**VI. Social Support Group**

# Introduction

## Goals of Social Support Group

-   Provide a safe discussion group where clients practice
    resocialization skills.

-   Provide opportunities for clients who are advanced in treatment and
    recovery to serve as role models for clients who have been in
    recovery for less time.

-   Encourage clients to broaden their support system of abstinent,
    recovering contacts with whom they can attend 12-Step or mutual-help
    meetings.

-   Provide a less structured and more independent group environment
    that helps clients progress from treatment in the more structured
    environments of Early Recovery Skills and Relapse Prevention groups
    to recovery maintained with group support but without clinical
    support.

#### 

#### Session Format and Counseling Approach

The Social Support component of the Matrix Intensive Outpatient
Treatment for People With Stimulant Use Disorders (IOP) model comprises
36 group sessions that are held once a week over 36 weeks. Social
Support group sessions overlap with the final 4 weeks of the intensive
phase of Matrix IOP method and allow clients to continue group work for
nearly 9 months after the conclusion of major treatment components
(Early Recovery Skills, Relapse Prevention, and Family Education).
Clients who have attained a stable recovery and have completed 12 weeks
or more of Early Recovery Skills and Relapse Prevention group sessions
should begin attending Social Support group sessions. Social Support
groups are primarily discussion sessions. They are 90 minutes long and
should be limited to 10 people per group so that each client has time to
participate.

Clients who have been co-leaders during Early Recovery Skills or Relapse
Prevention group meetings can act as facilitators, under the counselor's
supervision. Client--facilitators should be screened carefully for
emotional stability, intellectual competence, and strength of recovery.
They should commit to attending regularly for 6 months and should meet
with the counselor before the group session to be briefed on the topic
and issues relevant to individual clients.

The client--facilitator's job is to help the discussion run smoothly so
that clients can get the most benefit from the Social Support group. The
counselor should provide the client--facilitator the following
guidelines for aiding the discussion:

-   Listen to clients, help them clarify what they are saying, but do
    not speak for them or provide answers.

-   Encourage group members to accept and support one another.

-   Focus on the members; do not assume a position of authority or
    monopolize the discussion.

-   Permit clients to depart briefly from the session's topic if the
    discussion seems beneficial to all clients in the group.

-   Steer participants away from lengthy stories of using that might act
    as triggers for others.

-   Make sure that the group is not dominated by one or two members and
    that everyone in the group gets time to speak.

-   Avoid making generalizations.

-   Avoid asking "why" questions of members (e.g., questioning their
    actions or motivations).

The counselor opens the group session by welcoming clients and
introducing the topic for the session. The counselor then facilitates a
discussion that can include the session topic, abstinence issues, and
problems the clients are experiencing in establishing a substance-free
lifestyle. The following section lists the one-word session topics,
along with questions, that the counselor and client--facilitator use to
encourage discussion. If clinical issues arise that require the
counselor's attention before the end of the session (e.g., a client has
relapsed recently or is going through a personal crisis that places
recovery in jeopardy), the client--facilitator should notify the
counselor privately. If the group is broken into smaller discussion
groups, the counselor should reconvene the larger group 5 or 10 minutes
before the end of the session to recapitulate important issues relevant
to the session's topic and to address any problems or concerns that
arose during discussion.

**Social Support Group Topics**

The 36 topics below address key concepts in recovery and are suggested
focal points for discussion in the Social Support groups. Each topic
includes questions that the counselor and client--facilitator can pose
to initiate and sustain group discussion. Relevant session descriptions
and handouts from the Early Recovery Skills and Relapse Prevention
portions of treatment are listed after the questions for some topics.
During the course of discussion, the counselor may wish to refer to
information included in the session descriptions or the handouts.

The counselor may choose to use topics that are not listed here, as the
needs of the clients in the groups dictate. The topics are presented
alphabetically and can be used in any order the counselor deems most
useful to the group.

***Aging***

1.  How do you view the aging process? What negative aspects do you see?
    What positive developments come with age?

2.  How does getting older affect your staying abstinent and in
    recovery?

3.  Is this your first time in recovery? If not, have you approached
    recovery differently this time?

4.  As you grow older, is it important for you to find a 12-Step meeting
    or mutual-help group that has people your own age?

