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24-hour Drug Treatment

Prison-Based 24-hour Drug Treatment Program for Men Manual

(Level III)

2012

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TABLE OF CONTENTS

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24 HOUR DRUG TREATMENT PROGRAM (LEVEL III) ............................................................................................ 3

CARANICHE’S APPROACH TO TREATMENT ........................................................................................................... 4

CARANICHE’S THEORETICAL MODEL OF INTERVENTION – COURSE OF TREATMENT ......... 6

THEME A – BEGINNING THE CHANGE PROCESS ................................................................................. 18

SESSION 1: FORMING THE GROUP .................................................................................................................... 18

SESSION 2: DRUG EDUCATION .......................................................................................................................... 24

SESSION 3: WHY DO I USE? ............................................................................................................................... 42

SESSION 4: CREATING CHANGE ........................................................................................................................ 52

THEME B – UNDERSTANDING THE CHANGE PROCESS ..................................................................... 65

SESSION 5: A MODEL OF DRUG USE ................................................................................................................ 65

SESSION 6: UNDERSTANDING ME & MY EMOTIONS ......................................................................................... 72

SESSION 7: WHAT DO I NEED? ......................................................................................................................... 84

SESSION 8: EXPLORING MY BELIEFS AND SCHEMAS ......................................................................................... 94

SESSION 9: CONSEQUENTIAL AND HARMFUL THINKING ................................................................................. 115

THEME C – MAINTAINING CHANGE & MOVING FORWARD .......................................................... 129

SESSION 10: SELF MANAGEMENT – RELAPSE PREVENTION ............................................................................ 129

SESSION 11: SELF-MANAGEMENT – GOAL SETTING ........................................................................................ 144

SESSION 12: CLOSING SESSION & PSYCHOMETRIC TESTING ........................................................................... 153

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24 HOUR DRUG TREATMENT PROGRAM (LEVEL III)

The 24 Hour Drug Treatment Program is a closed group program for those who abuse

drugs. The aims of the program are:

To reduce drug use and increase motivation to join other programs

To assist in the development of new skills, hobbies, outlets and to increase

motivation and a sense of well being

More specifically, the program aims to:

Prepare participants, by developing an awareness of the need to support themselves, for

making changes in the direction of more healthy and legal alternatives. This is difficult to

describe without sounding moralising or patronising which is not how we want to be.

After increasing the participants’ understanding of their drug choice, and exploring drug

taking behaviour as an adjustment to life circumstances, they can start to gain some hope

of change. Participants explore their choices and establish goals for replacing outmoded

behaviour and thoughts with what is more suited to how they want to live their life in

future. Explored by applying the Drug Use Cycle – individuals deepen their understanding

of where they are at right now in relation to their drug use, and then apply the Stages of

Change Model to determine relevant and realistic action steps to move them along the

dependence to independence continuum.

The program is divided into 12 x 2 hour sessions. The content is divided into 3 themes being

beginning the change process, criminogenic thinking and its relationship to drug use and

maintaining change and moving on. The sessions comprise content and a range of activities

and handouts that can be incorporated into the sessions.

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CARANICHE’S APPROACH TO TREATMENT

Studies indicate that between 50% and 80% of Australian prisoners are incarcerated for

drug-related offences or were under the influence at the time of their arrest (McGregor &

Makkai, 2001)1. In a report released in June 2007, 57% of Victorian prisoners reported that

their offences were committed either to support their substance use or under the influence,

and 38% of violent offences were reported to have been committed under the influence of

alcohol (Corrections Victoria, 2008)2. These figures demonstrate the importance of providing

drug and alcohol treatment to offenders in prison as a means of reducing recidivism.

The various relationships that exist between drug and alcohol use and offending indicate a

need to provide different treatment types for offenders, based on their level of substance

dependence and antisocial tendencies, as well as the relationship between the two. For

instance, for those whose crimes are directly related to their substance use / dependence

(e.g. crimes of acquisition or offences committed under the influence) participation in

treatment programs that focus on substance use and increase awareness of the health,

social and legal consequences may reduce offending behaviour. Comparatively, more

antisocial offenders whose substance use may be incidental or indirectly related to their

offending are likely to require treatment with a stronger criminogenic focus (i.e. addressing

thinking and attitudes, as well as substance use).

The assessment process conducted by Corrections Victoria and Caraniche seeks to classify

offenders with substance use issues into treatment streams based on their criminogenic

risks and needs. Offenders identified as being low to moderate in criminogenic risk and need

are placed in level I, II or III programs, which primarily aim to reduce substance use and

associated harms using psychoeducational and motivational approaches. Offenders

identified as medium to high risk are placed in either level IV or V programs, which differ

from lower level programs as they include a focus on criminogenic factors in the aim of

reducing the likelihood of further offending.

Most often there is a degree of complexity in treatment/intervention need for clients who

present for drug and alcohol treatment programs. In addition to forensic clients’ substance-

using behaviour often having a relationship with their offending behaviour, a plethora of

other problems tend to interact with their substance use. These can include issues related to

health, finances, employment, family conflict, gambling, subclinical and clinical psychological

problems, poor problem solving skills, grief and loss, trauma, poor emotional-

regulation/coping skills, and social isolation. Caraniche’s best practice approach to

addressing clients’ clinical needs involves a multiphasic treatment approach, which

recognises that individuals come to treatment for different reasons, with different levels of

readiness and different capacities to change.

1 McGregor, K., & Makkai, T. (2001). Drugs and Law Enforcement: Winter School in the Sun Conference. Australian Institute of Criminology. Canberra. 2 Corrections Victoria (2008). Community Correctional Services Alcohol and Drug Strategy 2008. Department of Justice. Melbourne.

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CARANICHE DRUG AND ALCOHOL PROGRAM PHILOSOPHY

The framework of Caraniche’s prison-based drug and alcohol programs is founded on the

philosophy that change is best achieved when an environment supports, and provides

opportunities to reinforce, personal development and skill acquisition. Caraniche views

substance abuse as a maladaptive coping style and believes that delivering therapeutic

programs within treatment-focussed communities optimises opportunities for individuals to

implement positive lifestyle change(s). The organisation aims to work with the correctional

system, by assisting in the adaptation of prison processes, to develop a culture and

community that supports pro-social change.

Caraniche’s drug and alcohol programs are inclusive of the stages of change proposed by

Prochaska and DiClemente (1986). With regard to drug and alcohol use, Prochaska and

DiClimente propose individuals transition through five stages when moving from addiction to

abstinence. These include pre-contemplation, contemplation, determination, action and

maintenance. Application of this model of change reinforces several key ideas in drug and

alcohol treatment:

The individual is responsible for his/her own change

The role of the clinician is to support the individual in their change process, as

opposed to change the individual

A range of treatment interventions are required

The individual will benefit from different interventions as he/she moves through the

change process

Below is a linear representation of the theoretical underpinnings of Caraniche’s

approach. In the model, the stages outlined by Prochaska and Diclimente’s are

considered to represent 1) engagement and motivation, 2) treatment, 3) post-treatment,

and 4) support. Regard is given to critique about the indiscreet ordering of Prochaska

and Diclimente’s stages, with the following provided for illustrative purposes only. It

should be noted that treatment takes an undulating course; each stage is not a discreet

entity, there is the potential for clients to cycle through various stages, whilst remaining

susceptible to regression throughout.

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CARANICHE’S THEORETICAL MODEL OF INTERVENTION – COURSE OF TREATMENT

Theoretical Approaches

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As outlined in the model above, the theoretical components of Caraniche’s forensic drug and

alcohol treatment programs include:

Client-Centred Treatment

Calling on the basic principles of counselling, with the focus being on client-centred treatment,

empathy and positive regard are highlighted as critical therapeutic elements. These act as rapport-

building tools.

Motivational Interviewing (MI) and Treatment Planning. MI is a tool that is useful for working with

clients who are struggling to find the motivation to making positive changes. This is attributed to

ambivalence, feeling two ways about their substance use, and this is often present when clients

are extrinsically-motivated to attend treatment. MI can also be utilised at times of client de-

compensation or regression, as well as to reinforce motivation once behaviour change has been

attained.

Cognitive-Behavioural Therapy (CBT). This is a core component of the content of Caraniche’s

forensic drug and alcohol programs. It is used throughout the course of the programs. CBT is

suited to a large number of client presentations. Furthermore, it underlies the relapse-prevention

component of Caraniche’s programs, and is conducive to delivery of group-based therapeutic

treatment.

Schema-Focussed Therapy

Schema-focussed therapy acts as a bridge between cognitive-based therapies and

psychodynamic-based therapies. This type of therapy gives regard to schemas and constructs that

underpin clients world-views, which influence their behaviour and interpersonal interactions.

Systems Theory

Systems theory can be drawn upon at any stage of treatment or alternatively not at all. This

approach recognises that internal well-being, attitudes and behaviours, are influenced by the

system within which the person exists, and that for long term change, both the person’s

relationship with their system, and often the system itself, need to be explored and addressed.

Individual work should take a systems focus where relationships with significant others are brought

into the room. Mindfulness of this approach is critical to work with clients where increased pro-

sociality or reduced anti-sociality are treatment goals.

Psychodynamic Therapy

Psychodynamic therapy is often used in medium to long-term individual counselling, and its use is

encouraged in Caraniche’s more intensive group programs. It helps us gain insight into, 1) the

therapeutic alliance, 2) conscious and unconscious themes and interactions of the client, 3)

themes surrounding transference and countertransference, 4) a client’s personality structure and

how this affects their behaviour, and 5) the identification and effects of the clients’ schemas,

attachments and relational experiences.

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CARANICHE PROGRAMS

Caraniche programs account for individual differences in offenders’ responsivity. The responsivity

principle suggests that individuals will respond differently to the various types of therapeutic

programs. Programs focus on changing target behaviours, in addition to facilitating insight-driven

shifts in awareness. Thus, Caraniche provides programs that are skills-focussed, insight-focussed

and interpersonally-focussed.

The ultimate goal of all Caraniche’s substance-use programs is to enable

participants to achieve lasting abstinence or minimal substance-related

harm. The immediate goals include reducing drug-using behaviour,

improving the individual’s ability to function, and minimising the medical

and social complications associated with drug use.

The Caraniche prison-based drug and alcohol treatment program is designed to provide a range of

treatment services to prisoners according to risk and need. Two streams of programs are provided:

a health stream and a criminogenic stream.

Health stream programs (Level I-III) focus on educating prisoners about minimising harm,

increasing motivation to participate in treatment and improve the well being of program

participants. Prisoners assessed as low to medium risk are eligible for Health stream programs.

Criminogenic stream (Level IV – V) programs aim to reduce substance use and crime by

analysing the relationship between the two and examining the contributing factors. Criminogenic

programs target prisoners assessed as medium to high risk and are offence-specific programs.

An outline of the programs that Caraniche offers across the prison locations for drug and alcohol

services can be found in the table overleaf.

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CARANICHE TREATMENT PROGRAMS AND AIMS BY PROGRAM LEVEL

Program Level

Programs Program Aims

II Brief Individual Counselling

Orientation Program

To provide accurate and reliable information about treatment options available and prison IDU sanctions

To motivate prisoners to enter treatment

III

6 Hour Health Stream Programs

12 Hour Health Stream Program

24 Hour Health Stream Programs

Exploring Change

To educate harms associated with alcohol use and increase motivation to join other programs

To begin to explore drug related issues, develop new skills, increase motivation, a sense of well-being and reduce the risk of relapse.

IV

44hr semi-intensive (closed) Drug & Alcohol Treatment Program

Individual Counselling

To actively intervene in substance use and offending by addressing the thinking patterns, belief systems and behaviours that maintain prisoners in an offending lifestyle and reduce their capacity to develop more pro-social relationships and behaviours

V

130 Hour Intensive Residential Drug Treatment Program (Drug Treatment Unit)

To provide prisoners identified as having a significant substance abuse and offending behaviour with a safe contained environment in which their drug use and offending can be examined in the context of their broader lives, relationships and personal issues such as self-esteem and trauma

Transitional Programs

Release Related Harm Reduction (RRHR)

To provide accurate and reliable information regarding release from prison.

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HOW CARANICHE PROGRAMS ARE DESIGNED TO FACILITATE

SUBSTANCE-USE CHANGE

Level I and II substance-use programs utilise consciousness-raising interventions, such as psycho-

education, to increase awareness of the negative consequences of their substance use. Further,

for those who intend to continue engaging in high-risk substance use behaviours (for example,

sharing needles and unsafe sex) the educational components of these programs provide harm-

minimisation information and strategies. Such programs are considered suitable for those in the

pre-contemplation stage of change.

Similar approaches are also useful for those in the contemplation stage of change. At this stage

of the change process, individuals tend to be more responsive to consciousness-raising

techniques, as well as the motivational aspects of level I and II programs. For example,

participation in a program such as the Prison-Related Harm-Reduction Program facilitates

consideration of the costs and benefits of substance use, with the potential to instigate

consideration of more positive fundamental personal and social change.

For those in the preparation and action stages of change, involvement in more intensive

assessment and treatment planning activities provide a basis for lifestyle change and participation

in relevant programs. For example, level III and IV programs (such the 24-hour Drug Treatment

Program and the 44-hour Drug and Alcohol Program) are designed to provide participants with

skills, strategies and insights aimed at changing specific substance-using behaviours.

For individuals who are in the maintenance stage of change, a number of programs at various

levels assist in the development of relapse-prevention skills. Some offenders may only require

short duration programs that are focussed on relapse-prevention, and therefore a program is

provided in the level II format. Whereas, relapse-prevention may be more effectively presented in

the context of more intensive programs, which give regard to offending behaviour that is related to

substance use.

For those with chronic substance abuse histories, who have difficulties with social integration and

psychological stability, level V programs may be more appropriate. Here, the focus remains on

readiness to change substance use and offending behaviours. However, such chronic behaviour

means that a stated stage of change must be interpreted in the context of possible underlying

processes that may facilitate or hinder change. For example, Prochaska and Norcross (1999)

argue that stages varying between the pre-contemplation stage and the action stage often co-exist

with fixed maladaptive cognitions, along with interpersonal and intrapersonal conflicts.

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Program Manuals

Caraniche’s drug and alcohol programs are operationalised in the form of a program manual.

These manuals detail the aims, target outcomes and suggested delivery of each program.

The program manuals provide facilitators with clear content-based frameworks, designed with

regard given to the level of the program’s intensity and the client population. The session topics are

based on those found to often be relevant to the treatment needs of forensic drug and alcohol

users. The sessions are structured in a progressive manner, with latter sessions building upon the

content of, and thus therapeutic gains made in, prior sessions.

The session activities provide opportunities for 1) individuals to personalise the psycho-educational

material presented, and 2, the facilitator to encourage processing at a deeper level. The aim of this

processing is to optimise participants’ therapeutic gains through obtaining a deeper level of insight

and engaging in cognitive-reasoning. Such increases the likelihood of individuals making positive

lifestyle changes.

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FACILITATOR GUIDE

The aim of this section is to provide facilitators with guidance on administering the programs. This

guide will address issues around the group environment and facilitation itself. Further guidance

regarding the administration of individual sessions has been incorporated in session materials.

THE GROUP AS AN ENVIRONMENT FOR DEVELOPMENT AND

GROWTH

The group is a place that participants can interact, receive feedback, reflect on themselves, and

how they impact on others. The focus is NOT on diagnosis, or on analysing motives for past

behaviour. It is about participants developing an understanding of their behaviour. Group members

tend to benefit from group interaction in many ways. Their observation of others in the group acts

as a source of hope. You, as the facilitator, are a key player here.

Facilitator preparation includes considering what if any self-disclosure would enhance the group

process, whilst still maintaining the psychological safety of the facilitator and the participants. The

group is a place where participants can explore alternative ways to fill the void that their drug of

choice currently fills. It is a place where they can start to understand the impact of their behaviour

and to establish pro-social behaviours as alternative ways to the benefits they have received from

substance use.

The group program provides a space in which participants can see how their behaviour is separate

from themselves (i.e. the person they are) and can take responsibility for their behaviour. It

provides an opportunity for participants to learn and develop more self-supporting ways of

regarding themselves, and more socially acceptable ways of interacting with others. The

participants are there because they have learnt to meet their needs through engaging in socially

unacceptable behaviours. The group can provide participants with an understanding of how the

choices they have made, have impacted on themselves and their relationships with others. The

group is about 1) learning new ways of noticing oneself (awareness), 2) exploring new ways of

thinking (understanding), and 3) learning different ways of establishing behaving individually, in

relation to others (taking action).

By assisting participants to understand themselves in relation to others, they continue to develop

and shape their way of being in the world. How the participants relate to other group members is a

source of learning. To enable this learning, the activities and the group focus is on raising the

participants’ awareness of issues affecting their lives.

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GROUP PARTICIPANTS

The group will invariably have individuals who are at different points along a continuum of drug

use. Often group members need to be nurtured to develop a sense of hope regarding the potential

for change.

Continuum of Drug Use

Drug Dependence Independence from drugs

Lack of self-awareness and understanding about

drug using

↔ Clear self-understanding of drug using

Lack of self-awareness and understanding about

their emotions

↔

Clear self-awareness and openness of their

emotions

Lack of understanding about the impact on

themselves of drug using

↔

Clear understanding of the impact on

themselves of drug using

Lack of understanding about the impact on their

relationships of drug using

↔

Clear understanding of the impact on their

relationships of drug using

Lack of understanding about what they want to

change regarding their drug using

↔

Clear understanding of what they want to

change regarding their drug using

Lack of understanding about how to make

changes regarding their drug using

↔

Clear understanding of how to make changes

regarding their drug using

The facilitator needs to make choices about which components each session the participants may

be able to work through and the extent to which these can be worked through to the benefit of

participants by pairing up, working in small groups or as a whole group.

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THE FACILITATOR

Facilitator as Group Leader

Trustworthy, competent, respectful, self-accepting

As leader of the group, the facilitator has the potential to instil hope in people who do not believe

they have hope. Many of the participants have had a lifetime of manipulative behaviour, and an

absence of respect. The “transparency” of the group leader provides a significant learning

opportunity for group participants. Interacting with the leader may possibly be the participant’s first

ever experience of relating to someone who is trustworthy, respectful, self-accepting and real.

As a facilitator you are expected to demonstrate these qualities. There may be questions or

behaviour in the group that will challenge you. Your personal preparation regarding what you

reveal to the group about yourself and about your interest in the role is essential. You will need to

model trustworthiness, respect and clear boundaries with the participants. Your reputation as a

facilitator and the program’s reputation exist long before the group begins. Nonetheless, once in

the group, it is important to be able to be your real self with the participants within the professional

and ethical boundary limits. The group leader needs to establish and maintain clear boundaries, in

addition to a reputation in the group of being reliable and trustworthy.

Prepare for this role by knowing what you will disclose to the group. Write down your answers to

the following questions in preparation for Session One:

What qualifies me to be here in this role?

The participants’ belief is likely to be that anyone who is doing work in the prison system is there

because they can’t get anything better. Participants may also believe they have been rejected

everywhere else and that they are a last resort.

What interests me about being here in this role?

What is my belief about my potential and the potential of this group to instil hope in its participants?

Is it to increase their understanding about the impact of drug use in their lives? To achieve

personally satisfying changes? How do I portray this without being patronising and sounding like a

do-gooder?

Why do I want to be here for them?

Participant’s experience is likely to be that people leave them, and those who do not leave them

can’t be trusted.

In general, the facilitator’s approach should be to:

Instil more hope and less hopelessness.

Do more noticing and less judging.

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Model the ground-rules established for the group.

Share feedback about differences noticed in others in the group.

Be appreciative of participants input and modelling of ground-rules without labelling the

individual as “good” or “bad” people.

Facilitator as an Initiator of Discussion

Thought-provoking, challenging, engaging

Your clarity regarding what you do and do not want to disclose to participants about yourself

personally will have significant impact on how the group members see you. Participants, typically,

do not have a high appreciation of boundaries or an understanding of respect for privacy and how

that is different to evasiveness. It is likely that participants will want to know what your experience

is. It is important to pre-empt and prepare for participants’ questions to you specifically in relation to

the session topic.

Facilitator as Role Model and Support

In all facilitated learning events, modelling builds a safe learning environment. Learners respond

much more enthusiastically if the facilitator models the behaviour first. At the risk of restating what

is common sense, be mindful of the following:

If you want participants to write on the whiteboard, you write some things up first as an

example – without perfect spelling or neatness. This makes it safer for them to step forward

and risk because you yourself have risked and survived it.

If you want them to notice how the ground-rules are being followed, then you notice this

first. Refer to pages 165 – 167 Zinker, J. Creative Process in Gestalt Therapy

If you want the participants to draw a picture, then you draw one (not too perfectly) first, or

you set up the guidelines to ensure this is an activity that all will be willing to do and able to

benefit from. The most important thing about drawing for adults especially, is to keep it very

safe – which means no-one should have to share their drawing with anyone. If they do

show their drawings then it should be “all in” and without names. Sharing isn’t necessary for

the learning to occur from drawing.

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Facilitator of Adult Learning

The program has sessions designed to invite participants to learn concepts and skills. Experiential

learning is quite different from the traditional lecture approach to learning, in which a passive

listener receives material that a presenter directs at them. Experiential learning stresses the

intrinsic sense of success of accomplishment in learning. Motivation is based on what you see as

desirable learning goals and the method you choose to accomplish them. The goal-directed aspect

of motivation places an emphasis upon your feelings of success or failure in the learning situation.

What leads to a psychological feeling of success in a learning situation? Kurt Lewin and Associates

found that the learner will experience psychological success if:

1. They are able to define their own goals.

2. The goals are related to their central needs and values.

3. They are able to define the paths that lead to the accomplishment of the goals.

4. The goals represent a realistic level of aspiration for them – neither too high nor too low, but

high enough to test their capabilities.

Feelings of success will be promoted when the learner are encouraged to take as much

responsibility for their own behaviour as they can handle. They must believe that they are in control

of (or at least have some influence over) their learning in order to feel psychological success3.

These principles underpin the importance of creating expectations with group participants prior to

their commencement in the program, and then articulating their hopes at session one with

reference to the aims of the program and the subjects covered. The participants need to establish

their own learning goals to assist them to realise their hopes. These need to be goals that relate to

the program aims and will support them to consolidate their learning from session to session.

Consolidation between sessions can be further encouraged by setting homework activities for

participants; the completion of which may reflect commitment and motivation. Their hopes are

revisited/revised regularly throughout the program - as well as when goals are set and when the

program is drawn to a close.

3 Pg 23 Joining Together: Group Theory and Group Skills. Johnson, D.W. & Johnson, F.P.

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Facilitator as Program Administrator

Pre-Program

Communicating with program applicants and prospective participants maximises the opportunity to

create/establish a strong platform and reputation of the facilitator, the program, the tone of the

group and the opportunity that participation represents for their lives.

Post-Program

Careful consideration should be given to how the program will be evaluated in terms of targeted

outcomes. This is guided by the information collected in the pre and post program assessment, as

well as information gathered throughout the program. Facilitators should refer to the Caraniche

prison-based Assessment Manual for details regarding the evaluation process, and the role of pre

and post assessment.

Program Delivery Context

The facilitator should consider:

o What else is available to the participants between sessions?

(e.g. access to the facilitator? Access to library resources?)

o The availability of facilitator support?

(e.g. access to supervision? Resource materials?)

o How are the other people in the prison system educated to support the aims of the

program?

o Feedback loop - How is the program piloted/monitored/improved?

The program facilitator may wish to keep an expansion folder for the group to store their work

between sessions, to allow for optimum confidentiality.

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THEME A – BEGINNING THE CHANGE PROCESS

Session 1: Forming the Group

The purpose of this session is to create a strong foundation for the group, encouraging a culture of involvement and participation in the program overall.

- present the focus & overall aims of the program - explain the leaders role & hopes for/expectations of the group - establish the ground rules of the group - clarify the expectations & needs of each of its members.

Opening – Welcome and Overview

Introduce yourself to the group, and welcome them. List the topics of today’s session and explain how the time will be structured.

