An Introduction to the Use of Support Groups
Across Canada, community agencies and institutional services serving older clientele often see the negative effects of alcohol on the older adults’ lives. They are searching for effective ways to help even, if they have very few resources. Appropriate support groups for seniors can be one of those approaches.
It is generally recognized that older adults with substance abuse problems are often experiencing depression, loneliness, and social isolation. It is suggested that assistance to them should focus more frequently on helping to rebuild their social networks and self esteem. (Schonfeld & Dupree, 1997).
Generally speaking, support groups are one way of achieving those goals. The benefit of support groups has been well recognized in the gerontological literature on self help and mutual help in dealing with many issues that are more common as people age (e.g., bereavement or specific health conditions such as cancer, Parkinsons, etc.). The addictions literature underscores that senior-specific support groups (or at least groups where people have common interests) tend to fare better. Support groups can focus on reducing the amount drinking or can be abstinence based.
The general purpose of support groups when seniors are experiencing alcohol problems is as a way to break isolation; rebuild social skills; provide education; and as a way for seniors to support each other.
While support group members can be diverse, there are two different types of individuals who attend the groups. Some groups have members who may require socialization skills and opportunities (in other words, being together in a group setting is not an easy experience for them, and they need encouragement and support in that process). Other groups have members who enjoy taking part in challenging discussions on a wide range of social, health care, safety and addictions issues.
An Example of One Program's Support Groups
The Seniors Well Aware Program ("SWAP") is an outreach program for seniors with substance abuse problems located in Vancouver, British Columbia. It has been successfully utilizing different types of support groups for 10 years in three communities --Vancouver, Burnaby and New Westminster. The groups run by SWAP are varied according to the needs of the clients. Some are gender specific, some are mixed (women and men).
A. Why and Who
SWAP utilizes support groups in conjunction with outreach counselling. In some cases, a support group is available for those waiting for counselling, and it is often used as part of relapse prevention.
B. Types of Support Groups Being Developed
In the beginning, support groups are facilitated by the counsellor. However, SWAP has found that natural leaders will develop from the group and these individuals are encouraged to co-facilitate.
The exact type of group will depend on the clients’ needs. It can be a mixed sex or same sex group. Support groups can be located in a community setting including seniors' housing or an institutional setting ("nursing homes").
C. Elements of SWAP’s Support Groups
They are age-specific (“senior only”). However, "senior" for these purposes includes people aged 55 and over. In most cases, reflecting the general profile of people coming to SWAP, the average age is mid 70s.
The groups tend to be lifestyle support groups. The membership includes seniors who have alcohol or prescription drug misuse or abuse problems, or both. In other words, it is not "just an alcohol group."
The groups are non-confrontational. The purpose is to encourage change and reduce the harms that may be occurring in the person's life. It is not to embarrass, punish, or humiliate in order to achieve change.
Each group has one or more facilitators. The only rules are that the members can’t come to group when intoxicated (they are politely asked to come back on another occasion), and they will respect of confidentiality of the members in the groups.
D. Basic Features
Each of the SWAP support groups meets once a week, for one hour. There is no cost to clients. The location is important (a friendly, neutral place; close to where they live, or in case of seniors’ housing- right in the housing complex). Each group must be accessible by public transit (bus or Handi-Dart for more disabled clients).
E. SWAP Philosophical Approach to Support Groups
The support groups clearly use a harm reduction approach, in the sense that abstinence is usually not required (however, some counsellors do have A.A. groups). It is a non-medicalized approach. Absolutely no paternalistic behaviour toward client would ever be considered for those in the support group (e.g. no random breath tests, unannounced home visits) This is quite different from what has been written about in some American literature, (see for example, Atkinson, Turner,& Tolson, 1993).
F. Evaluation of the SWAP Support Groups
In 2000, SWAP conducted a review with 39 of their support group members (20 women and 19 men) representing six groups. Most had been attending regularly for a year. SWAP used was open ended questions to encourage participants’ views (in other words, the survey not driven by pre-established categories of responses).
SWAP needed to use several different methods to reach people for the survey because of their health, availability, or visual impairment. The survey was distributed in the group session. Seniors could work on it in small groups, or take home. Physically disabled members answered orally, with facilitators filling in the form for them. Others answered over the phone.
G. Profile of the Support Group Members
The age range was 55-85+, and most were over 65. Approximately one in three attended other groups as well (other SWAP groups, AA meetings, New Roots Adult Day Care).
