Curriculum for Addiction Professionals (CAP): Level 1

Competence 5: Continuing Care of Families Affected by FASD

Continuing Care for Clients with an FASD or Possible FASD

While establishing linkages to services may be a huge challenge to already overtaxed treatment providers, these linkages are essential to increase the effectiveness of substance abuse treatment and recovery services for people with an FASD. A study of people with disabilities treated by the Anixter Center in Chicago demonstrated that even individuals with severe and multiple disabilities are successful in treatment and maintain sobriety if provided with modified treatment and case management services.¹ Because FASD is often undetected, successful outcomes for the treatment center may increase as providers build linkages and use them to enhance their expertise and experience in identifying and accommodating FASD (see box for suggestions in the treament of persons with an FASD). There are no specific guiding principles for treating clients with an FASD. This chart is an example of how principles for a person with Co-Occuring Disorders might be adapted for those with an FASD. These principles were originally identified in the Treament Improvement Protocol Substance Abuse Treatment for Persons With Co-Occurring Disorders (TIP 42).

Suggestions in the Treatment of Clients With an FASD
Employ a recovery perspective. Develop a treatment plan that provides for continuity of care over time. Treatment may occur in different settings over time (e.g., residential, outpatient) and much of the recovery process occurs outside of or following treatment (e.g., through family and community support. It is important to reinforce long-term participation in these continuous care settings. Adopt a comprehensive viewpoint. People with an FASD and alcohol problems generally have an array of mental health, medical, family, and social problems. Most need substantial rehabilitation and habilitation (i.e., initial learning and acquisition of skills). Treatment should address immediate and long-term needs for housing, work, health care, and a supportive network. Develop a phased approach to treatment. Many clinicians view clients as progressing through phases. Generally, three to five phases are identified, including engagement, stabilization, treatment, and aftercare or continuing care. These phases are consistent with the stages of change. Address specific real-life problems early in treatment. Case management may be needed to help clients find housing or handle legal and family matters. It may also be helpful to use specialized interventions that target important areas of client need, such as money management. Psychosocial rehabilitation, which helps the client develop the specific skills and approaches she needs to perform her chosen roles (e.g., student, employee, community member) also is a useful strategy. Solving such problems often is important in engaging clients in continuing treatment. Plan for the client’s cognitive and functional impairments. Services for clients with an FASD must be tailored to individual needs and functioning. Clients with an FASD usually display cognitive and other functional impairments that affect their ability to comprehend information or complete tasks. Interventions must be compatible with client needs and functioning. Plans are needed for longer-term interventions and ongoing support, since people with an FASD have memory problems and difficulty applying what they learn to different situations. Use support systems to maintain and extend treatment effectiveness. The mutual self-help movement, the family, the faith community, and other resources that exist within the client’s community can play an invaluable role in recovery. In some cultures, the stigma surrounding FASD and substance use is so great that the client and even the entire family may be ostracized by the immediate community. In addition, the behaviors associated with active substance use may have alienated the client’s family and community. The addiction professional can help the client learn about available support systems and how to use them effectively.

Source: Adapted from Center for Substance Abuse Treatment. 2005. Substance Abuse Treatment for Persons With Co-occurring Disorders. Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA) 05-3992. Rockville, MD: Substance Abuse and Mental Health Services Administration.