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. 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. The key to using a manual is flexibility. A manual provides a framework and anchor points around which the practitioner can creatively deliver an intervention. It cannot anticipate all the situations that will be encountered; the skill of practitioners is to apply the principles and practices outlined to the circumstances and motivation of 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 addiction problems and mental health problems which can be opened from the home page. The guided treatment, also opened from the home page, mirrors the iSBNT manual and can be used for take home tasks.
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). Many approaches use these principles: Twelve Step programmes, SMART groups, residential rehabilitation, for example.
It is very much in the practitioner’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.
Choosing the right people to be in the network is key. Stability, concern, commitment and 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.
Being concerned about each other in a mutually respectful way is another cornerstone to making a network commitment. Working on helpful communication styles and enjoyable activities as well as daily routines make up the bulk of the conversations.
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
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. It can be bonding and reveal a lot about friends and family, to draw and keep a network map which might look like this one, to be used 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 and lost contacts
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 easy to agree a goal. Many help seekers, though, 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’. You can use 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
Identifying risky situations and the requisite coping skills is 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 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 see how it scores on the likelihood of leading to drinking or taking drugs. The next step is to brainstorm 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 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 once the substance use goal has been achieved. The practitioner’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 in this. 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. 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?