H. What Seniors Attending Personally Found Valuable about the Support Groups
The commonly cited feature that seniors found positive about the groups was that the support group gave them an opportunity for socialization (80%). About one in three (34%) pointed out that they were looking for and felt they received mutual support from the group. Almost one half (46%) enjoyed meeting people on a regular basis and they saw the support group as an important reason to get out regularly. People also identified the importance of the connections made in the group.
Five of the group attendees (12.5%) stressed that the groups helped them achieve their personal goals. Some also noted that coming to group gave them a reason to be sober.
Socialization was an extremely important function of the group. The support groups offered friendship and camaraderie. The group gave people an opportunity to know other people. People tended to value both the humour and the friendliness within the group.
The support group was important to many of the seniors because it gave them a place to talk to others who understood what they are experiencing. They stressed the importance of having a safe place to talk without feeling ashamed, as well as the non-judgmental attitude within the group. One in three stressed enjoying the support of people who were understanding, and maintained confidentiality.
3. Achieving Goals
About one in eight specifically identified that attending the support group helped them stay on track. They stated, for example, it was a reason to get out of the house, and a reason to remain sober. Others (only 7.5%) specifically stressed enjoying the education, the topics presented at the groups.
I. What They Suggested Could be Improved
Clients were asked what type of improvements they would like to see in SWAP's support groups. People’s “wish list” varied. It included having more new members; modifying the focus, education; transportation; smoking, comfort of the room, furniture, time and structure; and reducing the negative comments by other people.
1. Increase the Size
People often felt that their group was too small (averaging only 6-8 members and sometimes only 3-4 people), and could benefit from new blood. (Having more people will increase the socialization opportunities to some extent and broaden the discussions). However, a few preferred the small group size.
2. Sharpen the Focus
In the survey, 14% of the seniors commented that groups were insufficiently focused. The counsellors felt that there might be two possible causes:
a) co-facilitator taking the group in a new direction, or
b) the staff “trying to get people back on topic” (diverting the group from what they really wanted to talk about).
This raises important questions from a self- help/ mutual-help perspective about control, and how structured or free wheeling groups need to be. Who determines that (the seniors participating in the groups or the professionals)?
3. What Else They Would Change
Smokers in the group stated that they would like the opportunity to smoke (they usually have to step out to smoke, or wait until the end of the meeting). This is important in light of the prevalence tobacco dependence among older drinkers (50-70% in some addiction studies).
People also suggested it would be helpful to increase the physical comfort of the environment. Sometimes available rooms are too small, the chairs too hard, or the room needs better acoustics. This can b a difficult trade off in setting up groups, as locations used by SWAP are provided to them free of charge.
4. Assure More Reliable Transportation
The local Handi-Dart system currently does not meet the needs of older adults attending functions such as support groups as well as it could. Often the seniors are dropped off long before the meeting starts, and the meeting is often interrupted by the transportation services to pick the members. If the person does not leave then, he or she may have to wait hours before being picked up.
Staff had spent considerable time and effort assuring that seniors could get to the groups (public transit, or being driven or in some cases, driving them). The importance of transportation became even more evident in 2001 during a transit strike. At this time, the support groups shrank considerably. Lack of easily accessible transportation not only affected people’s access to the support groups, but it also impeded their ability to get to many medical appointments, and left the seniors feeling extremely isolated.
J. Some Observations on What Works Well in Substance Abuse Support Groups for Older Adults
Based on the seniors' observations and the counsellors' experience, it is helpful to:
“It is exhilarating to see their passion- their desire to give back to the group and the program…” (Facilitator comment)
A useful general resource on self help groups can be found at: www.selfhelp.on.ca/start.html with helpful information on establishing self help groups, especially the section on organizing groups. Parts of the suggestions offered there may be too formal or conversely too non-professional, for some people's liking. However, as the site authors note " If you decide to start a group or make changes in an established one, do it your way. Just choose the ideas that suit you and your circumstances. "
Schonfeld, L. & Dupree, L.W. (1997) Treatment alternatives for older alcohol abusers. In: A.M. Gurnack, Ed., Older Adults' Misuse of Alcohol, Medicines, and Other Drugs: Research and Practice Issues, New York, NY: Springer (pp. 113-131)
Atkinson, R.M.; Tolson, R.L. & Turner, J.A. (1993) Factors affecting outpatient treatment compliance of older male problem drinkers. Journal of Studies on Alcohol, 54(1):102-106.
Page last updated March 10, 2002.
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