We may not be able to stop natural or human made mass disasters, losses from major epidemics, or acts of random violence from happening in our world - from the international opiate epidemic, to the mass shooting in Las Vegas, to the Grenfell Tower disater in London, but we can take steps to prevent the mental and physical damage this trauma can do to individuals, families and communities. By working through natural change agents as Family and Community Links, we empower those communities and families to build resilience and lead healthier lives in the present and for future generations. This presentation will review several studies and clinical vignettes that illustrate the benefit of mobilising individuals, families, and communities to build positive attachment and to draw on their intergenerational strengths and resilience. Practical methods of assessment, mapping, and intervention that consider all levels of individual, family and community involvement and collaboration will be presented.

1. Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI
ARISE® Network
www.ARISE-Network.com
303-44-3755
HELPING FAMILIES AND
COMMUNITIES ACCESS
RESILIENCE TO PREVENT MENTAL
ILLNESS AND ADDICTION
FOLLOWING MASS DISASTER

2. WE FACE
GROWING GLOBAL
CONCERNS…

3. OPIOID EPIDEMIC

4. Number of drug-related deaths increase again to highest level
recorded:
• 3,674 drug poisoning deaths (involving both legal and illegal drugs)
registered in 2015
• Mortality rate increased 2014 to2015 from 59.6 to 65.1 deaths per
million people – the highest rate since comparable records began in
1993
• This increase is mainly heroin/morphine related death
Vanessa Fearn, mortality@ons.gsi.gov.uk
ENGLAND & WALES
© 1999-2018 Linking Human Systems, LLC

5. NATIONAL OVERDOSE DEATHS IN THE U S A
© 1999 - 2016 Linking Human Systems, LLC
A
• Drug abuse costs the US
484 billion dollars per year:
More than diabetes and
cancer combined.
• 2.5 million people die
annually from alcohol and
millions more suffer from
illness and injury
• 320,000 young people
aged 15-29 years die
annually: 9% of all deaths
in that age group
© 1999-2018 Linking Human Systems, LLC

6. Bloomberg reports that 2017 will
surpass last year’s profits for the
American heroin business.
RISING DEATH TOLL:
• Fentanyl (a synthetic opioid)
being introduced into the heroin
supply
• Doses are cheaper and more
deadly
• Carfentanil and other synthetic
opioids do not respond to
treatments like naloxone
https://inrecovery.com/how-did-cincinnati-become-heroins-ground-zero/

7. MASS TRAUMA

12. CHANGING
TECHNOLOGY

13. Using social media Web sites is among the most common activity of children
and adolescents:
• By age 2, more than 90% of all American children have an online history
• By 5 years old, nearly 50% interact with a computer or tablet
• By 7-8 years old, many kids regularly play video games
• 9 of 10 teens text and use social media
O’Keeffe et al., 2011
Digital technology and social media dominate personal
relationships, family and social interaction, daily habits
and even primary thinking processes:

14. • A 15-year-long study
by University of
Michigan researchers
found that the link
between childhood
TV-violence viewing
and aggressive
behavior persists into
adulthood.

15. • Children who spent excessive amounts of time
playing violent video games showed a greater
propensity towards aggressive behavior,
poorer grades in school and difficult
relationships with their parents.
(American Academy of Pediatrics)

16. CLIMATE CHANGE

18. • 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
CLIMATE REFUGEES

19. • A l l o f t h e s e f a c t o r s t h r e a t e n t h e
f a b r i c o f f a m i l i e s .
• F a m i l i e s a r e a k e y u n i t o f a l l
c o m m u n i t i e s .
• I f f a m i l i e s a r e a t r i s k ,
c o m m u n i t i e s a r e a t r i s k .
THE PERFECT STORM

20. ORIGIN OF ADDICTION &
ONSET OF MENTAL ILLNESS:
TRAUMA & LOSS

21. Regardless of genetic
factors, the onset of
addiction is almost
always connected to:
• Significant death (especially
if untimely)
• Abuse (Physical, sexual or
emotional)
• Natural or human-made
disaster

