Presentation #1: Bridging the knowledge of the treatment industry and Therapeutic Community.

1. ACCESSING THE KNOWLEDGE AND METHODS
OF THE TREATMENT INDUSTRY
(”TREATMENT PROGRAMS” & “THERAPEUTIC COMMUNITIES”)
TO FACILITE RESILIENCE AND IMPROVE OUTCOMES
ICAAD 2019
London, UK
Judith Landau, MD, DPM, LMFT, CFLE, CIP, CA
Gale Saler, LCPC, CRC-MAC CAI, CIP
ARISE® Network
www.ARISE-Network.com
1 (877) 229-5462

2. I N T R O D U C T I O N
Part I: Focus on background, history, case studies, outcomes
Part II: Techniques, methods, challenges and solutions
Part III: Goals, tasks and actions for your own program/practice and community

3. P a r t I
FOCUS ON BACKGROUND,
HISTORY, CASE STUDIES, OUTCOMES

4. W E FA C E
G R O W I N G G L O B A L
C O N C E R N S …

5. Gilberto Gerra,
Chief, Drug
Prevention and
Health Branch,
UNODC

7. © 1999 - 2019 Linking Human, LLC

8. M A S S T R A U M A

10. E c o n o m y n e x t . c o m

11. • Earth’s climate is changing at an unprecedented rate
• The United Nations estimates that there will be 200
million people displaced by climate change by the
year 2050
• Climate change could create the world biggest
refugee crisis
C L I M AT E R E F U G E E S

13. © 1999 - 2018 Linking Human Systems, LLC
Every refugee and
forced immigrant
population has an
average of 30%
increase in addiction,
mental health, heart
and lung issues
UNHCR (2017)

14. © 1999 - 2018 Linking Human Systems, LLC
E P I D E M I C S & PA N D E M I C S
YELLOW FEVER
At least 51 people
died in Angola after
a yellow fever
outbreak in
February 2016

15. R A N D O M T R A U M AT I C E V E N T S
Random, unpredictable acts of violence are more terrifying, and
have greater immediate and long term impact than violence in
a community that is organized and at a constant level of
preparedness, e.g., Israelis and Palestinians
Danieli, et al., 2010
© 1999 - 2018 Linking Human Systems, LLC

16. P H Y S I C A L O R E M O T I O N A L
A B U S E / N E G L E C T
I S A P R E C U R S O R
O F S E L F - I N J U RY A N D S U I C I D E
© 1999 - 2019 Linking Human, LLC
R i c h a r d L . L i u , P h D ( 2 0 1 7 )

17. PA R E N T S ’ C H I L D H O O D T R A U M A C A N
I N F L U E N C E T H E I R C H I L D R E N ’ S B E H AV I O R
A S C A N T H E I R S U B S TA N C E U S E ,
D I V O R C E , D E P R E S S I O N
Rapaport (2018)
© 1999 - 2019 Linking Human, LLC

18. C H A N G I N G
T E C H N O L O G Y

19. Fear of Missing out FOMO
Fear of Being Ignored FOBI
Peer pressure
Belief that all important information is on their digital media
Detaching from the Real World
Conditioned to instant response to the “ting”
WHY OVERUSE?
It’s estimated that kids and youth between the
ages of 8 to 28 spend about 44.5 hours each week
in front of digital screens. (NIH)
You are fat and ugly: you are a freak”
Cyberbullying
Sexting: 1 out of 7 youth has sent explicit picture; 1 out of 6 has received picture: Increases the risk of being trafficked
GAMING
GAMBLING
50 percent of youth say they feel addicted
to their mobile devices.
© 1999 - 2019 Linking Human, LLC

20. BRAINS & BODIES DO NOT FULLY
MATURE UNTIL 22 - 26 YEARS OF AGE
• Substances and behavioral compulsions can have a life-long impact
on brain and body
• Substances and compulsive behavior before maturity can cause
permanent abnormalities
• The later the use/behaviors start, the less damage is caused
• The sooner the use/behavior stops, the more opportunity for healing
© 1999 - 2019 Linking Human, LLC