Establish your credibility as Group Leader

Talk to the whole group – share with them – what brought you here and how you feel about being here – briefly describe your professional experience or an anecdote about your work-life in

a way that builds their confidence in you – express your confidence that this group will be a powerful, significant learning

experience for all, and explain how you can be so confident

Provide clear direction – explain content

Talk through the flipcharts you have created that show the Program Title and Aims, explain that to achieve these aims the group will require some rules... some you have brought and the prison system provides, and some you want them to choose.

Explain:

- Non-negotiable Group Guidelines – safety, group attendance, confidentiality, privacy

Explain that it is important that we have some shared ground-rules to work within. My role as leader is to ensure that we have rules that we all understand and work within.

Describe the methods you will use throughout the life of the group:

- Listening to others in pairs, small groups or in the circle - Individual reflection, exploring topics related to the session - Reviewing handouts and inviting them to do take-away tasks - Writing on butchers paper – bring each week, group use only

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Activity 1.1 - Ground Rules Related Materials

Ask participants to think about all the different groups they have belonged to in their life up to now: prison group, family, sporting, gangs, school, drug using etc. Suggest they recall what its like to be in a group, and then to look at what rules – probably unstated – the group may have been following that enabled them to feel a part of it, to know that they were in it. (e.g. shared purpose, seek to understand the others , listens to each other, knew each other.)

Also reflect, were there rules that shut you out of the group?

What can you learn from these other groups about rules for this group? Refer to the cards and ask them to choose one that they want to be followed in this group.

Have the rules stuck on the back of the whiteboard ready – 1 or 2 copies depending on group size, & pasted one on each half A4 sheet. Include A4 blanks & coloured markers for them to write their own.

Instruct participants to move their selected rule(s) on to the butchers’ paper /on the whiteboard with blue tack, and all sit and read through them. Then seek comments on: What would happen without (choose one ground-rule chosen)? or What would this (name one) rule look like/mean to the group? And

Place butchers paper on opposite side of the room – headed “ground-rules for our group.”

Explain what you will do or how you could ensure rules are in place; &/or ask for input & agree how to ensure rules are followed

Summarise by emphasising your role with regard to the ground rules, and seek their assistance with monitoring their own use of these.

Bring the list back to the following session and leave on display for the session. Continue doing this for the program duration (or tell group when it is the last time you will bring it.)

List of Ground Rules Now Created

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Activity 1.2 - Introductions Related

Materials

Explain all steps to this activity and then:

Invite participants to stand, walk around and look at the pictures.

After all walked & looked then suggest they choose one card that portrays:

A photo that appeals to you A photo that best describes you, or tells the group

something about you What is most important to you in your life right now How you are feeling about starting this group What you would like to achieve by the end of the

group The effects substance use/abuse has had on your

life How you would like your future to be

Scatter Photo Language cards on the floor.

In pairs - with a person beside them:

Each person to introduce self to a partner and then tell their partner about their photo.

Ask each person in the circle to show their picture, say their name and, if they want to, make a brief comment about the aspect of the photo that they chose it for.

Hear each person as they share in the large group about what its like for them to be here.

Thank them for their application of the ground-rules already.

Make connections between points shared, establish commonalities within the group, relate these back to the aims of the group and then to the topics.

Review the topics of the Program, making links back to themes from the photo language introductions if they have given you material to work with, otherwise just hand out the hard copy Handout 1.2. You may wish to have this already prepared and stuck into the front of a manila folder, which you distribute for them to put their name on the front. Invite them to put their folder in the expandable file that you will bring to the group each week. That way they have a safe place to store their material for the duration of the program and in the final session part of the closing can be to tear up material they do not wish to keep.

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Activity 1.3 - Hopes and expectations Related Materials

Describe your own Hopes about what it will be like to come here for each session, and expectations of them as participants and of yourself. Distribute Handout while they think about what they want from being here and Invite them, to write down 1 to 3 hopes on their worksheet.

Handout 1.1

Share in the same pairs, while standing, your hopes for yourself in this group. After both in the pair have spoken, return to the seats.

In circle - ask each person to share one of the hopes that they would like to aim for by being in this program. Write their name and hope on butcher’s paper.

Butchers Paper

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Session 1 - Handouts

Handout 1.1

listen – to the person talking

make “I” not “WE” statements

laugh with not at each other participate

speak so the

whole circle can hear

one speaker at a time in the circle

stick to the time

allocated

I am responsible

for my own learning here

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Handout 1.2 Program Topics & Aims Session One: Forming the Group

- to create a strong foundation for the group, encouraging a culture of involvement and participation in the program

Session Two: Drug Education - to provide participants with information about the dangers of drug abuse and

how it impacts on them emotionally, socially and physically Session Three: Why Do I Use?

- to look more closely at perceptions of own drug use and prior drug use influences

Session Four: Creating Change - to explore my perceptions of what, if anything, needs changing and how I

propose to change Session Five: A Model of Drug Use

- to provide a model of drug use and enable participants to become aware of factors that drive them to use

Session Six: Understanding Me and My Emotions - to examine the whole me which includes my thoughts, feelings, emotions

and sensations Session Seven: What do I Need?

- to understand participants basic needs and explore their own self-destructive strategies to achieving or avoiding these

Session Eight: Beliefs and Schemas - to understand what our own beliefs and schemas are and how they may

impact upon our interpretation and understanding of the world Session Nine: Consequential and Harmful Thinking

- to understand that nothing ‘just happens’; that we have a constant stream of thoughts in our heads that influence our behaviour

Session Ten: Relapse Prevention - to understand what relapse prevention is and develop one’s own strategies

to prevent relapse Session Eleven: Goal setting

- to understand the need to develop a healthy lifestyle and establish our own goals to achieving this

Session Twelve: Closing - to bring the group to a close and discuss the overall group content, the

significant moments and experiences

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Session 2: Drug Education

The purpose of this session is to provide participants with information about drugs and educate them on the dangers of drug abuse and how it impacts on them emotionally, socially and physically

Drug Education and Physical Effects of Using

Discuss the information on Handout 2.0 with participants and allow them an opportunity to express their own experiences with drugs.

HANDOUT 2.0 – Information Distribute the handout, found at the end of this session and use the table below to briefly summarise the effects of using. Ask participants to read the information over the next week

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Handout 2.0 – Drug Information

CEREBELLUM – controls

muscle tone, balance,

coordination & movement

HYPOTHALAMUS controls functions vital to survival: e.g., temperature regulation, heart

rate, blood pressure, feeding behaviour, water intake, emotional & sexual behaviour,

digestive processes, regulation of internal organs & metabolism

HIPPOCAMPUS controls social & emotional behaviour, memory & rage reactions

BACK FRONT

THALAMUS –

relays all sensory

information except

olfactory (smell)

RETICULAR FORMATION – receives

information from a number of pathways. It

functions in a number of processes including

arousal, sleep, attention, control over muscle

tone and various reflexes

MEDULLA – controls vital bodily functions

such as breathing, circulation, swallowing,

digestion and heartbeat

CEREBRAL CORTEX – Outer-most layer of the brain (grey matter). Responsible for our more complex mental activities: e.g.: specific areas control voluntary movement; experiences of heat, cold, touch, pain and the sense of body movement; vision; sound; problem solving & the location of objects in space; the comprehension of words in auditory (sound) form and word articulation.

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How Do Drugs Affect the Brain?

Neurons: The brain is made up of about 12 billion neurons (or brain cells) Neurons communicate the messages that control your body and your

thoughts Between each and every neuron are chemical messengers called

neurotransmitters. Neurotransmitters: These chemical messengers transmit thoughts and behaviour from one

brain cell to the next, allowing the brain cells to ‘talk to each other’. Note: neurons send and receive messages and neurotransmitters

carry the messages:

TYPES OF NEUROTRANSMITTERS: Neurotransmitters can be either: (1) Excitatory or (2) Inhibitory: Excitatory: allows messages to be sent (also known as “feel good”

transmitters). For example, in order for you to wake up after sleeping, excitatory transmitters are sent so that you can be alert.

Inhibitory: blocks messages from being sent. For example, when you

are in pain, inhibitory transmitters are used by the brain to restrict the transmission of pain. The more inhibitory transmitters present; the less pain you feel.

It is important that all of the major neurotransmitters are present daily and in sufficient amount in order for the brain to be chemically balanced. When there is not enough, or too much of these chemicals in the brain, then the person might experience the following symptoms: Depression Mood swings Irritability Sleeplessness Anxiety/panic Brain fog

When supply of “feel good” transmitters is low, it will be impossible for you to feel happy and motivated -> you will feel just the opposite: A decrease in energy and interest & feelings of worthlessness.

Certain transmitters, when in short supply, may cause you to be easily agitated or angered, experience mild to severe anxiety, have sleep problems and feel more psychological and physical pain.

MAJOR NEUROTRANSMITTERS:

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There are at least 300 different neurotransmitters. Below are examples of just a few:

Excitatory (feel good) neurotransmitters: ENDORPHINS (opioids): Lifts mood and increases feelings of

euphoria. Natural painkiller. The more endorphins there are: the happier you feel.

NOREPINEPHRINE: Feel happy, alert, motivated, appetite control.

o Natural anti-depressant. DOPAMINE: increases feelings of bliss and pleasure, controls appetite

and motor movements and helps you feel focused. ACETYLCHOLINE: involved in alertness, memory, sexual

performance, appetite control, release of growth hormone. PHENYLETHYLMINE (PEA): Promotes feelings of bliss (high

levels found in chocolate).

Inhibitory neurotransmitters:

ENKEPHALINS: restrict transmission of pain, reduce craving, reduce

depression. GABA (Gamma Amino Butyric Acid): anti-stress, anti-anxiety, anti-

panic, anti-pain.

Hormonal neurotransmitters:

SEROTONIN: Promotes and improves sleep, improves self esteem, relieves depression, reduces cravings, prevents agitated depression and worrying.

MELATONIN: Promotes ‘rest and recuperation’. Considered to be an anti-aging hormone and also regulates body clock.

OXYTOCIN: Stimulated by Dopamine – promotes sexual arousal and feelings of emotional attachment.

THE BRAIN’S RESPONSE TO DRUGS: Drugs change the way neurons communicate with each other. The actions of some drugs mimic those of naturally occurring

neurotransmitters – e.g. some drugs stop the release of chemicals in the brain, and other drugs block the reception of these chemical messages.

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How Heroin Affects the Brain

WHAT IS IT?

Heroin belongs to a class of drugs called opiates, which are all derived from the opium poppy.

Other opiates include codeine, opium and morphine. The active ingredient in all opiates is morphine.

HOW DOES IT WORK?

Morphine has a very similar chemical structure to endorphins. Endorphins are “feel good” chemicals that are naturally present in the

brain. Endorphins are released in response to pain or stress and they work by

blocking neurons from communicating pain messages. Endorphins also stimulate the “pleasure system” in the brain by

triggering the release of dopamine. When our natural endorphins do their work we feel high, euphoric

and free from pain. Endorphins are also involved in breathing, nausea, vomiting and

hormone regulation. Because the chemical structure of morphine is so similar to the body’s

natural endorphins, we have specific receptor sites for opiate drugs. Heroin is more powerful that the body’s own endorphins because our

brains usually control how much of the “feel good” chemical hits the brain. When someone uses heroin, the brain has no control over the amount of the chemical, its strength or contents.

Note: purity can vary greatly -> heroin is often cut with other drugs or with substances such as sugar, starch, powdered milk, baking soda, laundry detergent or strychnine.

WHAT HAPPENS WHEN YOU USE?

“The Rush”: lasts about 1 or 2 minutes and happens when the heroin bathes the brain before being distributed by the bloodstream where it is converted into morphine.

“The High”: lasts 4 to 5 hours. The morphine spreads throughout the bloodstream and the brain causing two main effects: (1) pleasure and (2) pain relief:

Pleasure – The morphine stimulates the release of dopamine; the neurotransmitter associated with pleasure. As a result, the user fells warm, drowsy, euphoric, has a sense of satisfaction and distance from everything in the environment.

Pain relief – The pain relief is caused by effects both in the spinal cord and in the brain:

In the spinal cord, the morphine blocks pain messages between neurons

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In the brain, heroin changes the way pain is felt still feel pain, but is not bothered by it

Morphine activates opiate receptors in many regions of the brain and produces effects that correlate with the area of the brain involved. For example, when the morphine attaches to the opiate receptors in the reticular formation (see diagram on page 1), control over arousal, sleep, attention, muscle tone and reflexes will be affected.

HOW DOES TOLERANCE HAPPEN?

Tolerance: occurs when more of the drug is needed to produce the same effect.

When the body’s chemical balance is upset, the body tries to set up processes to restore the balance.

The body does this by increasing the release of chemicals that have the opposite effect to the drug.

Over time and with repeated use – the user needs more and more of the drug to over-ride these chemicals and get the same effect.

HOW DOES DEPENDENCE HAPPEN?

There are two main theories about how and why people become dependent: When the drug is taken away, the neurons that were blocked from transmitting chemicals start pumping out neurotransmitters again. For example, the transmitters that were blocked from communicating pain are now released and flood into the body producing nausea, muscle spasm, cramps, fever, diarrhoea, muscle pain, anxiety and depression. These effects are the opposite to the effects of the heroin and are referred to as “withdrawal symptoms”. When a person uses an opiate repeatedly, over time, the receptor sites can be altered to fit morphine better than the body’s natural endorphins. It is almost as if the drug “carves out” the receptor sites. As a result, the user might become dependent on the drug to kill pain since its own receptors no longer “fit” well into the receptor sites. Once the person gets ‘clean’, the receptor sites eventually go back to their original shape.

TREATMENT:

Heroin abuse and addiction is usually treated with both behavioural and medical methods:

Behavioural treatment methods – address psychological processes involved in substance abuse and dependence. Medical treatment methods:

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Naloxone - administered when someone overdoses. Naloxone blocks the opiate receptor so the drug no longer works. The effect is immediate. Methadone – blocks the effects of heroin as well as the symptoms of withdrawal. It has no euphoric or sedative effects.

How Benzos Affect the Brain

WHAT ARE THEY?

Benzodiazepines (Benzos) are tranquillisers, which were designed to treat anxiety and induce sleep. Examples include: Xanax (alprazolam) Halcion (triazolam) Valium (diazepam) Serepax (oxazepam) Rivotril (clonazepam) Mogadon (nitrazepam) Rohypnol (flunitrazepam)

HOW DO THEY WORK?

Benzos affect a natural neurotransmitter called gamma aminobutyric acid (GABA).

GABA is an inhibitory neurotransmitter (blocks messages from being sent).

GABA slows down brain activity – it reduces the excitability of the neuron and causes slowing down of nerve transmission – you feel relaxed and less anxious.

Benzos work because they attach to GABA receptor sites on the neuron, which further reduces electrical activity in all areas of the brain.

Benzos make GABA work more effectively (slow down the brain) by reducing norepinephrine.

The binding of Benzos to the GABA receptors is most intense in the cerebral cortex.

Note: the cerebral cortex is involved in complex mental activities. When the Benzos bind onto the GABA receptor sites, it causes small

holes in the nerve tissue (chloride channels), which allow the nerve to become less excitable and more relaxed.

The Benzos cause these holes to open, stay open longer and increase in numbers – so that when the nerve is stimulated, it will not respond as forcefully, or will require much more to get it to fire.

Therefore – you feel relaxed, sedated, calm and not anxious.

WHAT HAPPENS WHEN YOU USE?

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Benzos take between 20 minutes and 2 hours to take effect. In less than 2 weeks, the user will have relief from anxiety, relaxation,

drowsiness, isolation, intoxication, clumsiness and drowsiness. Benzos are also known to cause abnormal behaviour:

Hostility and violence:

▪ Effects on emotions – irritability, anger, rage (uncontrollable) Nightmares Disinhibition:

▪ Similar to disinhibition seen with alcohol use Paranoia Suicidal ideation and depression:

▪ Can blunt out all emotion (“emotional anesthesia”) – person experiences a lack of emotional response to anything

▪ Make depression worse (feel “shut off” from the rest of the world)

Psychosis Mania Cognitive dysfunction:

▪ Memory impairment

▪ Confusion Sleep:

▪ In the beginning, Benzos decrease the time it takes to fall asleep

▪ Decrease the number of times you wake up during the night

▪ REM time is shortened

▪ Number of cycles of REM increase

▪ Total sleep time increases

▪ Complex effects of dream process (nightmares)

▪ Within a short time, insomnia develops Permanent brain damage:

▪ Patients who take high doses for long periods develop cognitive impairments.

▪ Structural changes in the brain.

▪ The abnormal development of the calcium channels is a physical change in the nerve tissue and is considered neural damage. No other medication will cause these types of severe neurological changes.

MIXING BENZOS WITH ALCOHOL AND OTHER DRUGS

Some people use Benzos with alcohol to increase the anxiety-reducing effects of the Benzos.

Using Benzos and alcohol can be fatal. Alcohol and Benzos have an action on the same receptors in the

brain. When you use both together – addiction and tolerance comes much

faster and the withdrawal symptoms are much more painful and longer lasting.

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The two together can shut down your breathing. Benzos also increase the effects of other drugs – run the risk of

overdose or a toxic reaction.

HOW DOES TOLERANCE HAPPEN? Because Benzos make GABA work more effectively (slows down the

brain), noradrenaline or norepinephrine activity tries to make up for it and increases in supply.

When noradrenaline is increased, the two chemicals cancel each other out – therefore, you need more and more Benzos to achieve the same anxiety-reducing effect.

After you take Benzos, the nerve cells build millions of extra calcium channels as tolerance grows.

HOW DOES DEPENDENCE HAPPEN? There are estimates that more than half of those people taking

Benzos by prescription will become physically dependent – the numbers are much higher when the drug is not prescribed.

After someone stops taking Benzos, its inhibitory effects are also stopped – the nerve cell now has billions of new channels for nerve firing that are not depressed by the Benzo.

The nerve becomes hyper-excitable – it will fire with much less provocation, it will fire millions of times more forcefully than a healthy neuron and may send out signals in other directions that it normally wouldn’t.

Essentially, there is now an electrical storm in the brain – withdrawal symptoms.

To stop these withdrawal symptoms, a person might continue taking the drug.

WHAT HAPPENS WHEN YOU WITHDRAW FROM BENZOS? Withdrawal symptoms include: Hallucinations Confusion Depression Irritability Amnesia Rash Itch Constipation or diarrhoea Impotence Nausea Vomiting Increased anxiety Increased panic Insomnia Nightmares Breathlessness

Suicidal feelings Aggression Sore eyes Agoraphobia Rage Distorted vision Dizziness Shaking Tight chest Tinitis Headache Muscle pain Stomach pain Memory loss Greater appetite

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The physical and emotional symptoms of withdrawal come from billions of nerve cells over-firing, firing to other cells they are not supposed to, or firing way too easy. Because nerve cells are firing all over the place, withdrawal symptoms are constantly changing and new withdrawal symptoms might appear months or even years after stopping the medication. Benzo withdrawal must be monitored by a doctor – as it can cause severe seizures. Withdrawal symptoms can take from 2 – 20 days to appear.

HEALING Coming off Benzos can be a long, drawn-out process. You do not create new brain cells to heal withdrawals – you need to

allow time for the brain to close the billions of calcium channels that the Benzos created.

Nerve tissue is the slowest of all tissue to heal. Since the brain is highly affected by diet, aerobic exercise, stress and

other chemicals, these are the ways to heal. Other medication may help to reduce the symptoms, but they do

nothing to heal the brain.

Amphetamines and the Brain

WHAT ARE THEY?

Amphetamines are a group of synthetic stimulants. The most common are: Benzedrine (amphetamine) Dexedrine (dextroamphetamine) Methedrine (methamphetamine)

HOW DO THEY WORK? Amphetamines cause the brain to release the neurotransmitter

serotonin in larger amounts than usual. Amphetamines also prevent the reuptake of serotonin, leaving a lot of

the chemical in between the neurons. Amphetamines also increase levels of dopamine in the brain. Dopamine is an excitatory neurotransmitter – increases feelings of

bliss, pleasure, controls appetite and motor movements and helps you feel focused.

Serotonin and dopamine make you feel excitable, increases alertness and talkativeness, depresses appetite, causes pupils to dilate, increases heart rate and blood sugar.

HOW DOES TOLERANCE HAPPEN?

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Amphetamines reduce the supply of serotonin and dopamine to the brain.

Because so much serotonin and dopamine are released when a person uses amphetamines, when the high is gone, so too is the normal supply of serotonin.

The person needs more and more to raise the levels of these chemicals.

HOW DOES DEPENDENCE HAPPEN? When the supply of serotonin and dopamine are gone, the user may

experience feelings such as depression, irritability and mood changes – they therefore need the amphetamines to counteract these symptoms.

POSSIBLE DANGERS The effects of heavy amphetamine use are similar to the symptoms of

paranoid schizophrenia. Heightened activity level can also lead to paranoid and violent

behaviour. Scientists also believe that amphetamine may also cause the bursting

of parts of neurons, which results in permanent brain damage. This has been shown in rats, but scientists have not yet been able to determine if this also happens in humans.

Cocaine and the Brain

WHAT IS IT?

Unlike the synthetic amphetamines, cocaine is a natural stimulant: it is the active ingredient in the coca plant.

An extract called coca paste is usually made directly from the leaves; then cocaine hydrochloride (cocaine) – the white powder – is extracted from the paste.

Cocaine hydrochloride is sometimes converted back into the paste and smoked in a pipe = crack.

Cocaine hydrochloride is an effective local anaesthetic. Psychological effects include – feeling of well-being, self-confidence,

alert, energetic, friendly, outgoing, fidgety, talkative, little appetite.

HOW DOES IT WORK? Cocaine mainly acts on 2 brain neurotransmitters:

o Norepinephrine (noradrenaline) o Dopamine

Cocaine causes more dopamine to be released then it blocks the dopamine receptor sites and stops the absorption of dopamine back into the neuron.

The high which cocaine causes is due to the excess of dopamine. Cocaine has similar effects on norepinephrine.

WHAT HAPPENS WHEN YOU USE?

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When you snort cocaine, the powder is inhaled into the nostrils, where it is absorbed into the bloodstream through the mucous membranes. The rush produced takes about 8 minutes and lasts about 20.

“freebasing” – when powder is heated with ether or some other agent (a process that “frees” its active ingredients) and then smoked.

o This method carries the psychoactive ingredient to the brain more quickly and delivers a more rapid high than snorting or injecting.

Crack is a form of free-based cocaine that is sold in small chinks, or “rocks”, which are smoked in a pipe:

o Because it is free-based, crack is exceptionally powerful, producing in seconds an intense rush, which wears off within 20 minutes

Withdrawal phases of binge users: Phase 1: “The Crash” Within half-an-hour of final cocaine dose: Mounting depression Agitation Craving for more Then changes to fatigue Sleepiness Lasts for several days

Phase 2: “Withdrawal Phase” Return to deceptively normal functioning Fluctuating states of boredom, restlessness Anxiety String cravings 1-10 weeks

Phase 3: “Extinction” Regain normal functioning Occasional cravings

DOES TOLERANCE HAPPEN? Cocaine does not produce the tolerance that other drugs do. Rather, cocaine exhibits a trait known as sensitisation – opposite of

tolerance. Sensitisation – when a user continues to abuse cocaine, the same

dose will eventually produce a greater behavioural response.

COMPLICATING FACTORS COCAINE PSYCHOSIS – has been observed during cocaine sprees or

binges. During cocaine binges there is a high risk of seizures, loss of

consciousness and death from respiratory arrest and stroke.

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Fatalities from cocaine are most likely following IV injection. Snorting cocaine damages the nasal membranes.

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Marijuana and the Brain

WHAT IS IT? Marijuana is a hallucinogen. It comes from the dried leaves and the flowers of the cannabis sativa

plant. The active ingredient is tetrahydrocannabinol (THC). Marijuana also contains over 80 cannabinoid’s (chemicals of the same

class a THC). Cannabis can be eaten or smoked: When you smoke marijuana, 20-80% of the THC is lost in the smoke. Most of the cannabinoid’s are found in a sticky resin covering the

leaves and flowers of the plant, which can be extracted and dried to form dark, cork-like material called hashish.

