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Wednesday, August 13, 2008

Guest Post on Substance Abuse

I am so thrilled to be able to put up a guest post from the husband of a valued commentor. I welcome guest posts from my readers that related to issues discussed on this blog. I've highlighted only a small number of important points (in orange) that I think are new to the discussion. Both the guest poster and I look forward to your comments.

by Nachshon Zohari, LCSW
-Program Administrator for Substance Abuse Treatment, Denver Human Services
-Certified Facilitator of the Power to Parent video series by Dr. Gordon Neufeld
http://zohari.typepad.com

I am grateful for the opportunity to address this issue. I have worked professionally in the field of substance abuse for the past 10 years, specializing in co-occurring mental health/substance abuse disorders, trauma, personality disorders as well as parenting education and family dynamics. I am also an Orthodox Jew and a father of (k'h) four children. I applaud all of you who are facing this issue directly and honestly.

Many of the comments on this blog post have been incredibly insightful and right on the money. It seems like the main issues expressed are: 1) What practical steps can be taken now to help kids who are struggling with substance abuse, and 2) How do we address the underlying causes of this problem?

Helping substance abusers begins and ends with the concept of confidentiality. It seems that the biggest resistance to getting help in the frum community is the fear of stigmatization. "How can I admit my family is dealing with a drug problem when I'm trying to get a son or daughter married or into a good school?" No professional substance abuse program could operate without strict rules of confidentiality. If I were ever to discuss a client with someone else I would lose my license and my agency would be sanctioned. Self-help groups like Alcoholics Anonymous also base their interventions on absolute confidentiality. So whatever we do as a community would have to have confidentiality at its core.

As one possible step, I would suggest identifying local activists who have demonstrated their ability to maintain confidentiality. These people could be trained in the basics of substance abuse intervention in order to: 1) identify the signs of drug or alcohol abuse; 2) assess the extent of the individual's problem; and 3) refer the person for appropriate treatment. Having a local resource that is trusted to not disclose information related to the problem would be a huge first step in effectively offering a solution.

Substance abuse education can also be quite effective as there are many people who honestly don't see a problem until it is too late. However, talking to kids about drugs is typically less effective than educating the parents. It has been my experience that young people tend to react negatively to "experts" they don't know telling them what to do. These messages are better received from people they know and trust, namely their parents. Therefore empowering the parents to bring up this subject should be the focus of any drug education program. Some appropriate venues for community awareness building could be: PTA meetings, shiurim, community centers, pediatrician and doctor offices, local law enforcement, etc.

Finally, it would be very important to have community leaders (rabbis and otherwise) to bless and support this type of initiative. People need to be reassured that there is nothing wrong with tackling this problem head-on.

Addressing the underlying causes of substance abuse necessitates that the most fundamental need of children is being met, that is, their need for attachment. A couple of responders to the post harkened back to the "good old days" when the child and parents spent more quality time together. Another noted that the kids who get into this kind of trouble often have "absentee parents." This is absolutely correct. We know that feeling disconnected to parents creates a vulnerability too great to bear for kids and that drug abuse is used as a coping device for getting through it. However, others noted that we live in an economic reality that means that we cannot turn back the clock to 1950s America - also correct. So what do we do?

The developmental psychologist, Gordon Neufeld (http://www.gordonneufeld.com), addresses this concern in his book: Hold On To Your Kids: Why Parents Need to Matter More Than Peers, which is an excellent book that I would recommend to anyone , [my note: see all references at this Orthonomics this book, as well as Mom in Israel’s review of this book, particularly the list at the end, particularly point 7 which is directly related to this discussion]. He describes this same situation of parents and kids separated by work and school. In response, he came up with the idea of the "attachment hand-off" as a solution to this reality of our times.

