Step 6: Home Group
After completing 10 weeks of the Skill Building phase, a program member is assigned to her/his ongoing, weekly 90 minute home group. Prior to this transition a member will be given our "Rules of Being in Group." Hopefully this group will become an important source of support, feedback and instruction while creating a sober, value-based, stable life. Most program members remain in the same group during their entire time in the program. We have noted that when groups are cancelled because of weather, holidays, or provider vacation time, members report an uptick in relapses.
Step 6 can continue for a long time if a group member is doing well, not using illicit drugs, not using marijuana, and developing a value-based life. Tapering is occurring at a rate the individual feels ready for. Several individuals have been in the program for over four years, and as long as one is making steady progress in one’s life goals, we do not insist on tapering but rather see it as one of many priorities to a better life. It can, alternatively, be a simple, straightforward goal that anyone can feel proud of achieving.
Some caveats from the provider’s point of view during this time of stabilization:
- Due to chaos and social turmoil, people often overlook deadlines, forget appointments, cancel their cell phone service — but they almost never miss their buprenorphine refill appointments. This can be useful. For example, getting refills after group meetings or other obligations assures attendance. If a patient repeatedly arrives tardy to group, providing refills before group meetings can help. If patients keep asking for early refills, shortening the interval of refills and seeing people more frequently will help.
- See the work as essentially collaborative. See the patient as driving the car of his/her recovery, the provider and therapist as “backseat drivers,” or perhaps the “good” trusting parents they never had, giving advice.
- Don’t forget that you own the car, that you are the parent, and that you control the Suboxone; negotiate reasonable expectations and hold patients accountable to what is visible and measurable.
- Your best tool is your relationship with the patient, and it matters. It has been said that if “relapse” is a drifting away, then “recovery” is reconnecting. They will shine with your praise and wither with your criticism. Use both carefully.
- People who abuse drugs are generally more clever than the provider and more knowledgeable about drugs; the provider needs to accept that he or she will be fooled some of the time. If a patient says he or she “needs” a higher dose, inquire nonjudgmentally about the need. Usually the reason involves anxiety, pain, insomnia, or some other issue that the patient can learn to address in non-drug ways.
- Emphasize the positive. Most lack self esteem and are full of shame and regret. Compliment any small progress.
Watch for and address signs of impending relapse such as early refills, missed group meetings, or continuing social chaos.