5.  As you spend more time in recovery, how will you keep your recovery
    strong?

***Anger***

1\. How do you feel about the way you handle your anger?

2\. How do you feel when anger is directed at you?

3.  Is anger a relapse trigger for you? In what ways?

4.  What strategies or behaviors help you cope with anger?

5.  How do you avoid being passive--aggressive when someone angers you?

> Relapse Prevention Session 23: Managing Anger
>
> Handout RP 23---Managing Anger

***Codependence***

1\. How do you understand the concept of codependence?

2\. With whom do you have codependent relationships?

3.  How do these relationships affect your recovery?

4.  During recovery, what changes have you made to address codependent
    relationships?

5.  What strategies and techniques will you use to avoid codependence in
    the future?

***Commitment***

1\. What does commitment mean to your recovery?

2\. What people or things have you been committed to in the past? What
are you committed to now?

3.  How important is the commitment of family and friends to your
    recovery?

4.  How important is your commitment to friends and fellow clients who
    are in recovery?

5.  How will you maintain your commitment to recovery?

***Compulsions***

1\. What have you done to avoid transferring your substance dependence
to other compulsive behaviors?

2\. To what compulsive behaviors are you vulnerable?

3.  Are all compulsive behaviors bad?

4.  How has being in recovery helped you get your life under control?

5.  What can you do to avoid abstinence violation syndrome?

> Relapse Prevention Session 28: Compulsive Behaviors

Handout RP 28---Compulsive Behaviors

***Control***

1\. How do you distinguish between things that you can control and
things you cannot?

2\. How do you respond to things you cannot control?

3.  How has attending 12-Step or mutual-help meetings helped you address
    these issues?

4.  What actions do you take to achieve balance and inner calm in your
    life?

5.  What aspects of your life do you still need to change to remain
    abstinent and in recovery?

> Relapse Prevention Session 27: Serenity Prayer

Handout RP 27---Serenity Prayer

***Cravings***

1.  Do you still experience cravings for substances? How have the
    cravings changed since you've been in recovery?

2.  Do you feel as if your recovery is in jeopardy because of cravings?
    Why or why not?

3.  When are you aware of cravings?

4.  What changes have you made to reduce cravings?

5.  What strategies and techniques will you use to keep cravings under
    control?

> Early Recovery Skills Session 1: Stop the Cycle

Handout ERS 1A---Triggers

Handout ERS 1B---Trigger--Thought--Craving--Use

Handout ERS 1C---Thought-Stopping Techniques

***Depression***

1\. Is depression a trigger for you? How do you recognize that you're
depressed?

2\. How have your feelings of depression changed as you've been in
treatment and recovery?

3.  What people, events, and feelings contribute to your depression?

4.  How do you respond when you recognize that you are depressed?

5.  What strategies and techniques help you avoid becoming depressed?
    What strategies and techniques help you get over depression?

Relapse Prevention Session 29: Coping With Feelings and Depression

Handout ERS 5---Roadmap for Recovery

Handout RP 29---Coping With Feelings and Depression

***Emotions***

1\. Do certain emotions act as triggers for you? Which emotions?

2\. How has the process of recovery helped you become more aware of your
emotions?

3.  How do you cope with dangerous emotions, such as loneliness, anger,
    and feelings of deprivation?

4.  During recovery, what have you learned about separating emotions
    from behavior?

5.  What strategies and techniques help you maintain an emotional
    balance?

Relapse Prevention Session 18: Emotional Triggers

Relapse Prevention Session 29: Coping With Feelings and Depression

Handout RP 18---Emotional Triggers

Handout RP 29---Coping With Feelings and Depression

***Fear***

1\. When you entered treatment, what aspects of recovery were you afraid
of?

2\. Have your fears about recovery changed since you've been in
treatment?

3.  What helped you move past your fear?

4.  What things concern you when you think about leaving treatment?

5.  As you move forward with your recovery, what strategies and
    techniques will help you minimize your fears?

***Friendship***

1\. How has your understanding of friendship changed since you've been
in treatment?

