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Empowering Women Toward Long-Term Recovery Kathleen Tavenner Mitchell, MHS, LCADC Vice President and International Empowering Women Toward Long-Term Recovery Kathleen Tavenner Mitchell, MHS, LCADC Vice President and International Spokesperson National Organization on Fetal Alcohol Syndrome (NOFAS)

2 Things Necessary for Life: Øwater Øwomen 2 Things Necessary for Life: Øwater Øwomen

FASD; AN UNEXAMINED CAUSE OF RELAPSE IN WOMEN Women that have used during pregnancy 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 Ø 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 Ø Women that were exposed to alcohol prenatally may have FASD putting them at high risk for relapse Ø

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

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

Discuss Birth Experiences with Women : Red Flags: Ø Two or more miscarriages? Ø Discuss Birth Experiences with Women : Red Flags: Ø Two or more miscarriages? Ø Stillbirths? Ø Infant/child deaths (SIDS)? Ø Children with LD, ADHD, MH or behavioral disorders ? Ø 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

During Screening Follow up the screening questions with probes Be non-judgmental Listen attentively to 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 Ø Make positive statements about the woman seeking prenatal care Ø Make positive statements about progress during each visit Ø Ø Ø

Refer to Treatment! Refer to Treatment!

Locate Treatment that provides Feminine Focused Recovery: Address the unthinkable: Ø Sexuality Ø Biological Locate Treatment that provides Feminine Focused Recovery: Address the unthinkable: Ø Sexuality Ø Biological differences Ø Menstruation Ø Abuse Ø Substance use during pregnancy and possible consequences Ø Secrets Ø Desires, dreams and fantasies

3 Things that Keep and Addict Using Stigma 2. Family Enabling (Guilt) 3. Defense 3 Things that Keep and Addict Using Stigma 2. Family Enabling (Guilt) 3. Defense Mechanisms 1.

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

Stage 1 Tolerance Progression of Alcoholism Stage 2 Stage 3 Physical Dependency Major Organ Stage 1 Tolerance Progression of Alcoholism Stage 2 Stage 3 Physical Dependency 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 depressionisolation MH diagnosis (depression, anxiety, panic) institutions and rx suicidal ideation or attempts K. Mitchell, 2004

Stage 1 Tolerance Stage 2 Physical Dependency Stage 3 Major Organ Change memories of 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. T’s 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

Empowering and Honoring the Feminine Intuitive wisdom Ø Motherhood / lifegiving Ø Healers Ø Empowering and Honoring the Feminine Intuitive wisdom Ø Motherhood / lifegiving Ø Healers Ø Caretakers Ø Artisans Ø Visionaries Ø

The Natural Order of the Universe Ø To live in tune with the Earth The Natural Order of the Universe Ø 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

Feminine and Masculine Balance Ø Yin and Yang Ø Shakti and Shiva Ø The Feminine and Masculine Balance Ø Yin and Yang Ø Shakti and Shiva Ø The basis for harmony in all of life.

Change Perception: linear to circular Change Perception: linear to circular

Yin Energy Taoist term for the Feminine force. The receptive, the watery, the earth. 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. Ø The power of Yin comes from natural responsiveness, nurturing and support not direct independent action. Ø The receptive force is sensual, flowing, accepting and allowing. Ø Yin energy moves through feelings rather than thoughts, it is diffuse, spacious, and open. Ø Ø Ø

The Feminine represents fertility, and is often seen symbolically as a chalice, cup, container, The Feminine represents fertility, and is often seen symbolically as a chalice, cup, container, valley or womb. Ø She is the earth, the ground, the mother, the maiden, and the crone.

