Reduce the Use 2 &

Solas sa SAOL Training

19th June 2014

Reduce the Use

The poly drug use edition

1. General overview of how addiction is different for women

2. What SAOL does

3. Theories underpinning the manuals

4. Reduce the Use

5. Solas sa SAOL

Running Order!

• Addiction is different for Women:

– Getting addicted – Staying addicted – Detox – Recovery – Aftercare

These are all different for women and so is everything associated with them

Different for Women? Different for Women?

• S: Stability

• A: Ability

• O: Work (from Obhair)

• L: Learning

• SAOL = LIFE

S.A.O.L

• The way of understanding addiction in SAOL is mainly a bio-psycho-social one.

• That is, if you really want to understand addiction, you need to examine it biologically, psychologically (including spiritually) and socially.

• This immediately highlights that addiction is a different thing for women.

Bio-psycho-social

Bio-Psycho-Social

• Bio – responding to the issues of the ‘body’ – drug diaries, food intake, exercise...

• Psycho – feelings/emotions, cravings, triggers, motivations

• Social – group setting, engagement with community/environment, practical solutions sought for day to day problems

Literacy

• In your initial interview with the client, you will have established the extent of their literacy skills and those that need additional help with writing should be assigned this support.

• While the Reduce the Use 2 is designed for those who have competency in

reading and writing, it has been our experience that some participants present with literacy difficulties and may need extra support to feel comfortable to take part in the workshops. We have found the following strategies to be useful:

– Offering the use of a ‘scribe’ to assist the learner in the modules – Using more discussion based formats during modules as opposed to written work – Introducing a set of symbols, short-hand or emoticons for drug diaries – Using a tape recording as a means of recording drug diaries or feelings and experiences – Using a ‘buddy’ system with another participant in the modules to help with writing, spelling,

etc

Remember: medical advice needed for some addictions

• For those wishing to use the Reduce the Use 2 with clients, it should be noted that some drugs may require medical supervision to detoxify from. Alcohol and tablets are particular cases in point.

• In this event, no attempt should be made by the facilitator to encourage

an individual to simply stop taking these drugs without medical supervision or a programme of slow withdrawal.

• The abrupt cessation of any drug can have severe consequences,

particularly if the person has been a chronic, long term user and it is always advised to seek medical advice and support in the event a client wishes to stop their drug use altogether.

• SAOL’s policy is to encourage all clients engaged in the Reduce the Use 2

programme to inform their doctor and to be guided by them throughout the process.

Use of groups

• The greatest resource a Facilitator has available are the group members. Your members will bring A group works best at problem solving if:

– The problem can be defined in different ways

– Information is needed from different sources

– It is a very specialised problem

– The problem has implications for many people

– There are likely to be many possible solutions

– It is a complex problem with many different aspects

• The advantages to taking a group approach to this programme is that each member will bring a different experience, knowledge, point of view, values and, as a result, a larger number of ideas for problem solving can be generated. The exchange of ideas can act as a stimulus to the imagination, encouraging individuals to explore ideas they would not have otherwise considered. Individual beliefs can be challenged by the group, forcing the individual to acknowledge them and rethink their beliefs. The Group can also encourage individuals to accept that change is needed.

Pre-requisites for facilitators Facilitators should be able to:

– effectively manage group discussions – have a good understanding of group dynamics – communicate new concepts – respond to questions posed by group members – think on their feet and facilitate unplanned group discussions – have the ability to develop good, supportive relationships with group

members – handle conflict – have experience and a good understanding of addiction work – handle congruence – display empathy – be patient – show unconditional positive regard – display an awareness of cultural sensitivities – maintain a high level of group leader focus

What is it?

• It is largely based on cognitive behaviour type interventions, in that it remains structured, goal oriented and focused on immediate problem solving.

• It includes a guideline structure for a Pre-Programme Assessment

Meeting. • We have also gone into greater detail to explain to the reader the

rationale behind the programme and to explain further the concepts involved.

• The Handouts, Worksheets, Exercises and Facilitator Directions have been amended to reflect a broad range of drugs, including alcohol.