Hash is 5-6 times stringer than marijuana. The hashish can be further processed into an extremely potent

produce called hash oil.

HOW DOES IT WORK? The THC in marijuana triggers the release of dopamine in the brain. Dopamine promotes feelings of pleasure and relaxation. Dopamine is also involved in the control over motor movements and

appetite regulation. The THC also binds to the areas of the brain involved in mood and

memory. For 24 hours after first smoking marijuana, a user will have trouble

paying attention. This effect is even greater because it causes a decrease in the number of neurons present in the hippocampus – an area of the brain related to memory.

THC also interferes with the reception of sensory messages (sight, sound, taste, touch and smell).

WHAT HAPPENS WHEN YOU USE?

THC has two consistent effects: Accelerated heart rate. Reddening of the whites of your eyes. Depending on how you use – the effects of the drug include relaxation,

feel passive, memory function decreases, coordination decreases, attention decreases, thoughts are impaired.

The effects of the marijuana are felt about one minute after smoking. These effects being to wear off in about one hour and disappear almost completely after 3-5 hours.

Traces of THC can be detected in the body for weeks. Cravings for food (“munchies”). Withdrawal symptoms are rare (but may include nausea, diarrhoea,

sweating, chills, restlessness, sleep disturbances).

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DOES TOLERANCE HAPPEN? Tolerance can develop with prolonged use, but it is not common.

CAN DEPENDENCE HAPPEN? The dependence potential for marijuana is low. Although researchers agree that marijuana is not physically addictive,

many agree that it produces psychological dependence.

POSSIBLE DANGERS Exposure to THC can damage and even destroy neurons (brain cells) –

ABI. Studies in rates have shown that the hippocampus is completely destroyed by high levels of THC.

Substance-induced psychosis. Effect on testosterone – regular marijuana use (about 9 joints per

week) for about 6 or more months will result in a decrease of the testosterone level in the blood:

The degree of testosterone reduction is directly related to the amount of marijuana smoked.

May impair sexual functioning. Immune system – chronic marijuana smoking impairs one part of the

immune system – the body’s mechanism for fighting the invasion of germs.

Effect of smoke on lungs – since marijuana smoke contains about 50% more carcinogenic hydrocarbon than does tobacco smoke – heavy, prolonged use greatly increases the risk of cancer.

“anti-motivational syndrome” – loss of ambition and difficulty concentrating has been demonstrated among marijuana smokers.

Driving – marijuana intoxicated people can stop as quickly as normal drivers, but they are not as quick to notice those things for which they should stop because of the dulling of the senses due to the THC.

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Drugs & Behaviour

Is it possible to restore the chemical imbalance caused by drug abuse? Yes, it is possible. There are 3 main causes of neurotransmitter deficiencies (apart from

drug use) – once you are clean, there are ways you can restore proper levels of these neurotransmitters.

Causes of neurotransmitter deficiencies: 1. Genetics – a person’s genetic makeup is responsible for low, high or

balanced levels of neurotransmitters from birth. 2. Stress – stress depletes neurotransmitters. Any type of stress … lack of

sleep, everyday mental and emotional battles or poor health, will deplete “feel good” transmitters.

3. Diet – the human brain makes neurotransmitters from amino acids found

in food. Experts in the field of brain nutrition all agree that it is very difficult to get the necessary supply of specific amino acids from our modern diet that our brain needs to create enough of the neurotransmitters that keep us feeling balanced and happy.

The 2 key amino acids your brain uses to make neurotransmitters are:

(1) Phenylalanine – is an essential amino acid, meaning that if you are not getting it from your diet, then your brain is not getting what it needs to make the transmitters that cause you to feel happy, loving and motivated.

(2) Glutamine – is used to make neurotransmitters which keep you

feeling calm, focused and in control – but during periods of stress, the body cannot make its own supply of glutamine and needs an outside source – either from food or supplements.

So, what can be done to restore the balance? Stop using the drugs that have altered the balance of chemicals in your

brain. Amino acid therapy provides the nutrition needed to overcome the

chemical imbalance (proper balance of amino acids, vitamins & minerals). If your diet is not providing adequate amounts of phenylalanine, then the recommended therapeutic dosage is 500-2000 mg/day.

Reduce stress. How do you feel when neurotransmitters are restored?

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As all levels are restored, you notice that you sleep better, think more

clearly, are slower to anger, feel more at peace, happy and relaxed. You will find that you are more positive, focused and motivated. These thoughts begin to replace negative thoughts, hopelessness and

depression. Is it possible to restore or reverse cognitive deficits caused by substance abuse? There is an association between age and recovery – that is, the

younger you are when you stop using, the more likely it is that you will recover.

However, this is not completely clear, as individuals often have unique

difficulties that change with age and sometimes older people recover better than younger people.

Generally, though, younger people seem to be able to learn new

abilities that compensate for these deficits than older people. Some researchers believe that if brain tissue is destroyed, it affects the

functions of that area of the brain as well as all associated functions. Alternately, others believe that other parts of the brain that are not

damaged can take up the functions that the damaged part of the brain used to perform.

The nervous system in the elderly loses its ability to adapt to new

functions in this way. The most favoured theory is that individuals recover by learning

alternative ways of achieving the same goals by different means based on functions that are still intact.

For example, memory loss can be improved by learning new ways of

reducing memory load, such as using external cues for memory such as a list of things to remember or keeping memory diaries.

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Psychoactive Drugs

Range of Effects Development of Tolerance

Prolonged Use of Large Amounts

Withdrawal Symptoms After Prolonged Use From To

Alcohol - Beer - Wine - Hard Liquor

Depressant Relaxation, lowered inhibitions, reduced intensity of physical sensations, digestive upsets, body heat loss, reduced muscular coordination.

Loss of body control, passing out (also causing physical injuries), susceptibility to pneumonia, cessation of breathing.

Moderate

Liver damage, ulcers, chronic diarrhoea, amnesia, vomiting, brain damage, internal bleeding, debilitation.

Convulsions, shakes, hallucinations, loss of memory, uncontrolled muscular spasms, psychosis.

Sedative Hypnotics

Barbiturates: - Nebutal - Phenobarbital - Seconal Tranquilizers: - Valium - Librium - Quaaludes

Depressant Relaxation, lowered inhibitions, reduced intensity of physical sensations, digestive upsets, body heat loss, reduced muscular coordination.

Passing out, loss of body control, stupor, severe depression of respiration, possible death. (Effects are exaggerated when used in combination with alcohol - synergistic effect).

Moderate

Amnesia, confusion, drowsiness, personality changes.

Opiates

- Opium - Morphine - Heroin - Codeine - Dilaudids - Percodan - Darvon - Methadone

Depressant Suppression of pain, lowered blood pressure and respiratory rate, constipation, disruption of menstrual cycle, hallucinations, sleep.

Clammy skin, convulsions, coma, respiratory depression, possible death.

High Depressed sexual drive, lethargy, general physical debilitation, infections, hepatitis

Water eyes, running nose, severe back pains, stomach cramps, sleeplessness, nausea, diarrhoea, sweating, muscle spasms.

Stimulants

Amphetamines - Dexedrine-Methamphetamines - Speed - Diet Pills Other Stimulants - Ritalin - Cocaine - Caffeine

Stimulation of Central Nervous System Increased blood pressure and pulse rate, appetite loss, increased alertness, dilated and dried out bronchi, restlessness, insomnia.

Paranoid reaction, temporary psychosis, irritability, convulsions, palpitations. (Not generally true for caffeine.)

High

Psychosis, insomnia, paranoia, nervous system damage. (Not generally true for caffeine.)

Severe depression, both physical and mental. (Not true for caffeine.)

Psychedelics

- LSD - Mescaline - Psilocybin - PCP

Alteration of Mental Process Distorted perceptions, hallucinations, confusion, vomiting.

Psychosis, hallucinations, vomiting, anxiety, panic, stupor. With PCP: Aggressive behaviour, catatonia, convulsions, coma, high blood pressure.

High

Psychosis, continued hallucinations, mental disruption.

Occasional flashback phenomena, depression.

THC - Marijuana - Hashish

Sedation, euphoria, increased appetite, altered mental process.

Distorted perception, anxiety, panic. Moderate

Amotivation (loss of drive). No true withdrawal symptoms except possible depression.

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Session 3: Why do I use?

The purpose of this session is to look more closely at participant perceptions of their drug use and prior drug use influences The prisoners are usually accustomed to acknowledging the damage that their drug use causes, but not acknowledging the gains they make from it. This session encourages discussion of the pros and cons of drug use

Drug use history

HANDOUT 3.0 – My drug use history Distribute the handout, found at the back of this session and ask group members to answer the questions around their early drug use influences. Participants can work on questions individually or as a group.

Why Do I Use?

HANDOUT 3.1 – Why Do I Use? Distribute the handout, found at the back of this session and ask group members to complete

Attribution of causality

Explain that attribution is the characteristics you give to yourself in order to explain the causes of your behaviour. Attribution of causality is a theory which states that: The way you perceive or understand your behaviour is determined by what you attribute to the causes of the behaviour. The attributions you make about the causes of your behaviour can be internal and/or external: Internal attributions are those factors that you believe have caused your behaviour

that come from within you (i.e. your personality, beliefs, attitudes, etc.) External attributions are those factors that you believe have caused your behaviour

that come from outside of you (i.e. a particular situation or event, the environment, etc.)

Examples Mr A attributes most of his drug abuse to the fact that his father was an alcoholic and his mother was addicted to prescription medication. Mr A believes that he has inherited an addiction gene from his parents that is beyond his control.

Mr A attributes his drug abuse to an external cause Mr B attributes most of his drug abuse to his shyness in social situations. Mr B experimented with amphetamines and found that his confidence increased and he was able to interact with and meet new people. Mr B soon found that he could not socialise

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with others unless he had used, which made Mr B very anxious and depressed when he was straight. This led Mr B to rely more heavily on the drugs

Mr B attributes his drug abuse to an internal cause

HANDOUT 3.2 – Internal and External Attributions Distribute the handout, found at the back of this session, and ask participants to evaluate whether their drug use is caused by mostly internal or external factors (refer to responses to Handout 3.1)

3.2 Substance Abuse Attribution Pie Related

Materials

Distribute Handout 3.3 and ask group members to list five internal and five external factors they believe have contributed to their own problems with drug use and dependence. Ask group members to divide their ‘Substance Abuse Attribution Pie’ to indicate their responses to how much is caused by internal and external factors respectively

Handout 3.3

Using and Crime

This section forms an introduction to the theme of using and crime to the group. Discussing the links between group members’ drug use and crime at this stage forms a basis for further exploration of this topic later in the program. Ask the group – “What is your biggest problem, drug use or crime? Why?” Some group members will believe it’s drugs and that without a drug problem they would not commit crime, for others it will be crime. It is important to recognise that the relationship between substance abuse and offending is different for different offenders. These relationships have been roughly categorised into four types:

early stage substance users addicts criminogenic substance users dual diagnosis

There is a progression from early stage to addict to criminogenic substance user. Dual diagnosis users often start for a different set of reasons, but can also overlap with the other categories.

HANDOUT 3.4 – Using and Crime Distribute the handout, found at the back of this session, and discuss the four types of offenders

Ask the group to reflect on their own experiences of using and crime. Look at when they started using and when they committed crime. Ask the group which categories they relate to. Early stage substance users

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These are the experimental and recreational users whose crimes stem from their drug use either through possession, or impaired judgement whilst under the influence. E.g. drunk youths vandalising property, urinating in a public place

For these offenders, the crime would not have occurred if the individual had not been under the influence. These offenders are often young and they are not addicted to the substance or may be early in their addiction.

Addicts

These offenders are physically and psychologically addicted to a substance. Their addiction has become primary in their lives and their daily life revolves around scoring and raising the money to score. They are rarely employed and usually commit petty crimes such as theft and shoplifting, but they commit a lot of these crimes. They do not usually commit violent offences and their offending is primarily to support their habit

Dually diagnosed substance abuser

To be dually diagnosed is to have another medical problem as well as a substance use disorder. Dual diagnosis offenders may also have a psychiatric disorder, intellectual disability, physical disability, etc. The relationship between the substance abuse and the other condition can vary.

Drug use may lead to the second condition, e.g. the teenager whose extensive marijuana abuse precipitated a psychotic episode

Drugs may be used to alleviate symptoms of the disorder, which is often called “self-medicating” – e.g. the person with depression who uses speed to control his mood

The key to dual diagnosis clients is to treat both disorders in an integrated manner. For those with psychiatric disorders it is essential to stabilise the psychiatric condition before embarking on substance abuse treatment

Criminogenic substance abuser

These offenders are involved in both the criminal and drug using cultures. They often feel outside of “straight” society and have little regard for the rules and laws of the general community. Many of these offenders have grown up in criminal or drug using families and all their social support is in these circles. These individuals are ‘career criminals’ and do not offend simply to support their drug habit, but as their main form of income. This group’s drug problems are as serious as the other groups, however drug treatment in isolation will not end their offending behaviour. This group requires intensive rehabilitation programs that address their criminogenic needs as well as substance abuse. For this group:

Jail is an acceptable consequence of their lifestyle

Jail gives time out to recover from drug addiction

It is an opportunity to get healthy and access medical services

It provides an opportunity to renew old friendships

It provides time out from the chaotic street lifestyle Many substance using offenders have never known anything but crime and drugs

as a lifestyle. They have no real connections with mainstream society. As each generation of substance using offenders comes along, they are in turn, more removed from the values of mainstream culture and less able to assimilate outside the drug using/offending cultures.

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Session Take Away Task

Ask participants to fill out the following handout over the next week. Inform participants that their answers will be used during the next session.

HANDOUT 3.5 – Pros & Cons of Using Distribute the handout, found at the back of this session and ask group members to complete over the next week

Session Close

Get participants to say one word to reflect how they feel at the end of this session

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Session 3 – Handouts

Handout 3.0 – Drug Use History

1. How old were you when you first used drugs? How did this come about? 2. Do you remember what you were using? How did this come about? Who were you

with?

3. How would you describe the drug habits of your mother, father, partner, extended family or culture (e.g., non-user, occasional or social user, frequent or heavy social user, problem user (at any time in life)?

4. Do you have any blood relatives whom you regard as being or having been a

problem drug user? 5. If you weren’t raised by your biological parents, what were you exposed to in terms

of drugs? 6. What were the rules around drug use growing up? 7. Who were the biggest influences on your drug use? 8. At what age did drugs begin to have an effect on your life? 9. Do you feel drugs are a problem for you now? 10. If you consider drugs to be a problem, were there any special circumstances or

events that occurred which you feel were at least partly responsible for it becoming a problem?

11. What is the largest amount of drugs you have ever consumed in one day? 12. What is the worst thing that has happened to you because of your drug use? 13. Have you ever been able to stop using drugs for an extended period of time? How

did that come about?

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Handout 3.1 – Why do I use?

Tick the reasons which apply to you:

Yes No

I use because it helps me relax

I use because it makes me feel good

I use because of pressure from others (friends, family, dealers etc)

I use because it is expected of me in certain situations

I use because it relieves stress

I use because I enjoy it

I use because there is nothing else to do

I use because I saw others using when I was growing up

I use to forget my worries

I use when I am angry

I use when I can’t cope with a situation

I use because I can’t help it: I am addicted

I use because it helps me get along better with other people

I use so that I can avoid withdrawal

I use because I want to feel the way others feel when they use

I use because I have an addictive personality

I use because I like to take risks

I use because it is easier to escape than to deal with problems

I use because my partner uses

I use because it helps me to fit in when I’m in social situations

I use because I like who I am when I’m high/stoned/sedated etc.

Others:

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Handout 3.2 – Internal and External Attributions

INTERNAL CAUSES Using helps me relax

Using makes me feel good

Using relieves stress

Using is enjoyable

Using stops me from getting bored

When I use, I can forget my worries

Using helps me deal with my anger

Using helps me to cope

Using helps me get along better with other people

I use so that I can avoid withdrawal

Using allows me to feel as good as everyone else does when they use

I use because I have an addictive personality

I like to take risks

Its easier to escape than to deal with problems

Using helps me fit in when I’m in social situations

I like who I am when I’m high/stoned/sedated etc

EXTERNAL CAUSES Pressure from others

Using is expected of me in certain situations

I learned to use from others when I was growing up

I am addicted: I can’t help it

Using helps me get along better with other people

Using allows me to feel as good as everyone else when

they use

I use because I have an addictive personality

I use because my partner uses

I use because it helps me fit in when I’m in social

situations

Other people like me more when I am

high/stoned/sedated etc

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Handout 3.3 – The Substance Abuse Attribution Pie In the space below, please write down 5 internal factors and 5 external factors that you believe have contributed to the problems you have experienced with drug abuse and dependence.

The circle below represents what is called a substance abuse “Attribution Pie”.

Divide the pie into pieces.

Each piece of the pie will represent each of the internal and external factors you have listed as contributing to your substance use.

The bigger the pieces of pie: the greater the contribution of that factor.

Handout 3.4 – Using and Crime

The four types of substance using offenders:

Early stage substance users: - Experimental, recreational, social user. - Usually uses with others

INTERNAL FACTORS

1.__________________________

2.__________________________

3.__________________________

4.__________________________

5.__________________________

EXTERNAL FACTORS

1.__________________________

2.__________________________

3.__________________________

4.__________________________

5._________________________

_

Shade those pieces of

the pie that represent

internal factors

Shade those pieces of

the pie that represent

external factors

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- Crimes stem from drug use through possession or impaired judgment under the influence.

- Offenders are often young. - Offenders are either not addicted or in early stages of addiction to substance. - Offences can be minor or serious, e.g., drunk youths writing graffiti, urinating in a

public place, vandalism, culpable driving.

Addicts: - Physically and psychologically addicted to substance. - Daily life revolves around scoring and raising money to score. - Rarely employed, entrenched in the lifestyle. - Many petty crimes committed, such as theft and shoplifting. - Offending is primarily to support their habit. - Ceases offending if substance abuse is treated

Dually diagnosed substance abuser: - Offenders have another medical problem as well as substance use disorder. - May have psychiatric disorder, intellectual or physical disability. - Drug may lead to second condition or drugs may be used to alleviate symptoms of

disorder. Eg – marijuana use leading to psychotic episode vs person with depression using speed to control mood.

- Both disorders must be treated in an integrated manner.

Criminogenic substance abuser: - Stuck in both criminal and drug using cultures. - Not part of mainstream society. - Little regard for rules and laws of the general community. - Has usually grown up in a family where crime/substance abuse is “normal”. - Offending is main source of income. - Require intensive rehabilitation programs that address crime as well as substance

abuse.

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Handout 3.5 – Pros and Cons of Drug Use

CONTINUING TO USE

PROS:

CONS:

NOT USING

PROS:

CONS:

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Session 4: Creating Change

The purpose of this session is to explore participants’ perceptions of what, if anything, needs changing and how they propose to change. This session also explores their attitudes towards change and blocks to change Purpose includes getting participants to identify what stage of change they are in and discuss this in the context of how they got there, where they would like to be, and where do they see themselves going.

Opening

Allow participants to have an opportunity to discuss the pros and cons of using drugs that they completed for homework.

Life Balance

4.1 Life Balance Related

Materials

Distribute Handout 4.1 and explain to the group that they have to mark in their level of satisfaction with different areas of their life. The more they colour in for each section, the greater their level of satisfaction. Note that one segment has been left blank for them to label themselves. Ask them to draw around the total shaded area so that they can see the “shape” of their life

Handout 4.1 Pencils

Discuss participant’s responses and address the following questions:

What area did they add in the blank segment? The overall shape of the wheel – is it in balance? What areas give the most satisfaction? What makes it satisfying? What areas give the least satisfaction? What makes it unsatisfying? What would they most want to change?

Exploring Change

Acknowledge that change can be beautiful, painful, frightening, hazardous, difficult, necessary, functional or natural. Sometimes, like the caterpillar, something has to die in order to allow change. Discuss with the group the following points:

Change is very difficult and very hard Even the most motivated people have days when they want to give up Familiar ways of behaving or habits are comfortable and safe, even when they hurt

us (e.g., drug use, violence, prison) Most people have patterns of behaviour that trap them in their old ways and

prevent change Ask the following questions:

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If I change, what will I give up? If I change, what will I gain? What gets in the way of my change? What are my supports for change?

Blocks to Change

This section attempts to get the group members to identify the ways they block or sabotage their change and share them with the group so that the group can be an environment in which their old patterns are being actively challenged. Discuss with the group the following points:

change is very difficult and very hard even the most motivated people have days when they want to give up familiar ways of behaving or habits are comfortable and safe, even when they hurt

us (e.g., drug use, violence, prison) most people have patterns of behaviour that trap them in their old ways and

prevent change Ask the group about their previous attempts to change something in their lives. What is different about the times they have succeeded in changing and the times they have given up?

What things made change difficult? In what ways did they block their own change?

HANDOUT 4.2 & 4.3 – Thinking about change & Barriers Distribute the handouts, found at the back of this session and ask group members to complete

Stages of Change

The “stages of change model” was developed by Prochaska and DiClemente from their work observing people trying to give up smoking. They found that people went through a predictable set of stages as they tried to stop smoking. Later studies confirmed that these stages apply to almost any change of a habitual behaviour, e.g. dieting, exercising, etc. Introduce the stages of change to the group. Choose which ‘Stages of Change’ handout to use from the options at the back of this session

HANDOUT 4.4-4.8 – Stages of Change Distribute one of the handouts, found at the back of this session and read through as a group. Break the group into pairs and ask participants to discuss which stage of change they are currently in and examples why (Most should be

in preparation/action)

Encourage them to be realistic and thoughtful in the process and not be swayed by others in the group. If anyone selects maintenance, try to process that response in the context that maintenance is only really truly tested once they are released and are exposed to the usual pressures and temptations. Remind participants that just because they aren’t

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currently using it doesn’t mean they are automatically in the action stage – to be in the action stage they need to have taken control of their substance abuse. (Relate their thoughts to Handout 3.5 that they completed for homework) Questions to consider as a group include:

How do you know you are in stage X? Do you recall being in the pre-contemplation stage – in what ways do you think

differently now? What have been your motivators? (Motivators are the people, events, etc. that

assist you to move from one stage to the next. E.g., the overdose of a friend might jolt someone into contemplation)

Questions for assessing motivation include:

How interested are you in changing your drug use now? How do you feel about your drug use now? Do you feel you should stop using drugs or do you really want to? What would you be prepared to do to solve this drug use problem? How confident are you that you can achieve this? Are you prepared to make a long-term commitment to this?

Precontemplative responses will be: “I’m happy with my drug use”, or, “my drug use is not a problem”

Contemplative responses will be “I’m thinking about stopping”

Action based responses will be “I want to stop now”, “I am getting help” or some type of recognition of the damage caused by drug use such as “I need to stop because I don’t want to keep hurting my children/partner anymore”

Maintenance based responses will be “I’ve managed to stop now for a while. I want to keep going because my life has changed for the better and I now feel I am in control of my life again”

Session Close

Get participants to say one sentence to reflect what they have learnt about themselves from this session

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Session 4 - Handouts

Handout 4.1 – Life Balance Wheel The life wheel shows different areas of a person’s life. On the wheel mark how satisfied you are with this area of your life. The middle is 0 (not satisfied at all), the half way mark is 50 (reasonably satisfied) and the edge of the circle is 100 (extremely satisfied). One of the segments has been left blank so that you can put in an area of your own (eg. education, prison, drugs, freedom, responsibility, spirituality).

Colour in the segments of your wheel and have a look at its shape.

Which area of your life is the most satisfying?

