By Kenia Valentin, CSW, Program Director of Children and Families Together        

Twelve Step based groups are a common treatment method used in substance abuse programs.  These relapse prevention groups provide a setting for clients to help each other with similar issues through sharing their stories, identifying with peers, confronting each other and usually creating a form of extended family.  As an extension of agency treatment, clients participating in a recovery based program are usually encouraged to attend Narcotics Anonymous or the other meetings that stem from the original Alcoholics Anonymous model.  Participation in the NA network helps clients to receive support in their daily experiences with addiction.  NA meetings serve as a community that educates the individual on the importance of building healthy relationships, limiting isolation, and finding strength where they otherwise experienced stigma and shame.   

In running a substance abuse program for women, I think it is very important to continue the tradition of using twelve step based groups and actively referring clients to NA, AA, and the other recovery meetings, but it is also important to address the other issues that I regularly see clients presenting with, and to use the group setting to address some issues that are more common to women. To that end, I offer parenting classes; anger management, bereavement, relationship (co-dependency), HIV awareness and self esteem groups. These focal groups are structured, goal-oriented groups where assignments and homework is given to promote growth and education.  The groups address a single problem area, and provide a more intimate setting to discuss difficult experiences.  They also promote greater group identification, cohesion and reduce client distress about disclosing information.  Other groups are offered to promote healthy living and stress reduction; examples are cooking, yoga/meditation, creative expression (arts/crafts), and dance class.  These groups also provide clients with opportunities for socializing with peers in a drug free setting.  In addition to groups, vocational counseling, child care, metro-cards and meals are provided on-site.  Clients are also actively encouraged to participate in individual therapy and case management services.  Recently we have added a men’s group on-site to offer services to men who are the primary caretakers for their children.    

Prior to my running this program, it was run by a former colleague of mine who is also a clinical social worker.  Our common social work background has strongly affected the vision and day to day operations of the program.  We acknowledge that group participation is often a powerful trigger for emotions and memories that are better addressed with the additional support individual therapy.  We often discuss psychotropic medication and educate clients on its effectiveness with reducing symptoms of anxiety, depression and insomnia.  My program is part of a larger agency that offers substance abuse treatment, mental health and medical services in the South Bronx community.  Clinical social workers make up about 90% of the mental health counseling staff and about 5% of the substance abuse counseling staff and probably less then 3% of MSW students do internships.  The group format in a substance abuse program is full of wonderful opportunities for clinical work. One problem with not having clinicians running groups is that serious disorders or trauma can go undetected or not addressed. I hesitate to include sexual abuse victims or domestic violence groups in the curriculum and opt to continue referring clients to individual therapy or programs that specialize in these areas as I am afraid my current over-utilized clinical staff will be over burdened or ill equipped to deal with all the issues that may arise from including these groups in our curriculum.  

Working in this program allows me to work creatively.  I continue to run groups and see clients who are having a difficult time adjusting to program life, individually on a short-term basis.  Every year in August clients who attended groups and remained drug-free for nine months or more participate in a graduation ceremony and also perform musical and dance numbers; for many clients this is the first time they receive a diploma.  I hope that this article encourages more social workers to explore the field of substance abuse professionally.