Effective iSBNT practitioners

Building a support network

You can deliver the building a network session in person or use it as take-home task. Network members are referred to as NMs and the person with an addiction problem as the focal person FP.

This guidance is for practitioners and supplements the guided recovery pages that service users follow. Make sure that you are familiar with the guidance to the four core iSBNT tasks for service users…

‘guided recovery’- the four core iSBNT tasks….

Role of the practitioner

The practitioner is a member of the network and an active participant. This role involves assistance and support for NMs as well as the FP, though NMs with their own problems should be advised to seek help for these elsewhere.

With the FP: identify who to involve for direct support and who for indirect support. Help to distinguish different types of support, for example direct support for finding and doing non drinking/drug use activities, and indirect support such as looking after the children while the FP goes to the cinema.

With the NMS and FP:

Negotiate tasks and add these to a network map.
Gather information on relationships between NMs and the FP, including their views/attitudes about the drinking problem, the support offered at present or in the past, the frequency of contact, activities they do or have done together. What each is willing and able to do now.

The practitioner can record the plan and agree the way forward with the FP and NMs. Working with NMs in the absence of the FP should be agreed as a possibility at the outset. Research has shown that this approach can help to re-engage the FP in the process. It is advisable to review the network periodically and consider recruiting new members to it.

Key practitioner skills

Introduce the idea of a network at the first contact when a supportive person may be present. Practitioners need to have...

① An ability to explore possible network members: understand who is suitable and who is not

② An ability to respond to a service user saying there is nobody who cares for them

③ An ability to deal, in a positive way, with an unsuitable person outside of the network

④ A willingness to approach possible network members with or for the service user

⑤ An ability to overcome likely resistance from possible network members

How to create a network map

You will want to do this with your FP and NMs. Describe the rationale of the network-based treatment including the benefits of developing a supportive network compared to working alone. Describe the nature of the people suitable to be members of the network: that they are not problem drinkers or drug takers, that they are concerned about the FP and support their goal, that they are available to give support.

Draw the network, build up an understanding of who is already in the FP’s social network, and identify who may be supportive to the FP. Do not be afraid to say that the FP’s nearest and dearest might not be suitable for this network.

Here are examples of dialogue you might use when drawing your map...

“Who is there who you care about and who cares about you?”

“Who would be willing to do things with you which would help you to avoid drinking?” “Who would you like to spend more time with when you are not drinking/taking drugs?”

“How do you think you might describe to your friend what it is that we are doing?” “What sorts of things do you think they might want to know?”

Agree a plan to recruit potential NMs, namely who will approach them, when and how. If the FP lacks the communication skills necessary to make this achievable, role play the dialogue that needs to take place. You can keep updating the map - and use it as a check that the network is functioning well.

Issues that might arise

1. Communication in the network

Good communication in the network stems from the ability of the FP and NMs to tell each other how they feel and what is helpful, without fear of criticism and rejection. Network members may need to practise listening to each other and responding in turn, not interrupting, not blaming, and respecting each other’s point of view.

The iSBNT practitioner should be aware that the FP and NMs could have damaging communication patterns. Such patterns may contribute to the re-occurrence, maintenance or escalation of the substance misuse problem. Look out for unhelpful communication styles. For instance:

  • Blaming “It’s your fault that I…”

  • Defensiveness “What do you expect me to say…”

  • Being judgemental “That’s what you always do…”

  • Making assumptions “I know what you are thinking…”

Try out alternative ways of communicating - agree and rehearse the best ideas.

Michael says that when Maria tells him “I can’t cope with you going back to drinking” Michael assumes that she is threatening to end their relationship. Michael responds by saying “do what you have to do then” whereupon he leaves the house, feeling angry, hurt, let down and at high risk of drinking or taking drugs.

Explore current communication and responses between members of the network and plan new, constructive styles where necessary. To do this:

  • Ask the FP and NMs to describe actual situations

  • Ask the FP and NMs to describe the impact of poor communication styles, and the way they affect their relationships and behaviours

  • Make plans for new strategies, record the plans and their outcomes

  • Review and amend as necessary

Here are some communication challenges to discuss:

Asking for help

  • dealing with drinking or drug use situations

  • with practical matters

  • dealing with craving

  • recruiting additional NMs

Managing criticism

  • exploring feelings that result from criticism

  • building self esteem

  • turning it into a positive, helpful experience

Listening and conversation skills

  • talking in turn

  • acknowledging feelings

  • talking about things other than drinking

2. NM coping responses

These are the ways that network members respond to actual drinking and drug use, or the risk of these. Some of these responses, or styles of responding are associated with better outcomes than others. ‘Tolerant’ (putting up with) and ‘withdrawal’ (distancing from) styles of coping are frequently used by network members, and are understandable responses but may in some cases exacerbate the problem. ‘Engaged’ coping refers to the principle of rejecting the drinking and drug use behaviour and not the person and is understood to be the most effective coping style from the point of view of helping the FP. It can be described to and rehearsed by network members.