21. Y O U N G P E O P L E A R E V U L N E R A B L E
D U R I N G T R A N S I T I O N

22. TRAUMATIC
TRANSITIONS
RESULT IN
INCREASED
RATES OF… RELAPSE
STRESS
DEPRESSION &
SUICIDE
“Suicide is the second leading cause
of death for people aged 10-24”
Alongi, 2017

23. “ S U I C I D E I S T H E S E C O N D L E A D I N G C A U S E
O F D E AT H F O R P E O P L E A G E D 1 0 - 2 4 ”
T H E M A J O R I T Y A R E W O M E N
April 22, 2017. Phyllis Alongi, Clinical Director of the Society for the Prevention of Teen Suicide

24. G E N D E R D Y S P H O R I A
GAMBLING/GAMING
LOVE & SEX
COMPULSION
? ? ? ? ? ? ? ? ?
EATING DISORDERS

25. • All of these factors threaten the fabric of families
• If families are at risk, youth and communities are at
risk
T H E P E R F E C T
S TO R M

26. By:
• Expanding the capacity to recognize early warning signs
• Finding hope in the face of despair
• Preventing the intergenerational legacy of disconnection and trauma
resulting in mental health, physical health and addiction issues
• Dealing with global challenges
WE NEED TO EMBRACE
OUR HI STORY TO BE EFFECTI VE

27. .
BECAUSE:
• Children were treated as small adults in all aspects of life
• Awareness of their separate developmental needs only started
between WWI and WWII
• Child guidance movement started in Britain from the end of the
First World War
• Children’s problems were attributed to maladjustment. This view
still prevails in some communities
ADOLESCENTS AND YOUNG ADULTS
WERE EVEN MORE AT RISK UNTIL THE
MID-1900’S

28. the first facility
specifically for
mental health is
established in
Spain
5th century BC
Ancient civilizations like the
Romans & Egyptians
considered mental health
problems to be a religious
nature. Some thought a person
with a mental disorder may be
possessed by demons, thus
prescribing exorcism as a form
of treatment
Pre 1400 CE
1407 CE
John Locke believed
all or almost
behavioral traits come
from "nurture" termed
tabula rasa ("blank
slate")
1690
Sir Francis Galton's English Men
of Science: Their Nature and
Nurture, argued
that intelligence and character
traits came from hereditary factors
(this was well before the modern
science of genetics).
We still argue the genetics versus
environment issue
1874
Hippocrates
believed that
mental illness
and alcoholism
were
physiologically
affiliated.
As a result, his
methods involved
a change in
environment,
living conditions,
or occupations
Phillipe Pinel (France)l: First
advocacy to improve living
conditions for mentally ill persons
occurred in France
1700s
Native American Alcoholic
mutual aid societies (sobriety
"Circles")
1750 to Early 1800s

29. Temperance
Societies
developed in
the UK,
Europe and
the US
1774
Dr. Benjamin
Rush’s “Effects of
Ardent Spirits on
the Human Mind
and Body” defined
alcoholism as a
disease
1784
1805
Rev. Lyman
Beecher's Six
Sermons on
Intemperance
"addicted to
sin"
1825
Dr. Samuel
Woodward called
for creation of
inebriate asylums
and 1840: The
Washingtonian
Society was
organized
1830-1840
1774: Anthony
Benezet's
“Mighty
Destroyer
Displayed”
published.
Procedures in mental health
facilities were unspeakably
cruel—unfortunately in
some countries these
conditions still prevail:
Insulin-induced comas;
Lobotomies; Malarial
infections; Ice cold baths
and showers (sometimes
with the ice); Electroshock
(Electroconvulsive)
therapy (ECT); Chemical
Interventions
1700’s- 1870’s
Dorothea Dix fought
for better living
conditions and
compassionate care
for mentally ill and
got government to
build of 32 state
psychiatric facilities.
1840s-1870’s
Frederick
Douglass issued
a call for
abstinence as a
foundation of the
drive to abolish
slavery
1840’s
1870
The American
Association
for the Cure of
Inebriety was
founded under
the principle
"Inebriety is a
disease."
German
psychiatrist Emil
Kraepelin studies
mental illness and
began to draw
distinctions
between different
disorders.
1883
Sigmund Freud
recommends Cocaine
for treatment of
alcoholism and
morphine addiction.
1880s
Bottled home
cures contained
alcohol, opium,
morphine,
cocaine and
cannabis
1890’s

