Effective iSBNT practitioners

Discuss with the network as a whole, including the FP, that lapses and relapses can be avoided and planned for. That is different to saying that such events are normal in addictive behaviours, as this may be interpreted that they are inevitable, the implication being that one is powerless in the face of a chronically relapsing condition. If a lapse or relapse does occur, it is best seen as a learning opportunity, rather than a symptom of personal or network failure or pathology.

Coping with high risk situations

General principles

The practitioner’s aim is to get to the heart of what it is that makes a specific situation a high-risk one. The detail that comes from the use of very focused questions – the ‘what, when, where and with whom’ aspects, can be valuable to the FP and NMs in helping them to see that such situations do not just happen, but can be explained in terms of the relationship between thinking and acting. The learning that comes from understanding the link between thoughts, feelings and behaviour can present some concrete ideas and options for coping with such situations without recourse to drinking or drug use. The network brings the collective minds of the FP, NMs and the practitioner together in deciding what will be most helpful and when.

• Rank all high-risk situations identified in order of risk. Riskiness is assessed by asking the FP to rate how confident they feel in terms of coping with each one right now.

• Agree with the FP and NMs the plan and tactics for coping with each high-risk situation.

• Where there are skills deficits, the network can suggest coping responses and role-play or otherwise explore them until everyone has confidence to apply them.

• Agree the role of each member of the network in helping the FP to cope. Once coping strategies are agreed they can be recorded and rated for confidence to strengthen self-efficacy.

An example of an exercise to develop a coping skill

Coping with high risk situations - drink/drug refusal skills

Being able to refuse drink or drugs is an important skill regardless of whether the agreed substance use goal is abstinence or moderation. This is a case where avoidance is a good strategy – simply stay away from people who might want the FP to drink or take drugs. If avoidance is not an option:

• Discuss the difficulty of using refusal skills – how is it for the FP?

• Practise adopting the right body language

• Practise an example of refusal

Elicit a risky situation and ask the FP to play the person offering alcohol or drugs. This will help for two reasons 1) the network will get an idea of how the other person offers the alcohol or drugs so you can play it realistically later and 2) the FP can see members of the network successfully modelling the skill steps. Role-play and discuss then change roles. Break down the skill into manageable steps for the FP (including body language) ensure that all participants get a sense of success at each step.

Feedback and repeat as necessary, adding additional skill and pressure until it feels realistic and the FP feels they have some mastery of the skill. Remember to reinforce positive approximations, and provide coaching to strengthen the skills. Plan to do this in real life situations with one or more network members present.

Repeat this approach for other high risk situations.