Nobody can be with their kids 24/7, nor would that be particularly healthy for anyone. There are always times when we need to be apart. But we must be aware that the separation can create feelings of anxiousness and vulnerability in our children. Therefore, Dr. Neufeld suggests that we must encourage and nurture feelings of attachment between our kids and what he describes as our surrogates. Surrogates are adults who interact with our children at school, extra-curricular activities, shul or anywhere else we are not present. To create a surrogate we must interact with that person in front of our child in a manner that conveys, "this person is an extension of myself and just as I am responsible for your safety and well-being so is this person." It is absolutely essential that we consciously map out our child's day in order to limit attachment voids between his leaving us in the morning and his re-connecting with us in the evening. Therefore, one of the worst things we could do is to bad-mouth the child's teacher or school in front of him. This just heightens his sense of danger and creates more need to defend himself. Real problems need to be addressed head-on, which in itself reduces a child's vulnerability and leads to even more trust and confidence in the parent.

Other more homey and old-fashioned techniques can also be used to keep away attachment voids, such as notes in lunch or school bags, coming to volunteer in the classroom on occasions, joining your child for lunch when you can. Obviously, teenagers present more of a challenge in this area. Adolescence is typically thought of as a time of "letting go" and encouraging autonomy. While teenagers are expressing their desire to become more independent and demanding new freedoms, they also have a heightened need for a reliable compass point that they can turn to in times of trouble and confusion - parents are that compass point. Anything we can do throughout the day in order keeps the kids emotionally connected to us will go a long way toward decreasing their feelings of vulnerability and reducing their risk of developing unhealthy coping strategies such as drug use.

I hope that I have succeeded in addressing the two major concerns of the readers of this post. I would be happy to respond to any questions or comments and continue the conversation into areas that were not directly noted in this post.

Nachshon Zohari, LCSW

16 comments:

SephardiLady said...

Since no one else is asking questions I will ask a few of my own:

*What are the signs a parent might notice when their children start to disconnect from them?

*How important is one-on-one time with a child in your opinion?

*Where/how/when can time stressed parents sneak in more time with their children?

*You suggested stopping in school for a lunch (my mother was known to randomly show up on campus when I grew up). How can mothers, in particular, get involved with their sons if they are enrolled in all boys schools?

*While I don't ever plan to send children away to sleep away camp or dorming yeshivot, many (and in some communities most) parents do: how can a parent best maintain attachments under such challenging circumstances?

Hope this will kick off the comments and get the conversation rolling.

Anonymous said...

Because of the fear of stigmas in the community, I worry about the parents who already think they may have a problem in their family.
Below, is the beginning of an article I thought to publish in local, frum style newspapers.

WOULD YOU NEED TO WONDER IF A DRUNK HAD A FEW DRINKS?
Someone who drinks cannot hide their addiction. But, someone experimenting or starting out using drugs, walks around undetected, like you and me. When someone uses drugs, the very first challenge for their loved ones, is suffering through the bouts of wonder, doubt, and second guessing themselves time and time again. "Does Chaim seem off to you somehow?" Does the latest excuse for being late or forgetful again really make sense?", "Why is he sooo tired?", "Was his speech just slurred?", "Wasn't there more money in here last night?", "Who is this new friend he's spending so much time with?", "Why are his grades and attitude changing so much?"............... Don't look away! Don't ignore possible warning signs. Drugs are sold in the frumest of neighborhoods, black hat, right wing, locally and in Eretz Yosroel. As much as you may not want to accept or address this possibility as your reality, it is possible, and there is much that needs to be done. For those times when it's no longer a doubt and you're sure there's some level drug use, minimal use needs attention too. It's a real and dangerous problem! Turning a blind's eye for the sake of supposed peace, may seem an easier, short term solution but the wrong one on behalf of your loved one. It is difficult to deal with, but, it is worse to look away. As time goes on, drug use increases. Open your eyes. Check for warning signs. And, get information about drug abuse, preventions, and treatment options.

Guest Poster-Zohari said...

*What are the signs a parent might notice when their children start to disconnect from them?

Generally, a disconnected child doesn't particularly like being with his parents because they get in the way of his pursuit of other attachments. You know you have a problem when the child is always pining to be with his friends or play on his computer to the exclusion of being with you. Of course children like to do their own thing and have their own friends but they should also be able to easily reconnect to parents when it's time.

Another sign would be increased episodes of counterwill. Dr. Neufeld explains that people - especially children - have an instinct to do the exact opposite of what is demanded of us when that demand is made by somebody to whom we are not attached. It is a sign of disconnection when counterwill becomes a pattern in your relationship with your child.