30. © 2015 International Recovery Institute, LLC
T H E C O M M O N V I E W
O F M E N T A L I L L N E S S

31. THE JOINT
COUNTIES’
LUNATIC ASYLUM

32. In the late 1880s, Nelly Bly posed as a mentally
ill woman, and documented everything that
happened to her in a series of articles and a
book.
1879
Placing the mentally ill in facilities
allowed members of the general
public to ignore the problem. They
didn’t see anyone who had a mental
illness and if they placed a person in
an institution or prison they just
disappeared
1880s
late 1800s
Wundt founded the first formal laboratory for
psychological research at the University of Leipzig.
Using psychoanalytical theories, Sigmund
Freud and Carl Jung treated their patients
for mental illness. Many of the theories they
employed are still discussed today and used
as a basis for the study of psychology along
with all the leaders of modern thought,
psychology and psychiatry
Early 1900s

33. THE KEY ROOTS
OF OUR CURRENT MODELS
Peer Recovery
Model (1920’s)
Maxwell Jones Model 1940’s
Psychiatric Therapeutic Community
basis of both medical and peer
systems
I n t e g r a t i v e M o d e l
Addiction Treatment
Center Model
(1950’s)
© 1999 - 2019 Linking Human, LLC

34. Synanon,
1958, Santa
Monica, US,
first addiction
focused
therapeutic
community
1935
Maxwell Jones, GB,
with Sanctuary
model therapeutic
community originally
in psychiatric
facilities
1940’s-1960’s
1805
The establishment of
drug-free TCs in
Europe for heroin
problems
TCs now in more than
65 countries
1960’s-1970’s
marked a movement
in advocacy and care
for mental health and
addiction with
development of
psychiatric facilities
marking a split in
treatment models with
both using variations
on the therapeutic
community
Early 20th century
Alcoholics
Anonymous (AA)
was founded in
1935 by Bill
Wilson (known as
Bill W.) and Dr.
Robert Smith
(known as Dr. Bob).
Beginning of peer
recovery movement
followed by
publication of the
“Big Book”
Methadone approved for
pain management
1947
A wave of
deinstitutionalization
began
1950s to 1960s
beginning of
psychiatric
medication with
lithium then
antipsychotics then
anti-depressants and
anxiolytics
1948-1950’s
1940’s – 1960’s
emergence of family
therapy and
integration of the
family into treatment
for both psychiatric
and addiction issues
A new generation of
prescription
antipsychotic drugs
emerged
1990’s
A new generation of
prescription drugs for
treatment and
withdrawal from
opiates and other
drugs
2000’s

35. Our clients may be best
served by our humility and
readiness to integrate that
which is tried and true and
proven to work across time
as we develop and grow to
address current challenges
“The thing that hath been,
is that which be: and that
which is done is that
which shall be done: and
there is no thing new
under the sun”
Book of Ecclesiastes 1:9
© 1999 - 2019 Linking Human, LLC

36. WHAT HAVE WE LEARNED?
A quick trip around the world to look at current models used independently or in
combination
Modern Therapies include medication, various forms of psychotherapy,
neurological interventions
PEER RECOVERY PSYCHOTHERAPY
Individual, couples, family, group
PSYCHOANALYSIS PSYCHIATRY
& NEUROLOGY
ADJUNCTIVE
THERAPIES
SCIENTIFIC MEDICINE
& MEDICATION
TRADITIONAL MEDICINESPIRITUALITY & SPIRITUAL
HEALING

37. Whatever our individual
practice, most of us
consider the multifactorial
nature of challenges facing
our youth, and explore
each level of bio-psycho-
social-spiritual-cultural
environmental factors
• Developmental history and life cycle
• Family and intergenerational developmental
history including previous trauma and unresolved
losses
• Individual, family and intergenerational health and
mental health history
• Relational history including attachment
• Family and community resources including
nutrition, education, housing, safety, etc.
• Family spiritual history and current beliefs
• Culture of the youth, family and environment
• Influence of transitions including displacement,
loss and trauma
• Family and community attitudes towards youth:
positive or negative predictors
© 2015 International Recovery Institute, LLC