22. CONSEQUENCES
OF TRAUMA
Far far away, behind the word mountains,
far from the countries Vokalia and
Consonantia, there live the blind texts.
Separated they live in Bookmarksgrove
right at the coast of the Semantics, a
large language ocean.
• Attachment disorder
• Depression and suicide
• PTSD
• Substance abuse
• Process addictions
• Mental illness
• Cardiac stress & other
pulmonary illness
• Physical illnesses

23. FAMILY LIFE
SPIRAL 1985

24. FAMILY LIFE
SPIRAL 2015:
THE
ODYSSEY
GENERATIO
N

25. 1985

26. Depression
& Suicide
Relapse
Stress
TRAUMATIC
TRANSITIONS
RESULT IN
INCREASED
RATES OF…

27. DURING STRESS
FAMILY ROLES
BECOME CONFUSED

29. Transitional Checkerboard
PGF PGM MGF MGM
Husband Wife
Mother
Sibling 1 Sibling 2 Sibling 3
Father

30. Transitional Checkerboard
PGF PGM MGF MGM
Husband Wife
Mother
Sibling 1 Sibling 2 Sibling 3
Father

31. Transitional Checkerboard
Husband Wife
Mother
Sibling 1 Sibling 2 Sibling 3
Father
PGF PGM MGF MGM

32. Transitional Checkerboard
Husband Wife
Mother
Sibling 1 Sibling 2 Sibling 3
Father
PGF PGM MGF MGM

34. FAMILIES INFLUENCE
OUTCOMES FOR
INDIVIDUALS &
COMMUNITIES

35. FAMILES ARE THE BASE
UNIT OF THE COMMUNITY
• The consequences of trauma, mental illness
and addiction extend well beyond the
individual directly impacted
• Healing of trauma and its consequences
require more than one individual
• Without involving families we lose our most
important resource
• Working without individuals, families and
communities the risk of long-term
consequences of the trauma is increased

36. IMPORTANCE
OF FAMILIES
• Families are the primary source of many
health-related beliefs and behaviors
• Families provide a more accurate picture of
the individual’s symptoms and compliance
than the individual alone
• Relapses and continued use/illness may
be associated with depression or chronic
physical illness in another family member
• Frequent and unexplained relapses in a
chronic illness may be associated with
living with a family member with addiction
or mental illness
McDaniel, Campbell & Seaburn (1990)

37. THE KEY BELIEFS OF THE COLLABORATIVE TEAM
FOR LONG-TERM HEALING
• The family (and family history over generations) will help the collaborative team discover why there are
problems here and now
• The risk of addiction in future generations is great if past trauma, stress and grief are unresolved
• Families are more motivated and more impactful than their professional allies
• When recovery work is focused on an addicted individual in isolation, the family almost always unwittingly and
unconsciously sabotages the effort
• Recovery only happens when individual and family realize both the magnitude of the problem and that there is
hope
• The collaborative team also needs to believe in hope

38. INTERGENERATIONAL
STUDY

43. INTERGENERATIONAL
STUDY • This intergenerational adaptation gets
perpetuated down the generations as “a way of
being,”
• If someone tries to go into recovery before the
grieving is done, the the addicted individual
relapses …subconsciously triggering
reconnection
• Between 3rd and 5th generations, the trauma is
forgotten and the grief has been naturally
resolved through the passage of time and people
move into recovery.

44. ADDICTION IS
RESILIENCE IN ACTION
This pattern holds across time,
countries and cultures.

45. CONNECTEDNESS
TO FAMILY
& CULTURE-OF-ORIGIN

46. CONNECTEDNESS STUDY 1
Measures
1. Sexual risk-taking
2. Frequency of contact with extended family
3. Knowledge of family stories across time
Subjects
Women in a Sexually Transmitted Disease Clinic compared with
women in Social Community Center
Results
Measures of frequency of contact and knowledge of family stories
held up together and separately and both correlated with reduced
sexual risk-taking
Landau, et al, 2000