*How important is one-on-one time with a child in your opinion?

One-on-one time is vitally important because that is where the basis of your relationship with the child is formed and maintained. The goal is to always remain emotionally relevant to your child. You want to be the person they want to tell their secrets to - both good and bad. There are many levels of attachment. The deepest levels are feeling loved and feeling understood. This can only take place in the intimate encounters that a close relationship offers.

*Where/how/when can time stressed parents sneak in more time with their children?

Wherever and whenever you can. Turn off the radio and the cell phone and talk while you drive them somewhere. There are a lot of day-to-day opportunities to connect to our kids but they often happen when we are preoccupied with something else. Developmental psychology describes how young toddlers can only take part in parallel play. That is, two toddlers will each take blocks from the same pile and play with them separately. Older children can take the blocks and create interactive games and creations. We need to get past parallel play where both we and our children are at the same place and the same time but we don't interact.

*You suggested stopping in school for a lunch (my mother was known to randomly show up on campus when I grew up). How can mothers, in particular, get involved with their sons if they are enrolled in all boys schools?

First, I would suggest that fathers also have a role to play in keeping the connections vital. If it's more appropriate for the father to be visible and present on campus then that's who should do it. Second, mothers can make their presence felt by developing real working relationships with the faculty and staff of their boys' schools. As I said in the post, these people need to be your surrogates while your son is there. One particularly effective way to accomplish this is to interact with the staff in venues other than school. Invite your sons' teachers for a Shabbos meal in order to interact with them as real people. Also, try and volunteer when you can or send refreshments in honor of special occasions. Your interactions with the school and teachers must be ongoing, not just when problems arise. This makes you relevant on all levels.

*While I don't ever plan to send children away to sleep away camp or dorming yeshivot, many (and in some communities most) parents do: how can a parent best maintain attachments under such challenging circumstances?

This is a very pertinent question that I will think about. But in the meantime, I would be curious to hear what your readers have tried.

Hope this will kick off the comments and get the conversation rolling.

queeniesmom said...

Parents need to be home and available to their kids. Many parents think once their kids are out of elementary school, they don't need as much supervision; they probably need more supervision!

What message are we sending to our kids with separate kid shabbat tables, lunches that don't include kids, etc. Having guests is a wonderful idea but why must it be 3 other families; how many times are the kids only heard at the table when they "perform", they know better than to intrude on the "adult" conversation.

How many kids have "play dates" with their parents? Shabbat is a great time to connect with your children. It's a great time to talk over cards, monopoly or during a walk around the block.

Most of all talk to your kids about everything! It is never to early to start!

Anonymous said...

i cannot believe that this important post received only 4 comments (before this one) yet the post about the cost of camp and what goes along with it got 15 comments. astounding!

SephardiLady said...

Anonymous-I agree. This is a fantastic post and I hope more comments and questions will come in.

You know you have a problem when the child is always pining to be with his friends or play on his computer to the exclusion of being with you. Of course children like to do their own thing and have their own friends but they should also be able to easily reconnect to parents when it's time.

I hear parents talk about their 2, 3, and 4 year old pining to be with their friends. I find this odd and even a bit disconcerting. What is your take on this?

What steps can a community take to increase attachment to parents?

Anonymous said...

hello...where is everyone? this is one of the most important issues facing a parent. the subject of substance abuse skirts every family. if not in your family, your extended family, maybe your friend's family. are parents afraid to face the reality and/or scope of the problem? sephardilady you seemed to have opened the conversation that too many are afraid to participate in. well good for you. i truly believe that parents must take primary responsibility for their children and not wait for the schools and rabbis. the strength is from the home, but parents have to be there to give their children the strength to know right from wrong and to face issues. i have 5 grown children of whom i am extraordinarily proud. they grew up knowing that first and foremost, they had a support system in their home made up of their parents and brothers and sisters. they could talk to us about everything and anything. nothing was taboo and every conversation could be confidential if needed. no, not always easy, but always necessary. the importance of dinner as a family has been mentioned, and i believe this to be of great importance. nachshon zohari spoke of homey old fashioned techniques. they work, so the adage of if it's not broken you don't need to fix it applies. i always told my children to have a good time but be smart. it works.

Nachshon Zohari said...