38. Y O U T H D I F F E R F R O M A D U L T S
I N T H E I R R E S P O N S E T O
T R A N S I T I O N S & S T R E S S

39. ALL YOUTHS AND FAMILIES ARE IN TRANSITION,
AND DEPENDING ON CULTURAL INFLUENCES ARE
IN OR OUT OF SYNC.

40. FAMILY LIFE
SPIRAL 1985

41. 1985

43. FAMILIES
CAN
INFLUENCE
OUTCOMES

44. C O N N E C T E D N E S S S T U D I E S
MEASURES
1. Sexual risk-taking
2. Frequency of contact with extended family
3. Knowledge of family stories across time
SUBJECTS
STUDY 1
Women in a Sexually Transmitted Disease Clinic compared with women in Social Community Center
STUDY 2
Troubled adolescent girls.
RESULTS
STUDY 1
Measures of frequency of contact and knowledge of family stories held up together and separately,
and both correlated with reduced sexual risk-taking
STUDY 2
Quantitative results were similar. Then analyzed stories for themes of resilience vs. vulnerability
1. Least risk-taking correlated to themes of resilience
2. Next lowest correlated with themes of vulnerability
3. Most risk-taking correlated with knowing no stories
Interesting Finding: Content in stories of “resilience” and “vulnerability” were often identical – what
varied was how the family perceived challenges they faced
Landau, et al, 2000

45. Draw on the family’s inherent resilience
rather than labeling behavior and
communication patterns as dysfunctional,
which leads to continued vulnerability and
risk-taking, rather than increased self-
esteem, competence and self-efficacy
Landau, et al., 2000
E N H A N C I N G P O S I T I V E
C O N N E C T E D N E S S

46. • Connectedness is interpreted as a
reward by the brain and is associated
with the release of dopamine
• Conversely, brain imaging studies
suggest that the same parts of the
brain are activated during social
rejection and physical pain
Ethat Kross, University of Michigan
THE BRAIN AND
CONNECTEDNESS

47. P O S I T I V E Y O U T H D E V E L O P M E N T
Focus on:
• Strengths and development potential rather than
deficits
• Rejecting the portrayal of adolescents and young adults
as “inevitable problems” that need to be fixed
• Nurturing core internal strengths and abilities
• Providing opportunities to believe in themselves and
their ability to influence their lives and the world
around them
• Encouraging strength and positive development to
ease a healthy transition into adulthood

48. Keys to ARISE® for adolescents and young adults
Respect
• Young people are full members of the family
Transparency
• Inviting young people to a family meeting
Strength Based
Establishing Boundaries
Focus on the family system
• When one member becomes symptomatic the health of all is impacted
• Young person is part of the solution for the whole family
K E Y S F O R A D O L E S C E N T S & Y O U N G
A D U L T S

49. WHAT CAN TREATMENT PROGRAMS DO?
• A sense of social connection is a fundamental human need
• Number of close confidantes in the US decreased from 3 in 1985 to 1
in 2004: 25% of respondents said they have none
• Increase in loneliness, isolation, and alienation may be the leading
reason people seek psychological counseling
• Lack of social connection leads to vulnerability to anxiety, depression,
antisocial behavior and suicidal ideation
• Building and maintaining social connections requires a level of self-
confidence and self-efficacy that many young people lack
S O C I A L C O N N E C T E D N E S S

50. SHIFTING
THE FAMILY
PERSPECTIV
E © 1999 - 2019 Linking Human, LLC

51. P H I L O S O P H Y
• Families are intrinsically healthy with both
strengths and vulnerabilities
• In constant transition
• Typically cope well with transition unless
there are 3 or more transitions in a short
space of time (or transitions are traumatic)
• Able to access and utilize their strength and
resilience unless they are cut off from their
natural support systems
Landau, 1982;
Landau & Griffiths, 1979,
Landau, Griffiths & Mason, 1978
WE BELIEVE THAT INDIVIDUALS,
FAMILIES AND COMMUNITIES ARE:

