Break­ing the grip of ad­dic­tion as a fam­ily

A par­ent­ing pro­gramme at Ire­land’s only mother and child res­i­den­tial ad­dic­tion treat­ment cen­tre helps to turn fam­i­lies’ lives around

The Irish Times - Tuesday - Health - - Parenting Addiction - Sheila Way­man

Emma Kin­sella didn’t think she re­ally had a drink­ing prob­lem in her 20s and, be­ing able to stop as soon as she found out she was preg­nant, con­vinced her that she couldn’t be an al­co­holic.

She had en­joyed nights out at col­lege but stud­ied hard in be­tween, de­ter­mined to do well in her ex­ams. She was al­ways a bit of a per­fec­tion­ist. “I had high stan­dards and high ex­pec­ta­tions of my­self in how I should per­form in ev­ery area of my life,” she says.

Af­ter grad­u­at­ing from col­lege in busi­ness stud­ies, she got a job in one of the “big four” ac­count­ing firms in Dublin. There was a post-work drink­ing cul­ture, but, af­ter 12-hour days, she pre­ferred to go home to re­lax – and treat her­self to a bot­tle of wine.

Out­wardly all was go­ing well; she was pass­ing her ac­coun­tancy ex­ams and get­ting good per­for­mance re­views at work. But in­wardly, she was car­ry­ing men­tal scars of sex­ual abuse in her child­hood. “It was a rel­a­tive and I blamed my­self a lot. I was only three when it started.”

She thought ev­ery­body knew what was go­ing on and they were all just cov­er­ing it up, so she went along with that. In fact, her par­ents didn’t know.

She started self-harm­ing be­fore she was 10 as a way of cop­ing and, a decade later, found al­co­hol had a sim­i­lar ef­fect. “It was turn­ing off my emo­tions and a relief when I did it.”

Even if she some­times felt her level of drink­ing was a bit wor­ry­ing, she had no prob­lem stop­ping “lit­er­ally overnight” af­ter a pos­i­tive preg­nancy test at the age of 28. She and her part­ner, hav­ing been liv­ing to­gether for a year, were both ex­cited about hav­ing a baby.

Emma didn’t give al­co­hol much thought from then on, with no han­ker­ing to re­sume. “I just fo­cused on the preg­nancy.”

But it turned out to be a trau­matic birth, pri­mar­ily be­cause Emma had “hor­rific flash­backs” to when she was a child. She was hold­ing her breath and the baby was get­ting dis­tressed. Af­ter­wards, he was okay and so was she – phys­i­cally.

Ly­ing in the ma­ter­nity hospi­tal, she felt like she was back in her child­hood, think­ing that peo­ple around her could see how trau­ma­tised she was, but were choos­ing to ig­nore it. In those cir­cum­stances, Emma wasn’t go­ing to be the one to make a fuss.

Her baby, Wil­liam, had to go into neo-na­tal care for a short while as his blood sugar was very low. “A big thing for me was that the breast­feed­ing didn’t work out. I was count­ing on it,” she ex­plains. “I had read ev­ery book and I knew breast­feed­ing was best so I was go­ing to find a way to make it work.”

With the baby re­fus­ing to latch, she pumped her milk in­stead. But then she started throw­ing it down the sink, be­liev­ing that for­mula would be bet­ter for him than any­thing that came out of her. “I knew what post-na­tal de­pres­sion was and I knew it wasn’t nor­mal,” says Emma who went to doc­tors and pub­lic health nurses look­ing for help in the early months.

How­ever, at ap­point­ments she didn’t dis­close what was re­ally go­ing on in her head. “I couldn’t put words on how I was feel­ing or how over­whelmed I was.”

Nor could she tell them that she had started drink­ing again a cou­ple of months af­ter the birth. Con­sumed by anx­i­ety when her part­ner went out to work in the morn­ing, leav­ing her alone with Wil­liam, she would be on high alert and stressed all day.