2\. Before you entered treatment, what were your friendships based on?

3.  Now, what qualities do you look for in a friend?

4.  What has being a friend to others contributed to your recovery?

5.  What plans do you have for making new, supportive friends and
    maintaining current friendships?

Relapse Prevention Session 25: Making New Friends

Relapse Prevention Session 26: Repairing Relationships

Handout RP 25---Making New Friends

Handout RP 26---Repairing Relationships

***Fun***

1\. How have your fun and relaxing activities changed since you've been
in treatment?

2\. What do you do now to have fun and relax?

3.  With whom do you have fun?

4.  What role does having fun play in staying abstinent and in your
    recovery?

5.  How will you incorporate new activities and hobbies into your life?

Relapse Prevention Session 31: Looking Forward; Managing Downtime

Elective Session C: Recreational Activities

Handout RP 31---Looking Forward; Managing Downtime

Handout RP Elective C---Recreational Activities

***Grief***

1.  What experience have you had with grief?

2.  Is grief a trigger for you? In what ways?

3.  How has the way you cope with grief changed since you've been in
    recovery? How do you cope with feelings of grief now?

4.  To whom do you turn when you experience grief?

5.  What strategies or techniques do you use to keep grief from
    disrupting your recovery?

***Guilt***

1.  How is guilt different from shame?

2.  Can guilt be a positive factor in your recovery? In what ways?

3.  How can guilt derail your recovery?

4.  What can you do to reduce the guilt you feel?

5.  What role has taking responsibility for past actions played in your
    recovery?

> Relapse Prevention Session 5: Guilt and Shame
>
> Handout RP 5---Guilt and Shame

***Happiness***

1\. Since you've been in treatment, when have you been happy? What made
you happy?

2\. Since you've been in treatment, how has what makes you happy
changed?

3.  Do you feel that happiness is essential to your recovery? Why or why
    not?

4.  How have friendships helped you be happy?

5.  What strategies or techniques can you use to help you through
    unhappy times?

***Honesty***

1.  How important is honesty to your staying abstinent and in recovery?

2.  In treatment, how have you learned to be honest with yourself?

3.  In treatment, how have you learned to be honest with others,
    especially family and friends?

4.  How does honesty relate to your self-esteem?

5.  What strategies or techniques will you use to continue being honest
    in your recovery?

> Relapse Prevention Session 8: Truthfulness

Handout RP 8---Truthfulness

***Intimacy***

1\. Since you've been in treatment, how has your understanding of
intimacy changed?

2.  What concerns or fears do you have about intimacy?

3.  Does sex function as a trigger for you? In what ways?

4.  What do you look for in an intimate, caring relationship?

5.  In what ways can intimate relationships support your recovery?

> Relapse Prevention Session 10: Sex and Recovery

Handout RP 10---Sex and Recovery

***Isolation***

1\. Are free time and being alone triggers for you? In what ways?

2\. How was feeling isolated related to your substance abuse?

3.  In what ways has scheduling activities helped you avoid isolation?

4.  How has attending 12-Step or mutual-help meetings helped you avoid
    isolation?

5.  What activities can you pursue on your own that will help keep you
    from isolation?

Relapse Prevention Session 2: Boredom

> Relapse Prevention Session 6: Staying Busy

Handout RP 2---Boredom

Handout RP 6---Staying Busy

***Justifications***

1.  What relapse justifications are you vulnerable to?

2.  What emotions make you more likely to try to justify a relapse?

3.  What are the dangers of assuming that your substance dependence is
    under control?

4.  How is being smart important to your staying abstinent and in
    recovery?

5.  In treatment, what strategies or techniques have you learned to help
    counter relapse justifications?

> Relapse Prevention Session 16: Relapse Justification I
>
> Relapse Prevention Session 21: Relapse Justification II

Handout RP 16---Relapse Justification I

Handout RP 21---Relapse Justification II

***Masks***

1\. How do you use masks to hide the way you feel, presenting yourself
as feeling one way when you really feel another?

