- People often wonder why we think group therapy
is an ideal form of counseling
for people with dual disorders.
Well, people use substances in a social context
so it makes sense to treat the substance use disorder
in a social context as well.
The group provides an opportunity for social support,
peer feedback, and modeling of skills to get sober.
Additionally, group treatments
are more economical than individual treatment.
Several different types of groups can be helpful
to clients with dual disorders.
We recommend you set up two separate groups.
An engagement stage group for clients
who are still using substances and aren't yet ready to quit.
And an active treatment group for clients
who have started to cut back and are ready to quit,
or who have already quit using substances
and are in the relapse prevention stage of treatment.
Self-help groups are useful to some clients
who are in the active treatment or relapse prevention stage.
Not all clients benefit from self-help.
Those who are very symptomatic
or those who just don't want to go
should not be forced to go.
To learn more about how to use self-help groups,
you can read the section in the workbook.
Social skills training groups are also helpful
for dual disorder clients
to learn the skills necessary to make sober friends
and to deal with people in high-risk situations.
The high-risk situations could be drug dealers
or friends who continue to
encourage clients to use substances.
You can learn more about how to
conduct social skills training groups
by reading a social skills training manual,
such as the one written by Kim Mueser.
In this video, we will discuss
dual disorder groups in more detail
and then show examples of groups.
A dual disorder group for clients who are in
the engagement or persuasion stage of treatment
is set up to be attractive and helpful to these clients.
The group is brief, supportive, and educational.
The purpose of this group is to help clients
learn about the impact of substance use on their lives
and to examine the pros and cons of their substance use
in a supportive environment.
To ensure that the persuasion dual disorder group
is attractive to clients,
the leaders provide refreshments
and a schedule of fun activities,
such as drawings for prizes.
The leader briefly checks in with each client
and then leads a brief interactive discussion
about substances or other topics of interest.
Although members are not expected to be clean and sober,
nor to attend the group regularly,
the rules and norms of the group are made clear.
They include confidentiality, regular check-in,
and no intoxication or disruptive behavior during the group.
The group is co-led by two people
so that the co-leader can help a
disruptive client leave the group
or help a client in crisis if needed.
Topics for discussion in persuasion groups
include personal and family history
in the form of a genogram,
discussion of personal experiences of substance use,
sometimes referred to as war stories,
decision balances, social skills training,
coping skills training, and health information.
The leaders use simple printed materials
to help clients learn about the topic of the day.
Guest speakers liven up the group
and make it more interesting for members.
Active treatment groups are for clients
who are trying to cut down or stop using substances.
Group leaders expect these clients to be more motivated
and to attend the group regularly.
These groups focus on education and skills building.
The leaders use cognitive behavioral techniques
to help clients cope with the cues
or triggers to use without using.
Leaders of active treatment groups
encourage more peer interaction
then in the engagement groups.
They are very supportive and the leaders actively work
to avoid confrontation of group members.
These groups meet weekly
and are offered in a long-term schedule
that allows clients to attend for years,
if they would like to.
The topics of active treatment groups
are similar to the topics covered in engagement groups,
but are more directly focused on stopping substance use
and avoiding relapse.
Topics include coping with cues or triggers to use
in high-risk situations,
managing emotions, coping strategies,
relaxation skills, and other ways of coping with stress.
The leaders teach clients these and other healthy behaviors,
including dealing with infectious diseases
such as HIV and Hepatitis.
Active treatment groups are an ideal form
for clients to learn and practice social skills
that they can use to help them stay sober.
Helpful skills include starting conversations,
maintaining conversations, expressing negative feelings,
and refusing offers to drink or drug.
Group leaders can help clients
find alternative leisure activities
and develop cognitive skills for sobriety,
such as identifying and challenging
self-defeating thoughts.
Next, you can watch a segment
of an active treatment group
where a group member discusses her recent relapse.
Notice how the group leader uses
reflective listening skills in this group.
Also notice how he elicits feedback
and support from other group members.
He asks the other group members
to describe similar experiences
and he educates the group about relapse
and relapse prevention.
And specifically, he talks about how to keep
a slip from turning into a relapse.
Note that he may have had a different
topic to focus on for the day,
but since the client came in describing her slip,
he took that as an opportunity
to support her and focus on relapse.
- You wanted to share before we got into any of the topic,
and that's fine. As you know,
when something comes up that you want to talk about
that's effected your recovery,
that's an important thing.
So go ahead.
- Well group, I had relapsed three weeks ago.
What happened was I went to a friend's funeral,
a very close friend of mine,
and I went by myself.
I didn't have any support with me.