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

Biological Differences Ø Women’s bodies have less body water than men of similar body Biological Differences Ø Women’s bodies have less body water than men of similar body weight l Achieve higher concentrations of alcohol in the blood with equivalent amounts of alcohol • NIAAA Alcohol Alert 1999

Biological Differences Women experience major organ complications more rapidly than men: Liver damage l Biological Differences Women experience major organ complications more rapidly than men: Liver damage l Cirrhosis Ø Brain damage Ø Heart disease Ø l High blood pressure Stroke Breast cancer Gastrointestinal hemorrhage Anemia Malnutrition Colon cancer l Ø Ø Ø • NIAAA, Alcohol Alert 1999

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

PMS Emotional Symptoms (Relapse Vulnerability) Mood swings Ø Critical of loved ones Ø Negative PMS Emotional Symptoms (Relapse Vulnerability) Mood swings Ø Critical of loved ones Ø Negative thinking Ø Crying spells Ø Depression Ø Controlling attitudes/behaviors Ø Forgetfulness Ø Indecision Ø Panic attacks-Suicidal ideation Ø

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

Honoring our cycle Let others know what your needs are. Indulge your creativity; it 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 don’t. If you need to cry…go ahead (set a time limit though, no all night pity parties allowed!) Ø Wear loose comfortable clothes. Ø Listen to your body, your inner wisdom knows best. Ø Ø Ø

Honor Thy Bitch! All women have a dark goddess; she holds the power of 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!

Menapause: The Crone Wisdom: Knowing arises from direct experiences This is a valuable natural Menapause: The Crone Wisdom: Knowing arises from direct experiences This is a valuable natural resource; a teacher…a healer Brings balance to the “family”

Women with Addictive Disease Many have lost their voice; have turned off their “inner Women with Addictive Disease Many have lost their voice; have turned off their “inner wisdom”: l l l 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

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

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

Ways to Destroy the Culprit ( Codependency) Ø Perfectionism l 3 P’s (perfectionism, procrastination, Ways to Destroy the Culprit ( Codependency) Ø Perfectionism l 3 P’s (perfectionism, procrastination, paralysis) Ø Vocabulary l Change “I can’t” to “I choose not to” or “I won’t” Ø Decision making l Make everyday decisions Ø Choices l Every action is a chosen action

Other Methods to Rescue Women from Addiction: Relationships l Consider physically separating from partner Other Methods to Rescue Women from Addiction: Relationships l Consider physically separating from partner l Detachment skills Ø Enabling l Remove client from enabling family members l Investigate “love verses enabling” Ø ACOA issues l Educate on effects on family l Treat childhood issues with relapse clients Ø

Women need Women 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

Identify or Create “Natural” Connections Ø Re-Connecting Women: l Family: • sisters, mothers, grandmothers, Identify or Create “Natural” Connections Ø Re-Connecting Women: l Family: • sisters, mothers, grandmothers, daughters, grand daughters l AA/NA • Women’s meetings, women’s retreats l Women Circle’s/Clubs/Meetings • Artist way meetings, inner child groups, quilting l l l Spiritual Communities Social Activities Health Club/Physical Activities/County Recreation • Art or yoga classes

Communication Skills: Setting Boundaries no Assertiveness not passive-not aggressive Honesty I can’t to I Communication Skills: Setting Boundaries no Assertiveness not passive-not aggressive Honesty I can’t to I won’t

Confrontation IS: l l l l A challenge to both parties to stay open Confrontation IS: l l l l A challenge to both parties to stay open An attempt to communicate honestly A courageous act of good intent to state one’s 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

Confrontation IS NOT: An attack l An effort to hurt l Verbal abuse when Confrontation IS NOT: An attack l An effort to hurt l Verbal abuse when done carefully l A thing to fear or avoid l The same as criticism l

Non-assertive Aggressive Verbal Apologetic word, rambling, failure to say what you really mean Statement Non-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 Weak, hesitate, soft Firm, warm, relaxed Eyes Downcast, teary, pleading Open, direct eye to eye contact, not staring Loud, authoritative, or deadly quiet Staring, not really seeing you Stance Lean for support, twisted Well balanced, at ease Hands on hips, feet apart Posture Stooped, sagging, head nodding Facing, relaxed Stiff and ridged, rude, head bobbing

