Substance Abuse Group Project

An estimated 23.5 million individuals in the United States suffer from drug
abuse (National Institute on Drug Abuse, 2011). Over 88% of those admitted to
publicly funded substance abuse treatment programs were 20 or older, indicating
that a large majority of drug abusers are adults (National Institute on Drug Abuse,
2011) . Although the cost of drug abuse in the form of damaged relationships,
unfulfilled dreams, and human suffering is incalculable, the societal cost for drug
abuse is enormous, with an estimated $428 billion annually in American drug abuse
costs related to crime, lost work productivity and healthcare. (National Institute on
Drug Abuse, n.d.)

Substance abuse is highly comorbid with other mental health issues,
including eating disorders, mood disorders, anxiety disorders, schizophrenia, bipolar
disorder, and depression (Grant et al., 2004; Holdcraft, Lacono, & McGue, 1998;
Linton, 2005). Furthermore, among all mental disorders, substance abuse has the
highest mortality risk (Harris & Barraclough, 1998). Overall, there is a clear need for
effective treatments and interventions for adult substance abuse, both for the benefit
of substance abusers themselves and society at large. Hence our substance abuse
group treatment plan is intended for the adult population.

The most common practice for treating people suffering from substance
abuse is through group counseling (Panas, Caspi, Fournier, & McCarty, 2003).
Although there have been inconsistent results concerning what type of group therapy
is most efficacious overall it has been supported that, in comparison to those who
undergo individual therapy, those who engage in group therapy have a better
outcome after treatment (Panas et. al, 2003). It is believed that the socially
supportive environment offered through a group significantly aids in helping
members avoid relapsing (Panas et al., 2003) There are a plethora of empirically
supported modalities utilized in group substance abuse counseling, including
Cognitive Behavioral Therapy, coping skills therapy, disease and recovery therapy,
and Alcoholics and Narcotics Anonymous (Panas et al., 2003).

From the spectrum of group treatments, we are interested in a group
structure like that of A.A., a 12-step program. A study by Ouimette et. al (1997)
compared the effectiveness of 12-step and cognitive-behavioral group treatments for
substance abuse. The study found that patients from the 12-step programs were
more likely to be abstinent than patients from the cognitive-behavioral programs at 1-
year follow up (Ouimette et. al, 1997, p.235). Moreover, the estimated odds of being
abstinent were 1.54 times greater for the 12-step program. Given its superior
efficacy, the 12-step treatment model is the basis for our group treatment plan.

For our treatment population, we specifically chose adults with parents who
abused alcohol. Parenting and familial influences on substance use and substance
use disorders (SUDs) are important areas of consideration in the development of
treatment interventions (Chassin and Handley, 2006, p. 135). Exposure to traumatic
experiences, especially those occurring in childhood, has been linked to SUDs
(Khoury, Yilang, Bradley, Cubells, & Ressler, 2010). A study conducted in Grady
Memorial Hospital in 2010 demonstrated a strong link between childhood trauma
and SUDs (Khoury et al., 2010). Furthermore, children of alcoholics seem to have
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lower self-esteem, in part because the family they live in is less cohesive than
nonalcoholic families (Bijttebier, Goethals, and Ansoms, 2006, p.129). In light of this
evidence, which speaks to the importance of family influence on SUDs, we believe a
focus on second-generation substance abusers will enable a tailored and thus more
effective approach to treating substance abuse in this population.




OBJECTIVES
1. Foster holistic awareness of self pertaining to substance abuse.
2. Cultivate a safe group environment in which members can receive social support.
3. Provide psychoeducation on drug abuse, the process and challenges of recovery,
coping skills, and environmental considerations.
4. Prepare members to begin the 12-step program.

SESSIONS:

Orientation (1st session):

Introduce self and co-counselor.

Icebreaker: Everyone take a notecard from the pile in the middle. On it is a question
you'll need to answer by talking to the other members of the group. Talk to each
person in the room, introducing yourself and asking any questions as needed. Youll
have 15 minutes before we move on.

Example questions on notecards -- Who in the room has the most unusual hobby?
Who in the room has traveled the farthest? Who in the room has the biggest family,
including pets? Who in the room has the most unbelievable story? Who in the room
is the best whistler? Who in the room can name the most celebrities whose names
start with S?

Processing: When finished with the previous activity, go around in a circle and have
members say their names, where they're from, and what they discovered (the
answers to the question on the notecard they drew).

