What works?

integrated social behaviour and network therapy - iSBNT

There is strong evidence supporting the active ingredients of iSBNT, which is is a structured treatment that can be applied to most kinds of addiction problem. Combining a motivational style of working with iSBNT is possibly the best psychosocial intervention for addiction problems - the active ingredients are much the same as for 12-step programmes. Digest the What is treatment? page before moving on to iSBNT. Practitioners use their professional knowledge and skills to create a bespoke package of treatment.

Using treatment manuals…

It is usual for evidence based interventions to be accompanied by a treatment manual of some kind. The key to using a manual is flexibility. The manual provides a framework and anchor points around which the therapist can creatively deliver an intervention. A manual cannot anticipate all of the situations that will be encountered; the skill of practitioners is to apply the principles and practices outlined to their particular service users.

The iSBNT Manual is designed to work with the result4addiction website - there are links to website pages. Make use of the self-assessments of different aspects of addiction problems and the recovery tasks which are all available to support the treatment journey.

The Integrated Social Behaviour and Network Therapy manual - iSBNT

The iSBNT manual was adapted by Drs Gillian Tober and Duncan Raistrick

For a quick overview of iSBNT take a look at the summaries of the core topics outlined below. Here there are also demonstration videos that are not included in the manual.

This is how to use social behaviour and network therapy…

There are four core topics to iSBNT i) Building a support network ii) Goal setting iii) Coping strategies and iv) Lifestyle change. Not all of these might be relevant but practitioners need to make sure that all four have been adequately dealt with. The iSBNT manual provides detail of how to tackle each of the four core topics. Practitioners are free to add additional topics as they see necessary: for example interpersonal communication, reviewing medication or handling financial problems.

Core topic: building a social network

Involvement of family and friends is at the heart of Integrated Social Behaviour and Network Therapy (iSBNT). More interventions than you might think use these principles: Twelve Step programmes, SMART groups, residential rehabilitation for example.
It is very much in the agency’s and the therapist’s interests to have family and friends supporting treatment. Where they are excluded there is scope for negative attitudes to develop and undermine the treatment effort or in extreme cases invoke complaints.

Choosing the right people to be in a support network is key to its working well. Stability, concern and commitment as well as respect for each other are the building blocks of a strong network. Stability in the lives of network members means an absence of drug, alcohol or mental health problems and underlies the ability to make a commitment.

Being concerned about each other in a mutually respectful way is another cornerstone to making a firm commitment. Working on helpful communication styles and enjoyable activities as well as daily routines make up the bulk of the conversations.

Key practitioner skills

It is best to introduce the idea of network therapy at the first contact when a supportive person may also 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 define, in a positive way, the role of 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 resistances from possible network members

In these video clips Gillian Tober demonstrates how to build the network - notice her consistent use of motivational dialogue. The first video demonstrates the essentials of getting started with iSBNT; the second is a discussion about the key points; and the third is a demonstration of engaging a potential network member…

The essentials of building a social support network

Discussion of key network building points

How to engage with a new network member

It is important for service users themselves to generate the material for discussion. One option is to give the ‘My Support Network’ recovery task as a take-home. Another option, which can be quite bonding and reveal a lot about friends and family, is to draw and keep a network map which might look something like this one and use it as a reference point in future discussions. Here is a list of people you might think to include:

Family, including those who have not been seen for a long time or who live far away
Friends, including neighbours, lost contacts and godparents
Workmates or colleagues
People who have helped in the past
People who share activities or interests
People who share religious worship or belief
Casual acquaintances seen during day-to-day activities
Social or health care workers who have been helpful

There are no rules about how to draw the map: some practitioners like to add more information such as how people get on together, in what ways they could help, and those people who may be a challenge rather than a support can be noted in red.

More detail in the iSBNT manual pp11-21

Core topic: goal setting

Setting a drinking or drug use goal is an important next step after bringing together a support network. Some people will have decided that they want to change, and indeed may already have done so, before help seeking. In this case it will be fairly easy to agree a goal, however, the majority of help seekers are likely to be ambivalent about making changes.

A good strategy is to help the service user understand their readiness to change. A useful tool to help with this is the decision matrix. Notice in the example that the list of ‘dislikes now’ outweighs the ‘dislikes after stopping’ while the reverse is the case for ‘what do you get out of drinking or drug taking’. Another option is to give the ‘My Substance Use’ recovery task as a take-home. In both cases you can take the results to explore further a person’s readiness to change and on the basis of this to set some goals.

More detail in the iSBNT manual pp22-29

Core topic: coping skills

Coping skills are central to developing a behaviour change plan and a relapse prevention plan. Some people spot what they need to do in the process of thinking about changes to their substance use. For example, very commonly people realise that hanging out with their old drinking or drug using friends is going to be a challenge to stopping drinking or drug taking as well as being a recipe for relapse - of course the prospect of not seeing these friends may also be the source of ambivalence.

As with goal setting it is important for service users themselves to generate the material for discussion. The risky situations worksheet is a good way to do this. Notice in the example that the first step is to identify a high risk situation and that it scores high on the likelihood of leading on to drinking or taking drugs. The next step is to brain storm possible alternative responses to the situation - only take up ideas that have a good chance of working and see if the risk is now scored much lower. You might rehearse the plan a few times to build confidence in it being implemented and working. Check again later how well it worked in the real world.

More detail in the iSBNT manual pp30-40

Core topic: lifestyle change

Making lifestyle changes is the key to long term success with whatever substance use goal has been achieved. It usually means giving up something that is currently valued without the expectation of a better life ahead. The therapist’s task is to explore how life will actually be better if there is a change in substance use and to bring their service user to believe that life will be better. Intellectually, service users are often able to see why life should be better but do not really believe that they can make the changes needed. There will need to be benefits in the short term as well as the long term for behaviour change to be implemented.

As before, it is important for service users themselves to generate the material for discussion. The daily activities worksheet is a good way to do this. Another option is to give the ‘My Daily Activities’ or ‘My Nice Things to Do’ recovery tasks as a take-home. The first task is about bringing some structure into a person’s life and the second is about finding something exciting and interesting to replace the substance use.

More detail in the iSBNT manual pp41-45