________________________________ Which area of your life is the least satisfying? ________________________________ How balanced is your life? _______________________________________________

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Handout 4.2 – Thinking about Change

Five things I want to stay the same

Five things I want to change

Five things I do that stop or block my

change

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Handout 4.3 – Barriers to Change INSTRUCTIONS: There are many different reasons why people who use drugs do not seek help. Here are some reasons that people give, as to why they don't seek treatment or other kinds of help. Please indicate how important each of these was for you as a reason for why you did not seek help. Please circle one answer for each reason (adapted from CASAA Research Division) Was this an important reason why you did not seek help with regard to your drug use? 0 = Not at all 1 = Somewhat important 2 = Important 3 = Very important

1 My drug use seemed fairly normal to me. 0 1 2 3

2 No one told me I had a problem with drugs or encouraged me to seek help.

0 1 2 3

3 I didn’t think I had a serious problem with drugs 0 1 2 3

4 I thought I could handle it on my own. 0 1 2 3

5 I didn’t think of myself as addicted to drugs. 0 1 2 3

6 I was concerned about what other people would think of me if I went for help.

0 1 2 3

7 I was too embarrassed or ashamed. 0 1 2 3

8 I thought that my family would be embarrassed. 0 1 2 3

9 I thought my job might be in danger if I went for help. 0 1 2 3

10 I didn’t know where to go for help. 0 1 2 3

11 I didn’t want to be told to stop using. 0 1 2 3

12 I didn’t think it would do any good. 0 1 2 3

13 I couldn't afford to pay for help. 0 1 2 3

14 I had no transportation, no way to get there. 0 1 2 3

15 I needed someone to take care of my children while I was getting help.

0 1 2 3

16 I didn't have the time. 0 1 2 3

17 I was afraid I'd be put into a hospital. 0 1 2 3

18 I didn't think I needed any help. 0 1 2 3

19 Someone important to me disapproved of my getting help. 0 1 2 3

20 I hate being asked personal questions. 0 1 2 3

21 I was afraid that I would fail, or that it wouldn't help me. 0 1 2 3

22 I thought I was too young to be getting help or treatment. 0 1 2 3

23 I didn't want somebody telling me what to do with my life. 0 1 2 3

24 I've had a bad experience with treatment before. 0 1 2 3

25 Somebody I know had a bad experience with treatment. 0 1 2 3

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26 I was afraid of what might happen in treatment. 0 1 2 3

27 My drug use wasn't causing any problems as far as I could see.

0 1 2 3

28 I don't like to talk in groups. 0 1 2 3

29 I liked using and didn't want to give it up. 0 1 2 3

30 I thought I'd lose my friends if I went for help. 0 1 2 3

31 I was worried about the bad feelings of going through withdrawal from drugs.

0 1 2 3

32 I didn't know how I could live without using. 0 1 2 3

33 I thought that going for help might get me in legal trouble. 0 1 2 3

34 It just seemed like too much trouble to go for help. 0 1 2 3

35 I liked getting high. 0 1 2 3

36 I couldn't get time off from work. 0 1 2 3

37 Using was a way of life for me. 0 1 2 3

38 Drugs really had not caused much trouble or problems for me.

0 1 2 3

39 I was afraid of the people I might see. 0 1 2 3

40 Drug use was not my main problem. 0 1 2 3

41 I didn't feel safe going where I'd have to go for help. 0 1 2 3

42 There seemed to be more good than bad about using for me.

0 1 2 3

43 Other people discouraged me from seeking help. 0 1 2 3

44 I don't like to talk about my personal life with other people. 0 1 2 3

45 I thought people would make fun of me. 0 1 2 3

46 I didn't know what would happen to me. 0 1 2 3

47 I didn't want to go to Narcotics Anonymous or other twelve-step groups.

0 1 2 3

48 I thought that "help" was for people who had worse problems than mine.

0 1 2 3

49 I had no insurance to pay for it. 0 1 2 3

50 I thought my troubles would just go away without any help.

0 1 2 3

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Handout 4.4 – Stages of Change

The Stages of Change and Associated Brief

Interventions for Drug Use

Stage

Definition Brief Intervention

Precontemplation

The hazardous or harmful drug user is not considering change in the near future, and may not be aware of the actual or potential consequences of continued drug use at this level

Feedback the results of the screening Information about the hazards of drug use

Contemplation

The drug user may be aware of drug-related consequences but is ambivalent about changing

Emphasise the benefits of changing Give information about drug related problems, the risks of delaying, and discuss how to choose a goal

Preparation

The drug user has already decided to change and plans to take action

Discuss how to choose a goal, and give advice and encouragement

Action

The drug user has begun to cut down or stop using, but change has not become a permanent feature

Review advice, give encouragement

Maintenance

The drug user has achieved moderate drug use or abstinence on a relatively permanent basis

Give encouragement and reinforcement

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Handout 4.5 – Stages of Change

61

Handout 4.6 – Stages of Change

62

Handout 4.7 – Stages of Change

63

Handout 4.8 – Stages of Change

Changing addictive behaviour involves progression through 5 stages. People typically recycle through these stages several times before termination of the addiction.

1. PRECONTEMPLATION (resistance to change):

No intention to change behaviour in the future.

Unaware or under-aware of substance abuse problem.

May present for treatment – usually because of pressure from others.

When pressure is off – return to using.

It’s not that they can’t see the solution – it’s that they can’t see the problem.

Typical self-talk : “As far as I’m concerned, I don’t

have problems that need changing”.

2. CONTEMPLATION (‘not ready’ stage):

Aware that a problem exists & are seriously thinking about overcoming it.

Haven’t made a commitment to take action.

Starting to weigh the pros and cons of using.

Typical self-talk: “I have a problem and I really think I should work on it”.

People can stay in this stage for long periods. Contemplators seem to struggle with their positive evaluations of their

drug use and the amount of effort, energy and loss it will cost to overcome their problem.

3. PREPARATION: (decision-making stage)

Intend to take action in the next 6 months and have unsuccessfully taken action in the past (may have tried to stay clean 3 or 4 times).

Usually already begun to change – lowered dose, delay in taking the drug.

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AT WHAT STAGE OF CHANGE ARE YOU?

Precontemplation Contemplation Preparation Action Maintenance

___________________________________________________________________________

4. ACTION (behaviour change stage)

People modify behaviour, experiences or environment to overcome their problems.

Giving commitment, time and energy to change.

Successfully altered the behaviour from 1 day to 6 months.

Typical self-talk: “I am really working hard to change” and “Anyone can talk about changing, I’m actually doing something about it”.

5. MAINTENANCE (stabilising stage):

People work to prevent relapse.

Consolidate the gains that were made during the action stage.

Behaviour maintenance can, in some cases, last a lifetime.

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THEME B – UNDERSTANDING THE CHANGE PROCESS

Session 5: A Model of Drug Use

The purpose of this session is to examine a model of drug use and to enable participants to start becoming aware of the factors that drive them to use

Opening

Start the session with the following linking activity. This activity links to the previous session by drawing on the information that participants will have gained from the previous three sessions

5.1 Call out the… Related Materials

Ask the group to call out: the physical effects of drugs what they attribute their drug use to barriers to change

Explain the Model

This part of the session involves running through a model of drug use which we will use throughout the whole program. As we progress through the modules we’ll gain further understanding of the various components of the model and how they may be influencing the participants. Explain that we will take a look at the overall model today and explore how it works to keep people in a cycle of using drugs.

HANDOUT 5.1 – Model of Drug Use Distribute the above handout found at the back of this manual. Allow participants time to have a look at the model and then start to work through it starting at the trigger point

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The model is as follows:

Facilitator Information about the model

Use the information on the model to talk participants through the process. Get them to remember examples at each point as you work through the model and write them up on the board so that they are in front of the participants for the next exercise which is about personalising the model.

Making the Model Personal

The objective of this session is to personalise the model with the individual experience of the participant.

HANDOUT 5.2 – Personalised Model of Drug Use Distribute the above handout found at the back of this manual. This handout of the model has space for participants to personalise it.

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable, Unpleasant Feelings or Emotions: The trigger event is usually followed by feelings or emotions which are unbearable or overwhelming. These feelings could be quite hidden or unfelt as we move to protect ourselves from them. They could include anger, grief, loss, fear, depression, anxiety..

Thoughts about using: The overwhelming or unbearable feelings are usually replaced quite quickly with thoughts about scoring or using drugs and these thoughts can include relief and excitement at the possibility at the relief the drug will provide..

Promise, Build Up: Another feeling which occurs after use is the anticipation of the next use. This is the first stage of relief. Users think about the future in order to forget the down period which is overwhelming them with bad feelings.

Shame, Regret: The down period and the period following that period is often characterized by shame. The user feels ashamed that they used and this can start to fuel another cycle of use because the shame starts to cause unpleasant feelings and emotions within the person.

Down, Shut-down: The high is inevitably followed by a period of feeling emotionally drained and low. This can be a period of increased irritability, mood swings, anxiety, depression, panic attacks and many other symptoms.

Hit, High: All drugs have some sort of hit or high which is different for each drug. For some the hit is merely a relief from the pain of not using. For others an abnormal emotional high is achieved. The high is part of addiction as it numbs whatever pain was preceding it.

Drug Use: This then leads to the seeking and using of drugs

Trigger Event: Usually drug use involves a trigger event which leads the user to feel some emotion which is either not tolerable or overwhelming and which they therefore need to cover over. Some examples of these trigger events could be relationship disharmony, fights with partners or friends, feeling lonely and bored, family arguments, etc.

A Drug Use Map

Model is © 2005 – Human Essence Pty Ltd

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable, Unpleasant Feelings or Emotions: The trigger event is usually followed by feelings or emotions which are unbearable or overwhelming. These feelings could be quite hidden or unfelt as we move to protect ourselves from them. They could include anger, grief, loss, fear, depression, anxiety..

Thoughts about using: The overwhelming or unbearable feelings are usually replaced quite quickly with thoughts about scoring or using drugs and these thoughts can include relief and excitement at the possibility at the relief the drug will provide..

Promise, Build Up: Another feeling which occurs after use is the anticipation of the next use. This is the first stage of relief. Users think about the future in order to forget the down period which is overwhelming them with bad feelings.

Shame, Regret: The down period and the period following that period is often characterized by shame. The user feels ashamed that they used and this can start to fuel another cycle of use because the shame starts to cause unpleasant feelings and emotions within the person.

Down, Shut-down: The high is inevitably followed by a period of feeling emotionally drained and low. This can be a period of increased irritability, mood swings, anxiety, depression, panic attacks and many other symptoms.

Hit, High: All drugs have some sort of hit or high which is different for each drug. For some the hit is merely a relief from the pain of not using. For others an abnormal emotional high is achieved. The high is part of addiction as it numbs whatever pain was preceding it.

Drug Use: This then leads to the seeking and using of drugs

Trigger Event: Usually drug use involves a trigger event which leads the user to feel some emotion which is either not tolerable or overwhelming and which they therefore need to cover over. Some examples of these trigger events could be relationship disharmony, fights with partners or friends, feeling lonely and bored, family arguments, etc.

A Drug Use Map

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable, Unpleasant Feelings or Emotions: The trigger event is usually followed by feelings or emotions which are unbearable or overwhelming. These feelings could be quite hidden or unfelt as we move to protect ourselves from them. They could include anger, grief, loss, fear, depression, anxiety..

Thoughts about using: The overwhelming or unbearable feelings are usually replaced quite quickly with thoughts about scoring or using drugs and these thoughts can include relief and excitement at the possibility at the relief the drug will provide..

Promise, Build Up: Another feeling which occurs after use is the anticipation of the next use. This is the first stage of relief. Users think about the future in order to forget the down period which is overwhelming them with bad feelings.

Shame, Regret: The down period and the period following that period is often characterized by shame. The user feels ashamed that they used and this can start to fuel another cycle of use because the shame starts to cause unpleasant feelings and emotions within the person.

Down, Shut-down: The high is inevitably followed by a period of feeling emotionally drained and low. This can be a period of increased irritability, mood swings, anxiety, depression, panic attacks and many other symptoms.

Hit, High: All drugs have some sort of hit or high which is different for each drug. For some the hit is merely a relief from the pain of not using. For others an abnormal emotional high is achieved. The high is part of addiction as it numbs whatever pain was preceding it.

Drug Use: This then leads to the seeking and using of drugs

Trigger Event: Usually drug use involves a trigger event which leads the user to feel some emotion which is either not tolerable or overwhelming and which they therefore need to cover over. Some examples of these trigger events could be relationship disharmony, fights with partners or friends, feeling lonely and bored, family arguments, etc.

A Drug Use Map

Model is © 2005 – Human Essence Pty Ltd

67

HANDOUT 5.3 – Human Body Distribute the above handout found at the back of this manual. This handout is to be used to assist participants to notice where they get bodily reactions when using drugs

Hand out the two sheets mentioned above and then use them to get participants to reflect upon their own experience of drug use. Start the session with a quick visualization as follows:

Activity 5.2: Visualizing my drug use?

Activity Related Materials

Ask the group to visualise the following (can be done with eyes closed if the group is OK with that):

Think about a situation where you have been drawn to use drugs…

Where were you…? What were you doing…? Who were you with…? What had happened…? What feelings did you have…? Look at the picture of the human body… What sensations did you get…? Were they in your chest, your back, your stomach,

your shoulders, your head…? Get them to write or colour them in on the picture of the human body… This will be used as a reference during the next activity.

Handout 5.3

Activity 5.3: Personalizing the model

Activity Related Materials

Ask the group to use the information they visualised in the previous activity to assist them to fill out the space around the model so that it becomes personalised for their own experience of drug use. It doesn’t matter how much information they have as this is only the beginning of an exploration of their experience of the model Use the questions on handout 5.2 for each section, the information on the board from the previous section and the notes participants have put onto their body charts to jog participants

Handout 5.2

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Session Take Away Task

For this session the participants should be asked to reflect on the session and write some notes on the following two questions:

What did I learn about myself? What did I learn about my drug use?

These will be reported back next session.

Session Close

Get participants to say one word to reflect how they feel at the end of this session

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Session 5 - Handouts

Handout 5.1 – Model of Drug Use Below is one model or map of a typical cycle of drug us. We’ll be using this model throughout the program and linking the content of the sessions to this model so keep it for use throughout the program.

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable, Unpleasant Feelings or Emotions: The trigger event is usually followed by feelings or emotions which are unbearable or overwhelming. These feelings could be quite hidden or unfelt as we move to protect ourselves from them. They could include anger, grief, loss, fear, depression, anxiety..

Thoughts about using: The overwhelming or unbearable feelings are usually replaced quite quickly with thoughts about scoring or using drugs and these thoughts can include relief and excitement at the possibility at the relief the drug will provide..

Promise, Build Up: Another feeling which occurs after use is the anticipation of the next use. This is the first stage of relief. Users think about the future in order to forget the down period which is overwhelming them with bad feelings.

Shame, Regret: The down period and the period following that period is often characterized by shame. The user feels ashamed that they used and this can start to fuel another cycle of use because the shame starts to cause unpleasant feelings and emotions within the person.

Down, Shut-down: The high is inevitably followed by a period of feeling emotionally drained and low. This can be a period of increased irritability, mood swings, anxiety, depression, panic attacks and many other symptoms.

Hit, High: All drugs have some sort of hit or high which is different for each drug. For some the hit is merely a relief from the pain of not using. For others an abnormal emotional high is achieved. The high is part of addiction as it numbs whatever pain was preceding it.

Drug Use: This then leads to the seeking and using of drugs

Trigger Event: Usually drug use involves a trigger event which leads the user to feel some emotion which is either not tolerable or overwhelming and which they therefore need to cover over. Some examples of these trigger events could be relationship disharmony, fights with partners or friends, feeling lonely and bored, family arguments, etc.

A Drug Use Map

Model is © 2005 – Human Essence Pty Ltd

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable, Unpleasant Feelings or Emotions: The trigger event is usually followed by feelings or emotions which are unbearable or overwhelming. These feelings could be quite hidden or unfelt as we move to protect ourselves from them. They could include anger, grief, loss, fear, depression, anxiety..

Thoughts about using: The overwhelming or unbearable feelings are usually replaced quite quickly with thoughts about scoring or using drugs and these thoughts can include relief and excitement at the possibility at the relief the drug will provide..

Promise, Build Up: Another feeling which occurs after use is the anticipation of the next use. This is the first stage of relief. Users think about the future in order to forget the down period which is overwhelming them with bad feelings.

Shame, Regret: The down period and the period following that period is often characterized by shame. The user feels ashamed that they used and this can start to fuel another cycle of use because the shame starts to cause unpleasant feelings and emotions within the person.

Down, Shut-down: The high is inevitably followed by a period of feeling emotionally drained and low. This can be a period of increased irritability, mood swings, anxiety, depression, panic attacks and many other symptoms.

Hit, High: All drugs have some sort of hit or high which is different for each drug. For some the hit is merely a relief from the pain of not using. For others an abnormal emotional high is achieved. The high is part of addiction as it numbs whatever pain was preceding it.

Drug Use: This then leads to the seeking and using of drugs

Trigger Event: Usually drug use involves a trigger event which leads the user to feel some emotion which is either not tolerable or overwhelming and which they therefore need to cover over. Some examples of these trigger events could be relationship disharmony, fights with partners or friends, feeling lonely and bored, family arguments, etc.

A Drug Use Map

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable, Unpleasant Feelings or Emotions: The trigger event is usually followed by feelings or emotions which are unbearable or overwhelming. These feelings could be quite hidden or unfelt as we move to protect ourselves from them. They could include anger, grief, loss, fear, depression, anxiety..

Thoughts about using: The overwhelming or unbearable feelings are usually replaced quite quickly with thoughts about scoring or using drugs and these thoughts can include relief and excitement at the possibility at the relief the drug will provide..

Promise, Build Up: Another feeling which occurs after use is the anticipation of the next use. This is the first stage of relief. Users think about the future in order to forget the down period which is overwhelming them with bad feelings.

Shame, Regret: The down period and the period following that period is often characterized by shame. The user feels ashamed that they used and this can start to fuel another cycle of use because the shame starts to cause unpleasant feelings and emotions within the person.

Down, Shut-down: The high is inevitably followed by a period of feeling emotionally drained and low. This can be a period of increased irritability, mood swings, anxiety, depression, panic attacks and many other symptoms.

Hit, High: All drugs have some sort of hit or high which is different for each drug. For some the hit is merely a relief from the pain of not using. For others an abnormal emotional high is achieved. The high is part of addiction as it numbs whatever pain was preceding it.

Drug Use: This then leads to the seeking and using of drugs

Trigger Event: Usually drug use involves a trigger event which leads the user to feel some emotion which is either not tolerable or overwhelming and which they therefore need to cover over. Some examples of these trigger events could be relationship disharmony, fights with partners or friends, feeling lonely and bored, family arguments, etc.

A Drug Use Map

Model is © 2005 – Human Essence Pty Ltd

70

Handout 5.2 - Personalise the Model of Drug Use The use of drugs happens in a cycle which is common for most users. Start by thinking of an occasion where you have used in the past and then fill out the boxes around the cycle. If you have difficulties filling out a particular box don’t worry as we’ll be working with this model over the whole program. Keep this handout to use and fill in later.

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

What feelings, emotions were you feeling at the time?

What was it like just before you used?

Did you then start thinking about using again? What happened?

Did you feel ashamed after using – what was that like?

What was the low like after you had used?

What happened when you got the hit?

What drugs did you use?

Think of an event that was happening when you thought to use? Write it down?

A Map ofMy Drug

Use

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

Unbearable,Unpleasant

Feelings

Promise,Build Up

Trigger Event

Thoughts about using – relief & excitement

Drug Use

Hit, High

Down, Shut-down,

Physical Reaction

Shame,Regret,

Remorse,Guilt

What feelings, emotions were you feeling at the time?

What was it like just before you used?

Did you then start thinking about using again? What happened?

Did you feel ashamed after using – what was that like?

What was the low like after you had used?

What happened when you got the hit?

What drugs did you use?

Think of an event that was happening when you thought to use? Write it down?

A Map ofMy Drug

Use

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Handout 5.3 – The Human Body Note down the emotions that you remember feeling when you use drugs and colour in the parts of the body where you experienced sensations at that time.

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Session 6: Understanding Me & My Emotions

The purpose of this session is to start to examine the whole me which includes my thoughts, feelings, emotions and sensations

How We Work as Human Beings

This part of the session involves running through a model of how we work as human beings and of the components that make us up. These include thoughts, feelings, emotions and sensations. Explain that we will take a look at the overall model today and explore how it works to keep people in a cycle of using drugs.

HANDOUT 6.0 – How we work Distribute the above handout found at the end of this chapter. Allow participants time to have a look at the model and then talk through it with participants

The model is reproduced below for your information:

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Facilitator Information about the model

Use the information on the model to talk participants through it. Ask them to stop at each point and experience a thought and name it (eg “what are we doing?”), a feeling word and name it (eg “I feel annoyed”), an emotion and name it (eg “the emotion I am feeling is anger) and a sensation and name it (eg a rising heat in my body which I call anger or I sense the chair under my buttocks)

Managing Emotions

There has been a great deal of research done about emotions and how they are expressed by human beings.

6.1 Managing Feelings Related Materials

Distribute Handout 6.1 and ask group members to circle the emotions that make them feel uncomfortable

Handout 6.1

Thoughts: Every Human Being has thoughts which are centred in our head. These include the self talk which we have with ourselves. They can include pictures and words and do include judgments about ourselves.

How We Work…

Feelings: Feelings are the way we make meaning of our emotions. We use feeling words to describe our emotional responses e.g. I feel sad, hurt, angry, etc.

Emotions: Emotions tend to rise up in our bodies. They arise from energetic and chemical responses in our body and they are a natural part of being human. If you notice your emotions when they come you will notice that they always rise up in your body and don’t originate in your head.

Sensations: Sensations are the way our bodies experience things. When we touch we experience what we touch at the location in our body that we touch with and then use our brains to process that sensation.

So you can see that we are not just our thoughts we are our whole bodies which provide us with thoughts, feelings, sensations and emotions to most situations. We are not

just our thoughts..

We are also our

emotions, feelings

and sensations

Model is © 2005 – Human Essence Pty Ltd

Thoughts: Every Human Being has thoughts which are centred in our head. These include the self talk which we have with ourselves. They can include pictures and words and do include judgments about ourselves.

How We Work…

Feelings: Feelings are the way we make meaning of our emotions. We use feeling words to describe our emotional responses e.g. I feel sad, hurt, angry, etc.

Emotions: Emotions tend to rise up in our bodies. They arise from energetic and chemical responses in our body and they are a natural part of being human. If you notice your emotions when they come you will notice that they always rise up in your body and don’t originate in your head.

Sensations: Sensations are the way our bodies experience things. When we touch we experience what we touch at the location in our body that we touch with and then use our brains to process that sensation.

So you can see that we are not just our thoughts we are our whole bodies which provide us with thoughts, feelings, sensations and emotions to most situations. We are not

just our thoughts..

We are also our

emotions, feelings

and sensations

Model is © 2005 – Human Essence Pty Ltd

74

6.1 Managing Feelings Related Materials

Discuss: How do they usually manage these emotions? Do they avoid, alter or accept it? Do drugs play a role in their management?

How do Emotions Escalate

Emotions often escalate if they are not felt. One famous model which demonstrates how this occurs is by Pluchek and it’s reproduced on Handout 6.2.

HANDOUT 6.2 – Emotional Escalation Distribute the above handout found at the end of this session. This handout shows how emotions can escalate.

Use the model to complete the following short activity.

6.2 Emotional Escalation Related Materials

Ask the group to look at model in Handout 6.2 and to look particularly at the anger axis and to think of a time when they have been annoyed and it has led to an angry outburst.

What was the sensation like in your body? What did you feel like? What thoughts were you having? What did you do?