47. CONNECTEDNESS STUDY 2
Measures Same as study 1
Subjects
Troubled adolescent girls. Quantitative results were similar. Then
analyzed stories for themes of resilience vs. vulnerability
Results
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
Tuttle et al, 2004

48. Draw on the family’s inherent
resilience rather than labeling
behavior and communication
patterns as dysfunctional
Labeling leads to continued
vulnerability and risk-taking,
rather than increased self-
esteem, competence and self-
efficacy
Landau, et al., 2000
ENHANCING POSITIVE CONNECTEDNESS

49. SO…WE NEED TO
RECONNECT
FAMILIES IN ORDER
TO BUILD OUR
COMMUNITIES

50. THE ROLE OF
THE FAMILY IN
RECOVERY & HEALING

51. FAMILY
MOTIVATION
TO CHANGE
Definition:
The adaptive force operating within a family
experiencing major loss or stress, which guides it first
toward maintaining survival, and then toward healing
when the threat is removed.
Garrett & Landau, 2007
.

52. THE TRANSITIONAL PATHWAY
Past
Present
Future Hope
Relief
Despair
Transitional
Pathway

53. HOW CAN FAMILIES FOSTER RESILIENCE
Increase quality time with extended
family
Talk about inter-generational family strengths,
values and themes Stay in regular contact with one another
Family activities
Worship together
© 1999-2018 Linking Human Systems, LLC

54. WHAT ELSE CAN FAMILIES DO?
• Share family meals
• Take care of one another during
times of stress
• Meditate together
• Get to know one another’s friends
• Celebrate together
• Grieve together

55. WHAT CAN
PROFESSIONALS DO?

56. WHAT CAN EDUCATORS & CONSULTANTS DO?
• Understand adolescent and young adult
development
• Understand the family life cycle
• Recognize learning styles and challenges
• Avoid judgmental language
• Create and cultivate tolerance
• Develop a robust referral network
• Be able to do focus on goals not problems
• Meet with people in their home setting
• Collaborate with families
• Know when to refer and when to delegate

57. WHAT CAN TREATMENT PROFESSIONALS &
PROGRAMS DO?
• Communicate with referring professionals
• A continuum of collaborative care
• Provide family psycho-education
• Multifamily group and activities therapy
• Family and group therapy
• Regular communication with family

58. WHAT CAN LAW ENFORCEMENT AND
OTHER FIRST RESPONDERS DO?
• Debrief with a colleague or therapist
on a regular basis
• Always work with a team and know
when to be a hero
• Observe safety precautions at all
times, for yourself and others
• Know when to call for help
• Be CPR certified
• Learn when and how to
administer naloxone

59. WHAT CAN COMMUNITIES DO?
Hold Community Meetings Create Social Groups Expand Community
Services
Reach Out to Neighbors Hold Community Wide Events –
Sing, Dance, Play Together

60. HOW DO WE MOBILIZE
INDIVIDUALS, FAMILIES
& COMMUNITIES?

61. LINC®
COMMUNITY RESILIENCE
Community & Family Level

62. LINC® COMMUNITY
RESILIENCE
LINC Community Resilience uses a 3-stage
process to empower the community and to
reduce long-term professional involvement:
1. The community comes together to share their
history, traditions, and current situation
(typically traumatic event, increase in problems,
or mass disaster, etc.)
2. The community selects Community Links who
lead them to establish clear goals and turn
these into small workable tasks with committed
work groups
3. The community takes over the process when
the outside professionals withdraw
Landau, 2004, 2007, 2011

63. • Elicit the invitation, authority, permission and
commitment of the community
• Provide the process – let the community
generate content and goals that relate directly
to their future directions and best interests
• Turn goals into realistic tasks and practical
projects, building on existing resources
• The more peripheral the Interventionist(s), the
more successful the program and community
• We tread lightly leaving no footprints while the
community takes credit for change
LINC®
COMMUNITY
RESILIENCE
(CONT.)