"I hear parents talk about their 2, 3, and 4 year old pining to be with their friends. I find this odd and even a bit disconcerting. What is your take on this?"

I think this situation speaks to the fact that we live in a peer-oriented society. All children have an instinctual need to attach and when things are going well that attachment will take place with parents - just like baby geese imprint on their parents. If there is a barrier to that attachment however they will float around until they find someone else - usually a peer. This is a dangerous situation because you have fickle, immature children having undue influence on each other.

"What steps can a community take to increase attachment to parents?"

What we have to remember is that attachment is a need just like food, water, and air - remember how poorly those babies in Romanian orphanages did without any bonding. We all need to become more conscious of the need for appropriate attachment. Once upon a time, parents could rely more on the community to just naturally share the attachment duties. If a child was needing direction or counsel adult neighbors felt comfortable stepping in to do the job when parents were not around. Today, most of us feel reticent to intervene with someone else's kids (this might be a whole discussion in and of itself).

Also, the attachment that children have towards their parents must be of a certain kind. The parent must put him or herself in the role as mentor, teacher, protector, guide - i.e., the parent must be in-charge. The child must look at the parent as the source of safety and direction. If the parent takes the alpha role and the child attaches to her, then raising the child is relatively easy. Parents should not cajole, plead, coerce, demand, or threaten. Rather, the parent needs to be confident in their role as the center point of the child's life, ready to take on all the responsibility that that entails.

But there has to be time together to do this. I will finish of with a letter to the editor in a recent Mishpacha magazine (Issue 219, 27 Tammuz, 5768). I think the writer describes one of the biggest challenges in the frum community when it comes to encouraging children's attachment to parents:

"Rabbi S. Aisenstark brought out some very valid points, but
he claims that parents are part of the problem and that
chinuch is not only the school's or yeshivah's job. He is
very right, except for the fact that educational institutions
of today do not allow any time for parents to educate their
children. My children leave our house at 8:00 am and come
home at 5:30 pm. Then they have homework for a minimum
of 45 minutes. Add to that all the other activities which the
school requires them to do in their own time, like play
practice, yearbook, monthly newsletter, G.O. carnivals,
shmiras haloshan, etc., etc., etc. Parents have almost no
time besides Shabbos and Yom Tov to interact with their
children and show them what a Yiddish home is supposed to
look like. They come out of school thinking life is just fun
and games (like in camp). It looks like the educational
institutions do not trust parents. They also do not teach
the children any life skills. Today what is most important
to get along with other people is to be a mensch. They come
out of our institutions thinking money grows on trees. All I
get home from school is "Send money for this or that." The
children want everything on a platter and it is not the parents
who want it this way."

rachel in israel said...

First, thank you for the guest post. Now that SL brought up the issue of peers let me ask some questions about it. I know that at some point parents become secondary to peers in a child's life. My daughter is 2 so we are at the age when I can choose her friends according to what I think is important. Until when can I safely do that, and how do I encourage kids (teens and pre teens) to "hang out" with the right crown?
I understand that if my kid is hanging out with the wrong crown it is because s/he is of the wrong crowd. I guess my next question is a typical chicken-and-egg question. What comes first? The kid choosing bad friends or the influence of bad friends? and how do you break the circles?

therapydoc said...

I'd like to add that we should look out for the children of other people, too, not only our own.

Nice job.

JS said...

I don't have children myself yet, but growing up I think what created the great attachment me and my siblings have with my parents are the following:

1) We almost always had family dinner and we actually spoke about each other's days and the news and world events. My parents heard about our days and we heard about theirs.

2) My parents knew what was going on at school both socially and academically and helped us whenever we needed it in either department.

3) We always walked to and from shul together as a family (mom too)even if that meant my dad got to shul late.

4) My parents always spoke to us as adults. We knew we could tell them anything and everything no matter what. We also knew we could ask them anything and everything. I think barriers between parents and children start here whether it's an inability to ask or speak about something personal or embarassing or having questions about where babies come from, children need to feel their parents can be there and listen and provide information.

5) My parents never ignored us. There wasn't a "kids' table" and when we were together, for the most part, it was "our time". My dad didn't ignore us to talk about sports or work or whatever with the adults. And if there was "adult conversations" we could always listen and participate.

