Van Horn, D. H.A., & Bux, D.A. (2001). A pilot test of motivational interviewing groups for dually diagnosed inpatients. Journal of Substance Abuse Treatment, 20, 191-195.

MI Group 3: Drugs on Trial

Written Exercise: Before beginning, pass out sheets entitled “Tipping the Balance,” along with pencils or pens. Have participants write down or think of three things they dislike about drugs/alcohol, and three things they like about them.

Rationale: “By the time people end up in a hospital for drug or alcohol use, most realize that substances are causing problems in their lives, or maybe even ruining their lives. At the same time, though, drugs and alcohol are really hard to give up. We find that one reason people have so much trouble giving up drugs and alcohol is that they remember things they used to like about using, so they aren’t so sure sometimes whether drugs and alcohol are really all that bad.”

Exercise

Introduction: “Today we’re going to put drugs and alcohol on trial. That means we’re going to decide what exactly are the charges, and then look at the evidence for the prosecution as well as for the defense. This should give us a clearer picture of how there are two sides to the story and how it sometimes seems harder to remember the crimes drugs and alcohol have committed. We will play the prosecuting and defense attorneys. This trial will be a little different than most; you all will be the jury, but will also be called as witnesses. Also, the jury can ask questions of the witnesses.”

Structure: This activity works best with two facilitators, one playing the role of the prosecutor and the other, the defense attorney. If only one is available s/he may play both roles. Patients play the role of witnesses, but are part of the “jury” when not on the witness stand.

Sequence: First, solicit from patients the “charges” that drugs and alcohol face; write these on the board. Patients are then called to the witness stand in the front of the room one at a time and questioned about their responses to the written exercise. Defense attorney goes first by soliciting the things the patient liked about drugs, and then the prosecutor asks about the negatives, as well as “cross-examining” the “witness” on the positives (i.e. challenging whether these positives are truly derived from drugs/alcohol in the long term). The “jury” is then given the opportunity to ask additional questions. When several witnesses have testified, the jury votes on a verdict. Next, offer patients the chance to make “victim impact statements,” in which they directly address the “defendant.” Finally, the jury is asked to deliver a “sentence” (usually “death” or “life without parole”).

Debriefing: Ask the group what they will do now that drugs are locked up or sentenced to death. Encourage them to consider alternative ways of obtaining the positive aspects of drug use. For example, a patient who says she enjoys the excitement of the “chase” and the fast pace of drug life might be encouraged to think of other ways to seek excitement (rock climbing, roller coasters, physical exercise). Also ask the “witnesses” about the experience of testifying, especially how they felt discussing the positive aspects of use.