66. PYRAMID OF PREVENTION &
INTERVENTION PLANNING
Landau, 1990
Knowledge
Authority
Mission
Change
Makers
Special Skills
Leadership
Context
Neighborhood
Motivation
Support
Invitation
Permission© 1999-2018 Linking Human Systems, LLC

67. BUILDING RESILIENCE THAT CAN BE SUSTAINED
OVER TIME WITH MINIMAL PROFESSIONAL
INVOLVEMENT
3-stage process:
1. The community comes together to share their
transitional pathway
2. The community selects community links who lead them
to establish clear goals, and turn them into small
workable tasks with committed work groups
3. The community takes over the process when the
interventionists withdraw
© 1999-2018 Linking Human Systems, LLC

68. SCRIPTS, THEMES, STRENGTHS, RESOURCES
• With song we heal our wounds
• Singing music and dancing
• Strong family values
• Connectedness
• Preservation of culture and language
• Protection and safety in the family
• Adaptability
• Closeness to the family
• Sense of unity rather than division
• Capacity to organize
• Religion and religious tolerance
• Education
• Flexibility and survival skills
• General enthusiasm and optimism
• Open dreams
• Honoring true worth
• Loyalty to family and community
© 1999-2018 Linking Human Systems, LLC

69. PRIORITIZING GOALS AND SETTING TASKS
1. Use singing, music and dance, help children to learn about the homeland
and identity and cultures. Using preservation of culture and language to
help children learn about homeland and identity
--Raise children's’ sense of pride - take them to cultural events, bringing other children
along, and then expanding into community
2. Be a role model for or children, raise children to be role models for other
children using adaptability and finding education by using education and
strong family values
--be an advocate for other families, with parent teacher association
3. Contribute to immediate then to larger family then community by using all
resources
--teaching sense of unity and tolerance© 1999-2018 Linking Human Systems, LLC

70. PRIORITIZING GOALS AND SETTING TASKS
CONT.
4. Use all resources particularly family connectedness and strong family
values sense of unity rather than division to talk about grief rather than
storing it for generations to come
--Encourage members of own family and extended family to talk about
loss and grief and any stress. Then spread to other families and join
together to talk on a community scale.
5. Help from international community for Kosovar Albanians everywhere,
using capacity to org and unity rather than division
--Join community by making a party, and write an article about the
community to invite leader from other communities, and tell to media. To
do this we need to have a team or a group© 1999-2018 Linking Human Systems, LLC

71. PRIORITIZING GOALS AND SETTING TASKS
CONT.
6. Develop and find facilities to work with children and families affected by
trauma using family and community links
--Identify family link to act as mentor
--Find community link who will find professional help for kids in society
because family doesn’t know where to look
7. Raise children to serve as role model for other children using education,
and adaptability
--Set boundaries and clear guidelines differently for discipline. Child
has to learn about education and take full advantage. Find good school
& extracurricular activities
© 1999-2018 Linking Human Systems, LLC

72. LINC® EXAMPLE 1:
COMMUNITY & FAMILY
Community Resilience: 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

73. 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 schizophrenics and families: 98%
Agani, Landau, & Agani, 2010; Weine, et al., 2005

74. LINC® EXAMPLE 3:
COMMUNITY & FAMILY
Community Resilience: Aurora, CO 2015-2017
• Focus: Enhancing positive connectedness across community
• Family/Community Links: Professional and lay members of community
• Results:
• Community is working together across racial and ethnic lines
• Involving all sections of the community including police, journalists, first
responders, refugees, immigrants, business owners
• Currently building a coordinated community story about their history and their
future hopes and dreams

75. LIFE®
(LINC® FAMILY EMPOWERMENT)
Group & Family Level

76. LIFE®
(LINC® FAMILY
EMPOWERMENT)
Group and Family Intervention
• Pilot studies: Taiwan and Rochester, NY,
STD/HIV/AIDS prevention; The Bronx,
reducing abuse in women and preventing
STD/HIV/AIDS in women and families
• Focus: 1) HIV+ person and family, 2) parents
and family involved in domestic violence, and
3) domestically abused minority women
• Links: Troubled person serving as a Link to
family and community
• enhance positive connectedness by
changing perception of vulnerability to one
of resilience
• provide psycho-education
Landau, Mittal & Wieling, 2008

