Principles and Practice of Group Work in Addictions

Robert Hill, Jennifer Harris, Robert Hill, Jennifer Harris

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781136709807
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

How can the group setting be used to treat those with drug and alcohol problems?

Many professionals working across a variety of addictions settings find themselves working in groups and tackling complex issues; however, there is often very little initial training or on-the-job support to help them in this challenging task. Principles and Practice of Group Work in Addictions has been written with the aim of addressing the key areas in working with drug and alcohol misuse while providing practical solutions to the more common problems that emerge in group work.

Drawing on the expertise of clinicians who work in the field of addictions, this book offers readers practical advice for everyday practice. Divided into three sections it covers:

• core group work in addictions
• practical issues and solutions to common problems
• specific issues within the field of addictions.

Principles and Practice of Group Work in Addictions is illustrated throughout with practical case examples, providing the reader with an insight into group work in this area. The book will supply guidance for mental health professionals including clinicians, psychologists, nurses and medical staff who encounter group work in addictions for the first time, as well as providing further knowledge and support to those who already work in the field.

Part I

Core considerations in
addictions group work

Introduction to core considerations

This first part of the book, ‘Core considerations in addictions group work’, explores what may be considered the core components of group work when working with individuals with drug and alcohol problems. The first chapter helps to set the scene for the book as a whole by offering readers a firsthand account of the role of groups in recovery. Tim Brown gives a fascinating account of his thinking about group work from multiple perspectives: as a client, as someone undertaking training in drug and alcohol work and currently as a staff member facilitating groups. We hope this ‘insider’ perspective offers some inspiration to those involved in or thinking about group work.

‘Motivation’ might be considered pivotal to our work within addictions, and indeed motivation is a theme that runs throughout the book. Without proper consideration of motivation, all other efforts can fail. Luke Mitcheson and Brett Grellier draw on their extensive experiences to offer a refreshing commentary on motivation, with practical ideas on how to apply motivational interviewing principles to the group setting.

One of the most commonly used approaches to group work is the relapse prevention model developed by Alan Marlatt in 1978, and this has been one of the mainstays of addictions treatments ever since. In Chapter 3, Shamil Wanigaratne and Francis Keaney, both NHS consultants, discuss how our understanding of addiction and relapse prevention has moved forward in the twenty years since the publication of Relapse Prevention for Addictive Behaviours (Wanigaratne, Wallace, Pullin, Keaney, & Farmer, 1990). Reflecting both on their own experience of running groups and on the most up-to-date theory and research, they provide a succinct overview of the field as well as some practical suggestions for those undertaking group work.

In Chapter 4, Martin Naylor and Ryan Little discuss their experiences of promoting physical health within an addictions context. They usefully summarize the policy context of health initiatives before discussing a number of core health-promotion groups for substance misusers. While more emphasis has been placed on health promotion for problematic drug use, the ideas incorporated in this chapter can lend themselves to clients with alcohol problems.

Often individuals in treatment are faced not only with changing their drug and alcohol use but also with the additional task of changing their lifestyle, support network, and self-identity. In Chapter 5, Siobhan Wilson and Claire Parry, both experienced occupational therapists, discuss ways in which groups can help clients to focus on these important questions of life meaning and self-identity in a way that promotes self-understanding, optimism, and the development of positive social networks.

Chapter 6 gives some background to the approach of mindfulness, along with some practical information about how to run mindfulness groups within an addiction service. Robert Hill, Jane Hutton, Marcus Koch, and Ann McDonnell discuss some of the issues that have arisen when introducing mindfulness to clients in an addiction centre, before concluding with suggestions as to how to explore the practice of mindfulness further. All of the authors practise mindfulness themselves and Jane Hutton is an active trainer of both clients and staff in the practice of mindfulness.

Chapter 7 considers how professionals working in addictions services can introduce clients to Twelve-Step approaches. A case example from an inpatient detoxification ward is provided. Andrew Parker, a consultant psychiatrist, provides a very clear overview of Twelve-Step groups and how we as professionals might correct myths about these mutual help groups and support clients to take the best from this valuable resource. A case study from a group he established entitled ‘Mind the Gap’ will, we are sure, provide an excellent template for staff who wish to introduce clients to Twelve-Step groups as well as correcting a number of myths about Alcoholics and Narcotics Anonymous.