Poly drug use

• SAOL’s experience has been that it is more unusual for us to be working with someone who uses cocaine only.

• In our experience most of our clients present with poly drug use problems, using

many combinations of drugs such as methadone, heroin, alcohol, cannabis, tablets, methadone, cocaine and other psychoactive substances.

• Whatever a client’s preferred ‘combination’ we ended up spending a lot of time

‘tweaking and editing’ the programme as we went along! • SAOL’s experience is that we encourage the client to initially look at whatever drug

is causing the most harm and to concentrate on reducing that first.

• We have found that the majority of our clients were successfully able to reduce their dependency on a variety of substances over time as a direct result of their participation on the programme.

Structure of the manual

• The Manual comes in two main parts.

– The first part gives a background to the production of this manual and a comprehensive overview of the programme and of the skills and materials needed to implement it

• The second part covers the (now) ten updated modules and includes

facilitator guidelines, handouts and worksheets and takes you step by step through the implementation of all aspects of the programme.

• The Manual is meant for retention by yourself or your agency/project as a

Master Copy. • Please do not write into the worksheets in the manual. All material

should be photocopied and used as appropriate.

Worksheets and Handouts

• Handouts – these will aid the learning and should be photocopied for the client’s retention

• Worksheets – these are provided for the client to write into and should be photo-copied as needed for each client

Poly-Responses

Motivational Interviewing

• Enhancing motivation

• Exploring ambivalence

CBT

• Understanding cravings and triggers

• Planned responses

CRA

• Rewards and Positivity

• Key purpose and named goals

Motivational Interviewing

• Motivational Interviewing is described (by Miller & Rollnick 2013) as a collaborative, person-centred form of guiding, with the aim of eliciting and strengthening motivation for change.

• It is a shared conversation about transformation that draws ideas for change from the participant, so that their commitment to change is stronger.

Motivational Interviewing

It is:

• Goal-oriented

• Person-centred

• It is compassionate throughout, even more so when addressing ambivalence

Cognitive Behavioural Therapy

• This is a time-limited, present-focused and problem-solving set of interventions that focuses on aiding participants in learning specific skills that are usable for the rest of their lives.

• These skills centre on identifying unhelpful thinking patterns, changing beliefs, relating to the world in different ways and modifying behaviours.

Cognitive Behavioural Therapy

• It is grounded in the understanding that the way we perceive a situation will influence how we feel emotionally; that if we are in distress, our perceptions are likely to be distorted and our thoughts will probably be unrealistic.

• As a result, our behaviour is likely to be unhelpful in achieving our goals.

Cognitive Behavioural Therapy

• CBT attempts to help us change our thinking so that we feel differently and we can focus attention on our stated goals, so as to bring about positive behaviour change. (Beck 2011)

Community Reinforcement Approach

• The Community Reinforcement Approach is a cognitive-behavioural intervention that was founded on the belief that environmental contingencies play a critical role in encouraging or discouraging substance use. (Hunt & Azrin 1973)

Community Reinforcement Approach

• Accordingly, CRA utilises community (i.e. familial, social, recreational and occupational) reinforcers to support change in an individual’s drinking or drug using behaviours.

• In essence, the goal is to rearrange environmental contingencies so that sober behaviour becomes more rewarding than substance abusing behaviour.

Community Reinforcement Approach

• This comprehensive intervention blends operant conditioning with a social systems approach to address multiple problem areas.

• CRA is appropriate for a wide range of clients and another strength of this approach is its flexibility.

Pathway through a field

Worksheets – Motivational Interviewing Style

Worksheets: CBT style

Worksheets: CRA Style

Duration

• The Reduce the Use 2© is designed to be delivered over 10 modules with an additional pre-assessment meeting beforehand. However this is merely a guideline and each project should decide what suits them and their clients best.

• We find there are no hard and fast rules about

programme duration. This manual is simply a guide to a tried and tested brief intervention model and therefore must be reasonably time restricted. The most important thing is to run the modules on a consistent basis, get through all of the material and make sure that your group understands every step.

• Women who are addicts get beaten and abused by their partners – who are mainly men but can be women.