52. THE FIVE
KEYS
PRINCIPLES
• Empower family, community, and natural support system
• Reinforce connection to family- and culture-of-origin
• Focus on individual, family, and community healing and recovery
• Remove the “we/they” dichotomy
• Mobilize and reconnect the extended natural support system

53. W H A T C A N F A M I L I E S D O ?
• Share family meals
• Talk to one another regularly
• Take care of one another during times of
stress
• Take of animals and garden together
• Share activities
• Worship, meditate, grieve together
• Share intergenerational family stories
• Get to know one another’s friends
• Enjoy family celebration

54. WHAT CAN
FIRST
RESPONDERS
DO?
• Observe safety precautions at all times, for
self and others
• Always work with a team
• Debrief with a colleague or therapist on a
regular basis
• Provide education about prescribing and
taking opiates
• Be certified in CPR and administering
Naloxone

55. W H A T C A N E D U C A T O R S &
C O N S U L T A N T S D O ?
• Understand the family life cycle
• Recognize learning styles and challenges
• Avoid negative language
• Support diversity and tolerance
• Develop a robust referral network
• Do motivational interviewing
• Meet with young people in their homes
• Collaborate with families
• Know when to refer and when to delegate

56. W H AT C A N T H E R A P I S T S , C O U N S E L O R S
& T R E AT M E N T P R O G R A M S D O ?
• Communicate, connect and collaborate with families and other professionals ensuring a
continuum of care
• Support family communication and connection
• Understand that symptomatic behavior in family members has its origins in love and
protection
• Life cycle transitions repeat themselves unless understood and resolved
• Symptomatic behavior in family members has its origins in love and protection
• Family, couples, group therapy and psycho-education
• Multifamily activities therapy
• Identify therapeutic modalities best suited to the client and family
• Teach positive ways of self-soothing

57. W H AT C A N T H E R A P I S T S , C O U N S E L O R S &
T R E AT M E N T P R O G R A M S D O ? ( C O N T D )
• Respect the natural hierarchy, identifying natural strengths and
resources
• Engage the entire system, being sensitive to issues of culture, gender
and spirituality
• Identify patterns across generations and expose and resolve secrets
• Assure continuity of family and community values, mission and
heritage
Landau, 2018

58. R E S E A R C H VA L I D AT I O N
O F
I N T E G R AT I V E A P P R O A C H E S

59. • “Few substance abusers enter treatment without pressure from
family and friends” (Marlatt, et al., 1997)
• Narratives of Recovery from Mental Illness: the role of peer
support. (Watts& Higgins, 2017)
• Engaging the natural support system significantly improves the
chances of treatment entry and completion, therefore improving
likelihood of long-term recovery (Simpson, 1981)
• There is substantial evidence of the effectiveness and longer-
lasting results of family couples treatment
(Stanton, 2013)
• SAMHSA/CSAT No. 39 Treatment Improvement Protocol
• Modified therapeutic community for co-occurring disorders: A
summary of four studies.
(Sacks, Banks, McKendrick & Sacks, 2008)
• Modified therapeutic community for mentally ill chemical
"abusers": Background; influences; program description;
preliminary findings.
(Sacks, Sacks, DeLeon, Bernhardt, & Staine, 1997)
Jessa please pretty up these next slides
FAMILY AND
COMMUNITY
SUPPORT
SYSTEMS DRIVE
RECOVERY

60. • Transitional FamilyTherapy protocol for adolescent
outpatient services, 16 sessions (NIAAA)
• Compared with treatment as usual at 3 years (NIAAA):
• Both adolescent and family markers were significantly
improved and continuing to improve at 3 years
• Treatment as usual (TAU) both adolescent and family
markers improved initially and then returned close to
baseline after 3 years
ADOLESCENT
& FAMILY
THERAPUETIC
INTERVENTION
National Institute of Alcohol Abuse and Alcoholism (NIAAA). Family and Group Therapies for
Adolescent Alcohol Abuse. (1 RO1 AA 12178–01). P.I. M.D. Stanton.

