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September 10, 2012

Simulated Group for Females with Alcohol Dependence

Simulated Groups: Adult Women with Substance Abuse or Dependence
Alissa, Corina, Allison, & Kate

i. The purpose of this group is to encourage abstinence from alcohol, build alternative coping skills, and motivate change towards positive behavior. The group is offered to adult gender-identified females who express motivation to make a change in their drinking behavior. This is not a dual diagnosis group.

ii. The problem is that the women have an alcohol use or dependence diagnosis and are attending group to make a positive change in their drinking behavior.

iii. The group leaders will use the stages of change model with motivational interviewing and cognitive behavioral techniques.
iv. The leaders will incorporate psycho-education and will model communication and problem-solving skills. Leaders will create a safe and empathetic environment for clients. Leaders will encourage motivation for change and facilitate group dialogue.

v. A short paper of 1-2 pages about the peer-reviewed, evidence-based practices

There are several different therapeutic group models that are being used in substance abuse treatment. These include psychoeducation, skills development, cognitive-behavioral, support, and interpersonal process groups. All of these models share some characteristics with other models. For example, most skills development groups operate from a cognitive-behavioral orientation (Flores 2005). The current group will use cognitive-behavioral therapy (CBT) as our primary model. The group will employ aspects of psychoeducation, specifically by teaching group members about the stages of change. Additionally, the group will use motivational interviewing (MI) techniques to help group members to increase their intrinsic motivation for change. There are four main principles of MI: express empathy, support self-efficacy, roll with resistance (explore client’s views), and develop discrepancy between client’s behaviors and what they wish for.

According to an analysis conducted by McHugh and colleagues, many large-scale trials and quantitative reviews support the efficacy of cognitive-behavioral therapy in treating alcohol use and dependence (2010). Researchers examined various CBT interventions, including motivational interventions, contingency management (using a nondrug reinforcer, such as a gift card), relapse prevention (identifying and preventing high-risk situations), community reinforcement approach (altering environment to reward sober behavior), and behavioral couples therapy. Researchers concluded that all of these interventions have shown efficacy and that, if combined, these interventions could yield even more positive outcomes.

A meta-analysis conducted by Magill and Ray (2009) found a small but statistically significant treatment effect of CBT for adults diagnosed with alcohol- or illicit-drug-use disorders. Effects were strongest when CBT was compared with no treatment, and the results suggest that the effects may be larger with women than with men and when delivered in a brief format, under 20 sessions. Their findings also showed that the CBT effects diminished around six to nine months and was significantly diminished after 12 months. They found no difference in efficacy due to format (group or individual).

Motivational Interviewing, an approach commonly used and discussed with alcohol abuse treatment, seems to be effective, though further research is needed. A meta-analysis conducted by Smedslund and colleagues (2011) looked at motivational interviewing (MI) in one-on-one individual interventions in comparison to no treatment, to assessment and/or feedback about substance use, and to other active treatment approaches. Researchers found that outcomes were significantly different between the groups. However, the analysis showed that other active treatments could be as effective as MI. At a medium follow-up period (defined as 6 months post-intervention up to, but not including, 12 months) MI proved more effective than for a group that only received assessment and/or feedback regarding substance use. Researchers of the analysis warn that the evidence they gathered is mostly “low quality” and should lead to caution when making use of their results.

vi. The Women’s Center of Ann Arbor will sponsor the group.

vii. The Women’s Center has space for the group to be held and staff to facilitate the group. The Center will provide water, tea, fresh fruit, and vegetables; 8AM-4PM phone support, and links to other resources in the community.

viii. Members are adult, gender-identified females with alcohol abuse or dependent diagnoses.

ix. The agency will recruit members through referrals of existing clients and will also accept referrals from outside agencies.

x. The group will screen clients based on gender, age (18+), and type of substance. The group is strictly alcohol use/dependence and not dual diagnosis.

xi. The group will be strictly adult (18+) and female. People from all identities according to race, ethnicity, ability, sexual orientation, and size will be accepted.

xii. It will be a closed and structured group. The group will meet for 12 sessions once a week for 1 hour.

xiii. Give a description of the types of activities planned for the group:

We will begin the first session by introducing ourselves and stating the goals and objectives of the group. We will then facilitate introductions through a round robin where members will be asked to state their name and one of their strengths or talents. The group leaders will describe a strength or talent of their own first; they will model an example that sets a positive and light tone for opening the session (ie “I’m Allison and I am good at gardening.”)
Next the leaders will facilitate the development of group guidelines with input from all members in a round robin style. Individuals will have the opportunity to “pass” if they don’t want to speak. If not mentioned by group members, the leaders will address the following: Confidentiality (including limits – mandated reporting), Respect (including “step up, step back” guideline), Attendance (“Please try to attend all groups and let us know 24 hours prior if you cannot make it; after three absences, you will be asked to leave the group”), and Promptness.