My mom was busy.
She had to go to a training at her job.
I didn't have no body else to go with me.
I took it harder than I thought I was going to take it.
I thought I was going to be able to go and be alright,
but once I seen him in a casket
it hit me so hard.
It took me for a loop,
so I went out and got a bottle
afterwards
and that started me up.
I drank for three days.
- So you drank for three days straight after that?
- Yes.
And I came up here--
I don't know why I came up here drunk.
It beats me. I don't know what I thought I was doing.
My friend said I said some things to her,
my best friend,
that hurt her feelings.
And Dr. Decoff said I was in her office
and I had no memory of being in her office.
I though it was going to ease my pain
that I was going through
because it really hurt my heart.
- So you were looking to get rid of the pain at that time,
with the alcohol.
What happened when you were drinking? Did it help?
- No. It made things worse.
It made me think about him more.
I can remember sitting on a bridge
telling myself my life wasn't worth nothing.
I wanted to just jump over, but I was a coward.
I couldn't do it.
- [Group Leader] So things got bad for you?
- Yeah.
- [Group Leader] To the point where you felt like
ending your life. - Yeah.
- Let me ask you. Is that what brought you back?
- [Joyce] Probably, yeah.
- As people are listening to what Joyce is talking about,
you're sharing some very painful things
that you've gone through.
Recently, we've been talking about
different stages of recovery.
People have an idea of what Joyce was going through
at that time.
- [Male Group Member] I do.
When I first started cross over, I was suicidal myself.
I was suicidal and homicidal.
I thought the world was coming down on me
and didn't understand me.
I felt like nobody liked me,
I thought I was ugly,
and I thought people were talking about me behind my back.
I don't think you was a coward when you was drunk,
contemplating suicide.
I think what you did was more courageous than ever
because you brought yourself back from the ruins.
Plus you explain to everybody how you feel.
If you kept it bottled up, it could have been worse.
- He was one of my support systems.
In my support system.
He was really good to me.
- [Group Leader] Sounds like he was a true friend.
- [Joyce] I'm going to miss him a lot.
Just like it was yesterday,
I be thinking.
well I guess he in a better place then here.
One day I hope to see him again.
- I'll tell you. What you're sharing,
the issue of losing somebody who is so important to you.
I know that you and I have spent some time
talking about how important he is to you.
That he is somebody who supports your recovery,
and has been with you a long time.
- [Joyce] Over 30 years.
- Over 30 years.
So it is a lot to lose.
It's not uncommon for people
to have a loss to reach out to a bottle.
A bottle, or a drug, or something like that.
Let me ask this, in terms of other group members,
have you ever had a loss, which led to
that urge or that craving, or that desire to use?
- [Joyce] I guess I'm the only one.
I guess I'm the only one.
- [Group Leader] I'm not sure.
It could be that other people are struggling
with talking about some of the experiences.
Bringing up loss is a painful thing, it's a painful process.
Coming in and sharing about what you've been through
is an important piece.
I do want to bring up something that Ray had said.
He talked about you being courageous to come back in.
- I was embarrassed. When I friend told me how I was acting,
I said, "I don't know how I'm going to face them again".
That's what I thought.
I better switch to a Hartford Hospital somewhere.
(laughs)
- [Group Leader] So you didn't have to come and face us.
So how was it facing us now?
- Well I was a little bit anxious
when I first came in last week.
Then I said, "that's where I go for treatment
and I'm going to keep on going.
I'm not going to let that stop".
I talked about it with my counselor over at Blue Hills.
She said, "You know what? You're not the only one.
They know it was the alcohol. It wasn't you".
So that kind of made me have more confidence to come back.
After we all talked, and me and Charlene talked.
She came over here and we talked.
- [Group Leader] So your Clinician came over there,
with you at Blue Hills.
Actually, you bring up one of the things
that often keeps people who relapse active in their relapse.
When you talk about the feeling of shame, in a sense.
You don't want to face people.
You don't want to come back and say that "I had that slip"
or "I said those things that I said that I didn't mean".
Those things are expected.
I do want to ask the other people in the group
if they had that experience.
Can you remember back to a time that you had a relapse?
Who here in this group has had a relapse?
Just a show of hands.
Ever.
[Male Group Member] Ever?
- [Group Leader] Ever.
- This is the conclusion of the evidence-based practice
integrated treatment of co-occurring disorders video.
We're grateful for the help of the many members
of the Implementation Resource Kit team.
As well as the clients, Clinicians,
and other people at the Mental Health Center
of Greater Manchester,
and the Hartford Capital Region Mental Health Center
for all their help with this tape series.