Handout 6.2

Coping with Distressing Emotions

HANDOUT 6.3 – Coping with Distressing Emotions Distribute the above handout found at end of this session and discuss as a group about participants personal views and experiences

Handling Strong Emotions

HANDOUT 6.4 – Handling Strong Emotions Distribute the above handout found at the back of this manual. This handout gives some tips for handling strong emotions

The role of feelings in my drug use

6.3 The relationship between feelings and drug use Related

Materials

6.3.1

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6.3 The relationship between feelings and drug use Related Materials

Break the group into pairs. Ask each pair to discuss a person or place they enjoyed when they were children. How did they feel when they were with this person or in this place (e.g., safe, secure, loved, cared for, etc.)? Reform the group and share the discussion. Encourage group members to re-experience the feeling as much as possible and describe it to the group 6.3.2 When did I start using? Going around to each member of the group ask them to share their first experience of drug use and when it became a problem for them. Elicit as much detail as possible about when it was first a problem, cover the following:

age what sort of kid they were who were they with what drug how did you feel at that moment what else was going on in your life at that time

Explore the feelings created by drug use and their feelings about other areas of their life, particularly family and school at that time. Draw out the common experiences and themes shared by the group

Usually, the drug use will be recalled as positive and be associated with positive feelings (belonging, mateship, acceptance, excitement, rebellion, experimenting) which will contrast strongly with their memories of other aspects of their lives at that time. Develop the discussion so that it becomes clear that drugs are a way to escape and avoid their feelings and problems Do this through any of the following:

contrast their feelings at the time of first drug involvement with how they felt when they were with their favourite person/place? (Be prepared for some of them to have commenced drug use under the influence of their favourite person. Discuss why this made them vulnerable to using and what they were hoping to gain from joining this person in drug use)

talk about when they are most likely to use now and the way they feel. E.g., are more likely to use when they are bored, depressed, lonely, frustrated then when they are content and satisfied?

Last time they did stop using and then relapsed, what was going on for them, how were they feeling?

Talk about the way that drugs can numb them inside so that they don’t know what they are feeling and how useful this can be if you are hurt or in pain.

Session Take Away Task

This activity examines the different aspects of self – shared, hidden and unknown. It aims to have the group members recognise their different sides and identify which they share with others. In particular, it examines whether their emotions are shared or hidden.

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HANDOUT 6.5 & 6.6 – My Different Selves Distribute the above handout found at the end of this session and ask participants to take away and think about over the next week

Session Close

Get participants to say one word to reflect how they feel at the end of this session

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Session 3 - Handouts

Handout 6.0 – How We Work as Humans The below model aims to portray how we experience life as human beings – our thoughts, feelings, emotions and sensations.

Thoughts: Thoughts are centred in our head. These include the self talk to which we may or may not attend. Thoughts can include pictures and words as well as beliefs and judgments about ourselves and others… The

Essence of

Being Human…

Feelings: Feelings are the way we make meaning of our emotions and of our sensations. We use feeling words to describe our emotional and sensory responses e.g. I feel sad, hurt, angry, I feel pain, roughness, etc.

Emotions: Emotions tend to rise up in our bodies. They arise from energetic and chemical responses in our body and they are a natural part of being human. If you slow down or pause and notice the sensations of your emotions you will become aware that they always rise up in your body. Emotions don’t originate in your head.

Sensations: Sensations are the way our bodies take in information and process internally. We have both internal and external sensations. Externally when we touch we sense what we touch at the surface of our body which is in contact and then use our brains to give meaning to that sensation. Internally when we feel anger we may sense heat rising from our gut.

So you can see that we are not just our thoughts we exist as a whole being. We have thoughts, feelings, sensations, emotions and a lifetime of experience within us and we bring this to all situations

We are more than

just our thoughts..

We are also our

emotions, feelings

and sensations

Model is © 2005 – Human Essence Pty Ltd

Thoughts: Thoughts are centred in our head. These include the self talk to which we may or may not attend. Thoughts can include pictures and words as well as beliefs and judgments about ourselves and others… The

Essence of

Being Human…

Feelings: Feelings are the way we make meaning of our emotions and of our sensations. We use feeling words to describe our emotional and sensory responses e.g. I feel sad, hurt, angry, I feel pain, roughness, etc.

Emotions: Emotions tend to rise up in our bodies. They arise from energetic and chemical responses in our body and they are a natural part of being human. If you slow down or pause and notice the sensations of your emotions you will become aware that they always rise up in your body. Emotions don’t originate in your head.

Sensations: Sensations are the way our bodies take in information and process internally. We have both internal and external sensations. Externally when we touch we sense what we touch at the surface of our body which is in contact and then use our brains to give meaning to that sensation. Internally when we feel anger we may sense heat rising from our gut.

So you can see that we are not just our thoughts we exist as a whole being. We have thoughts, feelings, sensations, emotions and a lifetime of experience within us and we bring this to all situations

We are more than

just our thoughts..

We are also our

emotions, feelings

and sensations

Model is © 2005 – Human Essence Pty Ltd

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Handout 6.1 – Managing Feelings

STEP 1. CIRCLE 5 FEELINGS THAT MAKE YOU UNCOMFORTABLE

STEP 2. HOW DO YOU USUALLY MANAGE THESE FEELINGS?

Avoid - How do you avoid the feeling?

Block or numb the feeling maybe through the use of drugs and/or alcohol,

Avoid any situations that make you feel emotional eg funerals, hospitals

Deny the feeling exists

Deny all feelings exist

Alter – Alter the feeling?

Cover it with another feeling – anger

Change the situation that lead to the feeling

Change the way you think about the situation

Accept – How do you live with the feeling?

Accept the feeling by acknowledging that it is ok to feel that way

See feelings as useful

Use the feeling as a weapon –Pay out on someone

Use feeling as a motivator – e.g., soldiers use fear to increase alertness

Lonely

Relaxed

Content (Happy/Relaxed)

Angry

Bored

Pained (Physical or

emotional)

Stressed

Sad

Happy

Fearful

Anxious

Joyful

Confident

Determined Disappointed

Exhausted

Guilty

Indifferent (Not happy/sad)

Hurt

Regretful (Sorry)

Paranoid

Negative

Frustrated

Miserable

Puzzled (Unsure)

Expectant (Waiting)

Creative

Optimistic (Positive)

Helpless Grateful

Satisfied

Excited

Hopeful

Amused

Homesick

Loveable

Blissful

Talkative

Timid (Scared)

Tired

Passive (avoid conflict)

Interested

Inspired

Enthusiastic

Worried

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Handout 6.2 – How our emotions can escalate… Research shows that our emotions escalate if we repress them. The most famous model is the one by Pluchek. This is reproduced below. Think about the anger axis. Have you ever noticed how your annoyance can escalate up to anger and then to rage?

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Handout 6.3 – Coping with Distressing Emotions

1. Myth: There is a right way to feel in every situation.

Fact: Our feelings don’t come with a manual. We are all individuals. Feelings are not “wrong”, it is how we cope with these emotions that is important.

2. Myth: Letting others know that I am feeling bad is a weakness.

Fact: We all have times when we feel bad. Asking for help or support is a sign that your want to feel better and stronger.

3. Myth: Negative feelings are bad and destructive.

Fact: Feelings are not destructive. Sometimes the ways in which we attempt to cope with bad feeling can be destructive.

4. Myth: Being emotional means being out of control.

Fact: The surest way to become out of control is to block or avoid emotions rather than expressing them.

5. Myth: Emotions can just happen for no reason.

Fact: Emotions are a reaction to an event or a thought, they do not happen randomly, even if you might not be able to pinpoint that you are feeling in a certain way.

6. Myth: All painful emotions are a result of a bad attitude.

Fact: Sometimes painful things get us down no matter how optimistic and positive we try to be.

7. Myth: If others don’t approve of my feelings I obviously shouldn’t feel the way that I do.

Fact: Sometimes disapproval of someone else’s feelings stems from an inability or unwillingness to cope or help.

8. Myth: Other people are the best judge of how I am feeling.

Fact: You are the best judge of how you should be feeling in response to a particular situation.

9. Myth: Painful emotions are not really important and should be ignored.

Fact: Painful emotions are your body’s way of telling you that you are not happy. Ignoring this warning can often make the situation worse because this is when you are likely to try and block the reality of your life circumstances (e.g., with drugs). When we face reality we have a better chance of making some of the changes we need in order to feel better.

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Handout 6.4 – Handling Strong Emotions

Observe your emotion

NOTE its presence

Step BACK

Get UNSTUCK from the emotion

Experience your emotion

As a WAVE – coming and going

Try not to BLOCK the emotion

Don’t PUSH it away

Don’t KEEP emotion around

Don’t AMPLIFY it

REMEMBER, YOU ARE NOT YOUR EMOTION

Don’t necessarily ACT on your emotion

Remember times when you have acted differently

Actively practice having emotions

Don’t JUDGE your emotion

Let them BE

ACCEPT your emotion (but remember you don’t have to act on it).

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Handout 6.5

MY DIFFERENT ‘SELVES’

Write words, draw a picture or a symbol to represent each of the different parts of yourself below: The shared self is the sides of yourself that you show to others. The hidden self is the parts of yourself you keep hidden from others. The unknown self is the things that you don’t even know about yourself.

Handout 6.6

MYSELF

SHARED SELF

HIDDEN SELF

UNKNOWN SELF

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MY HIDDEN SELF

Think about your

hidden self.

What things

about yourself do

you prefer to

keep hidden from

others?

Now think about why it

is that you keep these

things hidden – what is

the pay-off?

What would happen

if you let others

see aspects of your

hidden self? Is

there any evidence

to support this?

Who would you

let see these

aspects of your

hidden self?

Why these

people and not

others?

1

2

3

4

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Session 7: What Do I Need?

The purpose of this session is to give participants an understanding of what their basic needs are and to understand that to be an optimally functioning human being we need appropriate quantities of food, warmth, autonomy, love and stimulation. In the absence of these basic goods, human beings are not able to function well and may fail to develop into mature and effective individuals

Exploring Human Needs

7.1 What are our needs? Related

Materials

Using a ball, ask the group to think of what comes into their head when they hear the word “need” – it could be a thought, feeling or behaviour. Throw the ball around the group and write their responses on the board.

Ball

Ask the group to discuss their responses, and explain the difference between needs and wants, using examples from the board. Discuss the importance of needs: What roles do needs play in our life? How are they important? What happens if our needs are not met?

7.2 Which needs are most important? Related Materials

Separate participants into small groups or draw a pyramid on the board divided into at least five sections and complete together Using the list of needs from the board (having got rid of the ‘wants’) or other examples, ask the group(s) to decide which ‘needs’ they think are most important in people’s lives and order these in a hierarchy

Paper Pens

Ask the groups to discuss their responses and their respective rationales for the order of their needs. Discuss: What would happen if each of the needs they have placed in the triangle were not

met? How would this impact upon the other needs?

Maslow’s Hierarchy of Needs

HANDOUT 7.0 – Maslow’s Hierarchy of Needs Distribute the handout, found at the end of this session, and explain the model and its different levels of need

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Abraham Maslow created his own “Hierarchy of Needs” as a way of identifying the important role human needs play in our lives. He believed that for a person to grow and develop and reach their full potential and be satisfied in life their “needs” had to be met. He believed that there were different levels of need, some were very basic such as physical needs and others were complex and achieved by very few people. He believed that the only way to move up the hierarchy and to achieve ultimate life satisfaction was to meet each need in succession Physiological needs – these needs are to do with the maintenance of the human body. If

we are unwell, then little else matters until we recover. The primary need is for physical well being – food, shelter, warmth, sleep, etc. These needs are to be met before the next level up can be achieved. These are survival needs – it is pretty difficult just to stay alive if these needs are not being met. Safety needs – safety needs are about putting a roof over our heads and keeping us from harm. This involves physical safety, but also emotional security. It includes stability, protection, structure, security and freedom from fear. It is what children need from their parents to feel secure. Love and belonging needs – the need to escape loneliness and alienation, to give and receive love as well as achieve a sense of belonging in your environment. This also includes the need to feel loved and valued. Feelings of loneliness and rejection result if these are not met. Esteem needs – the need to feel valuable, to have respect for yourself as well as the respect of others and feeling a sense of achievement in your life. If a person does not fulfil their esteem needs, they feel inferior, weak, helpless and worthless. Self-actualisation – involves reaching your full potential and achieving self-fulfilment. Several specific traits (Jourard, 1974) include:

1. They see reality, and knowing "the facts are friendly," they accept reality more than most people. They see through phoniness, deception, and "games"--and avoid them. They cope with problems, rather than avoid them.

2. They accept themselves and others; thus, they can honestly self-disclose and forgive others' shortcomings.

3. They are spontaneous with their ideas, feelings, and actions, being genuine and confident.

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4. They focus on solving problems but their "problems" tend to be outside themselves. For instance, they often have a "mission" that may be difficult to accomplish but gives excitement, challenge, and purpose to their lives.

5. They enjoy privacy, withdrawing sometimes to be free to have their own thoughts. Occasionally, they may have mystical experiences in which they become part of all mankind or of nature.

6. They resist culturally prescribed roles, e.g. masculine or feminine. They resent unfairness caused by social roles and prejudice. They insist on thinking for themselves and completing their mission, even in the face of social criticism.

7. They enjoy and appreciate the commonplace, the little things in life--a rose, a baby, an idea, a considerate comment, a meal, a loving touch, etc.

8. They feel a kinship, a closeness, a warmth, a concern for every human being. 9. They are close to a few people, although not always popular. They can live

intimately and love. 10. They do not judge others on the basis of stereotypes, like sex, age, race, or religion,

but rather as individuals. 11. They have a strong self-generated code of ethics--a sense of right and wrong. Their

values may not be conventional but they do guide their lives. 12. They are creative and do things differently, not in rebellion but for the joy of being

original and talented. They are clever, even in their ability to be amused instead of angered by human foibles.

7.3 Meeting our needs Related Materials

Using Handout 7.0, ask each person to shade in the proportion of each level of need they believe has been met throughout the course of their lives

Handout 7.0

Discuss the following: What do people notice about their needs? Which needs have been met (ask for examples – how have these been met)? Which needs have not been met (ask for examples – what has prevented them from

meeting these needs)? How do people feel having their needs met or not met has impacted upon their

lives? How might their lives be different had certain needs been met? What does this tell us about their needs and their lives currently?

7.4 Needs through the lifespan Related

Materials

Split the group into five smaller groups and allocate each one an age group to discuss, e.g. baby, five year old, fifteen year old, thirty-five year old, seventy year old Ask each group to identify and cover the following:

important needs for that particular age group action that needs to be taken by an individual in

order to meet their needs the consequences if the particular needs for that

age group are not met

Handout 7.1

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Copy each groups answers onto the whiteboard and process. Explain (if the group does not discuss) As an individual matures their level of independence of their actions increases. An

example of this is that an unmet need might provoke a tantrum from a five year old, but a fifteen or thirty five year old is expected to behave more appropriately

Higher need levels require more complex skills. For example, satisfying physical needs such as hunger is easier than staying employed (to maintain one’s self-esteem)

The consequences of not having needs met. For example, unmet physical needs result in physical consequences – if you don’t breathe, the consequence is you die; unmet emotional needs result in emotional consequences – if you lose your job the consequence may be poor self-esteem, depression, anger, sadness, etc.

If needs are continually unmet, the emotional consequences may lead to self-destructive or counter-productive actions (e.g. drug abuse)

Meeting my Needs

HANDOUT 7.2 – Meeting my needs Distribute the handout, found at the end of this session, and ask participants to consider their own self-destructive or counter-productive actions which might be attempting to fulfil/cope with some need

Session Take Away Task

Explain that we all wear masks from time to time. Sometimes we are fully aware of the mask and sometimes we are not. We often use masks to shield our real feelings/self from others. Wearing a mask often causes us to limit our full potential. We often hide behind them and portray to the world that we are someone that we are not. In contrast, sometimes masks may be protective, such as out in the compound. Criminals usually wear some type of mask or façade. The biggest problem with the criminal mask is that after living with and projecting these types of false images for such a long time, they lose touch with themselves and who they really are. They become the criminal mask and no longer a real person experiencing and expressing true thoughts, feelings and emotions. In the process they often lack the ability to develop or sustain rewarding relationships with other people.

HANDOUT 7.3 & 7.4 – The Masks We Wear Distribute the handouts, found at the end of this session, and ask participants to consider over the next week whether they wear any of these masks or whether they know anyone outside or inside the prison that wears these.

Ask participants to draw the mask they wear most on one side of the handout and on the back of the page, ask participants to draw what they are shielding when wearing that mask

Session Close

Get participants to say one word to reflect how they feel at the end of this session

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Session 7 - Handouts

Handout 7.0 – Maslow’s Hierarchy of Needs Abraham Maslow created his own “Hierarchy of Needs” as a way of identifying the important role human needs play in our lives. He believed that for a person to grow and develop and reach their full potential and be satisfied in life their “needs” had to be met. He believed that there were different levels of need, some were very basic such as physical needs and others were complex and achieved by very few people. He believed that the only way to move up the hierarchy and to achieve ultimate life satisfaction was to meet each need in succession

Physiological needs – these needs are to do with the maintenance of the human body. If we are unwell, then little else matters until we recover. The primary need is for physical well being – food, shelter, warmth, sleep, etc. These needs are to be met before the next level up can be achieved. These are survival needs – it is pretty difficult just to stay alive if these needs are not being met. Safety needs – safety needs are about putting a roof over our heads and keeping us from harm. This involves physical safety, but also emotional security. It includes stability, protection, structure, security and freedom from fear. It is what children need from their parents to feel secure. Love and belonging needs – the need to escape loneliness and alienation, to give and receive love as well as achieve a sense of belonging in your environment. This also includes the need to feel loved and valued. Feelings of loneliness and rejection result if these are not met. Esteem needs – the need to feel valuable, to have respect for yourself as well as the respect of others and feeling a sense of achievement in your life. If a person does not fulfil their esteem needs, they feel inferior, weak, helpless and worthless. Self-actualisation – involves reaching your full potential and achieving self-fulfilment.

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Handout 7.1 – Needs through Life Age of Person Important Needs Action taken to meet need Consequence(s) if need not

met

Baby

Food Warmth/Cool Be held/touched

Cries Cries Cries

Gets sick/dies Gets sick/dies Adjusts/delayed emotional-intellectual development

5 year old

15 year old

Hope/belief in future Questions/idealises Despair/resignation/suicide

35 year old

Pride in achievements Works/ evaluates goals and progress Dissatisfaction/shame/guilt/despair (or work harder/question standards

70 year old

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Handout 7.2 – Meeting my Needs

Needs not being met Consequence of this need not being met

Self-destructive or counter-productive actions as a result of

need not being met

Action needed to meet this need via constructive means

E.g., substance abuse, antisocial attitudes, criminal associates, violence propensity, gambling, etc.

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Handout 7.3 – The Masks We Wear Good Guy – these individuals tell you what you want to hear, have a confident attitude, are cool breezes, but are backstabbers Nice Guy – these individuals try to please everybody and tend to cling onto others. They have difficulty telling things as they really are and will not confront people. They tend to be backstabbers Naïve Ned – these individuals come off sweet, innocent and naïve and use this method to get their way. They are often vicious and cunning manipulators Illiterate Dummy – when confronted, these individuals come off like morons or dummies, and in this way try to manipulate people into excusing them. They want people to believe they are dumb when just the opposite is true. Con Man – these individuals are usually older people who have been around a lot and think they can get away with whatever they want. They can use any mask, are heavy manipulators, and have no values. The pimp – these individuals are very materialistic. They have shiny cars, flashy cares, diamonds, etc. They are big spenders and heavy players and use this mask for attention and recognition.

Tough Guy – these individuals manipulate people by intimidation, by being pushy, loud and aggressive bullies. They are very paranoid and do not know how to act around other people. They project hostility to keep people away as inside they are quite afraid.

The Preacher – these individuals focus on religion as a way of supporting their own image to others. They are concrete thinkers and use religion as a shield to justify behaviours and keep the focus off themselves. Sam Sentimental – these individuals present an image of someone who loves and cares for puppy dogs, kittens, old people, family and others. This is a criminal ploy to avoid being discovered. It also helps the individuals maintain the victims’ role as they build themselves up. Sarcastic Sam – these individuals are smart alecks and loud. They seek sick attention, and try to be the life of the party. Inside they are really often very lonely people who are resentful and angry.

Sharp, B.D. (2000) Changing Criminal Thinking: A Treatment Program pp.57-58.

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Handout 7.4

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Session 8: Exploring my Beliefs and Schemas

The purpose of this session is for individuals to understand what their own schemas are and how they may impact upon their interpretation and understanding of the world

Opening

Encourage participants to present their masks that they completed for homework to the group and address some of the following questions: What masks do you wear? When do you wear these masks? Why do you wear these masks? What are you hiding from others in wearing these masks? What needs to happen in order for you to feel safe enough to take

these masks off? How have your experiences shaped what mask you wear (relate to

schema session)? What motivates you to wear a particular mask in the community and in

prison? Are the masks you wear in prison and the community different? Who do you know that represents these masks in prison?

What do we mean by ‘Schemas’?

8.2 What are my beliefs and attitudes? Related

Materials

Create an imaginary diagonal line from one end of the room to another with one end representing ‘likes’ and the other ‘dislikes’ or alternatively ‘agrees’ and ‘disagrees’ Call out different activities, e.g. football, cooking, etc. and ask participants to place themselves along the line from like to dislike; alternatively use agrees and disagrees and call out issues such as abortion, euthanasia, life is fair, I believe I can change, etc. Ask people at different sections on the line about their preferences: why do they like/dislike it; and where did they learn to like/dislike it, e.g. media, parents, experience (Facilitators may choose to complete some of these evaluations on the board)

Explain all human beings possess categorical rules or scripts that they use to interpret the world. New information is processed according to how it fits with these rules, called schema. These schemas can be used not only to interpret but also to predict situations occurring in our environment. Think, for example, of a situation where you were able to finish another person’s thoughts, or when someone asked you to pass that “thingamabob”. Schema theorists suggest that you used your schema to predict what your

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conversation partner was going to say and to correctly interpret “thingamabob” as the hammer needed to nail something into the wall. (Widmayer, 2005) Information that does not fit into these schemas may not be comprehended, or may not be comprehended correctly. This is the reason why readers may have a difficult time comprehending a text on a subject they are not familiar with even if the person understands the meaning of the individual words in the passage. For example, if the waiter in a restaurant asked your if you would prefer to sing, you may have a difficult time interpreting what he was asking and why, since singing is not something that patrons in a restaurant normally do. However, if you had been to the restaurant in the past and knew that it was frequented by opera students who liked to entertain you would have incorporated that information into your schema and not be confused when the waiter asked if you’d prefer to sing. (Widmayer, 2005) A schema is an extremely stable and enduring pattern that develops during childhood and is elaborated throughout an individual’s life. Schemas are important beliefs and feelings about oneself and the environment which the individual accepts without question. They are self-perpetuating, and are very resistant to change. For instance, children who develop a schema that they are incompetent rarely challenge this belief, even as adults. The schema usually does not go away without therapy. Overwhelming success in people’s lives is often still not enough to change the schema. The schema fights for its own survival, and, usually, is quite successful. Even though schemas persist once they are formed, they are not always in our awareness. Usually they operate in subtle ways, out of our awareness. However, when a schema erupts or is triggered by events, our thoughts and feelings are dominated by these schemas. It is at these moments that people tend to experience extreme negative emotions and have dysfunctional thoughts. Young & Klosko (1994) found 16 specific (problematic) schemas. They found that most people have at least two or three of these schemas, and often more.

