Rock Bottom Built

Main point: The goal of group therapy is to get people talking, thinking, and feeling for healing. But boredom from long talks and too much routine takes away from the experience, so it’s good to spice things up with some variety.

The activity: Have clients draw a question from a hat or bag and spend 60-seconds answering it before jumping to the next guy.

My rant: I love group because it’s such an evolution. There’s so much going on, from group dynamics to personal growth and processing to developing listening skills…several varieties of heavy lifting as a brotherhood. Sure, we are all crammed down each other’s throats in a rehab facility, but group therapy is a moment in time when we bond through sharing the darkest parts of ourselves. Things that maybe have never seen the light of day. And you know what they say, shame dies in the sunlight.

A big challenge of any class? Keeping it fresh. It’s easy to repeat the script of addiction, or swap the war stories, relish the glory days, or just berate each other for being helplessly diseased persons. It’s been done a million times but here’s the thing: a room full of men feeling helpless doesn’t help anyone. There is so much power in a group setting for us to better understand ourselves and why we walk this path of self-destruction. 

So…keeping it fresh. It’s a big one, right? If the class structure feels too routine and you know what to expect, you go into a situation “pre-bored.” So it is good to offer new and unexpected ways of telling our stories. 

So I snagged the addiction discussion questions worksheet off the fantastic resource Therapist Aid which offers “free evidence-based education and therapy tools.” These are some open-ended thought-provoking questions that invite addiction sufferers to start creating space between themselves and their addiction.

I cut up the questions and folded them up and stuck them in a hat. I passed it around and each client drew a question. We then went around taking 60-seconds to answer it. They’d return the paper to the hat and we’d repeat it, offering a lot of individual discussion and different perspectives. It was neat because the second pass around, the guys already knew the questions so their replies were deeper and more fluid. 

Here are some example questions:

How has your relationship with drugs changed from the time that you first used to now? Have you noticed any behavior patterns that occur only when you’re intoxicated? —This is good because it gets the client looking at the lifetime of their substance misuse. So much of addictive behavior is one day at a time Groundhog Day sort of existence, being hyper-focused on the immediate need to stay high. Second, it has the client pausing from identifying with his addiction. He’s now himself looking at the insane behaviors that occur while under the influence.

How did your functioning change at work or school after you started using? Even if you’re able to keep up with your responsibilities while you use, how do you think sobriety would change things? —This question makes it hard to deny that one’s addiction is the real problem. It also uses motivational interviewing by having a client imagine the ways his life will improve once he’s off the sauce. If he can think it, he can live it.

The rituals and activities that surround drug use can be difficult to give up. For example, a smoker might enjoy the ritual of having a cigarette–not just the nicotine. Similarly, a drinker might have more trouble saying goodbye to their drinking buddies than to alcohol itself. What are some rituals or activities that you associate with drug use, and how do you feel about giving them up? Do you think you could achieve sobriety without changing your lifestyle? —I like this one because it asks the client to question his automatic behaviors, his triggers, and the role his environment plays in fueling his substance use. It also makes his addiction feel less special. Beers after the game, cigarettes with coffee, cocaine at the club; it’s like hey man look, everybody does crap like this, let’s start discovering what activities make you uniquely happy.

Many people use drugs as a crutch to help them handle difficult emotions such as anger, depression, and anxiety. These emotions are challenging for everyone, and it can be hard to resist the temptation of an easy escape. What choices does a person have, other than drug use, when they are confronted with these painful emotions? What emotions might lead you to using drugs or alcohol? —This one says “hey, you’re not alone in trying to feel better in a harmful way, so let’s brainstorm some healthy coping mechanisms.” It also has the client looking at emotional triggers for substance use, which is how dependency usually forms.

How do you believe counseling, support groups, or other treatments could help a person who struggles with addiction? —This is to figure out if the client is wasting time in treatment. It also primes the client for success because if he believes treatment will work, he’s probably right.