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Competence 5: Continuing Care of Families Affected by FASD

Relapse Prevention

Relapse is common among persons with alcohol problems. Because of the many challenges people with an FASD face, they are even more vulnerable to relapse. Many have problems finding stable jobs or housing, creating stress that can trigger relapse. Some return to unhealthy environments that foster alcohol abuse, such as friends who drink and use drugs. Continuing care is needed to assist persons with an FASD in staying sober.

Addiction professionals also may work with clients who drank while pregnant, and may have children with an FASD. These women may have severe guilt and shame that needs to be addressed in order to prevent relapse. In addition, women who have children with an unidentified FASD are at high risk of relapse due to the behaviors of their children and the belief that they are poor parents. The addiction professional can assist these clients in accessing services for their children. Such services can help alleviate the stress of parenting a child with an FASD and contribute to the mother’s long-term recovery.

People with an FASD face the same stigma and barriers in aftercare as they do in the rest of society. Individuals with an FASD may be shunned or ignored in 12-Step meetings. They may not understand slogans or concepts or follow what is said in meetings. However, they may find groups or individuals who can be very accepting. It may help if counselors find someone in a local 12-Step group willing to act as a mentor and help someone with an FASD connect with others in the group.2

reading together

To act as the client’s advocate in such circumstances may require linkages with agencies that are familiar with ADA requirements, other Federal legislation, and applicable State and local disability laws and regulations. With a stronger understanding of the ADA, agencies and their field workers can become much more confident and effective advocates for their clients. In addition, agencies should establish working relationships with legal services, law school legal clinics, civil rights pro bono offices, and attorneys in order to provide clients with needed legal assistance. Many types of creative pro bono legal services are available on a local, State, and national level for both the agency as an organization and the client as an individual.

Because of the many situational factors that may facilitate or impede recovery, careful planning for aftercare is required and little can be taken for granted. Examples of key differences in aftercare likely to apply to many persons with disabilities follow3:

  • Ongoing and more frequent monitoring may be required, sometimes using different communication channels.
  • Friends, family, and advocates are often especially important to the recovery of a person with a disability because of a higher degree of reliance on their care and support.
  • The circle of people involved with recovery may be larger; for example, the support of attendants, residential facility staff, or home health care providers may be critical.
  • Modifications to “typical” aftercare plans are likely to be required. Provisions for transportation and communication aides may be necessary.
  • Service coordination and case management responsibilities are more prominent and time-consuming than for clients without disabilities.
  • The transition counselor for the referring program may need to brief outpatient program staff on the client’s needs, functional limitations, and capabilities, and suggest accommodations or modifications to usual procedures.

Upon leaving a program, clients with an FASD should be encouraged to return if they need assistance. Because the status of these individuals can be fragile, they need to be able to receive help or a referral quickly in times of crisis. Regular informal check-ins with clients also can help alleviate potential problems before they become serious enough to threaten recovery.

A good continuing care plan will include steps for when and how to reconnect with services. The plan and provision of these services also makes readmission easier for clients who need to come back. The client should maintain contact postdischarge (even if only by telephone or informal gatherings). Increasingly, substance abuse programs are undertaking followup contact and periodic groups to monitor client progress and assess the need for further service.

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