“The minute that he’d come home, I would just hand the baby over and lock my­self away in a room and say I need some alone time” – and she’d drink. “Very quickly it started dur­ing the day time as well.”

How­ever, al­co­hol no longer seemed to numb her feel­ings the way it used to and she drank more and more to see if it would. “Things just spi­ralled out of con­trol very, very quickly.”

Treat­ment pro­grammes

Emma, now aged 33, went into a psy­chi­atric hospi­tal when Wil­liam was a year and a half. But, af­ter six weeks, she dis­charged her­self and started drink­ing again. That is when her part­ner left, tak­ing Wil­liam with him. “In hind­sight, I don’t blame him; I am sur­prised he lasted as long as he did. But I fell apart com­pletely – he was gone, Wil­liam was gone and I was in this big empty house all by my­self.”

That was Au­gust 2014 and for the next three years she was in and out of treat­ment – do­ing var­i­ous pro­grammes at St Pa­trick’s Hospi­tal, seven months in Cluan Mhuire, a month at the Re­newal ad­dic­tion cen­tre in Cork – but ev­ery time she got out, she would re­lapse. “The ad­dic­tion was too strong; I was a night­mare pa­tient,” says Emma.

While she had a dual di­ag­no­sis of men­tal health is­sues and ad­dic­tion, she kept be­ing told they couldn’t start to treat the former un­til she had her drink­ing un­der con­trol. “I was ex­tremely im­pul­sive, reck­less, self-de­struc­tive – a lot of that would be the psy­chi­atric side of it but, be­cause of those ten­den­cies, I could never get sober long enough to be­gin the work that needed to be done.”

Since 2015, a psy­chi­a­trist at St Pa­trick’s, Dr Marie Naughton, has, she says, been “the one con­stant in my life and she has not given up”. Her rec­om­men­da­tion of Coolmine Ther­a­peu­tic Com­mu­nity’s Ash­leigh House in Da­mas­town, Dublin 15, proved to be the turn­ing point for Emma.

Ire­land’s only mother and child res­i­den­tial treat­ment cen­tre, it runs the Par­ent­ing un­der Pres­sure (PuP) pro­gramme, which was de­vised in Aus­tralia to help high-risk fam­i­lies with ad­dic­tion prob­lems. “The unique­ness of Ash­leigh House is that it al­lows a mother to come into treat­ment with her child – ei­ther when preg­nant or

I was ex­tremely im­pul­sive, reck­less, self-de­struc­tive . . . be­cause of those ten­den­cies, I could never get sober long enough to be­gin the work that needed to be done

with a pre-school child,” says Coolmine’s chief ex­ec­u­tive, Pauline McKe­own. Older chil­dren can also stay with their moth­ers at week­ends or dur­ing school hol­i­days.

While Emma came in alone last Novem­ber, the cen­tre im­me­di­ately sup­ported her in mak­ing ac­cess vis­its to Wil­liam, whereas in other treat­ment cen­tres it was like chil­dren were “put on the back burner”, she says. And fur­ther along in her treat­ment, he was able to come and stay with her at week­ends.

The pretty, sin­gle-storey quad­ran­gle of res­i­den­tial units, creche and of­fices be­hind a con­verted farm­house ac­com­mo­dates 24 women and up to 17 ba­bies and chil­dren un­der the age of five. But de­mand for the ser­vice far ex­ceeds ca­pac­ity, with more than an­other 30 women – 80 per cent of them moth­ers – cur­rently seek­ing a place­ment here. “A pro­por­tion of those women who are wait­ing are preg­nant,” says McKe­own, point­ing out that preg­nancy is an op­por­tu­nity to make a great change in these women’s lives, as it is a time they are highly mo­ti­vated to seek treat­ment. But they need a place here to sup­port them through that.

Although Emma was abus­ing only al­co­hol, most women com­ing in have also been us­ing heroin and opi­ates, and pre­scribed med­i­ca­tions.

All are home­less, “com­ing from prison, from emer­gency ac­com­mo­da­tion, from couches of friends or fam­ily and, on oc­ca­sion, from rough sleep­ing”, says McKe­own. They are also likely to have spent time in prison or be fac­ing crim­i­nal charges.