One of the leaders will also introduce the concept of “check-ins” and explain that in future sessions check-ins will relate to substance abuse and any challenges that have happened during the week. However, given that the group is still getting to know each other, the first “check-in” will be to answer the question, “what do I want to get out of group?” This activity will help us to understand members’ goals, gain a sense of where they might be at according to the Stages of Change, and help us to structure appropriate activities for future sessions. It will also help the group members begin to learn about each other.

Finally, the last activity of the first session will be a psychoeducational segment on the Stages of Change. The leader will explain the stages and then read a vignette. Members will then be asked to analyze where the person in the vignette is on the Stages of Change wheel. For homework the members will be asked to think about where they are on in the Stages of Change. They will be given a hand-out that will help them to identify where they are at on the wheel.

Session 1

xiv. Agenda for Session I

Introduce ourselves
1. Rationale for group – opening statement: stating the objectives of group, short history of the group and effectiveness of approaches used (hint: evidence-based) 5 min
2. Intro of members – name, ice-breaker: share one of your strengths -10 min
3. Present the agenda – 2 min
4. Discuss group guidelines – 10 to 15 min- offer the chance to brainstorm rules together, and then summarize:
Confidentiality
Respect: step up, step back rule
Attendance: Please try to attend all groups and let us know 24 hours prior if you cannot make it, and you can only have two absences
Promptness
5. Member check-in: 15 min
Introduce the concept of check-in: usually the check-in will be about each person’s substance use over the past week (report of using-keep nonjudgmental but explore what led to the episode, identify internal emotional cues during and after, and consequences), but for today check-in with each person’s goals for self in the group:
What are your goals for yourself in this group?
6. Topic/activity
Psyched: stages of change, handout – the wheel (depicting stages of change), discuss the vignettes (identify where person in case study is at on stages of change) - 15min
7. Homework – Where are you at on Stages of Change? – take home additional hand-out that assists in identifying where you are at
Summarize session – thank participants for attending and for participating in group activities

Session I Group Note
6/18/2012 2:45 PM-3:35 PM SSWB 3816
7 group members and 4 staff attended the weekly alcohol group for gender-identified women. In this initial session, two staff members facilitated introductions of staff and members, stated the rationale for the group, presented the agenda, and discussed group guidelines. Members participated in a go-around to discuss possible guidelines. Guidelines included confidentiality, respect, attendance, and promptness. At this point, two other staff members facilitated a check-in (pertaining to reason for joining the group and goal while in the group) and a psycho-educational discussion about stages of change. Staff provided group members with a handout about the stages of change, and the group discussed these stages pertaining to a case example and then to their own lives. Members are to think about barriers and triggers for the next session.


References

Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy. Treatment Improvement Protocol (TIP) Series 41. DHHS Publication No. (SMA) 05-3991. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005.

Hallgren, K.A., Moyers, T.B. (2011). Does readiness to change predict in-session motivational language? Correspondence between two conceptualizations of client motivation. Addiction, 106, 1261-1269.

Le Berre, A. P., Vabret, F., Cauvin, C., Pinon, K., Allain, P., Pitel, A.L., Eustache, F., & Beaunieu, H. (2012). Cognitive barriers to readiness to change in alcohol-dependent patients. Alcoholism, Clinical and Experimental Research.

Magill, M, Ray, LA. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs;70:516–27

McHugh, K.R., Hearon, B.A., Otto, M.W. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33, 3.

Muesser, K. T., Noordsy, D. L., Drake, R. E., & Fox, L. (2003). Persuasion groups. Integrated Treatment for Dual Disorders: A Guide to Effective Practice.

Smedslund, G., Berg, R.C., Hammerstrom K.T., Steiro A., Leiknes, K.A., Dahl, H.M., Karlsen, K. (2011). Motivational interviewing for substance abuse (review). Cochrane Database of Systematic Reviews 2011, Issue 5.

Posted by desolada at September 10, 2012 08:24 PM

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