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.
Key elements of iSBNT
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 below 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.
Using treatment manuals
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 here to particular cases.
The iSBNT manual was adapted by Drs Gillian Tober and Duncan Raistrick
The result4addiction website is designed to complement the iSBNT manual and so practitioners should be familiar with both the manual and the website. Make use of the self-assessments of different aspects of addiction problems and the recovery tasks which are all designed to support the treatment journey. Make sure your service user has easy access to result4addiction (read the mobiles and posters page) so that they can take advantage of the website.
Always remember the therapist’s mantra…
✔︎ Where are you now?
✔︎ Where do you want to be?
✔︎ Who is going to help you to get there?
✔︎ What will everyone be doing that is going to be helpful
✔︎ How shall we know whether this worked?
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 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.
It is a good idea to give take-home-tasks between treatment sessions. You might want to use the Networking Task as a way of preparing for the work demonstrated in the videos, and to consolidate after discussing what it is all about with your service user.
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.
Gillian Tober demonstrates goal setting in the page about motivational dialogue.
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
Good outcomes checklist…
✔︎ Were you able to identify and recruit suitable network members?
✔︎ Did you manage to set realistic substance use goals agreed with the network?
✔︎ Did you identify specific risky behaviours to change and develop alternative coping skills?
✔︎ Did you achieve a sustainable change in substance use?
✔︎ Did you lay the foundations for sustainable lifestyle change?
