Structured stories: reinforcing social skills in rural substance abuse treatment.

Rural communities have drug and alcohol problems (Edwards, 1992). Treatment approaches grounded in urban approaches cannot be used in rural areas without changes. However, there is little information about the changes required to make therapies designed for urban populations useful for rural substance abusers (Leukefeld, Godlaski, Hays, & Clark, 1999), and only a few projects have focused specifically on rural drug and alcohol treatment (Robertson, Sloboda, Boyd, Beatty, & Kozel, 1997). With support from the National Institute on Drug Abuse, a therapy for rural drug and alcohol users was developed that incorporates clinical approaches used with substance abusers: social skills training (Monti, Abrams, Kadden, & Cooney, 1989), motivational interviewing (Miller & Rollnick, 1991), case management (Rapp, 1992), and thought mapping (Leukefeld, Godlaski, Clark, Brown, & Hays, 2000). The therapy was developed and piloted over three years by rural therapists and university faculty. The purpose of this article is to describe how structured stories can be used as part of a therapy for rural substance abusers and to discuss how this approach can compliment social skills training. After discussing social skills training and describing the use of stories, we present an example of a structured story focused on negative thinking. The article concludes with a discussion of the possibilities of using structured stories and implications for social work. SOCIAL SKILLS TRAINING Social skills training sessions begin after each client is engaged, an assessment or evaluation is completed, and an individualized behavioral contract, as part of individual sessions, is developed. Social skills training is an approach to drug and alcohol treatment based on cognitive--behavioral theory. Behavioral therapy focuses on how people learn specific behaviors over time. For example, children learn how to respond to social situations by watching their caregivers and then imitating. This is not a planned process, but something that occurs naturally as a child grows. As a child "experiments" with these behaviors, a second process occurs: The child's behavior is reinforced, causing an increase in the frequency of that behavior: or the behavior is not reinforced, causing a decrease in or disappearance of the behavior. Reinforcement can occur on many levels. The combination of watching, learning, imitating, and receiving a response from the environment is quite powerful and leads to new personal habits an d automatic responses to situations. Cognitive--behavioral theory stresses integrating new skills into personal cognitive frameworks. Social skills group sessions usually incorporate the following structure: * Group members are introduced. The group begins with a review of previous session and, as appropriate, discussion of the last session's review exercise. * The therapist presents the session's background and discusses the sessions messages by listing key points on a flipchart and distributing handouts. * The therapist lists and briefly discusses the skills to be introduced and practiced in the session. * A group exercise is used to practice the skill. Different exercises are used in each session. * Each group ends with a discussion of a practice exercise for the next session. STORIES Stories are part of culture (Schank, 1990) and are more than entertainment. Very early stories facilitated individual and group survival by improving memory and recall, allowing efficient communication, and retaining information from generation to generation. Stories incorporate effective actions to project from the past into the future (Rush, 1996). Just as language is related to cognitive structure (Chomsky, 1968), stories are related to the structure of language. Language is a symbolic representation of experience, and stories are a representation of the relationships within experiences. …