6) We participated in youth baseball and soccer leagues and my dad often coached the team (he switched between us kids) and my mom always came to watch.

7) If we weren't in youth minyanim or youth programming at shul we were sitting next to our parents and not running around like a maniac.

I could go on, but I think you see the theme here - spend time with your kids (there's time even with long school days, you just need to find it), be open and honest with your kids, participate in their lives, and treat them like adults.

Anonymous said...

I found this post to be extremely valuable and forwarded it to several of my friends. I have been meaning to check out Dr. Neufeld's book for awhile and this post motivated me to have it reserved at the library. Thank you!

I had an epiphany recently while reading "The Kazdin Method for Parenting the Defiant Child: With No Pills, No Therapy, No Contest of Wills" (misnamed, incidentally, it is just a great all-around parenting book). I think it is common knowledge among many that the best way to teach/influence your kids is by example. However, what they don't say as often is if you don't have a close relationship, aka *attachment*, to your kids, your example won't mean much.

I have been really working on my relationship with my kids since I read that book and am really interested in more strategies and information about beefing up my hands-on parenting skills.

(incidentally, is this the same Gordon Neufeld who wrote Heartbreak and Rage: Ten Years Under Sun Myung Moon? If so, sounds like he has had an *interesting* life)

Nachshon said...

No, this is not the same Gordon Neufeld, but that would make it interesting wouldn't it?

You can find out more about the
"parenting" Neufeld by visiting his website at http://www.gordonneufeld.com. Click on audio/video downloads to hear recordings of live presentations. They will change your life. I highly recommend "The Trouble With Time Outs" and "Cultivating Caring Children." But they are all amazing and well worth the time and money to download.

I plan to respond tomorrow to the great comments that have been rolling in. Sorry to have been absent the past few days. We have been chasing bed bugs. Talk about a family bonding experience!

Nachshon said...

Rachel In Israel -

Parents definitely have a role in their adolescent children's choice of friends. Obviously from what has been said above our influence over that choice will be strongest when our kids are appropriately attached to us. I want to quote a previous post at length because this person gave some really good ways to engender attachment:


"1) We almost always had family dinner and we actually spoke about each other's days and the news and world events. My parents heard about our days and we heard about theirs.

2) My parents knew what was going on at school both socially and academically and helped us whenever we needed it in either department.

3) We always walked to and from shul together as a family (mom too) even if that meant my dad got to shul late.

4) My parents always spoke to us as adults. We knew we could tell them anything and everything no matter what. We also knew we could ask them anything and everything. I think barriers between parents and children start here whether it's an inability to ask or speak about something personal or embarrassing or having questions about where babies come from, children need to feel their parents can be there and listen and provide information.

5) My parents never ignored us. There wasn't a "kids' table" and when we were together, for the most part, it was "our time". My dad didn't ignore us to talk about sports or work or whatever with the adults. And if there was "adult conversations" we could always listen and participate.

6) We participated in youth baseball and soccer leagues and my dad often coached the team (he switched between us kids) and my mom always came to watch.

7) If we weren't in youth minyanim or youth programming at shul we were sitting next to our parents and not running around like a maniac.

I could go on, but I think you see the theme here - spend time with your kids (there's time even with long school days, you just need to find it), be open and honest with your kids, participate in their lives, and treat them like adults."


These are just fantastic examples of how to get your kids to stay attached to you. As a general rule you will know certain friends are potential trouble when you feel your child push you away when they are together - this push away is what Dr. Neufeld calls the "dark force of attachment." You must intervene when this happens. It would be great if you could align the friends with you instead of against you. Invite them over. Plan events that include them, etc. But if you are unable then you will need to attempt to end the relationship. How to do this is our great challenge.

It's going to be very difficult to just proclaim, "You are forbidden to see that person again!" This will just provoke counterwill (especially if the child's attachment to you is tenuous). It is better to initiate more meaningful time between you and your child. Find something that you can teach the teen and plan a day together. Pick up a hobby together. Get in shape and go walking/running together. The possibilities are endless and parents can decide best what to try because they know their children best. Increasing this time together will naturally decrease the time with the undesirable friends.

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