The Managing Psychosis and Drug Use Group
Intervention Program was developed by Wynne
James and Catherine Spencer
Group Intervention Program
The six-week group treatment program uses peer support,
motivational enhancement strategies, relapse prevention and harm
minimisation approaches and is an adjunct to existing case management
and the dual diagnosis liaison service within the Alma Street Centre.
The aims of the group are to:
- provide a forum for clients to discuss the pros and cons of drug
use
- provide information to enable clients to make informed choices
- enhance motivation to reduce drug use or minimise associated
problems
- encourage clients to develop ways of managing their symptoms,
relieving boredom or engaging in social activities without relying
on drugs.
The group is for people who have a psychotic condition and also use
drugs. Participants must be able to engage in group discussions. Each
group is tailored to the participants’ stage of change and their
reasons for drug use.
Outcomes of this program are currently being evaluated to assess its
impact on drug use in people with psychosis.
Planning the group
Before commencing the group, facilitators make themselves aware of
information on each participant, including:
- Which substances are most commonly used and their routes of
administration. Particular attention is given to any high risk
behaviours that have been identified.
- The stage of change of participants. It is important to tailor
the group to enhance motivation for participants in a
precontemplation or contemplation stage, as well as strategies to
cut down and avoid relapse for participants at the contemplation
and action stage.
- Participants’ reasons for use. They may include social
reasons, coping with negative affect or enhancement, ie making
life more fulfilling.
Consultation and liaison with each participant’s case manager or
key worker is advised to ensure clients are reminded of the group each
week and are supported in the process.
Assertive follow up is important if clients miss sessions.
Facilitators should contact case managers and the participant,
exploring reasons for their absence and encouraging attendance at the
next session.
Education and Motivational Enhancement
This module of the group intervention program develops an
awareness of the impact of substance use on mental and physical health
and lifestyle while exploring the reasons for substance abuse.
The module is completed in one or two sessions.
Objectives include:
- to develop an understanding of what the group is about
- to develop an awareness of the impact of substance use on mental
and physical health and lifestyle, including information about the
effects of relevant substances
- to engage the group in the process of discussing substance use
and psychosis
- to facilitate the group in exploring their reasons for substance
use
- to facilitate discussion of expectations of drug use and an
awareness of whether drug use is achieving these effects.
Content includes:
1. Setting the scene and introductions:
- The group aims to increase knowledge of the effects of drug
use,
- provide an opportunity to discuss the pros and cons of drug
use and different ways to cut down or use more safely, and
- making decisions about drug use
The group is also about managing mental health symptoms, which
may be related to drug use in some way. For some people, heavy use
of drugs may have been a factor in the first episode of psychosis or
hospital admission.
2. Setting rules, for example:
- Attend every session
- Give everyone a turn at talking
- Don’t interrupt people, and no verbal abuse
- Confidentiality. Don’t mention any names of people in the
group to family or friends. Respect each other’s confidentiality
- No dealing.
3. Drug education
Introduction to the effects of alcohol, cannabis, amphetamines.
4. Relationship between drug use and psychosis.
5. Exploration of why people use drugs.
Motivational Enhancement and Goal Setting
This module asks participants to explore their
expectations, review the advantages and disadvantages and consider
goals for management of substances.
Objectives:
- to explore the pros and cons of drug use and of cutting down
- to facilitate the decision process on appropriate goals for
managing substance use, while communicating free choice.
Content includes:
1. Feedback from module 1
Complete worksheets on what participants expect drugs to do for
them. Ask whether drug use met expectations and did they notice any
impact on their symptoms.
2. Pros and cons of changing drug use
Review the advantages and disadvantages of cutting down on current
drug use. This is an individual process, so worksheets are completed
in smaller groups.
Discuss what people have written down on the pros and cons of
drug use. Use motivational interviewing principles for example,
nonjudgemental, reflective listening, empathic, identify
discrepancies, assist participants to be aware of goals that drug
use has disadvantages. This is an important opportunity to enhance
motivation for change.
3. Goal setting
Consider goals for managing substance use and decide what they want
to achieve by attending this group. Use a worksheet on personal
goals regarding drug use, and explain the options:
- remain the same but learn about options
- use my drugs in a less harmful way
- reduce drug use
- try to stop altogether
- learn how to stay off drugs.
