Substance Abuse Support Group Substance

Substance Abuse Support Group

Substance abuse is a problem that has plagued humankind since man discovered that some substances can alter body chemistry. Various different types of groups have been utilized to try to treat substance abuse, with varying levels of success. The most commonly used groups to treat addiction are support groups, behavioral/cognitive groups, and 12-step programs. Cognitive and behavior therapy can include things like learning to talk about experiences, learning non-drug management skills, identifying problematic behavior, recognizing cravings, establishing methods to deal with cravings (Genetic Science Learning Center, 2011). However, behavioral-cognitive therapy is not generally successful all on its own. Addiction is a notoriously treatment-resistant condition. While almost all treatment programs have some rate of success, treatment success rates for all substance abuse rates are lower than one would desire. In fact, many people believe that relapse after recovery is one of the hallmarks of addiction, and that a treatment program where an addict might have an occasional relapse is not necessarily to be considered an ineffective program.

Moreover, drug addiction has at many times been confused with a lack of willpower. While it is true that, "Self-regulation and impulse control around the person's drug of choice are difficult for people with addictions. However, often these same people retain impulse control in most or all other areas of their life. This is truer with drugs like alcohol and less true with drugs like methamphetamine. Again, this difference is thought to be related to how stimulating the drug is to the reward circuits (dopamine tracts) in the brain" (Nash & Johnson, 2011). However, those who are not addicts or familiar with addiction oftentimes fail to understand the complexity of drug addiction and simply think that if an addict willed himself sober, he would be sober. That type of thinking betrays ignorance about the true nature of addiction:

Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person's ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior (National Institute on Drug Abuse, 2009).

Because drug addiction is such a complex disease, it involves a complex treatment. Simply getting an addict sober is not the most challenging part of the process; it is keeping the addict sober that presents the major challenge for the addict and for workers. "Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences" (National Institute on Drug Abuse, 2009). In fact, over the course of recovery and maintenance, an addict may need to access various different resources to help deal with the particular challenges he or she faces during that stage of the disease. Components of effective treatment programs will help the addict stop using help maintain a drug-free lifestyle, and move the addict from dysfunctional to functional roles in the family, work, and society (National Institute on Drug Abuse, 2009). Therefore, different types of groups may be necessary at different stages of recovery.

One of the challenges with addiction recovery is that the model that many people consider ultimately successful, the 12 step program, has not been very effective. While the 12-step programs spread the belief that anyone who follows those programs will be able to achieve lifelong sobriety, the studies belie that reality. According to A. Orange, "Nothing could be further from the truth. Even the most ardent true believers who will be honest about it recognize that A.A. And N.A. have at least 90% failure rates. And the real numbers are more like 95% or 98% or 100% failure rates. It depends on who is doing the counting, how they are counting, and what they are counting or measuring" (Orange, 2011). The spontaneous remission rate for alcoholics and drug addicts, in other words, the percentage of people who become sober without any remission, is approximately 5% (Orange, 2011). Because the 12 step programs are not generally more effective than spontaneous remission rates, it is impossible to see them as effective.

Psychoeducational groups

One type of group that has been used to help treat addiction is the psychoeducational group. Psychoeducational groups differ from traditional support groups and cognitive/behavioral groups in that they are less about support and more about education. "Psychoeducational groups provide information designed to have a direct application to clients' lives -- to instill self-awareness, suggest options for growth and change, identify community resources that can assist clients in recovery, develop an understanding of the process of recovery, and prompt people using substances to take action on their own behalf, such as entering a treatment program" (Center for Substance Abuse Treatment, 2005). These types of groups are going to be the most helpful for addicts considering recovery and for addicts in the earliest stages of recovery, but could also be helpful for people in later stages of recovery looking for information. For example, a psychoeducational group could be targeted towards recovering addicts who are facing challenges transitioning from the addictive lifestyle to a mainstream lifestyle, and are seeking ways to make themselves more marketable.

Group mission statement

The first purpose of this group is to expand awareness about the various consequences of substance abuse, including the legal, medical, psychological, and behavioral consequences that the addiction has on them and on their family (Center for Substance Abuse Treatment, 2005). The second purpose of the group is to help motivate addicts to enter into recovery (Center for Substance Abuse Treatment, 2005). The third purpose of the group is to challenge the denial that accompanies substance abuse, whether it is denial about having a substance abuse problem or denial about how that problem impacts the addict and his loved ones (Center for Substance Abuse Treatment, 2005). The final purpose of the group is to provide education to family members, and help them understand substance abuse and its treatment (Center for Substance Abuse Treatment, 2005).

Marketing

One of the problems with marketing addiction treatment programs to addicts is that there is no single place that addicts congregate. While bars may be a good location to find alcoholics, the vast majority of alcoholics are not drinking in bars but in private locations. Moreover, bars are highly unlikely to allow anyone to market addiction recovery programs from the bars, since that would help eliminate their customer base. Recognizing that addiction pervades all areas of society, it becomes even clearer that there is not a single way to market to addicts. Looking at places where one is likely to find addicts, such as through probation officers, can make it more difficult to judge the efficacy of a particular intervention, because many of them may be ordered into other treatment programs or be unable to complete small group programs because of periods of pending incarceration. However, one way to find people with substance abuse problems is in the pre-trial period for people charged with substance-related crimes, from drug crimes to driving while intoxicated. Therefore, the program will be marketed to local defense attorneys, particularly court appointed defense attorneys, as a way to help their clients get educated about abuse and motivate them to enter substance treatment programs, which may help them when they face trial.