Examples of positive coping:

  • Avoiding the FP only when drinking or taking drugs

  • Preventing children seeing their parent when drinking or taking drugs

  • Pouring away the drink, if there is no risk of it resulting in aggression

  • Taking away funds for drink or drugs

  • Buying food

  • Discussing with the FP which responses are helpful, and which unhelpful

Examples of unhelpful coping:

  • Avoiding or leaving the FP unless there are safeguarding concerns

  • Preventing the children from seeing the FP

  • Buying or providing alcohol or drugs

  • Giving money for drink or drugs

  • Making excuses and covering up

3. Problem NMs

Where the concerned others present are angry, frustrated, or do not share an appropriate treatment goal, their presence in the network will be unhelpful. The network approach is not an opportunity to sort out NMs’ problems and they may need to be steered elsewhere for this purpose.

Example dialogue...

“ Now may not be the right time for you to give support to your brother; perhaps if you are still feeling angry with him, it might help you to speak to someone, a friend or a professional person, and we can come back to this at a later date.”

4. FP resistant to networking

Some people see their drinking or drug use as their own problem and believe they should be self-reliant when dealing with it. However, the most common reason for this kind of resistance is that the FP is reluctant to change their drinking or drug use.

While the practitioner respects the FP’s reluctance to involve others they may...

  • Elicit from the FP their thoughts on what their concerned others would say in response

  • Assess the motivational state with reference to changing drinking or drug use, and find an area of the FP’s life that they do want to change

  • Where the FP says she/he does not want to involve anyone else, think about a virtual network where the FP is getting positive support without those people knowing that the support is to avoid drinking or drug use.

5. Alienated potential NMs or absence of NMs

The FP may have alienated potentially supportive NMs or may lack the skills to communicate with them.

Possible action...

Consider those with whom relationships have become strained or distant, to explore whether they might be suitable NMs in the future. Discuss ways of contacting potential NMs that are acceptable to the FP, for instance by message or email rather than more direct phone call or face-to-face encounter. If there are no identifiable NMs it may be necessary to look at recruiting alternative support from outside the FP’s network, for example support groups or other professionals.

6. Ensuring support for the FP and NMs

The point of network treatment is that everyone is supported – the FP, the NMs and the practitioner and no one person carries all the responsibility. It is shared in the network. If there are indications that the FP or NMs are not feeling supported then this needs to be explored.

Example dialogue...

To the NM “What sort of support do you think would be useful? Have you got a friend or family member who can support you? Have you tried Al-Anon (or other mutual support group for family members)?”

To the FP “What do you think you could do to make things easier for your mother, in understanding what is going on, what would be helpful?” “Is there something you could do in return?”

Possible action…

AA/NA, Al-Anon and carers’ groups can offer high levels of easily accessible support, as can other befriending agencies/day-centres/community support services. It is important to convey optimism about the possibilities of developing positive social support, even if the current network is limited. It is good to give out lists of support agencies.

7. Unhelpful influences

Where some or all of the FP’s social contact is still with other problem drinkers or drug takers, they are exposed to attitudes and behaviours that are unhelpful to, or at odds with, attempts to make positive changes. The challenge for the practitioner is to make and elicit suggestions about how to minimise these contacts and their effects whilst ensuring the FP does not feel even more socially isolated and unsupported. If this is not handled carefully, the FP could withdraw their consent to continue, believing that it is doing more harm than good.

Example dialogue...

“What is going to help in avoiding person x in the future?”

“What sorts of things can we think of putting in place to build a network that will help communicate to them that you are not going to be drinking/taking drugs in the future?”

"Can we try out some things that you might say to them?”

“Let’s have a look at what sort of support groups for abstinence are available and let’s get some information on activities that are planned for service users who are abstinent”

“What sorts of things can we think of that would bring you into contact with new (non-drinking/non drug-taking) people?”

“What would you feel comfortable trying out?”

“Who could we ask to go to this with you?”

Possible action…

At this point think about the available community resources for employment, training, alternative pleasurable activities. The practitioner might suggest recruiting a housing support worker, a health care assistant or other available support worker to accompany the FP to get them engaged in identifying new sources of social support and alternative activities. All AA and NA groups hold open meetings to which a NM could accompany the FP.

practitioner guides to iSBNT…