Describe the group. Specifically, give an overview of the next six sessions, and talk
about the objectives of the group. Psychoeducate on the effectiveness of group
counseling and the 12-step program for treating substance abuse. Psychoeducate
on how to get the most out of the group counseling experience, including listening
when others speak, respect for the other group members, not interrupting, not
smoking in session, participating in activities, and being positive. Also discuss
expectation for attendance of all group sessions except in the case of an emergency;
not using any substance for at least 24 hours before a session; and confidentiality
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agreement among group members. Ask if the group would like to propose and vote
on any rules not already stated.


Skill-building / Awareness Activity: Ask the group member to the counselor's left to
share a story about something interesting or funny that happened to them in the past
year. The group member to their left is asked to role-play a disrespectful way to treat
that group member either not listening, interrupting, responding with disrespect,
etc. Then the two are asked to switch roles. This continues until everyone has
participated.

Concluding activity: Ask group members to share both what makes them feel doubt
or fear about recovering from their drug addiction, as well as what makes them
hopeful they can change and recover.

Processing: Reflect feelings. Point out overlap and similarities in group member
responses, and ask other group members if any of them feel similarly after a
member has shared. Acknowledge that everyone has doubts, but also that everyone
present must have hope to have joined the group and come at all. Emphasize that
hope is a motivator and should be nurtured, hence the importance of maintaining
positivity and attending all group sessions.

Materials Needed
1. A note card for each group member with a question written on it.

Story Time (2nd session):

Opening Activity: Go around in a circle and have all group members give a brief
history of their substance abuse (the drugs they abused and for how long) and say
why they decided to join the group.

Processing: Point out commonalities and acknowledge differences. Emphasize
singular goal of overcoming drug addiction.

Awareness Activity: "Think about your past. What was life like before you were
abusing drugs? How did it change once you started abusing drugs? As you consider
the changes in your life, what do you feel is missing, and what do you think you
might gain by being abstinent? After letting the group reflect on these questions for
a minute or two, ask group members if they would be willing to share. Depending on
degree of voluntary participation, the group counselor may wish to go around in a
circle and have everyone share.

Concluding Activity: You've heard a lot of personal stories today and you've
reflected on your own. How has hearing these stories, and reflecting on your own
story, changed you today, or how do you think this will change you?

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Session 3: Triggers and Cravings
Goals: Identify triggers, prevent exposure, and begin to learn to cope differently with
triggers than in past.
1) Opening Activity
-Visualization: Lead members through a visualization concerning a period in which
they used regularly. Ask them to settle and get comfortable, close their eyes, and
take 5 deep breathes. Tell them to recall a time where they were about to use and
then proceeded to do so. Ask questions, leaving space in between each.
-What is happening right now?
-Where are you? How did you get there?
-What exactly are you doing?
-What do you see or notice about what is around you? Who is near you?
-What do you hear? Do you notice any noises?
-What do you smell? Does any odor remind you of anything or anyone?
-What are you touching? How does it feel?
-Notice your body; any sensations or physical changes you experience.
-Where are you emotionally? Has that changed?
2) Process the visualization: why could it be important to take note of all these
factors? What stood out to you that you may not have noticed before?
***Please note, this is done at the beginning of the session to allow ample time to
process; using technique like this could evoke strong responses in the members
towards the desire to use.
3) Define triggers and the importance of identifying them; explain how they can lead
to cravings, which can lead to use.
4) Discuss external and internal triggers: Worksheets ERS 2A and 3A
-Have members share their top ranked triggers
5) Trigger-Thought-Craving-Use
-Explore the connection between triggers, thoughts, cravings, and use
-Introduce Thought Stopping Technique with Worksheet ERS 1C
-Discuss thoughts and feelings about different techniques (visualization,
relaxation, snapping, calling someone)
6) Wrap Up
-Have each member anticipate a scenario in which they encounter a trigger,
possible thoughts that might arise, and the cravings that will come AND how they
could use one of the Thought Stopping techniques.

Session 4: Physicality and Early Challenges
Goals: Gain better awareness about what the body experiences in early phases and
the challenges related to early recovery.
1) Opening Activity
-Have each member share a negative and a positive experience from their last
week; facilitate members towards encouraging and supporting one another.
2) Discuss the physical recovery process
-Explain that recovery takes a physical toll on the body. People experience a range
of symptoms from withdrawal as their bodies adjust as a normal part of the process.
(Low energy, depression, anxiety, headaches, etc.)
-What are the members experiencing now? Normalize their experiences and
facilitate members relating to one another.
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3) Cycle of Recovery
-Segway into considering how the process in terms of stages
-Handout and use Worksheet ERS 5 to summarize stages, write them on a white
board or somewhere they can be seen.
-Discuss where they are in their process; what have been their experiences thus far
and what they anticipate.
4) Common Challenges of the Early Process Activity
-Continuing with what they anticipate, transition into addressing the most common
challenges in early recovery. Using Worksheet ERS 6A as a guide, on 5 sheets of
large paper, write each challenge: friends and associates who use; anger, irritability;
substances in the home; boredom, loneliness; special occasions.
-Briefly discuss each challenge and hang the 5 sheets around the room. Have
members start at different locations and write different solutions or coping skills they
brainstorm for each challenge; rotate until everyone has visited each challenge.
-Ask what will be most challenging for their current state of being? What solutions
will they try and when?
5) Wrap Up
-Have each member describe how awareness of their bodies impacts their progress
through recovery and one new strategy they plan on using once they leave group.

