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CREATING SOBRIETY:
FORGING THE ROAD TO
RECOVERY
C
A Curriculum by Hailey Kivler
Purpose Statement
• To develop an art therapy-based
curriculum for youth with substance use
disorder in an effective residential
group setting that addresses both the
substance use and mental health
concerns.
Problem to
be
Investigated
Ineffectiveness of Current
Substance Use Disorder
Treatment for Youth
Justification
Substance Use & SUD is a
prevalent problem among
youth
•Study found that by 12th grade, two-thirds of students had tried alcohol while two out of ten students
admitted to using prescription medication illegally (Johnson et al., 2014)
•nearly 1 million youths (ages 12 to 17) needed treatment for SUD in 2018, although only 83,000 of them
received services in a treatment center (SAMHSA, 2019).
Barriers to Treatment
•Barriers include racial bias, economic cost of care, and the stigma associated with SUD (Alegria et al.,
2010; Earnshaw, 2020; Farhoudian et al., 2022).
Current treatment methods
found ineffective
•“programs for adolescents using a pure abstinence-based approach (the “just say no” approach)
are ineffective in reducing substance use and abuse” (Marlatt & Witkiewitz, 2002, p. 2)
Untreated SUD in youth can
lead to a cycle of
incarceration
•“contribute to an elevated risk of recidivism, which leads to further, and oftentimes more serious,
involvement with the juvenile justice system” (Fisher et al, 2018, p. 3).
Overall lack of research of arttherapy based treatment for
youth SUD
Terms
Adlerian “Individual” Psychology
• An approach to psychology that emphasizes a “holistic and phenomenological understanding to human
behavior”, stressing the importance of viewing all aspects of an individual including lifestyle and social context
(Carlson & Johnson, 2016). Human behavior is goal-oriented and is often influenced by external factors such as
birth order, the family constellation, personal lifestyles, and social interest.
Art therapy
• “An integrative mental health and human services profession that enriches the lives of individuals, families, and
communities through active art-making, creative process, applied psychological theory, and human experience
within a psychotherapeutic relationship.” (AATA, 2022, para.1)
Recovery
• “A process of change through which individuals improve their health and wellness, live a self-directed life, and
strive to reach their full potential” (SAMHSA, 2012, p. 3).
Residential Treatment
• “Are licensed, community-based facilities that provide 24-hour inpatient care for people with mental health
and/or chemical dependency disorders in a residential treatment setting” (WSDOH, 2022, para. 1)
Terms
Substance
•“This is material abused (e.g. Cocaine, alcohol, marijuana), a medicine (sedative, for example)
or toxin” (Psychology Dictionary, 2013, para. 1)
Substance Use Disorder (SUD)
•“Characterized by recurrent use of alcohol or drugs (or both) that results in problems such as
being unable to control use of the substance; failing to meet obligations at work, home, or
school; having poor health; and spending an increased amount of time getting, using, or
recovering from the effects of using the substance.” (Lipari & Van Horn, 2017, para 1).
Overdose
•“Injury to the body (poisoning) that happens when a drug is taken in excessive amounts. An
overdose can be fatal or nonfatal.” (CDC, 2021, para. 24)
LITERATURE REVIEW
C
Adlerian
Major Tenants (Fong et al, 2015)
• Developed by Alfred Adler in the early 1900’s as an alternative to Freud’s Psychoanalytic Theory
• Focus on social, holistic, and goal-directed nature of people
• Looks at people as a whole; indivisible from individual parts
• Differs from Freuds separate Id, Ego, and Superego
5 Major Tasks of Life
• Coping with
• Coping with
• Coping with
• Coping with
• Coping with
problems of social relationships
problems of work
problems of love
the self
existence
***Unsuccessful attempts to navigate lead to psychopathology
Adlerian
Lifestyle
• holistic pattern of beliefs and goals that the person uses for interacting with others and for
measuring self-worth (Fong et al, 2015, p. 210)
• Develops in childhood through experiences; influences present and future
Family Constellation and Birth Order
• Family is first social group and shapes later experiences
• Birth order – first born, middle child, youngest, only child, ect.
• being a first born male or female was a protective factor against SUD while being the youngest
put the youth more at risk of developing SUD (Horner et al, 2012
Social Interest
• “An internal feeling of connectedness to others and their well-being, to the well-being of the
individual” and the desire to need and belong (Fong Chang et al, 2015, p. 207).