Clearly there are a number of other areas that we could have included in a section entitled ‘Core considerations in addictions group work’. Thus, space allowing, we would have included a separate chapter on managing emotions. However, we hope that Chapter 6 on mindfulness and Chapter 17 dealing with acceptance and change provide some insight and techniques for managing one's emotions.

Reference

Wanigaratne, S., Wallace, W., Pullin, J., Keaney, F., & Farmer, R. (1990). Relapse prevention for addictive behaviours. Oxford: Blackwell.

Chapter 1

From patient to practitioner

A personal journey

Tim Brown

Editors’ note

When debating and reflecting on what might be included in this book, we were very keen for readers to have a personal account of what groups can offer clients during their recovery. We are therefore very grateful to our colleague, Tim Brown, who currently works as a substance misuse worker on an inpatient detoxification unit. He generously gave his time to be interviewed so that we might hear about the role that groups played in his journey from service-user to co-facilitator of groups on an Acute Assessment Unit.

* * *

Disposing of the empty bottles became a bit of a problem. I'd go out at night dropping them off into various wheelie bins. I found myself thinking ‘I can't put too many in Mrs So-and-So's this week, otherwise the bin men might start thinking she's got an alcohol problem. How many did I drop in 29’s last week? I don't think I've done 33’s for a while. . .’

These were the words spoken by a client in a support group on the ward I am currently working on. Clients were reminiscing about their day-to-day lifestyles prior to admission.

Ring any bells?

Just a bit. They rang cathedral-sized bells in my head as I was facilitating that particular group. For until about four and a half years earlier it could have been me speaking. Same street numbers, same thoughts, same feelings of furtiveness and guilt. It was the first time since I had completed my training as a substance misuse worker that a client had articulated a situation that I myself had previously been in.

In fact four and a half years ago, I did say those words. In a group. In treatment. And I expected people to laugh, or scoff, but they didn't. They listened and nodded and smiled and I had their support. Just as now, our client had her peers’ support. And mine.

Tim, looking back to when you were in recovery, what sort of groups did you attend then?

Before I started the day programme, I attended three groups a week for six weeks. I did six weeks’ worth of Harm Reduction (that was just for alcohol), a Men's Group and another group, I forget what it was called but we played this board game, and if you landed on a certain square then you had to say something, I suppose as a way of sharing experiences or whatever. My biggest memory of that group was that one week, when it was sunny weather, I'd got there early, and so I went over to the pub and had a lime-and-lemonade. And then in the group talked about that and got the first sort of ‘You mustn't do that!’ and all that sort of stuff.

What was that like for you, hearing that from the group?

Horrible, very horrible. At the time I didn't realize it was very Twelve-Step based. The group wasn't, but the flak I was getting was very Twelve-Step based and it was a pretty uncomfortable group. I remember going home and feeling very ‘Grrrr’ and all that sort of stuff.

What do you think of that now?

I suppose now I'd know a bit more about where their reaction was coming from and I've also learned so much more about myself since then that I couldn't have articulated then, because at the time I thought ‘What's all this all about?’

When you heard you were going to be attending groups, what did you think, feel about that? Were you apprehensive, excited?

I suppose, yes, I was, it was all new stuff, I hadn't been to any groups before. Those initial groups weren't particularly large. Certainly there were two or three people in the Harm Reduction Group and they weren't always the same people. I don't think I had much fear about ‘What am I going to say?’ or anything like that. That was very much a learning group for me; I came across people who seemed to have different problems, which again with hindsight, I realized were sort of mental health problems that I knew nothing about at the time. And, people in that group would come and go, they wouldn't be there the next week and I would think ‘Well, what's happened to them then?’ and I didn't really understand that. The Men's Group was quite interesting. Again, I didn't really understand why they had the Men's Group, but they also had a Women's Group going on at exactly the same time in another room. I guess that was about covering areas that men didn't want women in, or women didn't want men in, or whatever. There were always fewer in the Men's Group than the Women's Group, which was interesting.

Do you think it was useful having a Men's Group?