Cutting Down, Harm Reduction and Self-Monitoring
Strategies for harm minimisation, cutting down and
stopping cannabis use, and self monitoring
Objectives:
introduce strategies for harm minimisation, cutting down and
stopping introduce self monitoring.
Contents Include
1. Introducing ways to change
The two topics in this session that might help achieve your goals.
2. Making drug use safer
Complete worksheets on Keeping Out of Harm’s Way and ask
participants to provide feedback their strategies.
3. Tips for cutting down
Provide worksheets on ways to cut down and reduce harm of alcohol,
cannabis and amphetamines. Add other suggestions from the group.
4. Introduce self monitoring
Provide self monitoring sheets that are used to keep track of drug
use, and identify times when it is difficult to cut down.
Coping with High Risk Situations
Assist participants to identify high risk situations and find
alternative ways to cope.
Objectives:
- to assist participants to identify high risk situations
- to facilitate an awareness of alternative ways to cope with
distressing feelings, thoughts and symptoms, and
- to show how to enhance mood or relieve boredom through
alternative activities
- to tailor these sessions to people’s individual high risk
situations.
Content:
1. Review self-monitoring forms
What did people notice about their drug use?
Did using drugs have the effect hoped for?
Did anybody try any of the tips to help cut down or use more safely?
Has anybody noticed any differences in their mood or symptoms due to
cutting down?
What did you find hard/easy about cutting down?
Did you notice which times you wanted to use the most high risk
situations?
2. Identify high risk situations
- Discuss the different kinds of high risk situations and group
them into Social situations (people and places, to feel
relaxed around people, to feel like part of a group).
Assertiveness training is one method for increasing positive
experiences and decreasing negative experiences in social
settings. Learning to be assertive will enable you to act in
your own interest, to stand up for yourself without experiencing
excessive anxiety, to express your feelings honestly and
comfortably, and to exercise your personal rights without
denying the rights of others. Facilitate role-play of high risk
situations that clients found difficult to resist.
- Feelings, thoughts or symptoms.
For example relieving boredom, wanting to get high, feeling
anxious, depressed, had a fight with family or partner.
Strategies are needed for dealing with these situations and
making a few changes in life (friends, activities etc).
3. Worksheets: use worksheets on:
Ensure there is plenty of discussion and sharing of what works and
what doesn’t between group members. Encourage them to try one of the
techniques between the two sessions and feedback to the group.
Review and Planning
Review previous sessions and
participants goals. Plan for the future and introduce community drug
and alcohol services.
Objectives:
- to provide a sense of completion by reviewing previous sessions
and participants’ initial goals
- to facilitate planning for the future and further goal setting
- to introduce community drug and alcohol services
- to discuss setbacks as a natural part of the process in managing
drug use
- to facilitate planning of support if required
- to ensure end of treatment questionnaires are completed.
Content:
- Review the week
Have people cut down?
Did they try any of the alternative ways of enhancement,
celebration or coping?
How have people’s symptoms been as a result of their drug use?
- Reviewing various sessions and progress
Look back at goals and acknowledge achievements.
Ask group members what they think they have achieved.
- Planning for the future
Introduce the importance of making plans so those goals can be met
now that the group will no longer be meeting.
Complete planning for the future worksheets and discuss plans.
Invite a speaker from community drug and alcohol agencies to
discuss the service they can provide. Ensure leaflets are provided.
Review with Mental Health Workers
After completion of the group, it is important to meet
with case managers or key mental health care worker to find out how
clients went during the group, what plans they made and what support
they require for managing drug use.
When meeting with case managers provide feedback about how
clients went during the group what plans they have made for managing
their drug use what support they might need from their case manager
or referrer
Ensure the case manager or referrer is aware that clients have a
written plan as well as other handouts outlining techniques for
cutting down etc.
Encourage the case manager to go through these materials with
clients at their next appointment and discuss how they client can
stay on track.
Talk to case managers about any queries they may have or advice
they may need about helping their clients to manage drug use. Ensure
they are aware that they can contact you if they need assistance or
information.