• Substance use is driven from a lack of social interest and used as a “means to evade the tasks
of life, including love, friendship, work, and self” (Giordano et al, 2014, p. 116)
Socio-Ecological Model of
Substance Use Disorder
• The model “recognizes the mosaic of interactions
that play a role in addiction, including society and
public policy (laws and regulations); communities;
organizations and personal networks; and our own
individual biological, genetic, and psychological
makeup” (Indiana University, 2022, para. 8).
Note: Adapted from Indiana
University. (2022). Understanding
the Crisis: Addictions.
IndianaUniversity.edu
Note: Adapted from Jalali et al., (2020) The opioid crisis: a contextual,
social-ecological framework
Substance Use
• Mind altering substances have been around since the beginning of time
• the English word Drug was taken from French word Drogue which means Dry Herb and
suggests that earliest drugs were taken and developed from plant sources (Wadud et
al, 2007).
• A substance can be considered “medicine” or a “drug” depending on the
intent of the user and medicinal value
• The use of substances is not considered a substance use disorder unless
the use becomes disruptive or impairing to everyday life
• What is considered disruptive/impairing is unique to everyone
• Moralization of Substance Use & Development of Stigma
• In America: Prohibition Era, Nixon’s War on Drugs
• Creates social barriers to receiving help
SUD: Recurrent use of alcohol or drugs (or both) that results in problems
such as being unable to control use of the substance; failing to meet
obligations at work, home, or school; having poor health; and spending an
increased amount of time getting, using, or recovering from the effects of
using the substance.” (Lipari & Van Horn, 2017, para 1).
Youth SUD
At least 1-in-8 teenagers (12-17) used an illicit substance in the last year
(National Center for Drug Abuse Statistics, 2023)
Most common substances used are alcohol, marijuana, and nicotine
(National Center for Drug Abuse Statistics, 2023)
Monitoring the Future (MTF) study found that vaping (marijuana, nicotine,
and/or flavored liquid) resulted in the largest increase that MTF ever
tracked (Johnson et al, 2014, p.1).
• In 2019, 2.7% of youth had a SUD but no Major
Depressive Episode(MDE); 1.7% of youth had
both a SUD and MDE. (SAMHSA, 2020)
• Total of 4.4% of youth having at least SUD in US
• 39% of youth with SUD had a co-occurring disorder
• Treatment for MDE in youth increased in 2019
(SAMHSA, 2020)
• For youth with co-occurring SUD and MDE:
(SAMHSA, 2020)
• 62.5% received only mental health services
• 2.4% received only SUD services
• 1.3% received both SUD & mental health services
• SUD treatment should always include mental
health care
Youth SUD
and CoOccurring
Disorders
Number of drug overdose deaths and deaths involving illicitly
manufactured fentanyl among persons aged 10–19 years (2019-2021)
Youth SUD
• Overdose: “Injury to the body
(poisoning) that happens when a drug is
taken in excessive amounts. An overdose
can be fatal or nonfatal.” (CDC, 2021,
para. 24)
• Can be accidental or intentional
Notes: IMF = illicitly manufactured fentanyl
Adapted from Center for Disease Control (CDC). (2022). Drug
Overdose Deaths Among Persons Aged 10–19 Years — United States,
July 2019–December 2021.
https://www.cdc.gov/mmwr/volumes/71/wr/mm7150a2.htm
• Lacing is when one drug is added to
another; may be done secretly by
dealers to lessen their costs or make
more addictive (Laguna Treatment
Hospital, 2022)
• Threat of overdose is what makes SUD so
dangerous
• “Recovery from alcohol and
drug problems is a process
of change through which an
individual achieves
abstinence and improved
health, wellness, and quality
of life.” (Finch et al, 2020, p.
2)
• In 2011, SAMHSA broadened this
definition even more by
removing the mention of
abstinence as a criterion for
recovery: “a process of selfdirected change through which
individuals improve their health
and wellness, live self-directed
lives, and strive to reach their full
potential.” (Finch et al, 2020, p.
2)
• For youth with SUD, “developmental, legal, and
familial context fundamentally differs in ways that
render adult based conceptualizations of recovery
insufficient”. (Finch et al, 2020, p. 3)
• Aim of the curriculum to encourage abstinence from
substances until adulthood/legal age by empowering
youth with psychoeducation & autonomy to make
their own choices
• Tracking Success: Focus on symptom & use reduction
rather than pure abstinence
Recovery &
Abstinence
Current Treatment
• Can be outpatient or inpatient; Intensive inpatient care is
usually preferred due to serious nature of SUD
• Residential treatment can lack addressing the issues that
contribute to SUD
• Failing to address Co-Occuring Disorders
• At time of aftercare check in one year after residential
treatment, “47 percent of the youth with mental
health issues used marijuana weekly compared to 39
percent of the other youth, 32 percent used
hallucinogens compared to 18 percent of others, and
17 percent had suicidal thoughts compared to 12
percent of the others” (Foxhall, 2001, para. 6).
