1A Addiction treatment program

Substance Abuse Treatment Program:  SOBER Group
Brandon Bruce Dellario LMSW LASAC

“The effectiveness of treatment is positively related to the length of time that clients spend in treatment.”(Prendergast, 2000)  This document is a proposal for a fifteen week outpatient substance abuse treatment program.
  The group’s name is S.O.B.E.R. (surrender and open-mindedness bring everything to recovery).  The purpose of SOBER is to support and encourage those with substance use disorders to live clean, productive and responsible lives.  The population served at our outpatient clinic all fall within the contemplation or pre-contemplation stages of change.  The target population for the SOBER treatment program is adults, eighteen to eighty, who have shown a significant history of substance abuse as measured by the SASSI instrument, without signs of non-substance-induce mental illness.  Clients who present with signs of mental illness will be referred out to agencies who can provide them with necessary services.
Around 75% of our clients are mandated by the courts to participate in treatment which make them overwhelmingly a non-voluntary clientele.  We at Plainwell Psychological Associates will take these factors into account when working with the clients of the SOBER treatment program in relation to formulation of a sound therapeutic contract.  There will be no reaquirements to attend 12 step meetings outside of group since this has been shown to have a negative effect on treatment outcomes.(Magura, 2000)  12 step attendance is however encouraged throughout our program.  We treat clients according to their individual social, cultural and environmental factors.  As interns will be facilitating this program and related groups, there will be no charge to our clientele.
The first five weeks of SOBER involve didactic groups for psychoeducation on addiction recovery.  The next four weeks are spent as therapeutic process groups where members share their individual experiences in recovery.  The last three weekly groups are focused on maintenance of ongoing recovery.  This is followed by three individual sessions with a counselor for client aftercare.
The didactic sessions, while allowing for some group discussion, will focus on the provision of addiction recovery information.  This fills the requirement of our substance abuse population’s great need for education regarding the disease of addiction and addiction recovery.  During this time we also focus on related topics including boundary setting, developing new relationships, developing healthy habits along with support and encouragement.  We at Plainwell Psychological Associates are 12-step oriented.  We seek to integrate our clientele with the local 12-step meetings and the recovery community at large.  We do this by making a suggestion to our clients to attend three 12-step (or other mutual help group) meeting minimum per week throughout our fifteen week treatment program.
The four week process group focuses on the individual experiences, strengths and weaknesses of each group member.  After five weeks of getting to know one another through attending group, group members begin to get comfortable with each other.  This is advantageous to the therapeutic process for comfort levels in sharing personal information in process group, as well as receiving help from and offering help to other regular group members.  The last three groups are geared toward detailed work on the supports and barriers each group member carries.  Finally, the three individual sessions following group treatment are for personal work with a counselor regarding the clients’ specific needs in their personal ongoing recovery.

Organizational Aspects
Information about SOBER will be dispersed through other local agencies such as Kalamazoo Community Mental Health and Substance Abuse Services, Drug and Alcohol Courts and Community Healing Centers.  SOBER pamphlets will be placed in waiting areas in these agencies, as well as sent to individual workers and probation officers inside each agency.  When a patient is referred from an agency, they will be further informed about SOBER through an initial meeting with one of our counseling interns.  This is where clients are given all the information about our program (including consumer rights), sign needed documentation and meet with at least one of our program facilitators. 
At SOBER, the client comes first.  We gear our program toward the Carl Rogers person-centered approach.  This is a recovery-focused model which is becoming more utilized by our contemporary American mental health care system.  Our SOBER client-centered approach puts our customers in the driver’s seat, while providing rough guidelines for appropriate behavior.  Clients gain more personal experience, competence, self-efficacy and self-accountability when expected to make their own decisions.  “The consumer should be paramount, people expect providers to systematically determine and respond to consumer needs.”(Wilkerson, 2000)
Within our small clinic, we will need to organize the required time allotments on the calendar in scheduling time for group in the large meeting room.  This may prove difficult, as we have no system for this in place as of yet.  Once we establish the system of reserving the large meeting room, we will need to have an agency meeting where the scheduling process will be announced to all staff.  At this time we can announce the proposed times for SOBER group sessions to look for scheduling conflicts. 
Another challenging area might be finding enough interns at Plainwell Psychological Associates to put in the hours necessary for SOBER to stay afloat.  We will approach individual interns and ask them what their schedules look like.  We will also ask them to take their SOBER program co-ordination responsibilities to their field supervisor and field liaison for final approval.  It looks as though we will have to discontinue SOBER through the summer months when interns are not available.  If after evaluation, SOBER is shown to be an effective program, our funding sources may pick it up for year-round activity.