Most are sta­bilised on methadone be­fore they come in. If they’re not preg­nant, they start by detox­ing off methadone and then do the re­hab pro­gramme. “If they are preg­nant, they come in on methadone and must stay steady on that for clin­i­cal rea­sons and they may detox af­ter birth,” she ex­plains.

An in­ter­nal study show­ing that 80 per cent of those at­tend­ing Coolmine’s ad­dic­tion ser­vices come from homes where one or both par­ents were ad­dicts, high­lights how so many are caught in a gen­er­a­tional cy­cle of chaotic lives.

Over­all, it’s a five-month treat­ment pro­gramme for moth­ers with a young child, but seven or eight months for preg­nant women who usu­ally come in dur­ing their fi­nal trimester. How­ever, the hous­ing cri­sis means what should be a fiveto six-month in­pa­tient pro­gramme stretches to nine or 12 months for these high-risk fam­i­lies, says McKe­own, be­cause there they have nowhere to move on to.

When Ash­leigh House started pro­vid­ing child­care in 2009, staff thought that was the key prac­ti­cal sup­port moth­ers at­tend­ing for treat­ment needed. Four years later, “we came to re­alise there was a whole big miss­ing bit – at­tach­ment,” she says, be­tween moth­ers and chil­dren.

“The women were re­ally strug­gling with their emo­tional man­age­ment and the fact that they had the child in their care,” says McKe­own. There is a lot of stigma as­so­ci­ated with par­ents who are abus­ing sub­stances, she points out, and they feel great guilt and shame about what dam­age they may have done to their chil­dren.

In look­ing for a par­ent­ing pro­gramme, Coolmine dis­cov­ered PuP, the fun­da­men­tal fo­cus of which is se­cure at­tach­ment be­tween child and par­ent. Con­ducted over 10-12 weeks, it in­cor­po­rates group ses­sions and one-on-one coun­selling. “When I was told I would be do­ing Par­ent­ing Un­der Pres­sure,” says Emma, “I just thought this is a pro­gramme for bad par­ents, to as­sess how much dam­age is done and cor­rect it for the fu­ture. It is not that at all; it is more about cel­e­brat­ing your strengths as a par­ent.”

Up to that point, she had of­ten thought her son would be bet­ter off with­out her. “I felt at least if I died when he was young he wouldn’t re­mem­ber me. I had very dark thoughts along those lines – I re­ally didn’t see any value of my­self as a per­son in his life.”

She had fought through the courts for more ac­cess, but mainly be­cause she thought that was what was ex­pected of her as a mother, she ad­mits. “When I did get ac­cess, I didn’t en­joy it. I felt he couldn’t wait for it to be over; that was all my own think­ing, rather than the way things ac­tu­ally were.”

PuP turned this per­cep­tion around, help­ing her re­alise that Wil­liam’s time with her had huge value for him. “It showed him he did have a mother and a mother who cared for him.”

Safe space

In the group ses­sions, Emma found she was able to open up more with these fel­low women res­i­dents than she had with any health pro­fes­sional. “It was a re­ally safe space, com­pletely free of judg­ment.”

She could be “to­tally hon­est” about “my low­est mo­ments and the worst of the guilt that I car­ried about things I had and hadn’t done, and times I hadn’t been there. Once you say these things, it takes the power out of them.”

A mind­ful­ness com­po­nent helped her ac­cept that she couldn’t change the past and it was now about mak­ing good mem­o­ries for Wil­liam. “It is not about un­do­ing the dam­age; it is about do­ing right from here on out.”

Emma believes that be­ing around moth­ers and chil­dren all the time also made a dif­fer­ence. She iden­ti­fied so much with the think­ing of the other women and re­alised that if she ad­mired their strength and had great com­pas­sion for them, she should have some of that for her­self too.