Structure

The group will be much more tightly structured than the average addiction-recovery support group. It will have a set start date, a set number of meetings, and a determined ending date. Moreover, each session will have a set agenda, during which the facilitator will teach participants about a different aspect of addiction. Group members will be expected to attend each session, and, if unable to do so, attend a make-up session before the next regularly-scheduled session.

Location

The group will be held at a local church that has agreed to allow one of its recreational areas to be used for the meetings. This location is actually not ideal. There is an overwhelmingly religious connotation to many of the 12-step programs, which many addicts have described as off-putting. Therefore, having the group at a church might reinforce the idea that it will involve some type of spirituality or religious education and might actually keep some members from attending the group. This is a real concern. If the potential members actually come to the meetings, they will see that the meeting space is not actually in the church. The church has an annex across the street from the church location with two church buildings that have very little indicia of religious affiliation. The room that the church is permitting the group to use has large couches in a living room area, along with a large wall with a whiteboard and projectors so that the facilitator has a place to put on presentations. There is a crucifix in the room and a bookshelf containing Bibles and other religious texts, but the room is otherwise free from religious decorations.

Number of members

The desired size for the group is 10 members. A group with 10 or fewer members is small enough to allow for individual attention, but large enough to provide for some diversity and anonymity in the group setting. However, if there are not sufficient referrals to meet the desired 10-member group size, the group should be able to function with as few as 5 members. Moreover, if there is a greater interest in the group, it should be able to function with up to 15 members. Therefore, group size is somewhat flexible. In addition, some of the weeks will involve education for family members, and attendance is expected to double or triple on those nights.

Open or closed

This group will be closed, which is another feature separating it from the standard 12-step addiction treatment program. The point of the group is education and the curriculum builds from week-to-week. Allowing a participant to join once the group was already in progress would not only deprive that member of the full group experience, but might also prove disruptive to existing group members.

Selection of group Members

The marketing method will help determine selection of the group members. Because potential members will have some legal problems that are linked to addiction, there will be more than a client's perception that he or she has a substance abuse problem recommending them to the group. In fact, the participants will not need to be able to acknowledge having a problem in order to be in the group. The facilitator will be working with the assumption that people who do not have drug or alcohol abuse problems are not going to engage in criminal behavior linked to drugs or alcohol. This may not be true in all cases, but illegal behavior related to substances is an indication of maladaptive behavior.

Duration

The group will be held on Thursday nights from 7pm to 9pm. The time has been chosen intentionally because the church location has a 12-step support program available from 9pm to 10pm in the same location, and many of the desired members will be attending that program on the advice of their attorneys. The group will last for a set period of four weeks, with a different learning topic scheduled for discussion each week.

Cost

The group will be free of cost. There is minimal overhead to the facilitator, because the church has offered use of the meeting space at no-cost. Furthermore, the church will actually provide refreshments including coffee, juices, and sweets, for the meetings.

Type of therapy

The type of therapy that will be used in the group is psychoeducational group therapy. This therapy differs significantly from traditional group therapy in that it is not aimed at providing support, but aimed at providing education. This difference will be made clear to group members during the first meeting. However, the temporal proximity to the standard 12-step program gives the participants the opportunity to seek out a traditional support group if that is something that they feel they need in order to achieve recovery. The goals of the therapy are: to teach people the signs of addiction, help deal with denial about addiction, teach why recovery is important, suggest treatment options, and identify other community resources that exist to help the addict.

Treatment plans

The first week introduction would focus on distinguishing between substance use and substance abuse. It would talk about the fact that any person who has encountered a legal problem related to substance abuse has demonstrated a certain lack of judgment in the substance use that suggested a substance abuse problem. The facilitator would also ask the participants to consider other instances in their lives when substance use had interfered with life functioning. The goal of week one would be to help silence the objections of the people who really did not think that they needed to be attending the group.

The second week would be a family week and family members and addicts would learn more about the different signs of addiction. It would discuss physical and emotional signs of addiction in the addict. However, the class would also talk about the signs of addiction in the family and the impact that addiction can have on the friends and family members of addicts. Many times family systems are either in denial of the addiction or are actively working to help the addict maintain the addiction, and the group lessons would be aimed at informing the families about enabling and teaching them methods of reducing the enabling activity.

The third week would introduce different methods that addicts can use to help them become sober and maintain sobriety. It would cover the broad range of addiction-interventions, from medication to residential treatment programs and 12 step programs. Moreover, the educational aspect would give the pros and cons of the different programs. For example, heroin addicts are frequently placed on methadone, which is, in and of itself, an addictive drug. However, its impact is far less than the impact of heroin. Giving the addicts a broad range of available interventions will help them decide which, if any, of those interventions are best tailored to their approach.

The fourth week will inform the group about the various community resources available in the specific intervention types. The facilitator will ask representatives from local organizations to come speak to the group and be available to enroll members in treatment programs. The fourth week will also involve administration of the exit interview/survey.

Group facilitator

Because the goal of the group is to educate its members, rather than provide counseling, the facilitator could be either an education professional or a professional counselor, but would ideally, a counselor with education experience. The facilitator should have a broad understanding of addiction and its issues, and comfortable confronting people about denial. Furthermore, the facilitator should have experience with establishing strong boundaries, because the goal of the treatment is not to establish a therapeutic relationship with the clients, but the group setting might encourage clients to try to establish that type of relationship with the facilitator.