H
elping Groups to Grow (HG2G), in partnership with Clinical
Psychology Associates, has developed and rolled out an innovative
group work programme across mid and west Wales which bridges
the gap between substance misuse and mental health provision.
Individual users suffering from anxiety and depression and other
common mental health problems, but who do not meet the thresholds for
community mental health team intervention, can end up falling between the
gaps in services and facing significant risks. So funding was obtained from Big
Lottery and Welsh Assembly Government – with support from local service
providers and commissioners – to deliver an intervention that would increase
personal wellbeing and reduce risk and harm.
The 12-week ‘Pathways to Recovery’ group programme uses a variety of
evidence-based psychosocial interventions from both substance misuse and
mental health practice, including cognitive behavioural therapy (CBT),
motivational interviewing, relapse prevention, mindfulness and acceptance and
commitment therapy. This provides service users with a range of coping
strategies to enable them to manage difficult situations and help them achieve a
healthier, more balanced lifestyle.
The programme is underpinned by the ‘lifestyle balance’ model, influenced by
a CBT framework, which explains how thoughts, feelings, sensations and
behaviour can influence us and links these to the person’s own situation and
circumstances. More than 20 programmes have been run in both community and
in-patient settings, and currently two thirds of group members complete the 12-
week group. Feedback from service users has been very positive: ‘My overall
opinion of the programme is that it serves a tremendously useful purpose to
those who are willing to embrace its principles,’ said one. ‘Despite my having
started from a rather cynical viewpoint, I soon saw the value in the methods and
techniques that were shared with those, who like me, were members of the
programme due to misuse of substances.’
We keep in touch with former group members and they are invited to meet
with a member of the HG2G team to complete follow-up assessments for up to a
year after finishing the programme. While we are still collecting this longer-term
data we have completed an interim evaluation of the service to date, which
demonstrates statistically significant results – levels of dependence, alcohol
consumption, depression and anxiety went down, while levels of social
functioning, personal and physical wellbeing and quality of life all improved. We
are excited by these findings and we hope that the longitudinal study – which
should be published in spring 2013 – will report equally successful results.
To achieve regional coverage we have worked in close partnership with staff
from both statutory and voluntary sector substance misuse providers, including
Kaleidoscope, Cyswllt Contact, Turning Point, Prism, West Wales Substance
Kim Johnson describes how her
organisation, Helping Groups to
Grow, is tackling the problems faced
by people with a dual diagnosis
16 |
drinkanddrugsnews
| April 2012
Treatment|
Dual diagnosis
www.drinkanddrugsnews.com
Misuse Service and the Dyfed-Powys Drug Intervention Programme. This
partnership approach has been a real bonus for us, is welcomed by services and
has led to very positive experiences of co-working.
*****
The Pathways to Recovery programme starts with a brief psychosocial
intervention (PSI) assessment over three one-to-one sessions. These are designed
to help the person engage, become familiar with a CBT approach and prepare for
the group work programme. Group members complete a range of standardised
self-assessment measures – such as social functioning, levels of dependency,
substance use, anxiety, and depression – with the results presented in a lifestyle
profile booklet that gives a ‘snapshot’ picture of their situation and areas they
would like to change.
The programme comprises weekly group sessions, which are highly
structured and led by two group facilitators, and each session is supported by an
individual key-working session with one of the facilitators. These enable each
person to discuss their own circumstances, goals and plans and to work in a
trusted relationship with their key worker.
The group programme and key-working sessions explore a range of topics,
taking the service user on a journey towards understanding substance misuse
and mental health problems and learning to manage them more effectively.
First, service users are introduced to the basic underlying lifestyle balance model
before moving on to understand the function of their own substance use. The
programme helps service users consider potential risk behaviours and helps
them to plan for how they might minimise these. Service users learn to
understand and manage cravings and urges associated with substance use
before being introduced to the possibility of a period of sobriety.
Significant changes to lifestyle are introduced through rebuilding
relationships and building new social networks, with self-rewards for successes.
There are four related sessions covering mental health – from understanding
thoughts, feelings, sensations and behaviours that may be early signs of mental
ill health to exploring the underlying beliefs that underpin many mental health
problems and strategies to manage or replace these. The programme ends with
planning next steps for the future.
An important component is to introduce coping strategies and enable group
members to practise and develop skills to help them move towards a healthier
lifestyle. Many service users attributed their successful outcomes to the various
coping strategies taught on the programme. One example is ‘urge surfing’, a
technique developed by the late Alan Marlatt in his work on harm reduction and
substance use which helps people manage the intense physical symptoms
associated with urges to use a substance. It is a mindfulness-based technique to