Strengthening Social Support for People with Co-occurring Disorders
By Jeanie Whitecraft
A strong network of social support is an essential component to every individual's capacity to remain healthy in a stressful world. Friends, family and coworkers who know us as unique individuals provide guidance, supportive feedback, and comfort regarding both the day to day issues of life and the long term challenges and goals.
Behavioral health problems and issues can have a profound negative impact on this vital resource. Within the field of substance abuse treatment, helping people to establish sober social support and learn to engage in leisure activities, absent the influence of alcohol and drugs, are considered key elements to a successful recovery.
Similarly, social support is acknowledged by mental health specialists as essential for the full integration of people with mental illness into the community. Although therapists and clinicians play critical roles in a persons recovery, by definition they cannot be considered sources of social support. Those who help others manage their recovery form mental illness including problems with substance abuse may see much of their patient's progress undermined because of a lack of resources in this critical area.
The role of peer social support in interdisciplinary services serves to fill this gap. Peer social support helps individuals to identify and mobilize psychological resources to better cope with emotional burdens; it helps individuals navigate their way through complex social and leisure activities; and, it provides role modeling of the tools, skills, and behaviors that will improve their handling of social situations. This role of providing peer social support is effectively filled by the Friends Connection.
The Friends Connection was founded in 1989, and utilized peer counselors as the mainstay of the program. Peer counselors, or Friends Connectors are carefully recruited, trained, and intensively supervised. The program is designed to work in tandem with interdisciplinary intensive case management models. Participants engage in a wise variety of social activities and gatherings sponsored by the agency or by the community, and they also learn to attend and participate in 12 step programs that are geared towards helping those with co-occurring disorders establish a sober support network.
No two consumer at the Friends Connection are the same in terms of level psychological functioning, type and severity of substance abuse history, access to personal and community resources, and their own personal desire to initiate and maintain abstinence from alcohol and other mood-altering substances. To meet the demands of working successfully with such a diverse population, the Friends Connection has developed a model that embodies the concept of "treatment without walls".
To participate, clients do not have to come to a group or adhere to a rigid schedule. The program emphasizes that helping the client to achieve and maintain abstinence is an essential part of the over arching goal of helping the client have a desire to participate in the program, and refrain from drug and or alcohol consumption before and during planned activities. As the consumers level of involvement with the program increases through a series of carefully defined progressions, he or she gradually becomes invested in a social support system the supports recovery and substance abuse through the 12 Step model.
Entering into a program of recovery from addiction then becomes a clearly defined and peer supported objective for the consumer, who is helped along the path by peer counselors. Peer counselors receive intensive initial and ongoing training and supervision. All time that is spent with a consumer is carefully planned in advance, and documented using approved record-keeping procedures.
The Friends Connection philosophy incorporates the multi-disciplinary team approach to Intensive Case Management (ICM), and defines itself as a component of ICM. The Friends Connections taps the resources of individuals who have successfully coped with mental health issue and substance abuse. It provides opportunities for the consumer to interact in a relaxed, social setting and in the more structured venue of 12 Step meetings. But the peer counselors are not just healthy role models; they are paid staff who offer reliability, consistency, and accessibility to a client population where establishing trust can be a long and arduous process.
Peer counselors help clients with co-occurring disorders engage in "real life" social events where they interact with others and develop social skills, overcome isolation, and develop much-needed social support. Counselor availability is geared towards the clients needs, rather than the agency's limitations. Peer counselors are even available to meet with consumers at "Double Trouble" meetings - 12 Step groups that are geared to helping those with concomitant mental illness and substance abuse problems.
The results of a pilot study of this program conducted by Amelia Rocco Klein, Ph.D. (John F. Kennedy Community Mental Health and Retardation Agency) were published this year in Research on Social Work Practice ("Significance of Peer Social Support With Dually Diagnosed Clients"). The study indicated that the program has a significant, positive effect on the client's subjective experience of their quality of life. A group of clients who received the services of intensive case management and the help of Friends Connection peer counselors for six months (treatment groups) were compared with a group of clients who received intensive case management only (comparison group) for six months.
Members of the comparison group spent an average of 25 days in institutional care during this period of time. No one in the treatment group required such care. Members of the treatment group reported improvements in their perceptions of their living environments, their financial situation, and perceived that their physical and emotional well being had improved over the course of the six month study period. The study reports that intensive case managers whose clients participate in the Friends Connection declared the "symptomatology was noticeably improved".
The Friends Connection, a service of the Mental Health Association of Southeastern Pennsylvania, was recently awarded a Community Action Grant by the Substance Abuse and Health Services Administration (SAMHSA) through its Center for Mental Health Services (CMHS). The four-year grant will support a full evaluation of the program by the University of Pennsylvania Center for Mental Health Services as one of eight exemplary programs being studied at different sites throughout the country.
Published in the Mental Illness and Substance Abuse Newsletter, December 1998