61. Improving Life
Outcomes For
Children With
History Of Mental
Health Challenges
And Trauma
SAMHSA’s CMHI National Evaluation data show:
• Children who experience trauma and receive treatment show:
• Significant improvements in behavioral and emotional
health
• Improved school attendance
• Fewer problems at school
• Evaluation data after one year of treatment show:
• Rates of suicidal thoughts reduced 68 percent
• Suicide attempts reduced 78 percent
• Displays of externalizing behaviors reduced 17 percent
• Internalizing symptoms reduced 22 percent

62. • 2010 (52 countries)– repeated 2016 (26 countries)
• Effective for individual and social outcomes and cost
effectiveness.
• Understands and responds to vulnerable
populations and the complexity of other conditions
accompanying drug abuse
• Responsive also to their families, social environment
and communities
• Adapt Interventions to participants’ needs and their
cultural, social and religious diversity.
• Provide aftercare services focused on improving the
social reintegration of the participants.
GENOA &
MALLORCA
INTERNATIONAL
MEETINGS TO
REVIEW
EFFECTIVENESS OF
THE THERAPEUTIC
COMMUNITY

63. LINC® EXAMPLE 1:
COMMUNITY & FAMILY
COMMUNITY RESILIENCE: 10,000 LIDERES PARA EL CAMBIO (BUENOS
AIRES PROVINCE, ARGENTINA – POPULATION 12 MILLION)
• FOCUS: Violence, HIV/AIDS and substance abuse prevention for the entire community
• FAMILY/COMMUNITY LINKS: Concerned community members working in collaboration
across all levels of the community
• RESULT: 400% increase in young substance abusers being brought into treatment by their
families within 2 years
• Follow up 15 years later, in one city of two million people, 37 of 43 projects were still
functioning
Landau, 2004, 2007, 2011; Yaria, 2002

64. LINC® EXAMPLE 2:
COMMUNITY & FAMILY
COMMUNITY RESILIENCE: POST-WAR KOSOVO
• FOCUS: improving services and treatment compliance of chronic mentally ill; reducing rates
of addiction; developing health and mental health services
• FAMILY/COMMUNITY LINKS: Professional and lay members of community
• RESULTS:
• Established regional decentralized home health houses and treatment clinics
• Mobilized Family and Community Links to reach out to families in each region
• Ensured collaboration between health, mental health and new addiction services
• Compliance rate of individuals with schizophrenia and their families: 98%
Agani, Landau, & Agani, 2010; Weine, et al., 2005

65. LINC COMMUNITY RESILIENCE (1990): 10,000 Lideres
para el cambio (Buenos Aires Province, Argentina - pop.
12 million)
• FOCUS: Violence, HIV/AIDS and substance abuse
prevention for the entire community
• FAMILY/COMMUNITY LINK: Concerned community
members working in collaboration across all levels of the
community
• RESULT: 400% increase in young substance abusers
being brought into treatment by their families within 2
years
• Follow up 15 years later, in one city of two million people,
37 of 43 projects were still functioning
Landau, 2004, 2007, 2011; Yaria, 2002
A R G E N T I N A

66. TOGETHER WE CAN WORK TO INTEGRATE THE MEDICAL,
SCIENTIFIC AND PEER RECOVERY METHODS TO BENEFIT
AND BRING HOPE AND HEALING TO ALL
THE COMBINED KNOWLEDGE OF THE TREATMENT INDUSTRY
AND THERAPEUTIC COMMUNITY CAN HELP CHILDREN,
ADOLESCENTS, YOUNG ADULTS, FAMILIES AND
COMMUNITIES FACILITATE RESILIENCE AND IMPROVE
OUTCOMES
© 1999 - 2019 Linking Human, LLC

67. Y O U T H A T R I S K :
W H Y F A M I L I E S M A T T E R
Lee Fitzgerald’s London Conference
London – Nov 16 – 17, 2018
Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI
ARISE® Network
www.ARISE-Network.com
Hotline: 1-877-229-5462
Office: 303-44-3755