2.  In what circumstances do you mask your feelings?

3.  How has the masking of your feelings changed since you've been in
    treatment?

4.  How does masking your true feelings affect your recovery?

5.  How is being honest with yourself and others important to your
    recovery?

Relapse Prevention Session 8: Truthfulness

Handout RP 8---Truthfulness

***Overwhelmed***

1.  What contributes to your feeling overwhelmed?

2.  How does feeling overwhelmed affect your behavior?

3.  How has your response to being overwhelmed changed since you've been
    in treatment?

4.  What risk does feeling overwhelmed pose to your recovery?

5.  What can you do to ensure that you do not feel overwhelmed?

> Relapse Prevention Session 20: Recognizing Stress
>
> Relapse Prevention Session 22: Reducing Stress

Handout RP 20---Recognizing Stress

Handout RP 22---Reducing Stress

***Patience***

1.  How has patience helped you in your recovery?

2.  When is it hard for you to be patient?

3.  Are there situations in which you can be *too* patient? What are
    they? Why can it be bad to be too patient?

4.  How has attending 12-Step or mutual-help meetings helped you be more
    patient?

5.  What strategies and techniques have you learned to help you be more
    patient?

***Physical***

1\. How is your recovery related to your self-esteem?

2.  During recovery, how has your body changed?

3.  What new exercise or activity have you begun since entering
    treatment?

4.  How have you begun to take better care of your health?

5.  Why is it important to stay healthy to keep your recovery on track?

Relapse Prevention Session 19: Illness

Relapse Prevention Session 17: Taking Care of Yourself

Handout RP 19---Illness

Handout RP 17---Taking Care of Yourself

***Recovery***

1\. Has your motivation for recovery changed since you've been in
treatment? In what ways?

2\. What has been your biggest challenge in recovery so far? Your
biggest triumph?

3.  From whom do you draw inspiration and encouragement in your
    recovery? Do you have a recovering role model?

4.  How has attending 12-Step or mutual-help meetings helped you in your
    recovery?

5.  As you move forward with recovery, what are the most important
    aspects for you to focus on?

Relapse Prevention Session 7: Motivation for Recovery

Handout RP 7---Motivation for Recovery

***Rejection***

1\. Did feeling rejected contribute to your substance abuse? In what
ways?

2\. How have the ways you cope with rejection changed since you've been
in treatment?

3.  How has support from friends and family helped you cope with
    rejection?

4.  As you make amends and repair relationships, some people may refuse
    to forgive you. How will you cope with this rejection?

5.  What strategies and techniques will you use to address rejection as
    you go forward with your recovery?

Relapse Prevention Session 26: Repairing Relationships

Handout RP 26---Repairing Relationships

***Relaxation***

1\. How have the things you do to relax changed since you've been in
treatment?

2\. Are leisure and downtime triggers for you?

3.  How have you managed to separate relaxing from substance abuse?

4.  Do you prefer to relax alone or with friends and family? Why?

5.  How have you used scheduling and islands of enjoyment to help you
    relax and keep your recovery on track?

Relapse Prevention Session 31: Looking Forward; Managing Downtime

Elective Session C: Recreational Activities

Handout RP 31---Looking Forward; Managing Downtime

Handout RP Elective C---Recreational Activities

***Rules***

1\. How do you respond to rules in general? How have you responded to
the rules you've encountered in treatment?

2\. What rules do you impose on yourself?

3.  How do you balance the structure that rules provide with the need to
    relax and enjoy yourself?

4.  How have the guidelines of 12-Step or mutual-help programs supported
    your abstinence and recovery?

5.  What rules will be important for you as you move forward with your
    recovery?

***Scheduling***

1\. In what ways have you used scheduling during your recovery? How has
it helped support your recovery?

2\. Do you use scheduling all the time or only once in a while? At what
times do you find it is helpful to use scheduling?

3.  What makes scheduling difficult for you?

4.  How have friends and family supported your use of scheduling?

5.  Do you think you will continue to use scheduling after you leave
    treatment? Why or why not?

Early Recovery Skills Session 1: Stop the Cycle

Handout SCH 1---The Importance of Scheduling

***Selfishness***

1.  In what ways did selfishness contribute to your substance
    dependence?

2.  Are there times when it is a good idea to be selfish? What are they?

3.  How can selfishness be harmful to your recovery?

4.  How have family and friends helped you become less selfish? How have
    12-Step or mutual-help programs helped you become less selfish?