Yes, yes, I think it was. Again it would vary so much, you know, because it was people who weren't on the day programme, so you had people who were still drinking, others who were trying to control their drinking, and others who were trying to give up. So it was a mish-mash of different people, and who were all there for different reasons. But again, with all these groups, even the one that was horrible, I sort of had the feeling of ‘Well this is what I've got to do’. No one said that, but I felt it and I suspect it was them seeing how motivated I was.

What did you find helpful about those first groups you went to?

Well, I think, the fact that I wasn't alone, that whole thing about it not just being you and the mixture of different stories and different backgrounds, and hearing the different ways that people will try and handle it.

What was helpful about that?

Well . . . that no one's the same, well, I mean apart from the fact that we all have probably the same sort of problem, everyone's different, everyone has their own way of doing it. It was useful learning, watching how some people seemed to cope, and others didn't. But then again that feeds into now, you know. Every day I come into work and I never know who's still going to be here, who's suddenly decided they've had enough, whatever, so that sort of, again ties in.

It sounds like those first experiences prepared you for the changing nature of the groups here at work?

Yes, yes, absolutely. Another thing that was helpful about those groups was the joy of actually driving again as I needed to get behind a wheel to get there, being out and about, it was all sort of new, it was all about rediscovering things. So they were very much positive feelings. I was still having individual counselling once a week, so that was useful and it was good to talk things through. I only had four or five sessions, but I think that was probably all I needed. After about 6 weeks, I started the day programme proper, when things became much more structured. It was 4 days a week and there were the same people in each group and by then I was feeling much more confident.

From those groups, what would you say was useful for day-to-day living without alcohol?

From the day programme? Most of it, really. Again we went back through all the Harm Reduction stuff, which was no bad thing. We covered lots of facts and figures, the costs involved in alcohol, which I knew nothing about and found fascinating. We also covered the psychological and physical aspects of alcohol. We looked at anger stuff, I loved all that, it was all new to me. Before these groups I thought that something happened and I got an emotion, I didn't realize that I thought about it and made sense of it, interpreted it. We also did assertiveness, covered all the background stuff like rights. What else did we do? Oh yes, problem-solving . . . things like don't bite it all off in one chunk, and all that. I really enjoyed the 6 weeks and it was then on a Monday morning that one of our number came in and he had lapsed over the weekend and I watched how the facilitator handled it. And as a result of that, we then did lapse versus relapse and all that sort of stuff. But, it was watching him, that was the first little sort of thing that went in there about (points to head) ‘Ah, I think I fancy doing that.’ So that's where I got the idea of ‘Okay, I think I might have a go at this’ came from. It was certainly only a very fleeting thought, and I didn't have a clue of how to do it or how to go about doing it, but that's where the idea came from.

The planting of the seed?

Yes, that was the planting of the seed. And then again, one of the practical things they did at the end of the course, we had a little a quiz, which was interesting, to see how much we had taken in. But it was all very gentle. And we made quite a good sort of group, the seven of us, we all got on pretty well. I mean they didn't all last, two dropped out before the end of the six weeks.

You said that you got on well. How did you develop that bond?

It just sort of grew really, I think, as people opened up and shared stuff with each other . . . One I still keep in touch with, admittedly only Christmas cards, but we're still in touch.

So you had individual counselling and attended groups. What do you think groups added to your recovery?

For me, it was three things really. It was the fact that I wasn't alone and therefore sharing experiences, even if they weren't similar, that was a big thing, for me. And through sharing those experiences, people saying ‘Well I managed this once before, I stayed dry and this is how I did it’. Then there was learning stuff from other people. I realized that actually you learn almost as much from your peers as you do from the facilitator. Well you learn from both. So for me the groups were about learning from others, it was the not being alone, and also learning to articulate my own stuff that I suspect I'd kept locked inside. So they were the key elements really. Quite early on, I had this sort of vision, of me going back and grabbing the younger me and pulling him back through the thickets and brambles . . . and saying ‘It's alright, it is alrigh...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Table of Contents
• Contributors
• Acknowledgements
• Foreword
• Introduction
• PART I Core considerations in addictions group work
• PART II Practical considerations in addictions group work
• PART III Specific considerations in addictions group work
• Index