Domestic violence

Over-bearing L veless

Nasty

Control escape

Domestic Violence Workshop Modules

1) Definition of domestic violence

2) Power and Control

3) The impact domestic violence has on children

4) Abusive relationships

5) Assertiveness and putting in boundaries

6) My Future (celebration)

Session 1 – Definition of Domestic Violence

Having brainstormed a definition of domestic violence, we introduce a questionnaire “What is Domestic Violence” This is followed by tackling the myths about domestic violence. Some of the common myths surrounding this issue include: “It’s just a family argument”, It can’t be that bad or why does she stay”

Session 2 - Power and Control

‘Power and Control’ is abusive behaviour that can be used in different ways at different times. Often times there are several types of power and control going on at any one time. They include: Intimidation: Emotional Abuse Isolation Minimizing, denying, blaming Children Male Privilege Economic Abuse Threats

Stand

Up

Explosion

Remorse

Pursuit

Honeymoon

Build

Up

The Cycle of Abuse

Session 2 - Power and Control

We explore the role of addiction in domestic violence :

• For the victim

• For the perpetrator

• In blocking change

• Adding endangerment to change

Harm reduction

Stabilisation

Early Recovery Detox

The Role of Addiction in DV

Drug/Alcohol Free

Each point of change can be a point of

danger

While each stage brings its own excuse for further

abuse

• This is perhaps one of the most difficult weeks for the participants in the workshop. It is important to stress that nobody will be judged and everyone feels safe enough to contribute.

• This is broken down into discussions on the impact at various stages in the child’s life e.g womb to 1 years, 2-4 years etc.

Session 3 – The Impact and Effect of Domestic Violence on Children

• While many of the participants may have social worker involvement already, this discussion is also about ensuring everyone has an understanding about what child protection is and what the legal situation is.

• This also refers to contact with the offender and

the issues this brings, i.e. children wanting to or not wanting to see the perpetrator.

Domestic Violence and Children

• Discussion about how this can occur in a safe manner that is not over compensating.

• The topics covered are:

– trust & respect, – Providing emotional security, – Providing physical security, – Providing discipline, – Giving time, encouragement & support, – Giving affection to and care

for yourself.

Rebuilding relationships with children

Session 4 – Abusive Relationships

• What makes a relationship a relationship? - respect, - communication, - sharing • What makes a relationship abusive?

fear, intimidation, not able to express opinions safely

• What role does addiction play in the relationship.

• What help is available?

What are the options, what can be changed?

Session 4 – Abusive Relationships

Session 4 – Abusive Relationships

• What role does addiction play in the relationship

• We discuss why a woman might stay in an abusive relationship & how she might leave

• Remember the option of fleeing to a refuge is not open to a woman on methadone maintenance.

• When your safety has been compromised, being assertive and establishing boundaries can sometimes feel like the hardest things in the world to achieve

• Through exercises and looking at assertiveness and

boundaries, participants will gain an understanding of their own blocks and how they can begin to start to implement positive ways of asserting their boundaries.

• The tips and tools learnt in this module can be useful when applied to their addiction also.

Session 5–Assertiveness and Boundaries

• If you have lived in the shadow of domestic violence, the future can be a very scary place. This module aims to celebrate the future as something to look forward to and the participants name what they want and how they can be active in achieving this.

• Through exercises, participants will be able to

recognise isolating behaviour as an old pattern linked to domestic violence and identify ways in which they can overcome it in the future.

Session 6 – The Future

• The negative impact of self-criticism is then discussed, and participants are reminded that changing thought patterns takes a lot of time but it is essential to rebuilding self-esteem and confidence.

• New relationships can often be the last thing the women want however it is important to look at the possibility of a new relationship and establish what they want from a potential partner.

Session 6 – The Future

• A simple exercise to look at what they want for the future, it could be emotional, psychological, and or physical. Or something entirely different like progressing to education, returning to work or moving house.

Session 6 – The Future

Session 6 – The Future

3 months

6 months

9 months

1 year

Session 6 – The Future

3 months

6 months

9 months

1 year