• inability to listen
• competitive
• aggressive
• dont answer every remark
• dont give opinion unless asked

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When life gives you lemons
Make lemonade
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Lemons to Lemonade

• Self centered fear..ability to work a
  selfish program
• Self reliance.independence
• Self doubtwillingness to listen to
  others
• Self pity..ability to self
  nurture
• People pleaser.successful, wants to excel,
  desire for approval
• Sneaky..opportunity seeker
• Manipulative.ability to obtain trust,
  people listen
• Experiences..wisdom
• Extreme negativity.extreme
  positivists
• Chameleon...chameleon
• Liar....creativity
• Con artistinnovative, thinker

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Achieving Abundance

• Abundance does not mean having and wanting
  things. It means understanding that eternity and
  the universe are endless

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Achieving Abundance

• Be thankful for each experience
• Repeat and surround yourself with daily
  affirmations
• Go the extra mile
• Suspend thoughts of separateness
• Be for things and people
• Be conscious and selfish with your daily time
• Identify goals (write them) intention converts to
  conscious action
• Trust your intuition
• Spend time with nature
• Walk and eat

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You are responsible for your own recovery!
H.A.L.T.HUNGRYANGRYLONELYTIRED

• 3-6 Meals a Day
• Exercise (walking)
• 8-9 Hours of Sleep (naps okay!)
• Practice Prayer and meditation
• Talk to sponsor, be around positive people

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Children with FASD are a blessing, but they will
always need a sober mom to advocate for them.
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Recovery is Honoring the Feminine

• Dance like no-one is watching!
• Play-create-dress-up!
• Immerse yourself in water, play in the snow, lay
  in the sunshine, and jump in the leaves.
• Open your heart, help othersit is the way of the
  feminine.
• Allow the tears come, so that the sun will shine
  brightly.
• Meditate, listenyour inner wisdom is speaking to
  you.
• Sing, hug trees, scream with the wind, and howl
  at the moon.
• Fill your house with flowers.
• Paint your walls in colors.
• Make love scream and howl if you want to!

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Contact Info

• Kathy Mitchell
• 202-785-4585 x 205
• mitchell_at_nofas.org
• www.nofas.org