Groups are 90 minutes, 5-12 participants, co-led by one social worker and the provider who also prescribes the buprenorphine for the group members, usually in individual sessions before or after the group.
The group starts with 2-5 minutes of a simple mindfulness meditation breathing exercise. Because of this it is important that all members arrive on time. This is followed by a 3-15 minute psycho educational Youtube clip on recovery-related skill building topics. Other groups show the video clip while inevitable stragglers arrive, followed by the quiet mindfulness session. Video topics include:
- Relapse prevention skills
- The importance of and how to quit smoking
- Urge surfing
- Animated clips of great books such as Viktor Frankl: “Man’s Search for Meaning, (Youtube channel: Fight mediocrity)
- “How mindfulness meditation redefines pain, happiness and satisfaction”Tedx Talk by Dr. Kasim Al-Mashat,
- “The Struggle Switch” Acceptance and Commitment Therapy by Dr. Russ Harris etc. Sample list of videos are available
Check in: Following the mindfulness session and short video clip, each group member “checks in” by sharing important elements of their past week. Individuals are asked directly: “How is your recovery going?” and share if they have had any relapses, cravings or difficulties. Individual check-ins vary from being thoughtful and profound to perfunctory. Group members often share feedback with us about check-in: “This is the only time during the week when anyone cares about how I have been doing.” We are aware of an individual’s greater goals and the group serves as a source of accountability, support and critical feedback. “Wait a minute Simon, you are thinking of going back to Maureen after you spent six months getting out of that relationship because she continued to use? Do you think that is a good idea?”
We openly discuss that Suboxone is a tool to stabilize and that true recovery revolves around creating positive and supportive relationships. Relationships, stability in housing, employment and having worthwhile life goals are stressed as the primary work of recovery.
We define our recovery groups as a supportive environment of peers and providers who share the very human journey of recovery. We strongly believe in the healing power of relationships and structure our program with that in mind. We include them in program development and actively seek their input in establishing program protocols. For example, we might ask them the following: “We need you all this evening to be our consultants. Please give us your feedback. Several of you who are farther along in recovery have shared that most individuals do not need more than 8 mg of Suboxone a day to feel fine. What are your thoughts?” or “Dental pain is a huge issue for some regarding pain medication, what are your thoughts? These open and honest exchanges have resulted in recovery program members feeling valued and respected and our policies being shaped by our program members needs and feedback. What seems an apt metaphor for our approach is that they are driving the “car” of their recovery; we staff are the backseat drivers, and the car happens to be ours.
Goal setting: To support the notion of being in the action stage of change, each group member defines a goal they will achieve before the next group. These goals can be as simple and pragmatic as: “getting the oil changed in my car” to “apologizing to my grandmother who I stole from while I was using.” The social worker records the weekly goals. Interesting patterns develop regarding what is revealed about a person’s life by the weekly goals they set.
During subsequent check in an individual reports back if they completed their weekly goal. Goal setting also allows the group to be involved in celebrating/affirming successes. We can also humorously chide or encourage the individual who has had the same goal (“I will go to the career center to get an updated resume) for several weeks to hopefully go forward.