HANDOUT 8.0 – Schemas Distribute the handout, found at the end of this session, and read through as a group

Ask participants to identify and discuss: Which schemas apply to them Why a particular schema applies to them Specific life examples

How schemas work

In order to understand how schemas work, there are three schema processes that must be defined. These processes are schema maintenance, schema

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avoidance, and schema compensation. It is through these three processes that schemas exert their influence on our behaviour and work to ensure their own survival. Schema Maintenance Schema maintenance refers to the routine processes by which schemas function and perpetuate themselves. This is accomplished by cognitive distortions and self-defeating behaviour patterns. These distortions consist of negative interpretations and predictions of life events. (We are going to discuss cognitive distortions more in depth later). Many cognitive distortions are part of the schema maintenance process. The schema will highlight or exaggerate information that confirms the schema and will minimize or deny information that contradicts it Schema maintenance works behaviourally as well as cognitively. The schema will generate behaviours which tend to keep the schema intact. For instance, a young man with a Social Undesirability schema would have thoughts and behaviour in line with the schema. At a party he would have thoughts such as: “No one here likes me” and “I’m not going to succeed at meeting new people”. Behaviourally, he would be more withdrawn and less outgoing. Schema Avoidance Schema avoidance refers to the ways in which people avoid activating schemas. As mentioned earlier, when schemas are activated, this causes extreme negative emotion. People develop ways to avoid triggering schemas in order not to feel this pain. There are three types of schema avoidance: cognitive, emotional, and behavioural. Cognitive avoidance refers to efforts that people make not to think about upsetting events. These efforts may be either voluntary or automatic. People may voluntarily choose not to focus on an aspect of their personality or an event which they find disturbing. There are also unconscious processes which help people shut out information which would be too upsetting to confront. People often forget particularly painful events. For instance, children who have been abused sexually often forget the memory completely. Emotional or affective avoidance refers to automatic or voluntary attempts to block painful emotion. Often when people have painful emotional experiences, they numb themselves to the feelings in order to minimize the pain. For instance, a man might talk about how his wife has been acting in an abusive manner toward him and say that he feels no anger towards her, only a little annoyance. Some people drink or abuse drugs to numb feelings generated by schemas. The third type of avoidance is behavioural avoidance. People often act in such a way as to avoid situation that trigger schemas, and thus avoid psychological pain. For instance, a man with a Failure to Achieve schema might avoid taking a difficult new job which would be very good for him. By avoiding the

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challenging situation, he avoids any pain, such as intense anxiety, which could be generated by the schema. Schema Compensation The third schema process is schema compensation. The individual behaves in a manner which appears to be the opposite of what the schema suggests in order to avoid triggering the schema. People with a Functional Dependence schema may structure aspects of their life so that they don’t have to depend on anyone, even when a more balanced approach may be better. For instance, a young man may refuse to go out with women because he is afraid of becoming dependent and will present himself as someone who doesn’t need other people. He goes to the other extreme to avoid feeling dependent.

8.3 Case Examples Related Materials

Ask participants to complete the following handout alone or in pairs. In each one, the schema processes are demonstrated. By reading through this section, you will get a better feel for how these processes can operate in real life situations. In each case, participants must identify:

a) the main schema b) the schema processes

i. maintenance ii. avoidance iii. compensation

Handout 8.1

Schemas in Action

HANDOUT 8.2 – Schemas in Action Distribute the handout, found at the end of this session, and discuss the negative consequences of adopting such a schema

Ask participants whether they can identify with any of the behaviours and how this impacts upon their lives, e.g. work, relationships, leisure, etc. Are there any positive consequences, e.g. not getting hurt?

Origins of schemas

8.4 Where do your schemas come from? Related

Materials

Distribute Handout 8.3 and allow participants to discuss their own schemas and what factors influenced their own development. If appropriate, allow them to draw a pictorial representation of how they feel and understand the world.

Handout 8.3 Paper Pens

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Father died when I was 5

Mother was unstable. She became depressed, angry and drunk

Biological predisposition to separation anxiety

Filter

Avoid intimate relationships

Worry excessively that your partner will die

Overreact to minor things and interpret them as your partner wants to leave you

Avoidance

Maintenance

Compensation

An example of someone’s schema drawing may be:

Session Close

Get participants to say one word to reflect how they feel at the end of this session or reflect on what they have learnt

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Session 8 – Handouts

Handout 8.0 – Schemas Emotional Deprivation This schema refers to the belief that one’s primary emotional needs will never be met by others. These needs include nurturance, empathy, affection, protection, guidance, and caring from others. Often parents were emotionally depriving of the child. Abandonment/Instability This schema refers to the expectation that one will soon loose anyone with

whom an emotional attachment is formed. The person believes that, one way or another, close relationships will end imminently.

As children, these clients may have experienced the divorce or death of parents. This schema can also arise when parents have been inconsistent in attending to the child’s needs; for

instance, there may have been frequent occasions on which the child was left alone or unattended to for extended periods. Mistrust/Abuse This schema refers to the expectation that others will intentionally take advantage of them in some way. People with this schema expect others to hurt, cheat, or put them down. They often think in terms of attacking first or getting revenge afterwards. In childhood, these individuals were often abused or treated unfairly by parents, siblings, or peers. Social Isolation/Alienation This schema refers to the belief that one is isolated from the world, different from other people, and/or not part of any community. This belief is usually caused by early experiences in which children see that either they, or their families, are different from other people. Defectiveness/Shame This schema refers to the belief that one is internally flawed, and that, if others get close, they will realize this and withdraw from the relationship. This feeling of being flawed and inadequate often leads to a strong sense of shame. Generally parents were very critical of their children and made them feel as if they were not worthy of being loved. Social Undesirability This schema refers to the belief that one is outwardly unattractive to others. People with this schema see themselves as physically unattractive, socially inept, or lacking in status. Usually there is a direct link to childhood experiences in which children are made to feel, by family or peers, that they are not attractive. Failure to Achieve This schema refers to the belief that one is incapable of performing as well as one’s peers in areas such as career, school, or sports. These children may

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feel stupid, inept, untalented, or ignorant. People with this schema often do not try to achieve because they believe that they will fail. This schema may develop if children are put down and treated as if they are a failure in school or other spheres of accomplishment. Usually the parents did not give enough support, discipline, and encouragement for the child to persist and succeed in areas of achievement such as schoolwork or sports. Functional Dependence/Incompetence This schema refers to the belief that one is not capable of handling day-to-day responsibilities competently and independently. People with this schema often rely on others excessively for help in areas such as decision making and initiating new tasks. Generally, parents did not encourage these children to act independently and develop confidence in their ability to take care of themselves. Vulnerability to Harm and Illness This schema refers to the belief that one is always on the verge of experiencing a major catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking excessive precautions to protect oneself. Usually there was an extremely fearful parent who passed on the idea that the world is a dangerous place. Undeveloped Self This schema refers to the sense that one has too little individual identity or inner direction. There is often a feeling of emptiness or of floundering. This schema is often brought on by parents who are so controlling, abusive, or overprotective that the child is discouraged from developing a separate sense of self. Subjugation This schema refers to the belief that one must submit to the control of others in order to avoid negative consequences. Often these clients fear that, unless they submit, others will get angry or reject them. Clients who subjugate ignore their own desires and feelings. In childhood there was generally a very controlling parent. Self-Sacrifice This schema refers to the excessive sacrifice of one’s own needs in order to help others. When these clients pay attention to their own needs, they often feel guilty. To avoid this guilt, they put others’ needs ahead of their own. Often clients who self-sacrifice gain a feeling of increased self-esteem or a sense of meaning from helping others. In childhood the person may have been made to feel overly responsible for the well-being of one or both parents. Emotional Inhibition This schema refers to the belief that you must inhibit emotions and impulses, especially anger, because any expression of feelings would harm others or leads to loss of self-esteem, embarrassment, retaliation, or abandonment.

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You may lack spontaneity, or be viewed as uptight. This schema is often brought on by parents who discourage the expression of feelings. Unrelenting/Unbalanced Standards This schema refers to two related beliefs, either you believe that whatever you do is not good enough, that you must always strive harder; and/or there is excessive emphasis on values such as status, wealth, and power at the expense of other values such as social interaction, health, or happiness. Usually these clients’ parents were never satisfied and gave their children love that was conditional on outstanding achievement. Entitlement/Self-Centeredness This schema refers to the belief that you should be able to do, say, or have whatever you want immediately regardless of whether that hurts others or seems reasonable to them. You are not interested in what other people need, nor are you aware of the long-term costs to you of alienating others. Parents who overindulge their children and who do not set limits about what is socially appropriate may foster the development of this schema. Alternatively, some children develop this schema to compensate for feelings of emotional deprivation, defectiveness, or social undesirability. Insufficient Self-Discipline This schema refers to the inability to tolerate any frustration in reaching one’s goals as well as an inability to restrain expression of one’s impulses or

feelings. When lack of self-control is extreme, criminal or addictive behaviour rule your life. Parents who did not model self-control, or who did not adequately discipline their children, may predispose them to have this schema as adults.

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Handout 8.1 – Case Examples By reading through the following case examples, you will get a better feel for how these processes can operate in real life situations. Identify:

a) the main schema b) the schema processes

i. maintenance ii. avoidance iii. compensation

Abby

Abby is a young woman who tends to see people as very controlling even when they are being appropriately assertive. She has thoughts such as “I can’t stand up for myself or they won’t like me” and is likely to give in to others (schema __________). At other times she decides that no one will get the better of her and becomes very controlling (schema _________). Sometimes when people make unreasonable demands on her she minimizes the importance of her own feelings and has thoughts like “It’s not that important to me what happens”. At other times she avoids acquaintances with whom she has trouble standing up for herself (schema ____________). Abby’s main schema is ____________.

Stewart

Whenever Stewart is faced with a possible challenge, he tends to think that he is not capable. Often he avoids triggering his schema by staying away from

challenges altogether and convinces himself that the challenge was not worth taking (schema ________). Most of the time he only tries half-heartedly, guaranteeing that he will fail, and

strengthening the belief that he is not capable (schema ___________). At times, he makes great efforts to present himself in an unrealistically positive light by spending excessive amounts of money on items such as clothing and automobiles (schema _______). Stewart’s main schema is _____________.

Rebecca

Rebecca believes that there is something basically wrong with her and that if anyone gets too close, the person will reject her. Her core schema is ________. She chooses partners who are extremely critical of her and confirm her view that she is defective (schema __________). She makes sure that none of her partners get too close, so that she can avoid their seeing her defectiveness and rejecting her (schema ________). Sometimes she has an excessive defensive reaction and counterattacks when confronted with even mild criticism (schema ________).

Michael

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Michael is a middle-aged man whose main schema is ___________. He sees himself as being incapable of doing daily tasks on his own and generally seeks the support of others. Whenever he can, he chooses to work with people who help him out to an excessive degree. This keeps him from developing skills needed to work alone and confirms his view of himself as someone who needs others to help him out (schema ________). At times, when he would be best off taking advice from other people, he refuses to do so (schema _______). He reduces his anxiety by procrastinating as much as he can get away with (schema _______).

Ann

Ann sees herself as being different from other people and not fitting in. At times she chooses to avoid group activities altogether (schema ________). When she does things as part of a group she does not get really involved (schema _________). At times she gets very hostile towards group members and can be very critical of the group as a whole (schema _________). Ann’s core schema is _________.

Sam

Sam’s central schema is ________. He chooses partners who are not very capable of giving to other people and then acts in a manner which makes it even more difficult for them to give to him (schema _______). At times he will act in a very demeaning, belligerent manner and provoke fights with his partner (schema _____). Sam avoids getting too close to women, yet denies that he has any problems in this area (schema ________).

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Handout 8.2 – Schemas in action

ABANDONMENT SCHEMAS IN RELATIONSHIPS 1. You avoid intimate relationships even with appropriate partners because you

are afraid of losing the person or getting too close and being hurt. 2. You worry excessively about the possibility that your partner will die or

otherwise be lost, and what you would do. 3. You overreact to minor things your partner says or does, and interpret then as

signs that he/she wants to leave you. 4. You are excessively jealous and possessive. 5. You cling to your partner. Your whole life becomes obsessed with keeping

him/her. 6. You cannot stand to be away from your partner, even for a few days. 7. You are never fully convinced that your partner will stay with you. 8. You get angry and accuse your partner of not being loyal or faithful. 9. You sometimes detach, leave, or withdraw to punish your partner for leaving

you alone.

MISTRUST/ABUSE SCHEMAS IN RELATIONSHIPS 1. You often feel people are taking advantage of you, even when there is little

concrete proof. 2. You allow other people to mistreat you because you are afraid of them or

because you feel it is all you deserve. 3. You are quick to attack other people because you expect them to hurt you or

put you down. 4. You have a hard time enjoying sex – it feels like an obligation or you cannot

derive pleasure. 5. You are reluctant to reveal personal information because you worry that

people will use it against you. 6. You are reluctant to show your weaknesses because you expect people to

take advantage of them. 7. You feel nervous around people because you worry that they will humiliate

you. 8. You give in too easily to other people because you are afraid of them. 9. You feel that other people seem to enjoy your suffering. 10. You have a definite sadistic or cruel side, even though you may not show it. 11. You allow other people to take advantage of you because “it is better than

being alone”. 12. You feel that men/women cannot be trusted. 13. You do not remember large portions of your childhood. 14. When you are frightened of someone, you “tune out”, as if part of you is not

really there. 15. You often feel people have hidden motives or bad intentions, even when you

have little proof. 16. You often have sado-masochistic fantasies. 17. You avoid getting close to men/women because you cannot trust them. 18. You feel frightened around men/women and you do not understand why. 19. You have sometimes been abusive or cruel to other people, especially the

ones to whom you are closest. 20. You often feel helpless in relation to other people.

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EMOTIONAL DEPRIVATION SCHEMAS IN RELATIONSHIPS

1. You don’t tell your partner what you need, then feel disappointed when your needs are not met.

2. You don’t tell your partner how you feel, and then feel disappointed when you are not understood.

3. You don’t allow yourself to be vulnerable, so that your partner can protect or guide you.

4. You feel deprived, but you don’t say anything. You harbour resentment. 5. You become angry and demanding. 6. You constantly accuse your partner of not caring enough about you. 7. You become distant and unreachable.

SOCIAL EXCLUSION SCHEMAS IN RELATIONSHIPS 1. You feel different or inferior to the people around you. You exaggerate

differences and minimize similarities. You feel lonely, even when you are with people.

2. At work you are on the periphery. You keep to yourself. You do not get promoted or included in projects because you do not fit in.

3. You are nervous and self-conscious around groups of people. You cannot relax and be yourself. You worry about doing or saying the wrong thing. You try to plan what to say next. You are very uncomfortable talking to strangers. You feel you have nothing unique to offer other people.

4. Socially, you avoid joining groups or being part of the community. You only spend time with your immediate family or with one or two close friends.

5. You feel embarrassed if people meet your family or know a lot about them. You keep secrets about your family from other people.

6. You pretend to be like other people just to fit in. You do not let most people see the unconventional parts of yourself. You have a secret life or feelings that you believe would lead other people to humiliate you or reject you.

7. You put a lot of emphasis on overcoming your own family’s deficiencies: to gain status, have material possessions, sound highly educated, obscure ethnic differences etc.

8. You have never accepted certain parts of your nature because you believe other people would think less of you for them (e.g., you are shy, intellectual, emotional, too feminine, weak, dependent).

9. You are very self-conscious about your physical appearance. You feel less attractive than other people say you are. You may work inordinately hard to be physically attractive, and are especially sensitive to your physical flaws (e.g., weight, physique, figure, height, complexion, features).

10. You avoid situations where you might seem dumb, slow, or awkward (e.g., going to college, public speaking).

11. You compare yourself a lot to other people who have the hallmarks of popularity that you lack (e.g., looks, money, athletic ability, success, clothing).

12. You put too much emphasis on compensating for what you feel are your social inadequacies: trying to prove your popularity or social skills, win people over, be part of the i=right social group, have success in your career, or raise children who are popular.

DEPENDENCE SCHEMAS

1. You tend to select partners who are willing and eager to protect you from

danger or illness. Your partner is strong, and you are weak and needy.

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2. Your prime concern is that your partner is fearless, physically strong, very successful financially, a doctor, or otherwise specifically equipped to protect you from your fears.

3. You seek people who are willing to listen to your fears and reassure you. 4. You turn to wiser or stronger people all the time for advice and guidance. 5. You minimize your successes and magnify your shortcomings. 6. You avoid new challenges on your own. 7. You do not make your own decisions. 8. You do not take care of your own financial records or decisions. 9. You live through your parents/partner. 10. You are much more dependent on your parents than most people your age. 11. You avoid being alone or travelling alone. 12. You have fears and phobias that you do not confront. 13. You are quite ignorant when it comes to many areas of practical functioning

and daily survival skills. 14. You have not lived on your own for any significant period of time.

COUNTER-DEPENDENCE SCHEMAS

1. You never seem too be able to turn to anyone for guidance or advice. You

have to do everything on your own. 2. You are always taking on new challenges and confronting your fears, but you

feel under constant pressure while doing it. 3. Your partner is very dependent on you, and you end up doing everything and

making all the decisions.

VULNERABILITY SCHEMAS

1. You feel anxious much of the time as you go about daily life because of your exaggerated fears. You may have generalized anxiety.

2. You worry so much about your health and possible illnesses that you (a) get unnecessary medical evaluations, (b) become a burden to your family with your constant need for reassurance, and (c) cannot enjoy other aspects of life.

3. You experience panic attacks as a result of your preoccupation with bodily sensations and possible illness.

4. You are unrealistically worried about going broke. This leads you to be unnecessarily tight with money and unwilling to make and financial or career changes. You are preoccupied with keeping what you have at the expense of new investments or projects. You cannot take risks.

5. You go to exorbitant lengths to avoid criminal danger. For example, you avoid going out at night, visiting large cities, travelling on public transportation. Therefore, your life is very restricted.

6. You avoid everyday situations that entail even a slight degree of risk. For example, you avoid elevators, subways, or living in a city where there could be an earthquake.

7. You allow your partner to protect you from your fears. You need a lot of reassurance. Your partner helps you avoid feared situations. You become overly dependent on your partner. You may even resent this dependence.

8. Your chronic anxiety may, in fact, make you more prone to some kinds of psychosomatic illnesses (e.g., eczema, asthma, colitis, ulcers, flu).

9. You limit your social life because, as a result of your fears, you cannot do many of the things other people do.

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10. You restrict the lives of your partner and family, who have to adapt to your fears.

11. You are likely to pass on your fears to your own children. 12. You may use a variety of coping mechanisms to an exaggerated degree to

ward off danger. You may have obsessive-compulsive symptoms or superstitious thinking.

13. You may rely excessively on medication, alcohol, food, etc. to reduce your chronic anxiety.

DEFECTIVENESS SCHEMAS

1. You become very critical of your partner once you feel accepted, and your

romantic feelings disappear. You then act in a demanding or critical manner. 2. You hide your true self so you never really feel that your partner know you. 3. You are jealous and possessive of your partner. 4. You constantly compare yourself unfavourably with other people and feel

envious and inadequate. 5. You constantly need or demand reassurance that your partner still values

you. 6. You put yourself down around your partner. 7. You allow your partner to criticize you, put you down, or mistreat you. 8. You have difficulty accepting valid criticism; you become defensive or hostile. 9. You are extremely critical of your children. 10. You feel like an imposter when you are successful. You feel extremely

anxious that you cannot maintain your success. 11. You become despondent or deeply depressed over career setbacks or

rejections in relationships. 12. You feel extremely nervous when speaking in public.

FAILURE SCHEMAS 1. You do not take the steps necessary to develop solid skills in your career

(e.g., finish schooling, read latest developments, apprentice to an expert). You coast or try to fool people.

2. You choose a career below your potential (e.g., you finished college and have excellent mathematical ability, but are currently driving a taxicab).

3. You avoid taking the steps necessary to get promotions in your chosen career; your advancement has been unnecessarily halted (e.g., you fail to accept promotions or to ask for them; you do not promote yourself or make your abilities widely known to the people who count; you stay in a safe, dead-end job).

4. You do not want to tolerate working for other people, or working at entry-level jobs, so you end up on the periphery of your field, failing to work your way up the ladder. (Note the overlap with Entitlement and Subjugation).

5. You take jobs but repeatedly get fired because of lateness, procrastination, poor job performance, bad attitude, etc.

6. You cannot commit to one career, so you float from job to job, never developing expertise in one area. You are a generalist in a job world that rewards specialists. You therefore never progress very far in any one career.

7. You selected a career in which it is extraordinarily hard to succeed, and you do not know when to give up (e.g., acting, professional sports, music).

8. You have been afraid to take initiative or make decisions independently at work, so you were never promoted to more responsible positions.

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9. You feel that you are basically stupid or untalented, and therefore feel fraudulent, even though objectively you have been quite successful.

10. You minimise your abilities and accomplishments, and exaggerate your weaknesses and mistakes. You end up feeling like a failure, even though you have been as successful as your peers.

11. You have chosen successful men/women as partners in relationships. You live vicariously through their success while not accomplishing much yourself.

12. You try to compensate for your lack of achievement or work skills by focusing on other areas (e.g., your looks, charm, youthfulness, sacrificing for others). But underneath you still feel like a failure.

UNRELENTING STANDARDS SCHEMAS

1. Your health is suffering because of daily stresses, such as overwork – not

only because of unavoidable life events. 2. The balance between work and pleasure feels lopsided. Life feels like

constant pressure and work without fun. 3. Your whole life seems to revolve around success, status, and material things.

You seem to have lost touch with your basic self and no longer know what really makes you happy.

4. Too much of your energy goes into keeping your life in order. You spend too much time keeping lists, organizing your life, planning, cleaning, and repairing, and not enough time being creative or letting go.

5. Your relationships with other people are suffering because so much time goes into meeting your own standards, working, being successful, etc.

6. You make other people feel inadequate or nervous around you because they worry about not being able to meet your high expectations of them.

7. You rarely stop and enjoy successes. You rarely savour a sense of accomplishment. Rather, you simply go on to the next task waiting for you.

8. You feel overwhelmed because you are trying to accomplish so much; there never seems to be enough time to complete what you have started.

9. Your standards are so high that you view many activities as obligations or ordeals to get through, instead of enjoying the process itself.

10. You procrastinate a lot. Because your standards make many tasks feel overwhelming, you avoid them.

11. You feel irritated or frustrated a lot because things and people around you do not meet your high standards.

SPOILED ENTITLEMENT SCHEMAS

1. You do not care about the needs of the people around you. You get your

needs met at their expense. You hurt them. 2. You may abuse, humiliate, or demean the people around you. 3. You have difficulty empathizing with the feelings of those around you. They

feel you do not understand or care about their feelings. 4. You may take more from society than you give. This results in an inequity and

is unfair to other people. 5. At work, you may be fired, demoted, etc. for failing to consider the needs and

feelings of others, or for failing to follow rules. 6. Your partner, family, friends, or children may leave you, resent you, or cut off

contact with you because you treat them abusively, unfairly, or selfishly. 7. You may get into legal or criminal trouble if you cheat or break laws, such as

tax evasion or business fraud.

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8. You never have a chance to experience the joy of giving to other people unselfishly – or of having a truly equal, reciprocal relationship.

9. If your Entitlement is a form of Counterattack, you never allow yourself to face and solve your underlying schemas. Your real needs are never addressed. You may continue to feel emotionally deprived, defective, or socially undesirable.

DEPENDENT ENTITLEMENT SCHEMAS

1. You never learn to take care of yourself, because you insist that others take

care of you. 2. You unfairly impinge on the rights of people close to you to use their own time

for themselves. Your demands become a drain on the people around you. 3. People you depend on may eventually become fed up or angry with your

dependence and demands, and will leave you, fire you, or refuse to continue helping you.

4. The people you depend on may die or leave, and you will be unable to take care of yourself.

IMPULSIVITY SCHEMAS

1. You never complete tasks necessary to make progress in your career. You

are a chronic underachiever, and eventually feel inadequate as a result of your failures.

2. The people around you may eventually get fed up with your irresponsibility and cut off their relationships with you.

3. Your life is in chaos. You cannot discipline yourself sufficiently well to have direction and organization. You are therefore stuck.

4. You may have difficulty with addictions, such as drugs, alcohol, or overeating. 5. In almost every area of your life, your lack of discipline prevents you from

achieving your goals. 6. You may not have enough money to get what you want in life. 7. You may have gotten into trouble with authorities at school, with police, or at

work because you cannot control your impulses. 8. You may have alienated your friends, spouse, children, or bosses, through

your anger and explosiveness. Acknowledgement Taken from Jeffrey Young & Janet Klosko. (1994) Reinventing Your Life. Dutton, New York.