Non-Assertive behavior Assertive Behavior Aggressive Characteristics of §Allows others to the behavior choose for Non-Assertive behavior Assertive Behavior Aggressive Characteristics of §Allows others to the behavior choose for her §Permits others to infringe on her needs §Chooses for self §Chooses for Feeling when you Hurt, anxious, engage in disappointment, behavior and anger Confident, selfrespecting, feels good about self Angry, righteous, superior, then guilty Outcome Doesn’t achieve desired goal May achieve desired goal Payoff Avoids conflict Honest relationships Achieve desired goal by hurting others Justifies resentment others asserts own §Expresses needs at expense of §Emotional honest others direct §Inappropriate outburst §Expresses and

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

Sexuality Ø Ø Ø Ø Ø Promiscuity Prostitution Rape Fear of sex Incest and/or Sexuality Ø Ø Ø Ø Ø 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

Use Spiritual Concepts: (No longer in charge) “Breathe God in and me out” Use Spiritual Concepts: (No longer in charge) “Breathe God in and me out”

Developing a Sense of Self Ø Kill the critics: Whose voice is that? Ø Developing a Sense of Self Ø Kill the critics: Whose voice is that? Ø Discover the rule makers: Whose rules are those?

Meet the Committee Ø Have client focus on childhood (i. e. year 0 to Meet the Committee Ø 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? Ø List them, list the behaviors

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

Clearing Negativity ; Releasing Attachments Stuff Ø l Everything is borrowed, I own nothing Clearing Negativity ; Releasing Attachments Stuff Ø l Everything is borrowed, I own nothing People Ø l l l It’s okay to love someone and celebrate connectedness Wanting to possess another = misery The less you try to control, the closer you become

Releasing Attachments Ø Past guilt living in “shoulds” living in “what ifs? ” can’t- Releasing Attachments Ø Past guilt living in “shoulds” living in “what ifs? ” can’t- they won’t never- have to self pity criticism Ø Form preoccupation with appearance

Releasing Attachments Ø Being right l l l prevents communication inability to listen competitive Releasing Attachments Ø Being right l l l prevents communication inability to listen competitive aggressive don’t answer every remark don’t give opinion unless asked

When life gives you lemons: Make lemonade When life gives you lemons: Make lemonade

Lemons to Lemonade Self centered fear………………. . …ability to work a selfish program Self Lemons to Lemonade Self centered fear………………. . …ability to work a selfish program Self reliance……………………. ………independence Self doubt………………willingness 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 artist………………………innovative, thinker

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

Achieving Abundance Ø Ø Ø Ø Ø Be thankful for each experience Repeat and Achieving Abundance Ø Ø Ø Ø Ø 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

You are responsible for your own recovery! H. A. L. T. HUNGRY*ANGRY*LONELY*TIRED Ø 3 You are responsible for your own recovery! H. A. L. T. HUNGRY*ANGRY*LONELY*TIRED Ø 3 -6 Meals a Day Ø Exercise (walking) Ø 8 -9 Hours of Sleep (naps okay!) Ø Practice Prayer and meditation Ø Talk to sponsor, be around positive people

Children with FASD are a blessing, but they will always need a sober mom Children with FASD are a blessing, but they will always need a sober mom to advocate for them…….

Recovery is Honoring the Feminine Ø Ø Ø Ø Ø Dance like no-one is Recovery is Honoring the Feminine Ø Ø Ø Ø Ø 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 others…it is the way of the feminine. Allow the tears come, so that the sun will shine brightly. Meditate, listen…your inner wisdom is speaking to you. Sing, hug tree’s, 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!

Contact Info: Ø Kathy Mitchell Ø 202 -785 -4585 x 205 Ø mitchell@nofas. org Contact Info: Ø Kathy Mitchell Ø 202 -785 -4585 x 205 Ø [email protected] org Ø www. nofas. org