Session 5 Group Activity plan
The focus of todays session is on the etiology of substance abuse and emotions
associated with addiction.
Ice Breaking Activity
Members of the group will write and talk about their first experience with using
substances. Write out answers to the following questions, then present in group:
What was the first substance you used?
How did you come to possess that substance?
What was happening that day?
What emotions you were feeling prior to using?
What emotions were you feeling the next day or after the high came down?
Awareness Activity- Lifeline of an Addict
The purpose of this activity is to demonstrate how interactions with parents,
hereditary factors, and messages from society play major roles in the development
of addiction.
Materials needed for Activity
1. A piece of loose leaf paper
2. A pencil or writing utensil
3. 3-4 volunteers from the group
For this activity, three members of the group will be selected to represent the
developmental stages (child, teenager, and adult). These three members will spread
out in a line across the room. The member representing the child will sit on the floor,
the member representing the teen will sit in a chair, and the member representing
adulthood will stand. A fourth volunteer or the group facilitator will briefly represent
the parent speaking to the child. A role play will ensue where an alcoholic parent
receives a call from the childs school regarding the childs behavior. The volunteer
parent will then speak to the child in an upset manner about their behavior and
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worthlessness. After this interaction the group facilitator will stop the role play and
ask the rest of the group to identify what emotions the child is feeling at this time,
and what cognitions may be associated with those emotions. The emotions will be
written down on a sheet of paper and held by the child volunteer. The facilitator will
help identify messages being learned from the parent such as means of coping
using alcohol or substances, how to handle frustration, and styles of
communication. The facilitator will move on to identifying adolescence as the age of
onset for substance abuse as a means for escaping emotions experienced in
childhood. Group members will be asked to identify messages and expectations
from society and family being told to the teenager, and reasons for inability to meet
expectations. The facilitator will speak on the effect of being unable to meet
expectations compound emotions felt by teen and correlate with the increase in
substances used to suppress heightened emotional states. The facilitator will
educate the group on the effects of drugs on the normal developmental process for
individuals. The facilitator will move on to point out upon reaching adulthood a cycle
of deceit, rationalization, and public persona has been used to mask the emotions
still felt from childhood. The facilitator will inquire from group members about what
messages from society and family members that the adult substance abuser is
receiving. Does the adult addict likely feel capable of meeting expectations? What
level of functioning is the adult addict likely operating at?
Concluding Activity:
Group members will process how they identify with the awareness activity
individually.