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Handout 8.3 – Possible Origins of Schemas

The Origins of the Abandonment Schema

1. You may have a biological predisposition to separation anxiety – difficulty being alone.

2. A parent died or left home when you were young. 3. Your mother was hospitalized or separated from you for a prolonged

period of time when you were a child. 4. You were raised by nannies or in an institution by a succession of

mother figures, or you were sent away to boarding school at a very young age.

5. Your mother was unstable. She became depressed, angry, drunk, or in some other way withdrew from you on a regular basis.

6. Your parents divorced when you were young or fought so much that you worried the family would fall apart.

7. You lost the attention of a parent in a significant way. For example, a brother or sister was born or your parent remarried.

8. Your family was excessively close and you were overprotected. You never learned to deal with life’s difficulties as a child.

Origins of the Mistrust and Abuse Schema

1. Someone in your family physically abused you as a child. 2. Someone in your family sexually abused you as a child, or repeatedly

touched you in a sexually provocative way. 3. Someone in your family repeatedly humiliated you, teased you, or put

you down (verbal abuse). 4. People in your family could not be trusted. (They betrayed confidences,

exploited your weaknesses to their advantage, manipulated you, made promises they had no intention of keeping, or lied to you.)

5. Someone in your family seemed to get pleasure from seeing you suffer. 6. You were made to do things as a child by the threat of severe

punishment or retaliation. 7. One of your parents repeatedly warned you not to trust people outside

of the family. 8. The people in your family were against you. 9. One of your parents turned to you for physical affection as a child, in a

way that was inappropriate or made you uncomfortable. 10. People used to call you names that really hurt.

The Origins of Emotional Deprivation

1. Mother is cold and unaffectionate. She does not hold and rock the child

enough. 2. The child does not have a sense of being loved and valued – of being

someone who is precious and special. 3. Mother does not give the child enough time and attention.

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4. The mother is not really tuned into the child’s needs. She has difficulty empathizing with the child’s world. She does not really connect with the child.

5. Mother does not soothe the child adequately. The child, then, may not learn to soothe him/herself or to accept soothing from others.

6. The parents do not adequately guide the child or provide a sense of direction. There is nothing solid for the child to rely upon.

The Origins of Social Exclusion

1. You felt inferior to other children, because of some observable quality

(e.g., looks, height, stuttering). You were teased, rejected, or humiliated by other children

2. You family was different from neighbours and people around you. 3. You felt different from other children, even within your own family. 4. You were passive as a child; you did what was expected, but you never

developed strong interests or preferences of your own. Now you feel you have nothing to offer in conversation.

The Origins of Dependence Overprotectiveness

1. Your parents are overprotective and treat you as if you are younger

than you are. 2. Your parents make your decisions for you. 3. Your parents take care of al the details in your life so you never learn

how to take care of them yourself. 4. Your parents do your school work for you. 5. You are given little or no responsibility. 6. You are rarely apart from your parents and have little sense of yourself

as a separate person. 7. Your parents criticize your opinions and competence in everyday tasks. 8. When you undertake new tasks, your parents interfere by giving

excessive advice and instructions. 9. Your parents make you feel so safe that you never have a serious

rejection or failure until you leave home. 10. Your parents have many fears and always warn you of dangers.

The Origins of Dependence in Underprotectiveness

1. You do not get enough practical guidance or direction from your

parents. 2. You have to make decisions alone beyond you years. 3. You have to be like an adult in your family, even when underneath you

still feel like a child. 4. You are expected to do things and know things that are over your

head.

Origins of Vulnerability

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1. You learned your sense of vulnerability from observing and living with parents with the same schema. Your parent was phobic or frightened about specific areas of vulnerability (such as losing control, getting sick, going broke, etc.).

2. Your parent was overprotective of you, particularly around issues of danger or illness. Your parent continuously warned you of specific dangers. You were made to feel that you were too fragile or incompetent to handle these everyday issues. (This is usually combined with Dependence).

3. Your parent did not adequately protect you. Your childhood environment did not seem safe physically, emotionally or financially. (This is usually combined with Emotional Deprivation or with Mistrust and Abuse).

4. You were sick as a child or experienced a serious traumatic event (e.g., car crash) that led you to feel vulnerable.

5. One of your parents experienced a serious traumatic event and perhaps died. You came to view the world as dangerous.

The Origins of the Defectiveness Schema

1. Someone in your family was extremely critical, demeaning or punitive

toward you. You were repeatedly criticized or punished for how you looked, how you behaved, or what you said.

2. You were made to feel like a disappointment by a parent. 3. You were rejected or unloved by one or both of your parents. 4. You were sexually, physically, or emotionally abused by a family

member. 5. You were blamed all the time for things that went wrong in your family. 6. Your parent told you repeatedly that you were bad, worthless, or good-

for-nothing. 7. You were repeatedly compared in an unfavourable way with your

brothers or sisters, or they were preferred over you. 8. One of your parents left home, and you blamed yourself.

Origins of the Failure Schema

1. You had a parent (often your father) who was very critical of your

performance in school, sports, etc. He/she often called you stupid, dumb, inept, a failure, etc. He/she may have been abusive. (Your schema may be linked to Defectiveness or Abuse).

2. One or both parents were very successful, and you came to believe you could never live up to their high standards. So you stopped trying. (Your schema may be linked to Unrelenting Standards).

3. You sensed that one or both of your parents either did not care about whether you were successful, or, worse, felt threatened when you did well. Your parent may have been competitive with you – or afraid of losing your companionship if you were to succeed in the world. (Your schema may be linked to Emotional Deprivation or Dependence).

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4. You were not as good as other children wither in school or at sports, and felt inferior. You may have had a learning disability, poor attention span, or been very uncoordinated. After that, you stopped trying in order to avoid humiliation by them. (This may be linked to Social Exclusion).

5. You had brothers or sisters to whom you were often compared unfavourably. You came to believe you could never measure up, so you stopped trying.

6. You came from a foreign country, your parents were immigrants, or your family was poorer or less educated than your school mates. You felt inferior to your peers and never felt you could measure up.

7. Your parents did not set enough limits for you. You did not learn self-discipline or responsibility. Therefore you failed to do homework regularly or learn study skills. This led to failure eventually. (Your schema may be linked to Entitlement).

Origins of the Subjugation Schema

1. Your parents tried to dominate or control almost every aspect of your

life. 2. Your parent(s) punished, threatened, or got angry at you when you

would not do things their way. 3. Your parent(s) withdrew emotionally or cut off contact with you if you

disagreed with them about how to do things. 4. Your parent(s) did not allow you to make your own choices as a child. 5. Because your mother/father was not around enough, or was not

capable enough, you ended up taking care of the rest of the family. 6. Your parent(s) always talked to you about their personal problems, so

that you were always in the role of listener. 7. Your parent(s) made you feel guilty or selfish if you would not do what

they wanted. 8. Your parent(s) were like martyrs or saints – they selflessly took care of

everyone else and denied their own needs. 9. You did not feel that your rights, needs, or opinions were respected

when you were a child. 10. You had to be careful about what you did or said as a child, because

you worried about your mother’s/father’s tendency to become worried or depressed.

11. You often felt angry at your parent(s) for not giving you the freedom that other children had.

The Origins of Unrelenting Standards

1. Your parents’ love for you was conditional on your meeting high

standards. 2. One or both parents were models of high, unbalanced standards. 3. One or both parents used shame or criticism when you failed to meet

high expectations.

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Origins of Entitlement Origin 1: Weak Limits Weak limits is the most obvious origin for Entitlement. These parents fail to exercise sufficient discipline and control over their children. Such parents spoil or indulge their children in a variety of ways.

(A) Spoiled Entitlement: Children are given whatever they want, whenever they want it. This may include material desires or having their own way. The child controls the parents. (B) Impulsivity: Children are not taught frustration tolerance. They are not forced to take responsibility and complete assigned tasks. This may include chores around the house or schoolwork. The parent allows the child to get away with irresponsibility by not following through with aversive consequences.

Origin 2: Dependent Overindulgence The origin of Dependent Entitlement is parents who overindulge their children in ways that make the children dependent on them. The parents take on everyday responsibilities, decision, and difficult tasks for the child. The environment is so safe and protected and so little is expected of the child that the child comes to demand this level of care. Origin 3: Entitlement as Counterattack for Other Schemas For the majority of patients, Entitlement is a form of overcompensation, for other core schemas – usually Defectiveness, Emotional Deprivation, or Social Exclusion. For the origin of the Entitlement cases, see the chapter relevant to the underlying core schema. Adapted from Young, J.E. & Klosko, J. (1993) Reinventing Your Life.

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Session 9: Consequential and Harmful Thinking

The purpose of this session is for participants to: a) Understand that nothing ‘just happens’; we have a constant stream of thoughts in our heads that influence us that we are often hardly aware of b) Recognise some of their own and others harmful thinking patterns

Opening

Explain that today’s session is about gaining an understanding that how you think about things effects how you feel and how you behave. One of the most powerful skills you have when trying to change behaviour is your thoughts. Unfortunately, we are not taught to understand our thoughts and take control of them. Consequential thinking is the art of examining your thoughts and feelings before you act on them.

What is consequential thinking?

9.1 What if…? Related

Materials

Ask group members to think about how they would act in the following situations:

you are planning to break into a house and there’s no one home

you are planning to break into a house and can hear a barking dog

you are planning to break into a house and there’s a police car outside

Discuss group member’s thinking processes and how this leads to different behaviour in each situation. Ensure that participants understand what a thought is.

Self Talk

Explain that we have a range of thoughts going through our heads all the time. We also think things to ourselves all the time, like our own personal narrator. These thoughts are called self talk. Self talk is so routine that we often don’t pay any attention to it and don’t recognise the way it influences our feelings and behaviours. Self talk may be: negative or positive (e.g., “I can’t” or “I will”) true or false automatic easily believed stop you from thinking alternative thoughts a part of old thinking patterns

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Negative self talk

Substance users often have negative self talk patterns that keep them trapped in their substance abuse. A key skill for substance users to learn is to challenge their negative self talk and to develop positive thinking patterns.

HANDOUT 9.0 – A self-talk test Distribute the handout, found at the end of this session, and discuss. Ask participants to consider a real-life example.

We can know whether our self talk is positive or negative by asking some of the following questions: What is the evidence for my self talk?

What proves to me that what I’m thinking and feeling is correct and based on fact?

Is this way of thinking going to get me into trouble?

If I think this way is it likely to put me in a negative or positive frame of mind?

Am I likely to behave responsibly when I think this way? How does this self talk help me to reach my goals?

Is thinking this way going to help me maintain a drug free or crime free existence?

How does this self talk make me feel? (e.g., does it bring me down or build me up?)

Am I making a thinking mistake? (e.g., is what I’m thinking actually true?)

Automatic self talk

Automatic thoughts are a special type of self talk. They are fast, strong and automatic – we are not usually consciously aware of them. Automatic thoughts are based upon our core beliefs, so we usually see them as facts and rarely challenge them. Usually automatic thoughts are powerful, negative and habitual and they determine how we react to the world around us. Relate section back to schema session

9.2 Automatic self-talk Related Materials

Distribute handout 9.1, and ask participants to: write down some of the negative rules that you

were told when you were younger write down some of the negative beliefs messages

that came from these rules write down the automatic thoughts you have when

these rules are broken or when you try to live by these rules

Handout 9.1

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Positive Self-talk

9.3 Practicing positive self-talk Related

Materials

9.3.1 Distribute handout 9.2, and ask participants to write down after each statement:

the first thought that would come to mind if you were in that situation

how that would make you feel how you would be likely to respond/behave

9.3.2 Distribute handout 9.3, and ask participants to fill in the handout. Explain the difference between this activity and the previous activity – this one put positive self talk in to replace the negative self talk. If appropriate ask them to practice their positive self talk on a real life example and write in on the sheet before the next session.

Handout 9.2 Handout 9.3

Unhelpful Thinking

HANDOUT 9.4 – Unhelpful Thinking Distribute the handout, found at the end of this session, and discuss whether participants use any of these thoughts.

Thinking Errors

HANDOUT 9.5 – Thinking Errors Distribute the handout, found at the end of this session, and explain how these are errors usually used by offenders which help support their offending behaviour. Discuss groups own

experiences.

Session Close

Get participants to say one word to reflect how they feel at the end of this session or reflect on what they have learnt

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Session 9 – Handouts

Handout 9.0 – A self-talk test

1. What is the evidence for my self talk? (What proves to me

that what I’m thinking and feeling is correct and based on fact)

2. Is this way of thinking going to get me into trouble? (If I think this way

is it likely to put me in a negative or positive frame of mind? Am I likely to behave responsibly when I think this way?)

3. How does this self talk help me to reach my goals? (Is thinking this way going to help me maintain a drug free or crime free existence?)

4. How does this self talk make me feel? (Does it bring me down or build me up?)

5. Am I making a thinking mistake? (Is what I’m thinking actually true?)

Handout 9.1 – Automatic Self-talk To get an idea of what and where your beliefs come from, write down some negative rules that you were told when you were younger. Then write down

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some of the negative beliefs messages that come from these rules. Finally, write down the automatic thoughts you have when these rules are broken or when you try to live by these rules.

Learnt Rules/Values Negative Belief Automatic Thoughts

Eg. boys don’t cry.

Feelings are a sign of

weakness

“If I cry I’m weak”

“if I show anything they’ll have it over me”

Eg. Don’t make mistakes

I must be perfect.

“I’m a f… up”.

“I never do anything right”

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Handout 9.2 – Thinking on the Run

After each statement, write down: (1) The first thought that would come to mind if you were in that situation. (2) How that thought would make you feel. (3) How you would be likely to respond/behave.

EVENT

THOUGHTS FEELINGS RESPONSE/BEHAVIOUR

you are driving and get cut off

a friend wants to borrow $200

you receive an anonymous love letter

you get called to the seniors office

you lose your license for speeding

own example

own example

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Handout 9.3 – Positive Self-talk

EVENT

THOUGHTS FEELINGS BEHAVIOUR POSITIVE SELF TALK

NEW FEELINGS

NEW BEHAVIOUR

some one knocks into you in the canteen queue.

“how dare he” “he’s trying to get one over me” “I need to stand my ground or I’ll be stood over”

angry, aggressive, paranoid, threatened

abuses other person starts a fight

“its one bump it doesn’t mean anything” “its just an accident” “theres no need to react”

concerned but calm

stays in queue waits to see what happens

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Handout 9.4 – Unhelpful Thinking Everyone has ways of thinking that are unhelpful that might lead them into difficult situations.

Some common unhelpful ways to think (from McKay et al, 1981)

1. Filtering: You only look at the negative details and make them bigger while

filtering out all positive aspects of a situation. This may mean that you blame

yourself for one lapse of using when you have been going generally well.

I’ve tried psycho stuff and it doesn’t work.

2. Black & White Thinking:Seeing things as black and white, all or nothing, good

or bad (there is no middle ground). This could mean that you have to be perfect or

you are a failure. You may think that all men or women are out to take advantage of

you; people either like you or they hate you.

If I can’t be the best it’s pointless trying at all.

If I don’t stay abstinent I’m a total failure.

3. Overgeneralising:You use one piece of evidence to make a general conclusion.

If something bad happens once you expect it to happen over and over again. This

is based on faulty logic.

I relapsed after I stopped five years ago; I’ll never be able to stop

drinking/using.

4. Mind reading: Without them saying so, you know what people are feeling and

why they act the way they do. You know how people feel about you without them

saying anything.

My friend has interrupted me twice. I must be really boring to listen to.

5. Catastrophising: Making mountains out of molehills. You expect disaster. You

notice or hear about a problem and start ‘what ifs’. What if tragedy strikes?

If I get a craving, I’ll freak out.

6. Personalisation:Thinking that everything people do or say is some kind of

reaction to you. You also compare yourself to others, trying to determine who’s

smarter, better looking etc and you take responsibility for negative events for which

you are not responsible.

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My partner has come home in a bad mood; it must be something that I have

done.

7. Control fallacies:If you feel extremely controlled (external control), you see

yourself as helpless, a victim of fate. The fallacy of internal control has you

responsible for the pain and happiness of everyone around you.

No matter how hard I try, some officer gets in my way.

Everyone I know has either died, gone to gaol or has taken off.

8. Fallacy of fairness: You feel resentful because you think you know what’s fair

but other people won’t agree with you.

I’m doing my bit and these guys keep stuffing around.

9. Blaming: You hold other people responsible for your pain, or blame yourself for

every problem.

When I got out the cops were on to me straight away; I had no chance even

though I was clean at the start.

10. Shoulds and musts:You have a list of rules about how you and other people

should or must act. People who break the rules anger you and you feel guilty if you

violate the rules. Other people should always treat you fairly; you must be kind and

patient.

He wouldn’t write a letter to the Parole Board, so I told him to go jump.

11. Emotional reasoning:You believe what you feel is true – automatically. If you

feel stupid, you must be stupid. Results in believing the feeling represents one’s

true situation.

I feel like a failure – therefore I am a failure.

12. Fallacy of change: You expect that other people will change to suit you if you

just pressure or cajole them enough.

I’ve stopped drinking, so she should stop nagging me now.

13. Being right:You are continually on trial to prove your opinions and actions are

correct. Being wrong is unthinkable and you will go to any length to demonstrate

your rightness.

14. Heaven’s reward fallacy: You expect all you sacrifice and self-denial to pay off,

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as if there were someone keeping score. You feel bitter when the reward doesn’t

come.

When I get out after all this therapy, I’ll get a car/house/girlfriend/job in no

time.(from Burns, 1984)

15. Minimisation:Of your own of another’s positive qualities. You are hopeless at

everything.

I might have been clean for 2 years, but I still relapsed & it got me nowhere.

16. Selective abstraction: Selective choice of only a single piece of evidence that

supports the individual’s depressive ideas whilst ignoring all of the positive data.

17. Comparing: Competing and/or comparing excessively.

I am not as competent as my father.

18. Externalisation of self-worth: My sense of worth depends mainly on what

others think of me.

19. Objectifying the subjective: I have a belief that I need to be popular, so it must

be true.

20. Unrealistic expectations:I must be at my best at all times.

21. Fallacy of attachment: I can’t live as a single person.

22. Jumping to conclusions:Making up your mind before all the facts are known,

often leading to a negative or incorrect judgment.

My friend is not as nice as usual, because he or she is upset with me.

23. Pathologising:Calling a learned behaviour a disease. Depression, aggression

or drug addiction as evidence of a disease.

24. Entitlement: Expecting special privileges that don’t exist.

25. Complicating:Choosing a more complicated explanation over a simple one.

26. Impossibilising: My load is too heavy, it’s too hard.

27. Downing the source:Attempting to discredit the opponent instead of the

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opponent’s argument.

How can you help me if you’ve never been an alcoholic?

28. Appeal to authority:Asserting that something is true because an authority said

so.

29. Mystifying:Explaining the straight forward in an esoteric or jargonistic manner.

Memories of past lives are evidence of former lives.

30. Sidetracking:Changing the subject to an irrelevant issue to hide the weakness

of one’s position.

31. Point out the other’s wrong: Tit for tat.

32. Emotive Language: Using emotionally loaded phrases.

You are dumb, stupid and boring…

33. Anger attack: Sidetracking others by expressing anger at them.

34. Invincible ignorance: Totally denying that there is any problem whatsoever. I

have no idea.

35. I can’t stand it:Telling yourself and others that you simply can’t bear it (when in

fact it’s difficult but manageable).

36. One more doesn’t matter: Ignoring the need to draw the line from doing one

more thing.

37. Analysing:Using analytical approach when a simpler gut level approach is

called for.

38. Fantasising: May involve unrealistic expectations or evaluation.

39. Denial:Expressing a message that blocks out the truth, in order to avoid pain or

responsibility.

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Handout 9.5 – Thinking Errors (Sharp, 2000)

Thinking Error One-Excuse Making

Excuses are made by the responsibility-evader for anything and everything. Excuses are given whenever criminals are held accountable for their actions. Excuses are a way of finding a reason to justify problem behaviour. Excuses include such expressions as “I forgot,” “Someone told me it was ok,” Nobody told me,” “I forgot what time it was,” “I was never loved” and “My family was poor” etc.

Thinking Error Two-Blaming

Blaming is an excuse to not solve a problem. It is used by responsibility-evaders to excuse their behaviour and build up resentment toward someone else for “causing” whatever has happened-“I’m miserable and it’s your fault.” In blaming criminals point the finger at someone else and say that they caused whatever was happening. This takes the focus off them and often allows them to build themselves up by putting others down. “You make me angry” is another blaming statement, and if we accept that we make them angry, then it is not their fault. Some blaming includes: “The cops are always giving me a hard time,” “You know the way the laws are now,” “The trouble is you’re being too critical,” “The staff didn’t tell me it was time for my medication,” “My group member is asking for a beating,” “She doesn’t care about me so why should I give a damn about what I do.”

Thinking Error Three-Justifying

This is a criminal’s way of explaining the reason for things they have done and for which they do not want to take responsibility. They find justification for any and all issues for which they take no responsibility. It is there way of proving they are right and correct. Examples include some of the following: “I usually don’t drive if I am drinking, but my friend got too drunk that night,” “If you can, I can,” “We had a fight, so that’s why I went out and drank,” “ No one listens to me so that’s why I can’t do anything.”

Thinking Error Four-Victim Playing

Criminals act as if they are unable to think, to solve problems, or to do anything for themselves. They often whine and act as if they are helpless as well as being incapable of doing anything for themselves. The victims’ wish is to get pity and be excused for their behaviour. Even if they act aggressive, they may use a victim stance to justify their behaviour. They believe that if

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they do not get want they want, they are a victim. The victim players get people around them to either put them down or rescue them from their problems. The “victim playing” thinking style often leads criminals to blaming society for their problems, that society is against them, has not given them a chance or that somehow society doesn’t understand them. It is counterproductive to allow criminals to go on about how they are the victims of society; how their behaviour is due to the way they have been wronged by others. Criminals will use this to defocus attention away from their own behaviour. This victim’s role is used almost as often as the anger role. They have convinced even themselves that they are the victim.

Thinking Error Five-Redefining

Redefining is the process that criminals use to shift the meaning or focus of an issue to avoid having to take responsibility for their actions. It is way of refocusing/defocusing the attention to something or someone else. It evades addressing the issues and behaviour. When you ask them how many times they have been in prison, they may reply by redefining the situation to focus on whether you have been in prison. Other examples of the “redefining” thinking error are as follows: Question: “How often have you driven intoxicated in the last 5 years?” Answer: “Not as often as a guy I work with. Boy, he should be here.” Question: “What was your BAC when you were arrested?” Answer: “Those breathalysers aren’t that accurate-they can be thrown off even by breath mints-they shouldn’t use them.”

Thinking Error Six-I am unique

“I’m unique” is a constant cry of the criminal. I am not like the rest of the people in here. Yes, they are criminals, but I am not. All criminals believe they are unique and special, that no one else is like them, so any information applied to other people simply does not affect them. The beliefs underlying this thinking error are those things such as “I know everything and I can handle things alone.” “I don’t need anyone. No one understands me anyway.” This last belief is held to and applies to everyone, including recovering addicts and counsellors. Criminals may even discount the stories of recovering people because they are unique and the stories do not hold true for them. It is common in an alcohol/drug treatment group with criminals for clients to see their own situation as unique. Another example of this type of thinking error is individuals believing that rules and laws do not apply to them. “I took a fifteen-minute shower (the rule is five minutes) because I work harder than the other clients in this place.”

Thinking Error Seven-The Power Thrust

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Criminals need power and control over others. Their greatest excitement is in doing the forbidden and getting away with it. Their need for power, control and dominance show in all areas of their life. The occasions when criminals appear to show an interest in a reasonable activity are generally opportunities for criminals to exercise power and control. In their thrusts for power, criminals view themselves as extraordinary and prestigious figures. The term “control” signifies management of another person, whereas “power” refers to the triumph criminals experience from managing others and achieving what is to them a victory at the expense of others. Power and control are based on fear and intimidation. The payoff is excitement which is a big high for criminals. Some other tools are sex, drugs, anger, tattoos, and bizarre grooming.