5.  Do you think it is selfish to take time alone for exercising,
    relaxing, meditating, or writing in a diary? Why or why not?

***Sex***

1\. Is sex a trigger for you? In what ways?

2\. What distinguishes impulsive sex from intimate sex?

3.  How can impulsive sex lead to relapse?

4.  How can an intimate relationship help support your recovery?

5.  What will you do to encourage healthy, intimate relationships in
    your life?

Relapse Prevention Session 10: Sex and Recovery

Handout RP 10---Sex and Recovery

***Smart***

1\. Why is sheer willpower not enough to help you stay abstinent and in
recovery?

2\. How is being smart part of having a strong recovery?

3.  How has anticipating situations in which you would be prone to
    relapse helped you stay abstinent and in recovery?

4.  When have you tried to be strong, instead of smart? What were the
    results?

5.  What strategies and techniques will you use to be smart as you go
    forward with your recovery?

Relapse Prevention Session 13: Be Smart, Not Strong

Handout RP 13---Be Smart, Not Strong

# *Spirituality*

1.  How would you define spirituality? Has that definition changed as a
    result of being in treatment?

2.  Why is it important for your recovery to have a spiritual component?

3.  How has attending 12-Step or mutual-help group meetings helped you
    stay abstinent and in recovery?

4.  What qualities are important to you in choosing a 12-Step or
    mutual-help group to attend?

5.  Aside from attending meetings, what other spiritual elements have
    you incorporated into your life during recovery? Will you continue
    these practices?

Relapse Prevention Session 27: Serenity Prayer

Relapse Prevention Session 30: 12-Step and Mutual-Help Programs

Handout RP 27---Serenity Prayer

Handout RP 30---12-Step Programs

***Thought Stopping***

1\. How has thought stopping helped you cope with cravings to use? Give
some specific examples.

2\. Which thought-stopping techniques are most effective for you? Why?

3.  What do you visualize when you use thought-stopping techniques?

4.  Do you feel that you are more in control of your thoughts now than
    you were when you entered treatment? Why or why not?

5.  What role will thought stopping play in your recovery after you
    leave treatment?

Early Recovery Skills Session 1: Stop the Cycle

Handout ERS 1C---Thought-Stopping Techniques

***Triggers***

1.  What triggers do you still encounter in your daily life?

2.  Are there triggers you cannot avoid? How do you cope with those
    triggers?

3.  How has charting your external and internal triggers helped
    strengthen your recovery?

4.  How have family and friends helped you cope with triggers?

5.  What strategies and techniques have helped you stop triggers you
    encounter from becoming cravings for substances?

Early Recovery Skills Session 2: Identifying External Triggers

Early Recovery Skills Session 3: Identifying Internal Triggers

Handout ERS 1A---Triggers

Handout ERS 2B---External Trigger Chart

Handout ERS 3B---Internal Trigger Chart

***Trust***

1.  How has lack of trust damaged relationships in your life?

2.  Why is it important for your recovery that your friends, family, and
    others be able to trust you?

3.  In addition to staying abstinent, what can you do to earn back
    people's trust?

4.  If people are slow to trust that you are abstinent and in recovery,
    how will you respond? What will you do if trust never returns to
    some relationships?

5.  How has placing your trust in fellow treatment group members and
    12-Step or mutual-help group members helped your recovery?

Relapse Prevention Session 12: Trust

Handout RP 12---Trust

***Work***

1\. How has your work life affected your recovery? Have there been
positive effects? Negative effects?

2\. What steps have you taken to balance work with recovery? Have they
been successful?

3.  How has the balance of work and recovery changed since you've
    progressed in recovery?

4.  Have you considered leaving your job? What are the potential
    pitfalls of doing this? What are the benefits?

5.  Aside from the money, what do you find rewarding about your work?

Relapse Prevention Session 4: Work and Recovery

Handout RP 4---Work and Recovery