• Focusing on only abstinence
• Marlatt & Witkiewitz (2002), “programs for adolescents
using a pure abstinence-based approach (the “just
say no” approach) are ineffective in reducing
substance use and abuse” (p. 2)
Barriers to Treatment
Racial Barriers
Economical Barriers
Stigma
•Minorities in the US are less
likely to receive effective
treatment
•“Black adolescents with SUD
reported receiving less
specialty and informal care,
and Latinos with SUD
reported less informal
services” (Alegria et al, 2010).
•Found to be one of the most
expensive types of care in the
United States, limiting the
availability of treatment
depending on economic
status and insurance
coverages (Farhoudian et al,
2022).
•$25,000 and up for at least 30
days (not counting insurance)
•stigma has been defined as a
social process that exists
when labeling, stereotyping,
separation, status loss, and
discrimination occur within a
power context (Link & Phelan,
2001
•“leads to the development of
substance use disorders
(SUDs), undermines SUD
treatment efforts, and drives
persistent disparities within
these crises (Earnshaw, 2020,
p. 1300)”
Individual
• Youth’s biological predisposition to developing SUD and
personality/temperament factors (Youth.gov, 2022).
• Stress and Trauma
• Pain
Interpersonal
Risk Factors
• Lack of social support, isolation
• Exposure through Family
• “approximately 1 in 8 children in the US were living in a household
with at least one parent with SUD” (Lipari & Van Horn, 2017, para.
15).
Community/Peers
• Peer Pressure in Schools
• Availability of care
• Accessibility to substances
Society
• Public Opinion on Substances/Media
• Laws and norms that are favorable towards substances, such as the
more recent nicotine vaping marketing advertisements towards
teenagers, can impact a youth’s perception about the dangers of
drug use (Youth.gov, 2022).
Youth SUD
& COVID-19
Lockdown increased risk
factors but lowered access
to substances (Lundahl &
Cannoy, 2021)
Opioid overdoses
skyrocketed due to lack of
in-person treatment and
social supports (Richter, 2022)
Vulnerable Youth
• Foster Care
• Group Homes: Foster youth congregate care lacks family-based care; increases risk factors
(Watson, 2016)
• Juvenile Justice System
• Juvenile Justice System fails to address SUD or provide treatment while in juvenile detention (The
National Center on Addiction and Substance Abuse at Columbia University, 2004)
• Low reliance on adolescent self-reporting utilized by most of the research, the failure of justice
and other systems to routinely assess youth for either current drug use or indicia of drug use
(e.g., “resiliency” or “protective” factors), and confidentiality and other restrictions pertaining to
access to juvenile justice system information. (Cooper, 2009, p. 2)
• “Art therapy is an integrative mental health and human
services profession that enriches the lives of individuals,
families, and communities through active art-making,
creative process, applied psychological theory, and human
experience within a psychotherapeutic relationship” (AATA,
2022).
• Art therapy offers a non-judgmental means of expression
that explores the deeper issues behind substance use in an
alternative manner than traditional talk therapy.
• benefits art therapy brings in SUD treatment include
decrease in denial, reducing opposition towards
treatment, providing an outlet for communication and
lessening shame (Aletraris et al, 2014)
• helps to target rigid defenses and denial, fostering insight
and awareness, encouraging emotional expression,
enhances self-esteem and promotes creativity and
problem solving in SUD clients (Hanes & Rojas, 2022).
Art Therapy
and Youth
SUD
Curriculum Structure
• 10 Week Curriculum; 1h 30 mins
• Begins with Introduction, Ends with
Termination
• 8 weeks in-between based upon elements of
the socio-ecological model of substance use
C
disorder
• Individual, Interpersonal,
Community/Peers, and Society
• Intended to be used in a residential setting,
assuming youth are receiving other services
including individual therapy and
psychoeducation on mental health &
substances
• Facilitated by Master’s leveled art therapist
Week 1 (Introduction) Forging Direction:
The Road Drawing
Activity
•Intro: Introductions, Rules
•Check-in: “Tell us your name, where you are from, and one unique fact
about yourself”.