Group Members
Given the population of Plainwell, MI and surrounding areas, we have come up with a general expected client population of local, white males between the ages of 18 and 64.  Most of these local men are employed by farms and factories in the area, around 60% of them are married with children.  These men have historically come to treatment because of DUIs and other substance abuse charges.  They are normally court-ordered to treatment with us.  This makes many of them involuntary.  We have very few that are beyond the contemplation stage of development.
When the individual group member first comes in and is informed about the SOBER program, they will also be given a needs assessment, a mental status exam and testing through use of the SASSI instrument.  This will tell us the level of the specific substance use disorder which requires treatment.  This instrument will be the major criteria of inclusion or exclusion depending on the results which will be discerned by individual program facilitators.  Aside from agency policy regarding clientele, and exclusion of those with a severe and persistent unrelated mental illness, the SASSI instrument is the only criteria of inclusion or exclusion needed for participation in the SOBER program.  Our program will be run charge free by the unpaid labor force of interns.  Since interns are only at our agency from September to April, with very few here in the summer months, the SOBER program will not be operating during the months of May through August.
The people we serve are our primary stakeholders.  We will provide them with healthy, safe  evidence-based treatment in a timely manner.  If they are not able to find transportation to appointments, we will provide transportation.  The SOBER program will be sensitive to individual differences and show respect regarding individual client needs, cultures and backrounds.  We actively engauge clients in design, delivery and evaluation of services.  Our clients make many key decisions regarding their own treatment plan while receiving informed choices.(Wilkerson, 2000)

Group Session Focus & Dynamics
The clients involved in the SOBER program will be predominantly involuntary.  This raises issues regarding low-motivation, denial, and refusal to participate in group sessions.  For this reason, group sessions will be organized appropriately with a defined structure.  “Drug dependence treatment produces improvements in drug-use-related behaviors (e.g. use by injection, crime) and in positive social functioning (e.g. employment, family relationships, psychological adjustment).”(Prendergrast, 2000)
The 15 sessions will be 45 minutes in length.  We have agency rules which all group members must abide by.  Some of these which most pertain to SOBER participants are:  1) No weapons, drugs of abuse, or drug paraphernalia on the premises; 2) Clients must not attend sessions while intoxicated; 3) Clients in group sessions make an agreement that “what is said in group, stays in group.”  There are no specific SOBER program rules aside from the following other than the guideline which states that any member who misses more than 3 group sessions is automatically dropped from the SOBER program.
In our history of treating involuntary clients with substance abuse disorders, we have some realistic expectations of client/leader interaction.  Our group leaders are trained in Mandt, Motivational Interviewing and Person-centered Planning.  These group leaders are our intern staff who are educated and experienced in methods of working with resistant and low-motivated clients.  We have made this foresight into the SOBER program because so many of our previous and current substance abuse group members have a history of physical and verbal abuse.  A client acting out in these issues comes into play within the group and challenges group sessions.  These type of traumatic issues coupled with the frustration clients sometimes feel when they are court-ordered to treatment can be explosive.  We at the SOBER treatment program and Plainwell Psychological Associates have a firm grasp on all that is needed in treating this population safely and securely with a minimum of negative consequences.
Our goals will all correlate with the SOBER mission statement which is, “. . . a program to aid clients in finding their own inner wisdom and strength to achieve sobriety.”  Thus, group didactic sessions will focus on education of lifestyle changes which will support individuals in their own recovery path.  Process sessions will explore individual changes along with supports and barriers to change.  Frankly, our group goals will center on sobriety and ongoing recovery from substance abuse.

Evaluation
     Our program, SOBER, will utilize a meta-analysis, “to examine the relationship between selected program factors and client outcomes. . . .  it is the most systematic and comprehensive assessment of the impact of selected program factors on client outcomes conducted to date.”(Magura, 2000)  In the beginning, the formative stage of evaluation, we will utilize The Rehabilitation Accreditation Commission (CARF) accreditation standards for substance dependency programs.  We will match up our program very tightly to these standards of practice.  SOBER will utilize only evidence-based practices to treat our clientele, such as Cognitive Behavioral Therapy (CBT).
     After the first three groups have finished and been discharges from the fifteen-week SOBER program, we will begin an evaluation of the effectiveness of the program at our clinic.  In this summative stage of evaluation, we at the SOBER program will employ Archibald Cochrane’s evidence-based approach of randomized control trials (RCTs) with the use of instruments such as the Addiction Treatment Inventory (ATI) “designed to measure key structural, organizational and service delivery variables of substance dependency programs.”(Magura, 2000).  The ATI evaluates program variables for the practical measurement of change.  It was designed to be used regularly, so we will use this instrument as a yearly evaluation of the SOBER program in relation to its effectiveness regarding client outcomes.  This will be done in relationship to our three quarterly contacts with clients during their aftercare.(Prendergast, 2000)
     In the final, ascriptive, stage of evaluation for the SOBER program, we will hire an outside party to come into our work week and evaluate the program.  We will require that the evaluator pursuit information regarding all criteria which make up our program, with special regard to its effectiveness in treating our clientele.




Cochrane, A. L. (1972). Effectiveness and Efficiency: Random Reflections on Health Services. Nuffield Provincial Hospitals Trust, London, England.

Magura, S. (2000). Introduction: Program Quality in Substance Dependency Treatment. Institute for Treatment and Services Research at National Development and Research Institutes, Inc., New York, NY.

Prendergast, M. L., Podus, D. (2000). Drug Treatment Effectiveness: An Examination of Conceptual and Policy Issues. Drug Abuse Research Center, Neuropsychiatric Institute, University of California, Los Angeles, CA.

Rogers, C. R. (1977). Carl Rogers on Personal Power: Inner Strength and its Revolutionary Impact. Delacorte Press: New York, NY.

Wilkerson, D., Migas, N., Slaven, T. (2000). Outcome-Oriented Standards and Performance Indicators for Substance Dependency Rehabilitation Programs. Commission on Accreditation of Rehabilitation Facilities (CARF), Tucson, AZ.