My MH agency offers a dual diagnosis group, but most of my clients won’t go. How can I help them with their co-occurring substance use if they won’t attend group? Isn’t group treatment the treatment of choice for people with a substance use disorder (SUD)?

Groups can be a helpful intervention for those who are inclined to attend, but many SMI clients, particularly those that are having difficulty engaging in any treatment at all, are not interested in attending groups. These clients can receive help for their co-occurring SUD just the same and can make considerable progress. Applying basic integrated intervention strategies such as welcoming engagement, building hope, reinforcing strength and success, stage-matched interventions for the SUD, connecting SUD choices to hopeful goals, and skill-building to make change are all interventions that can help slowly over time, within whatever individualized services they do choose to receive. Further, group attendance is more likely if the group is “stage-matched” as well (see Implementation Guide: Stage-matched Interventions for Individuals with Serious Mental Illness (SMI) and Co-occurring Substance Use). If a client does not want to stop using substances, attending an active treatment group is a poor match. A client who is using substances and wants to continue may be engaged in a “decision-making group” for people in the contemplation stage of change entitled: “Finding the right amount of drug use.”

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