Ash­leigh House started us­ing PuP in 2014 and an in­de­pen­dent eval­u­a­tion by Trin­ity Col­lege re­searchers, which was pub­lished in Septem­ber, found that 100 per cent of par­tic­i­pants were sub­stance free at the end of the pro­gramme.

Dr Jo-Hanna Ivers and Prof Joe Barry also re­ported sig­nif­i­cant re­duc­tions in lev­els of anx­i­ety, stress and de­pres­sion among the par­ents, along with in­creases in mind­ful par­ent­ing and ac­cess­ing so­cial sup­port.

Fa­thers

The study was car­ried out in 2017/18, dur­ing which PuP was ex­tended to fa­thers at­tend­ing a sep­a­rate res­i­den­tial cen­tre, Coolmine Lodge. A to­tal of 23 mother and 10 fa­thers were sur­veyed be­fore and af­ter the pro­gramme.

Jack (who asked that his real name not be used) did the par­ent­ing pro­gramme while at­tend­ing the Lodge for co­caine ad­dic­tion. He is back out, in the “step down” phase, and due to go back to his job in a cou­ple of weeks’ time.

“I learned tools and tech­niques in how to build bonds with my chil­dren and make amends,” says Jack, who now sees his three sons, rang­ing in age from seven to 17, once mid-week and ev­ery sec­ond week­end.

He has also been re­build­ing a par­ent­ing re­la­tion­ship with his ex-part­ner. “She can see the work that am I do­ing on my­self and ul­ti­mately be­ing there for the chil­dren as well. Life is a lot bet­ter.”

While he says he never did any­thing through his ad­dic­tion in front of the chil­dren, there were times he turned up late, or not at all, for ac­cess. “I wasn’t spend­ing the time with them that they de­served – qual­ity time.”

PuP is also avail­able to par­ents at­tend­ing day ser­vices in Coolmine House on Lord Ed­ward Street in the city cen­tre but ad­di­tional fund­ing is needed to “up­scale it in the com­mu­nity”, says McKe­own, who es­ti­mates it would cost about ¤108,000 for 12 months. “We want this piece of re­search,” she adds, “to in­form Gov­ern­ment de­part­ments and State agen­cies to adopt and agree a na­tional roll-out of [the] PuP pro­gramme for home­less fam­i­lies af­fected by sub­stance abuse.”

Mean­while, Emma is sober for a year now. She left Ash­leigh House in June, spent two months in a Vin­cent de Paul house be­fore be­ing “lucky enough to find an apart­ment through HAP [Hous­ing As­sis­tance Pay­ment] where I am liv­ing now, which is great. The first time in three years I have a place to go home to.”

Wil­liam, aged five, stays with her ev­ery sec­ond week­end and she also col­lects him from af­ter-school care three days a week. She rev­els in their “re­ally nor­mal” motherson re­la­tion­ship.

How­ever, she takes noth­ing for granted, know­ing the num­ber of re­lapses she has had in the past. “I can’t af­ford to get com­pla­cent and I don’t. I do keep re­cov­ery at the fore­front.”

While her former part­ner still has pri­mary care of Wil­liam, she says they are func­tion­ing much more as co-par­ents. “There is no ques­tion of any rec­on­cil­i­a­tion, but we’re able to talk and com­mu­ni­cate about the nitty gritty stuff, and even the more ca­sual stuff of send­ing each other pho­tos and videos and stuff. I do feel fully in­volved.

“He trusts me,” she adds, “and I never saw that day com­ing again af­ter ev­ery­thing that has hap­pened.”

The unique­ness of Ash­leigh House is that it al­lows a mother to come into treat­ment with her child – ei­ther when preg­nant or with a pre-school child

PHO­TOGRAPHS: DARA MAC DÓNAILL

Emma at Ash­leigh House, run by Coolmine Ther­a­peu­tic Cen­tre, in Da­mas­town, Dublin: “I knew what post-na­tal de­pres­sion was and I knew it wasn’t nor­mal,” she says. Left: Pauline McKe­own, CEO at Ash­leigh House.

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