•“For this project, I would like for you to create an image of a road. There are
no right or wrong responses to this prompt. Some things to think about: What
is your road made of? Where does your road lead to? What surrounds the
road?”
Processing Prompts:
•
•
•
•
What was your road made of and where
did it lead to?
Were there any signs that assisted the
road? What about any hazards
surrounding the road?
Where do you believe you are on this
road right now?
How do you feel this could be related to
your personal journey and recovery?
Goals
•Begin to envision what recovery looks like for each participant
•Evaluate where participants are in road to recovery
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint,
Paintbrushes, Construction Paper, Plain Paper, Paint, Textile Fabric
Week 2: (Individual) Looking Back –
Timeline of My Life
Activity
•Check-in: “Think about a high and low of the last week. Take about five
minutes to think and then we will share.”
•“For this activity, I would like you to create a timeline of your life. Think about
moments in your life that have defined you, from birth to this point in time.
There are no right or wrong ways to develop this timeline.”
Goals
Processing Prompts:
•
•
•
•
What are the most impactful events that
happened in your life?
Are there any patterns that you notice?
Have there been events that have made
you stronger? Are there any events that
have made you feel vulnerable?
Try to identify when you first started using
substances. Was this related to any
particular event?
•Examine specific events that have influenced substance use
• Identify protective and risk factors developed through participants
experiences
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint,
Paintbrushes, Construction Paper, Plain Paper, Paint Paper, Air Dry Clay,
Modeling Clay, Clay Tools, Textile Fabric, String, Beads,
Week 3: (Individual) Processing Trauma –
Body Map
Activity
•Check-in: “If you were an animal, what animal would you be and why?”
•“For this activity, we will be creating a body map. Chose a partner to help
trace your body on a life sized sheet of paper. After this, take a moment to
close your eyes and envision how your body feels. Use art materials to map
out the different feelings.”
Goals
Processing Prompts:
•
•
•
•
How did this activity feel?
Were there any parts that surprised you?
Were there any areas that you feel pain?
Has substance use influenced any parts of
your body?
•Show how trauma impacts the physical body
•Examine how drugs impact the body
•Encourage social support
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint,
Paintbrushes, Large Rollable Paper
Week 4: (Interpersonal) Family of Origin –
Genogram
Activity
•Check-in: “Now that we’ve been meeting for a few weeks, I’m wondering what are
your goals from these sessions?”
•“Take a moment to think about your family, whether biologically related to you or
people you consider like family. Including yourself, create a genogram or family tree
including yourself and how these important people are connected to you. Use patterns,
words, lines, shapes to identify specific connections. You can include a legend that
depicts what each symbol means, if you’d like too. Try to include as many people as you
can that have come to impact your life”.
Goals
Processing Prompts:
•
•
•
Who are some of the people that you
included in your genogram?
Are there any patterns or similarities
between the people and yourself? Any
differences?
Are there any relationships you consider
toxic? Any relationships that are healthy
and supportive?
•Explore familial connections
•Create a physical representation of family systems
•Understand impact of family relationships and drug use
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes,
Large Rollable Paper, construction paper, colored tape, stickers
Week 5: (Interpersonal) Birth Order –
Kinetic Family Drawing/Sculpture
Activity
•Check-in: “What is your earliest memory from childhood? Take a few minutes to write or
draw this memory.”
•“For this activity, I would like you to create a drawing or sculpture of you and your family
doing something together. Think of your immediate family and the household you grew
up in. Include yourself, siblings, parental figures or other family members/family friends
that were impactful to you and that you lived with.”
Goals
Processing Prompts:
•
•
•
Who is in the drawing/sculpture and what
are you doing together?
Looking at Adler’s birth order roles, what
do you feel like your role was? Does the
personality description resonate with you
or do you feel like you connect with a
different description?
Who do you have the best relationship
with? Who do you have a strained
relationship with?
•Examine the roles and relationships within immediate family
• Understand how birth order affect’s youth personality and personal experience
• Examine how personality factors and familial role contributes to substance use
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes,
Paper, Construction Paper, Clay, Fabric, Textiles, Beads, Aluminum Foil
Week 6: (Community/Peers) Exploring
Supports – The Tree of Life
Activity
• Check-in: “How do you want to be perceived or thought of by others?”
