Substance Abuse Programs for Individuals with FASD
2002 Teresa Kellerman

Q: Do you know of any programs designed to help people with Fetal Alcohol Spectrum Disorders (FASD) who have a drug addiction? Our son has gone through about 4 different programs, mostly he starts, but never finishes. His Probation Officer is looking for another program that he can assign him to, and it would be really great if they had an idea of what would really help our son. He is 27 is on SSI. Thanks.

A: I would like you to print out the brochure "FAS and the Brain," and three documents that I use in training people in the court system about FASD. (see below)

All the experts agree that 12-step programs as they are will not be very effective because they are too abstract and place all the responsibility for recovery on the individual. Our folks are not capable of being totally responsible for themselves. So, they need lots more guidance and long-term support if they are going to make it. A 12-step program might work if there is a mentor along side the person to act as a role model and to have daily contact with to talk them through the program and explain things over and over and remind them of what is necessary to succeed. The structure of the program is good, if it can be broken down into even more simple steps, and if there is close monitoring.

I would suggest that the P.O. take responsibility for contacting your son on a regular basis, maybe a phone call every day and a face-to-face meeting once or twice a week. The sanctions and incentives that are usually applied in the court system might not be effective unless they are immediate and meaningful and concrete. The key to planning a program for recovery that will work is holding everyone on the team accountable for learning about and understanding FASD and accepting that your son may not have the capacity to adhere to any program without lots of close monitoring and assistance on a daily basis.

I am assuming that a thorough assessment was done for him to qualify for SSI, so I would refer to the report of the psychologist to remind everyone on the team about how the disability limits your son in his ability to function safely in life.

My son is 25 and has obvious signs of the alcoholic personality. He has not had a drink since he was born, but the symptoms are there, and I believe the risk for addiction is high. When John was about 12 years old, I decided he didn't need alcohol in the house to tempt him, and I decided that he needed some healthy role models, so we dumped out all the bottles of booze, and I ended a long-term relationship with a man who had an alcohol problem (not an alcoholic, never drunk, never abusive, but alcohol was affecting our relationship, and his behavior was not what I wanted modeled for my son), and from that time on, we have had an alcohol-free home, family, and life style. We talk a lot about addiction, alcohol and other drugs, and how each of them affect people's lives and the risk each poses to my son personally. There is high awareness of the dangers of alcohol for him, and the need for close supervision and support to prevent a problem occurring in the first place. So my son has supervision at all times, to keep him out of all kinds of trouble.

This is what everyone needs to understand:

Adults with FASD have a 50%-70% chance of having substance abuse problems.

Individuals with FASD have a social development that is stunted at the level of a child. Their ability to function emotionally can have a range at any given time from that of a two-year-old child, or an adolescent, or an adult. They can ACT like an adult, but inside they may still be very child-like in their thinking and feelings. We need to be careful that our expectations do not exceed their ability to perform and carry out tasks or follow directions or attain goals.

They may be able to function well mentally one day and not the next. They may have several good days in a row, a few weeks or months, and then they will lose it, and everything will fall apart, and they won't understand why. They may lose control, and be aware of losing control, and try to maintain control, but just can't sometimes, no matter how hard they try.

Adults with FASD have brain damage that interferes with their ability to remember rules and consequences, their ability to control their impulses, and their ability to make wise decisions. These things are sometimes in their control and sometimes out of their control. We cannot predict when they will or will not have control over the way their brain will function at any given time. Therefore, they need close monitoring and guidance at all times to ensure they do not act on their impulses or make bad judgments and get themselves into trouble or pose a risk to themselves or others.

Group therapy is usually not helpful, because of the risk of imitating unhealthy behaviors of others in the group. Cognitive therapy and insight therapy are usually not helpful either, unless the therapist has a really good understanding of FAS issues. One-on-one therapy may work, but often the problems are not psychological as much as they are neurological. A mentor that meets with the individual on a daily basis may be more effective than traditional counseling.

First WE have to accept the limitations imposed by the FAS disability. Then we have to help the individual accept the limitations and the restrictions necessary to ensure safety and health first, so that they can enjoy what freedoms they can handle. Without the safety or health assured, they will end up on the streets, in jail, or in the morgue, with no freedom at all.

Once EVERYONE understands what is needed to help the person succeed, then we can identify areas of talents where the individual can find the potential of expressing their gifts, whether it is art or music or mechanics or working with animals.

Share this message and the attached documents with EVERYONE who is involved with your son's program or treatment. I hope this is helpful. He can succeed, but only if everyone else does their part in helping him to maximize his potential.

Please read the following documents:

When the Teenager With FASD Drinks

FAS and the Brain

Court System: Factors to Consider (PDF file)

Court System: SCREAMS Strategies (PDF file)

Court System: What Works (PDF file)

Tough Kids and Substance Abuse: A drug awareness program for children and adolescents with ARND, FAS, FAE and cognitive disabilities. From the FAS Bookshelf Inc. in Manitoba.
updated November 8, 2003
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