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THEME C – MAINTAINING CHANGE & MOVING FORWARD

Session 10: Self Management – Relapse Prevention

The purpose of this session is for participants to understand what relapse prevention is and develop their own strategies to prevent relapse

Opening

Explain that drug or alcohol addiction is a chronic relapsing condition. This means that even after a significant period of abstinence, the user is vulnerable to returning to their previous drug use. This occurs because: Substances create pleasurable experiences that are reinforcing Long term use results in changes to the brain structure that contributes

to craving for the drug Chronic users have usually built a lifestyle around drug use and ending

drug use requires a complete lifestyle change The social network of chronic users is usually involved in drug use so

contact with their social supports often puts them in the vicinity of drugs Relapse prevention does two main things: 1. It teaches users the relapse cycle which helps them to recognise the types

of thoughts, problems and situations that trigger their drug use and to recognise that the way they respond to these can increase/decrease their chances of using

For example, do they tend to use with certain people, in certain places, at certain times. By teaching the person to recognise their risk factors and their own relapse cycle they are better able to recognise when they are setting themselves up to use again. They can then be taught specific coping skills or strategies to help them manage those situations more effectively in the future

2. It also teaches the person how to stop themselves from relapsing after a

single episode of use. That is to prevent a lapse from becoming a relapse. What is a lapse? After a period of not using, you use once for a short period, but then

stop using. For example, after not using for three months, you have a taste one night, but then get back on track the next day

What is a relapse? After a period of not using, you gradually start old behaviours and

return to old patterns. You haven’t been able to maintain your changes

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or new behaviours. For example, after not using for three months you meet your dealer by chance and score each day for the next week until you have developed a habit

There is about a 50-50 chance of relapsing, and relapses are most likely to occur within the first three months of quitting The idea behind relapse prevention is to:

a) know that this is what you really want to do b) have a clear understanding of the reasons we lapse and relapse c) have a good plan that deals with lapse and relapse situations d) have good self-control techniques that will help you manage stress e) stick to it

Relapses don’t go on forever, but tend to be part of a cycle. Encourage participants to recall the stages of change that were looked over earlier in the program. Ask participants to reconsider at which stage they are currently at and explore whether ceasing/reducing their drug use is what they really want to do.

Lapses and Relapses

HANDOUT 10.0 – Lapses and Relapses Distribute the handout, found at the end of this session, and ask the group to identify their own experiences of lapses and relapses.

Ask participants to think of what they were feeling and thinking at the time of these relapses and lapses and whether there was anything that they felt was happening at the time that impacted on them lapsing or relapsing. Discuss: The difference between lapses and the relapses? What did they do differently in each situation Were there different thoughts, feelings or situations that impacted on

whether an instance was a lapse or a relapse?

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The Relapse Cycle

HANDOUT 10.1 & 10.2 – The Relapse Cycle Distribute the handout, found at the end of this session, and walk through each of the stages with examples. Encourage participants to fill out their own examples either during or after the session.

Explain to the group that the relapse cycle fits any habitual behaviour – exercise, eating chocolate, dieting, smoking, etc. Ask the group to share their own experiences. High Risk Situations There are generally four high risk situations that may trigger relapse (but may be different for everyone): 1. Emotional lows and highs Feeling low and feeling high can trigger a relapse Apart from using when you’re feeling depressed and unhappy, have

you ever used when you’re feeling good, happy and excited? 2. Physical lows and highs Body aches and pains, tiredness, low energy, craving and urges can all

influence relapse if you have learned to deal with these things by using substances

Relapse can also occur when you’re feeling physically fit and by using substances you may think that you will feel and perform even better

3. Problems/Conflict Everyone has problems in their lives – however, if you have learned to

deal wit problems in your life or conflicts with other people by using drugs, then these problems can trigger a relapse

4. Peer group pressure For some people, staying clean may be as simple as staying away from

other people who encourage or pressure you to take drugs Peer group pressure can be an internal or an external trigger – you

may feel that using drugs helps you to fit into social situations, or others may actively encourage you to use

HANDOUT 10.3 – High Risk Situations Distribute the handout, found at the end of this session, and ask the group to reflect on their personal high risk situations for using

Coping

One of the main ingredients of relapse prevention is having a plan so that when things go wrong you know what to do to get yourself out of it. Don’t leave your plan for when you get out of prison. You need to work on it while you are thinking straight.

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The main steps are: Develop your support network Make a list of the people who you can trust and will keep you on the

“straight and narrow” when things go wrong Talk to them and ask if you can turn to them when things go wrong They need to be people who will put positive thoughts into your head

Alternative Activities Write up a list of activities that you can do to keep yourself busy and to

distract yourself when you feel like using Areas I need to work on Identify priorities for personal development (e.g. anger management,

problem solving, assertiveness, stress management, etc.) and start practicing them daily

Start with little problems and work up to the bigger issues Escape Plan For each of your high risk situations, make an escape plan If you are faced with the situation – you will know how to get out of it

Positive Self-talk List positive self-talk statements you can think of that will help you to

stop relapsing and stop you falling into negativity

Remember that drug and alcohol users usually have very negative self talk (session 7). Self-talk is the messages you give to yourself or the things you say to yourself in your own head. We all have a running commentary in our heads – if that commentary is positive, you will have a more positive view of yourself and the world. If that commentary is negative your view of the world and yourself is fairly negative. One of the keys in preventing a lapse from becoming a relapse is your self-talk and how you perceive the lapse. If you see it as the end of the world, you will be more likely to keep on using. However, if you see it as a mistake to be learnt from, you are more likely to stop using and get back on track

HANDOUT 10.4 – My Personal Coping Strategy Distribute the handout, found at the end of this session, and ask the group to identify the members of their support network, alternative activities to prevent relapse, and escape plans for high

risk situations.

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Positive Coping Mechanisms

‘In-Betweens’ Negative Coping mechanisms

▪ Humour

▪ Brainstorm options

▪ Write a letter

▪ Watch a sunset

▪ Sleep

▪ Draw

▪ Go to the pool/ beach

▪ Take 5 deep breaths

▪ Listen to music

▪ Have a shower/bath

▪ Go for a walk

▪ Pamper yourself

▪ Writing a journal

▪ Using drugs

▪ Withdrawal

▪ Debates

▪ Raising the past

▪ Putting on a mask

▪ Confrontation

▪ Writing a letter

▪ Crying

▪ Taking drugs

▪ Denial

▪ Gambling

▪ Sleeping excessively

▪ Violence

▪ Drinking excessively

▪ Compulsive exercising

▪ Slamming doors

▪ Bitching

▪ Abusing drugs

▪ Putting someone down

▪ Self-harm

▪ Fighting

Cognitive Coping Strategies –Positive Self-talk Self Calming Strategies What we think affects how we feel. Distorted thinking can increase the

chances of us experiencing negative emotions such as fear, guilt, anger, while calming or challenging our thoughts can reduce the impact of these feelings. Self-calming statements are thoughts that can be:

a) developed earlier to help cope with difficult situations b) used to cope with a situation when it arises c) used to help calm ourselves after the situation has passed

For example,

Distorted thought – “She’s having a go at me”

Self-calming statement – “Don’t take it personally” Distraction Sometimes we dwell on things that are not helpful to us, thereby

increasing our sensitivity to the issues. This does not accomplish anything and can make us feel worse. Deliberately choosing to think about something else (distraction) can help us feel better or at least give us a break and prevent an escalation of negative feelings.

For example,

Slowly count to 10

Imagine a peaceful, relaxing scene

Remember a pleasant event Humour Humour is a positive emotion and therefore competes with negative

feelings such as fear, hurt, blame or anger. Attempting to see the

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“funny side” of a situation will give rise to humorous thoughts. Similarly, being able to bring to mind an amusing memory will help to dispel unpleasant feelings

Rationalising This technique involves examining our thoughts and challenging them

objectively. ‘Standing back’ from our thoughts can allow us to view them from a different perspective. Viewing the situation from the perspective of someone who we are having trouble with is a particularly valuable technique.

For example,

Ask ourselves – “If I were her, what would I be thinking or feeling?” Self-praise After a difficult situation has passed, we may still be left with

unpleasant feelings. Praising ourselves for being assertive in a situation we have previously felt powerless, for example, can help to make us feel better about the situation and increase our chances of future success

Focusing on the task This technique helps us to focus on the objective or task that needs to

be accomplished. It is easy to get side-tracked into irrelevant issues. Reminding ourselves of our goal (understanding past destructive behaviours, developing self-awareness) can help to detach ourselves from the negative feelings we may be experiencing

Accept your emotion Sometimes the best way to deal with a difficult emotion is to:

a) identify and acknowledge your feeling b) accept that you feel that way – don’t judge how you feel; and c) allow your feelings to happen – remember, you are not your

emotion, you don’t have t act on how you feel you just need to feel it

(Adapted from the ACT Programme Guide (1998) by Emma Williams and Rebecca Barlow and from the Skills Training Manual for Treating Borderline Personality Disorder (1993) by Marsha Linehan)

HANDOUT 10.5 – Personal Cognitive Coping Strategies Distribute the handout, found at the end of this session, and ask participants to identify their own coping strategies in or after the session

What happens if I slip?

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HANDOUT 10.6 – What happens if I slip? Distribute the handout, found at the end of this session, and discuss as a group

Session Close

Get participants to say one word to reflect how they feel at the end of this session or reflect on what they have learnt

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Session 10 – Handouts

Handout 10.0 – Lapses and Relapses Think about the events that led to the lapse and relapse occurring. How did you stop the lapse from becoming a relapse?

Describe the last time you experienced a LAPSE:

Describe the last time you experienced a RELAPSE:

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You & your hassles

Stress, problems,

everyday living,

Urges & cravings

Thinking about using, feeling like

using

Seemingly Unimportant

Decisions Making decisions that

increase your changes of

using - setting your self up

E.g., Walking past your dealers on your way to the shops

High Risk Situations

Placing your self in situations that increase you risk of using. E.g Going into dealers house

Poor coping response Not using positive coping strategies EG Staying at dealers house

LAPSE

Using once

RELAPSE Keeps using -

restarting habit

Positive thinking about self & lapse

Realistic & balanced thinking, putting lapse into perspective. & positive self talk E.g.: It was a slip up, I can learn from this, I can control it.

Negative thinking about self & lapse

That's the end of everything, Might as well go on with it, I'm useless, I'll never change

STOPS USING-gets

back on track

Handout 10.1 – The Relapse Cycle

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You & your hassles

Urges & cravings

Seemingly Unimportant

Decisions

High Risk Situations

Poor coping response

LAPSE

RELAPSE

Positive thinking about self & lapse

Negative thinking about self & lapse

STOPS USING-gets

back on track

Handout 10.2 – My Relapse Cycle

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Handout 10.3 – Personal High Risk Situations

Emotional Highs and Lows

Physical Highs and Lows

Problems and Conflict

Peer Pressure

e.g., feeling

lonely

e.g., stomach

pain

e.g., relationship

break-up

e.g., meeting up with others who

use

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Family Friends

Work Mates

Professionals Others

1.

2.

3.

4.

5.

6.

Handout 10.4 – Personal Coping Strategies

HIGH RISK SITUATION ESCAPE PLAN

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Handout 10.5 – Personal Cognitive Coping Strategies Self-calming Statements Note at least two things you can say to yourself to help when dealing with a difficult situation _________________________________________________ ______________________________________________________________________________________________________________________________ Distraction Note at least two ways of distracting yourself that can help when you are experiencing negative feelings ______________________________________ ______________________________________________________________________________________________________________________________ Humour Note at least two things that your could think to yourself to make light of a difficult situation _________________________________________________ ______________________________________________________________________________________________________________________________ Rationalising Note at least two things you can say to yourself to help you see the situation from someone else’s perspective ____________________________________ ______________________________________________________________________________________________________________________________ Self-praise Note at least two things you could say to yourself to reinforce your success _____________________________________________________________________________________________________________________________________________________________________________________________ Focusing on the task Note at least two things you could say to yourself to keep you focused on what you are doing _____________________________________________________________________________________________________________________________________________________________________________________________

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Accept your emotion Note the emotions that you find hard to allow yourself to feel. Why do you think you have difficulty feeling these particular emotions? _____________________________________________________________________________________________________________________________________________________________________________________________

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Handout 10.6 – What happens if I slip? After a slip, you might find yourself in one of the following stages of change: Precontemplation You may be doubting that it is worth trying to change your drug use. If so, it may be helpful to do the following: Review information about how drugs can affect you physically, socially

or emotionally Think about your values and whether using drugs conflicts with them Think about how your drug use affects other people

Contemplation You may be considering making changes in your drug use, but you may not be quite sure. If so, it may be helpful to do the following: Think about the consequences for yourself of the behaviour Weigh the advantages and disadvantages Think about what you expect to get out of using drugs and if these are

realistic expectations Preparation You may decide that you want to get ready to change your drug use again. If so, you might try the following: Take small steps toward behaviour change Start taking to people who have successfully quit using Keep people in mind the situations that led to the slip and think of ways

to avoid them Develop a change plan

Action You may decide that you want to stop using drugs again. If so, then it will be helpful to do the following: Avoid or alter situations that tempt you to use Change your responses to offers to use, stressful situations and

automatic thoughts Reward yourself for successes Interact with people who support your changes Try to help others who are trying to quit

(Adapted from Velasquez, Maurer, Crouch and DiClemente (2001))

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Session 11: Self-management – Goal setting

The purpose of this session is for participants to understand the need to develop a healthy lifestyle and establish their own goals to achieving this

Why set goals?

Goals are personal road maps for life. If you don’t have a goal, how do you know which direction to go in? You could be going around in circles not knowing which way to go. Goal setting is the only real way to achieve what we really desire. Indulging in short term pleasure and quick fixes is too high a price to pay for those who want a life full of pleasure. Why don’t some people set goals? “I will fail and be disappointed” “It’s only a dream, and therefore not real” Some have set goals in the past and failed – “the fear and pain of

failure prevents me from trying again” “I am not prepared to pay the price in terms of time, effort, money,

emotions and so on” “The pain of my existing lifestyle is smaller than the pain of changing”

Goal setting is an important method of: Deciding what is important for you to achieve in your life Separating what is important from what is irrelevant Motivating yourself to achievement Building your self-confidence

By setting goals you can: Achieve more Improve performance Increase motivation to achieve Increase pride and satisfaction in your accomplishments Plan to eliminate attitudes that hold you back and cause frustration and

unhappiness Research has shown that people who set goals effectively: Suffer from less stress and anxiety Concentrate better Show more self-confidence Perform better Are happier and more satisfied

All you have to do is: Believe that something in your life must change Believe that you must change or succeed Believe that you can change or succeed Have a clear idea of what it is you want to change or succeed in

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As long as you are prepared to pay the price in terms of time, effort and money etc., and be consistent with it, you will always achieve your goals. For example, if you are hanging out and need a hit, you would do whatever it takes including face risk and consequences to get what you want. If this effort was applied to other areas of your life, where could you actually be in terms of having what you desire? What are you prepared to pay for long term pleasure and NO legal

risk?

Goal Setting

Types of goals Short-term Medium-term Long-term

Smart goals Specific – set in time and based on all the senses Measurable – how do you know that you are achieving? Action – you need to put in the effort to get a result Reality based – is it achievable? Time based – all your steps to goals need to have dates – day, month

and year timeframes

Ask participants to start thinking about:

What are their goals? What are the steps involved? What are the times lines? What resources are needed? What are the potential obstacles? What are the solutions?

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Thinking about goal setting

1. What’s going on? What are the problems, issues, concerns or opportunities I should be working on? This stage involves clarifying the key issues calling for change Choose the right problems and/or opportunities to work on Work through blind spots that prevent one seeing themselves, the

problem situations and unexplored opportunities 2. What solutions make sense for me? What do I want my life to be like? What changes would make me happier? Find the incentives that facilitate commitment to oneself and to change

agendas Choose realistic and challenging goals that are real solutions to the key

problems and unexplored opportunities identified previously Use your imagination to spell out the possibility for change

3. How do I get what I want? What plan will get me where I want to go? This involves developing strategies for accomplishing goals See that there are different ways to achieving goals Choose best-fit strategies Develop a plan

4. How do I get results? How do I turn planning and goal setting into solutions, results, outcomes or accomplishments? How do I get going and keep going? This stage represents the implementation stage (Adapted from The Skilled Helper (Egan, 2002))

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Defining goals

HANDOUT 11.0 or 11.1 – Defining goals Distribute the handout, found at the end of this session, ask participants to identify what their short, medium and long term goals are:

Encourage participants to present their goals to the group and address some of the following questions: Are you just starting or are you somewhere along the way? How do you know how far you have gone? What will have to happen for you to move further along the way? How do you know how far you have to go? What will be the hardest part of the journey? How can/have other people been helpful? What has been the most useful thing you have learned?

11.1 Obstacles to achieving one’s goals Related Materials

Distribute Handout 11.2 or 11.3 and ask participants to: re-identify goals consider the obstacles to achieving these goals identify how these obstacles can be overcome identify who can support them in achieving these

goals Encourage participants to draw from previous sessions in terms of obstacles and strategies.

Handout 11.2 - 11.3

Discuss participants responses to the above handout – if time permits ask participants to present their handouts to the group. Obstacles to achieving goals may include: lack of patience frustration negative attitude unclear thinking peer pressure continued drug use boredom loneliness

Strategies to deal with these obstacles may include: Finding a mentor Spending more time with people whose qualities and attributes you

admire and less time with people who might distract you from your goals

Harness strengths – what are they?

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Be mindful of weaknesses or things you want to work on – what are they?

Apply consequential thinking whenever possible (i.e., thinking ahead before you act)

Be more aware of physical sensations of stress and frustration and in the moment, trying to relax, take a deep breath and think through how you want to act – will the outcome be worth it?

Challenge negative thoughts rationally – remember that you have worked hard for your goals, you have experience, you can find the resources you need and you can and will do a great job

Concentrate on the things within your control and affirm to your self that no matter what happens, you will overcome any hurdles and come back stronger and wiser

Despite things not always going to plan – what have you learnt from the experience? Setbacks can provide useful learning opportunities for your own self-development and recognising this can be half the battle

Physical activities often work well as a stress/frustration relief – what are your interests in this area?

Summary

Summarise the goal setting session and encourage participants of the importance of working towards achieving a healthy lifestyle.

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Session 11 – Handouts

Handout 11.0 – Defining Goals

SHORT-TERM GOALS

MEDIUM-TERM GOALS

LONG-TERM GOALS

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Handout 11.1 – Defining Goals

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Handout 11.2 – My Healthy Lifestyle Goals Obstacles to Achieving

Goals Ways to Overcome these Supports

E.g., Relationships

E.g., Social life

E.g., Health/Physical

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Handout 11.3 – Healthy Lifestyles

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Session 12: Closing Session & Psychometric Testing

The purpose of this session is not only to collect data, but to discuss the overall group content, the significant moments and experiences. The purpose is also to tie up all loose ends, bring the group to a close and provide certificates and individual reports to the participants in a forum that allows their progress to be discussed and processed in a safe and constructive manner.

Psychometrics

PSYCHOMETRICS Distribute the four assessment tools needed for post assessment being the Carlson, Stages of Change, PICTS, and Situational Confidence questionnaires. Offer further feedback sessions to the

group once scoring has been completed regarding their scores and their progress in group overall

Closure

Closure can be discussed via the following questions:

What things worked in the group? What things didn’t work in the group? Was there a topic not covered that you would have liked to cover? Have your feelings/thoughts about drug use changed? Do you have a better or more informed understanding of how you

came to use, why you use now, what underlies your use and why it is so hard to stop?

Did you learn anything new? (about group, yourselves or each other) Did the group reinforce what you already know? What was your main motivation to enter group, e.g. for parole? Has

that view of group now changed and will you be happy to do group work in the future?

What will you continue to work on? What are the issues you still face? How are you feeling about the future? What will you take with you from the group? Have your goals/priorities changed?

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12.1 Processing Feelings about group being over Related Materials

12.1.1 Photo Language Cards Each group member selects a photo as instructed by the facilitator. Group members are required to explain to the group why they chose that particular photo in response to the question asked. Select a photo that:

appeals to you represents how you are feeling about ending this

group represents what is most important to you in your life

right now represents what you have achieved in the group represents how you feel about your future and what

you are getting out to 12.1.2 Feeling Stones Each group member selects a card which represents how they are feeling about the group ending and about the future. 12.1.3 Closure Questions Alternatively, ask the following closure questions which signify optimism, reinforce purposefulness and create pictures of the future

choose a stone you would like to become or the stone you would like to be

can you describe how you will be feeling what will you be thinking and what will you be doing how will it be different to what you are feeling,

thinking and doing right now what differences will other people see what effect do you think these differences may

have on them how do you think you might hang on to, or capture

or control these feelings to make them last how can you hang on to the feelings you feel now

and retain the good things you have felt about this group

If appropriate, there may also be space for the facilitator to reflect to the group what they saw or felt and to reflect on their own experiences of the group. This feedback is often welcomed by participants and is a positive way of bringing to an end the whole experience.

Appendices

Completion Advice

Name:

CRN:

Date: Location:

Program: 24 Hour (closed) Drug Treatment Program (level III) Program Description: The 24 Hour Drug Treatment Program aims to develop participants’ awareness of

the need to support themselves, for making changes in the direction of more healthy and legal alternatives

to their behaviour. After increasing the participants’ understanding of their drug choice, and exploring drug

taking behaviour as an adjustment to life circumstances, consideration is given to the process of change.

Participants explore their choices and establish goals for replacing outmoded thoughts and behaviours

with what is more suited to how they want to live their life in future.

Session Dates:

Attendance and punctuality:

1 2 3 4 5 Poor Excellent

Participation:

1 2 3 4 5

uninvolved involved

Motivation to program and addressing substance issues:

1 2 3 4 5 Unmotivated extremely motivated

Commitment to program and addressing substance issues:

1 2 3 4 5 little high level commitment of commitment

Communication skills:

1 2 3 4 5 needs excellent improvement

Problem solving skills:

1 2 3 4 5 needs excellent improvement

Comprehension of the group content:

1 2 3 4 5 poor comprehension extremely good comprehension

Completion of group assignments:

1 2 3 4 5 unsatisfactory excellent

Comments:

Recommendations:

Caraniche Representative: _______________________

Non-Completion Advice Name: CRN: Date: Location: Program: 24 Hour (closed) Drug Treatment Program (level III) Program Description: The 24 Hour Drug Treatment Program aims to develop participants’ awareness of the

need to support themselves, for making changes in the direction of more healthy and legal alternatives to their

behaviour. After increasing the participants’ understanding of their drug choice, and exploring drug taking

behaviour as an adjustment to life circumstances, consideration is given to the process of change. Participants

explore their choices and establish goals for replacing outmoded thoughts and behaviours with what is more

suited to how they want to live their life in future.

Session Dates: Number of sessions completed: Reason for Non – Completion: Comments: Recommendations: Caraniche Representative: ________________________________ Date: / /

CERTIFICATE OF COMPLETION

This certificate is presented in acknowledgement of

having completed the

on

Insert participant’s name

24 Hour (closed) Drug Treatment Program

(level III)

Insert date

Caraniche Clinician: ______________________ Insert clinician’s name

Program Attendance Log

Prison: _______________ Program: 24 hour closed drug treatment program (level III)

Start/End Date: ____________________ Facilitator:________________

Notes for using this form: Write in the date of each session at the top of the column. If a session is longer/ shorter than the normal duration, note this at the bottom of the column. If the client attends session, tick the appropriate box. Otherwise use the following codes for non-attendance: 1 = declined to attend 2= sick/medical 3= reclassified/ relocated 4= called to work/other program 5= attendance at Sent. Mgt 6= required for trial/APB 7= released 8=loss of privileges/ locked in cell/ unit or prison lockdown 9= terminated by therapist 0 =don’t know/ unable to determine/ can’t find prisoner

Name CRN

Tier 1

Low/Med/High

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Comments

Complete