• “For this activity, we will be creating a Tree of Life representing social connections. The first step is
to envision and draw a tree with roots, a trunk, and a crown. In the roots sections, include
pictures and/or words that represent social connections, any
people/groups/organizations/places that have influenced who you are as you were growing
up. On the trunk, write your name and include anything you feel represents you in the present.
On the crown of the tree, include leaves/branches of social connections that you would like to
keep, ones that you would like to form, and ones that you would like to disconnect or fall off like
dead leaves.”
Goals
Processing Prompts:
•
•
•
•
What connections have defined you to
this point in your life?
How do you feel others view you now in
the present?
What connections would you like to form
or keep? What connections would you
like to severe?
Have you noticed any connections that
are positive, neutral, or negative?
• Explore social connections and supports
• Determine if connections are positive, neutral, or negative
• Explore social impacts of substance use
Materials
• Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes, Paper,
Construction Paper
Week 7: (Community/Peers) Recovery
Groups – Group Mural
Activity
•Check-in: “Think of the people that you were close with before joining this group. How
will they influence your newfound view of recovery? How will they support your
recovery?”
•“For this activity, I want you all to image what your recovery looks like. Work
collaboratively to share this wall space for your creation. You may work together or
independently, but try to be aware of how the space you chose impacts and relates to
what others are creating around you.”
Goals
Processing Prompts:
•
•
•
•
How did this activity feel?
What was it like working with others in
this process?
Were there any conflicts or any
compromises?
How can working with others support
your recovery?
•Provide new perspectives on recovery
• Encourage social connection
•Model healthy relationships
Materials
•Acrylic Paint, Paintbrushes, Wall Space (inside or outside), Sidewalk Space or Large Cloth
(at least 10ft x 8ft)
Week 8: (Society) Self-Concept vs Social
Identity – Dual Self-Portrait Collage
Activity
• Check-in: “What is your role in society? Take a few minutes to write or draw your ideas.”
• “Today we will be creating a dual-self portrait based on our ideas of self-concept and social
identity. Self-concept is the ideas you have about yourself, while social identity is how you feel
you fit into the world around you. To start the portrait, create an outline of yourself being as
detailed or as vague as you prefer. Once finished, draw a line up and down through the center
of the outline. Label one side “How I view myself” and the other side “How others view me”. Take
the rest of the time using art materials and collage materials provided to fill in the space within
your outline.”
Goals
Processing Prompts:
•
•
•
•
• Examine self-concept vs. social Identity
• Compare aspects of self-concept and social identity
• Make connections to protective and risk factors of substance use in both self-concept and
social identity
How are the sides of your portrait similar? How
are they different?
How does substance use influence the sides of
your portrait?
If you could change anything about the portraitMaterials
for the future, what would you change and
• Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes, Paper,
why?
Construction Paper, Magazines, Old Books, Text Cut Outs, Pictures
It can be hard when our idea of self and social
identity do not match or are not similar. How
can your ideas of self and how others view you
change to become more aligned with one
another?
Week 9: (Society) Overcoming the
Stigma of Addiction – Group Mandala
Activity
• Check-in: “Are there any stigma’s that exist for individuals that use substances? Have you ever
felt judged by others? What did this feel like?”
• “Each of you will receive a part of a piece of paper that together form a circle. For this activity, I
want you to think about what your have brought to this group over the course of weeks we’ve
been meeting. What parts did you play? How did you impact others? What was your overall role
in our group? Please draw or paint your response to these questions on the piece of paper. At
the end, we will attach all of the pieces to form a circle or mandala that represents our group.”
Goals
Processing Prompts:
•
•
•
What do you think your role was in this
group?
How have you overcome the negative
stigmas you’ve faced?
How does this group defy the social
stigmas put against us?
• Show how each individual impacts the group
• Display how each individual part put together creates meaning and connection
• Encourages connection and social interest
Materials
• Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes, Paper,
Construction Paper
Week 10: (Termination) Letting Go of
Addiction – Torn Paper Transformation
Activity
• Check-in: “What was your favorite thing we did during these sessions? How do you feel ending
the sessions? What does recovery look like for you?”
• “For this activity, I want you to write, draw, and/or paint what you felt like when you first entered
into group therapy. Think about your mindset and thoughts of substance use. When finished, rip
or cut up this piece of paper into smaller pieces. Use these pieces, art materials, and a new
sheet of paper to create your current mindset. Think about what you’ve learned about yourself,
substance use, and what recovery is like.”
Goals
Processing Prompts:
•
•
•
How has your mindset transformed from
the first session to now?