Session 6 Group Activity Plan
The focus of todays session will be on introducing the core concepts of the 12-step
program.
Opening Activity:
Group members will be informed of and recite the 12-steps and Serenity Prayer.
12 Steps
1. We admitted that we were powerless over alcoholthat our lives had become
unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to
sanity.
3. Made a decision to turn our will and our lives over to the care of God as we
understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature
of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed and became willing to make amends
to them all.
9. Made direct amends to such people wherever possible, except when to do so
would injure them or others.
10. Continued to take personal inventory, and when we were wrong, promptly
admitted it.
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11. Sought through prayer and meditation to improve our conscious contact with
God as we understood Him, praying only for knowledge of His will for us and the
power to carry that out.
12. Having had a spiritual awakening as a result of the steps, we tried to carry this
message to alcoholics and to practice these principles in all our affairs.
The Serenity Prayer
God grant me the serenity to accept the things I cannot change, the courage to
change the things I can, and the wisdom to know the difference.
Awareness Activity:
Materials Needed:
1. Paper for each group member
2. A writing utensil for each group member
Members will identify a step that seems the most difficult to them at this
time. Members will process what key words in that step stand out as the most
difficult, and how that step has been difficult for them in the past.
Concluding Activity:
Members will be asked to envision their addiction as a person or entity speaking to
them. They will write out a monologue from the perspective of their addiction and
what it is saying to them. Members will then read and process what their addiction
said to them in the group. The facilitator will help group members identify similarities
in addiction monologues, and garner support from other group members about how
to combat the enticements of addiction.
Issues in Application
Several issues of practicality and implementation should be considered
when following this plan. First, the group calls for a particular qualification
beyond dealing with substance abuse: they must have also had parents or
guardians who abused substances as well. We recognize this potentially
narrows the scope when conducting pre-group screening and may increase the
difficulty of arranging such a group in given locations. Additionally, because that
is a shared component among all members, counselors should be aware of
cultural considerations concerning how members choose to express their
experiences and feelings.
As with other substance abuse groups, some challenges counselors could
anticipate members coming to group while under the influence. It will be up to
the counselor to determine whether or not the member should participate for that
session. Also, the counselor should monitor the group for war stories: redirect
from members glorifying their drug use. Similarly, as people are honest about
their experiences those details could potentially act as a trigger for
others. Because of the beginning nature of the group, members who are in the
process of first maintaining sobriety could be particularly anxious, disruptive, or
unstable. This approach is more CBT and psychoeducationally directive than 12-
step self-help support groups, like A.A. Hence, the counselor may encounter
resistance from those who are used to a more informal structure. If there is
involvement with legal trouble among group members, they could be particularly
resistant to the counselor as a leader. Also, there could be further resistance to
the spiritual component of the 12-step model that is introduced during this initial
phase.
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As previously described, this plan is for the first of three phases of
treatment. This first phase focuses on awareness and preparation for the later
phases, which would actually go through the 12-steps. That being said, it was
still a challenge to condense pertinent information into six sessions. There was a
plethora of other activities and topics that could have been included within the
realm of awareness. Counselors using this plan may feel a topic needs to be
addressed to aid in further awareness and are encouraged to add/modify as
needed.

RESOURCES
WORKS CITED

Resources for Counselors

Center for Substance Abuse Treatment. (2006) Counselors treatment manual:
Matrix intensive outpatient treatment for people with stimulant use disorders. (HHS
Publication No. SMA 08-4152). Rockville, MD: Substance Abuse and Mental Health
Services Administration.

Chassin, L., & Handley, E.D. (2006). Parents and families as contexts for the
development of substance use and substance use disorders. Psychology of
Addictive Behaviors, 20(2), 135-137.

Harris, E. C, & Barraclough, B. (1998). Excess mortality of mental disorder. British
Journal of Psychiatry, 173, 11-53.

Holdcraft, L. C., Iacono, W. G., & McGue, M. K. (1998). Antisocial personality
disorder and
depression in relation to alcoholism: A community-based sample. Journal of Studies
on
Alcohol, 59, 222-226.

Khoury, L.,Tang, Y.L.,Bradley, B., Cubells, J.F.,& Ressler, K.J. (2010). Substance
use, childhood traumatic experience, and posttraumatic stress disorder in an urban
civilian population. Depression and Anxiety, 27, 1077-1086.

Linton, J. M. (2005). Mental health counselors and substance abuse treatment:
Advantages, difficulties, and practical issues to solution-focused interventions.
Journal of Mental Health Counseling, 27, 297-310.

Ouimette, C., Finney, J.W., Moos, R.H. (1997). Twelve-Step and Cognitive-
Behavioral Treatment for Substance Abuse: A comparison of treatment
effectiveness. Journal of Consulting and Clinical Psychology, 65(2), 230-240

Panas,L., Caspi, Y., Fournier, E., & McCarty, D., (2003). Performance measures for
outpatient substance abuse services: Group versus individual counseling. Journal of
Substance Abuse Treatment, 25 (4), 271278.
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Resources for group members
Bijttebier, P., Goethals, E., & Ansoms, S. (2006). Parental drinking as a risk factor
for childrens maladjustment: The mediating factor of family
environment. Psychology of Addictive Behaviors, 20(2), 126-130.

Bonn-Miller, M.O., Zvolensky, M.J., & Moos, R.H. (2011) 12-step self-help group
participation as a predictor of marijuana abstinence. Addiction Research & Theory,
19(1), 74-86.

Grant, B. F., Stinson, F.S., Dawson, D.A., Chou, S.P., Dufour, M.C., Compton, W.,
Pickering, R.P., Kaplan, K. (2004). Prevalence and co-occurrence of substance use
disorders and independent mood and anxiety disorders: Results from the National
Epidemiologic Survey on Alcohol and Related Conditions. Archives of General
Psychiatry, 61(8), 807-816.

National Institute on Drug Abuse (2011). Drug facts: Treatment statistics. Retrieved
from http://www.drugabuse.gov/publications/drugfacts/treatment-statistics

National Institute on Drug Abuse (n.d.). Trends and Statistics. Retrieved from
http://www.drugabuse.gov/related-topics/trends-statistics