77. LIFE®
NIMH STUDY
Project SUPPORT: Reaching Healing and
Recovery Through Love, Hope and Respect
• Focus: Abused inner city minority women
• Aim: Reducing risk for HIV/AIDS infection and
Reducing frequency and intensity of intimate
partner violence (IPV)
• Links: Abused women serving as Links to their
families
Data showed:
• Increase in positive conversations with family
members and interpretation of family stories
• Increased sense of self worth and self advocacy
• Increase in condom use
• Increase in conversations related to the practice of
safer sex with sexual partners
• Women experienced reductions in physical,
emotional and sexual violence
Mittal, et al. (2016)
NIMH KO1.
PI: Mona Mittal, PhD.
University of Maryland, College Park

78. ARISE®
COMPREHENSIVE
CARE WITH
INTERVENTION

79. THE ARISE® MODEL:
BASED ON TRANSITIONAL
FAMILY THERAPY
Transitional Family Therapy is
an integrative approach that
considers:
• Here-and-now and “why now?”
• Intergenerational family and
contextual history, themes,
scripts, stories, strengths
• History of the family and their
context. (Ecosystem)
Landau, 1982; Landau-Stanton, 1986; Seaburn, Landau-Stanton, &
Horwitz, 1995

80. ARISE®
PHILOSOPHY
We believe that
individuals,
families and
communities are:
• Intrinsically healthy and
competent
• 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

81. ARISE®
PRINCIPLES
Recovery and
healing are
based on:
• Empowering family, community, and natural support system
• Mobilizing and reconnecting the extended natural support system
• Reinforcing connection to family- and culture-of-origin
• Focusing on individual and family healing and recovery
• Removing the “we/they” dichotomy

82. ARISE® COMPREHENSIVE CARE WITH INTERVENTION:
• Focus: Individuals and families suffering from any progressive, relapsing,
chronic and/or life-threatening illness
• First Caller/Contact: Concerned family member, other support system member,
or concerned professional
• ARISE Support Network: Members of nuclear family, extended family, friends,
community members, and relevant professionals
• ARISE Comprehensive Care:
• Begins right from the First Call or contact with the First Caller
• Continues for a minimum of 6-12 months
• May continue for several years in the case of serious mental illness and/or
dual diagnosis
© 1999-2018 Linking Human Systems, LLC

83. NIDA RESEARCH OUTCOME DATA
Results of original ARISE NIDA study for substance abuse, replicated in the
real world for substance and process addictions:
• Treatment entry:
• 50% entered treatment within 1 week (First Call or First Meeting)
• 76% within 2 weeks
• 83% within 3 weeks
• Informal follow up at 6 months: 96% entered treatment
• Most significant predictor: the more members of the support system involved,
the better the outcome
• Real world replication: 61% sober at 1 year with additional 10% improved
Landau, et al., 2004

84. Preliminary Data: Brandeis Independent Evaluation
of ARISE® Service at SSTAR and Gosnold
• 2.5 years
• 419 families
• Over 60% successfully engaged through ARISE Intervention and
retained in treatment for ARISE Continuing Care
• Cost effective and efficient
• Family members and addicted individuals spoke highly about ARISE
Emsellem & Paull, March 2014
© 1999-2018 Linking Human Systems, LLC

85. FERNANDEZ, BEGLEY & MARLATT (2006),
IDENTIFIED KEY ARISE SUCCESS FACTORS
• The Intervention Network remains involved in collaboration
throughout intervention, treatment & early recovery
• The process relies on the inherent strength, motivation, and
resilience of the family
• The focus is on individual AND family recovery and healing
• Individuals are invited and motivated to enter and participate actively
in treatment
© 1999-2018 Linking Human Systems, LLC

86. Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI
ARISE® Network
www.ARISE-Network.com
303-44-3755
HELPING FAMILIES AND
COMMUNITIES ACCESS
RESILIENCE TO PREVENT MENTAL
ILLNESS AND ADDICTION
FOLLOWING MASS DISASTER