What are the most important insights
you’ve learned about yourself?
Do you feel like you will still use
substances after this group?
• Examine past before engaging in group therapy
• Examine present values and beliefs
• Leave group with a clear understanding of what recovery looks like for each individual
Materials
• Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes, Paper,
Construction Paper
Discussion
Personal
Experience
witnessing SUD in
Family Members
Working in an
Adolescent
Residential Facility
for youth SUD
Not officially test; validity and
reliability not assessed
Limitations
Not all may connect with Art
Therapy Modality
Intended for use within a
residential setting
Curriculum relies on social
aspect of group therapy
Areas for Future Research
Could curriculum
be used with
adults?
Further research
into art therapy
with SUD
Differences of the
socio-ecological
model of
substance use from
youth vs adult
Q&A
References
•
Aletraris, L., Paino, M., Bond Edmond, M., Roman, P.M., Bride, B.E. (2014, December 17). The Use of Art and Music Therapy in Substance Abuse Treatment Programs. J Addict Nurse, 25(4): 190-196.
doi:10.1097/JAN.0000000000000048
•
American Art Therapy Association (AATA). (2022). About Art Therapy. AATA. https://arttherapy.org/about-art-therapy/
•
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•
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•
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•
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•
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•
Foxhall, K. (June, 2001). Adolescents Aren’t Getting the Help They Need. Monitor, 32(7). https://www.apa.org/monitor/jun01/adolescents
•
Fong Chan, P. C., Norman L. Berven, P., & Kenneth R. Thomas, De. (2015). Counseling Theories and Techniques for Rehabilitation and Mental Health Professionals: Vol. Second edition. Springer Publishing Company.
•
Giordano, A. L., Clarke, P. B., & Furter, R. T. (2014). Predicting Substance Abuse Relapse: The Role of Social Interest and Social Bonding. Journal of Addictions & Offender Counseling, 35(2), 114–127.
https://doi.org/10.1002/j.2161-1874.2014.00030.x
•
Hanes, M. J., & Rojas, J. (2022). Modified Bridge Drawings With a SUD Population in a Residential Setting. Art Therapy: Journal of the American Art Therapy Association, 39(3), 138–145.
https://doi.org/10.1080/07421656.2021.1986328
•
Horner, P. S., Andrade, F., Delva, J., Grogan-Kaylor, A., & Castillo, M. (2012). The Relationship of Birth Order and Gender with Academic Standing and Substance Use Among Youth in Latin America. Journal of Individual
Psychology, 68(1), 19–37.
•
Indiana University. (2022). Understanding the Crisis: Addictions. IndianaUniversity.edu https://addictions.iu.edu/understanding-crisis/understandingaddiction.html#:~:text=The%20socioecological%20model%20of%20addiction%20and%20substance%20use,our%20own%20individual%20biological%2C%20genetic%2C%20and%20psychological%
20makeup
•
Jalali, M.S., Botticelli, M., Hwang, R.C. et al. The opioid crisis: a contextual, social-ecological framework. Health Res Policy Sys 18, 87 (2020).
https://doi.org/10.1186/s12961-020-00596-8
•
Johnson L.D., O’Malley, P.M., Bachman, J.G., Schulenberg, J. E., Miech, R.A. (2014). Monitoring the Future national survey results on drug use, 1975-2013.
Institute for Social Research, University of Michigan, 1, 32-36.
•
Laguna Treatment Hospital. (2022). How Dangerous is Marijuana When Lace with Another Drug. https://lagunatreatment.com/drug-abuse/marijuana/lacingdanger/
•
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. https://doi.org/10.1146/annurev.soc.27.1.363
•
Lipari, R.N. & Van Horn, S.L. (2017, August 24). Children living with parents who have a substance use disorder. Center for Behavioral Health Statistics and
Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.
https://www.samhsa.gov/data/sites/default/files/report_3223/ShortReport-3223.html
•
Lundahl LH, Cannoy C. COVID-19 and Substance Use in Adolescents. Pediatr Clin North Am. 2021 Oct;68(5):977-990. doi: 10.1016/j.pcl.2021.05.005. Epub 2021
May 18. PMID: 34538307; PMCID: PMC8445753.
•
Marlatt G. A., Witkiewitz K. (2002). Harm reduction approaches to alcohol use: health promotion, prevention, and treatment. Addict Behavior, 27: 867-86.
•
National Center for Drug Abuse Statistics. (2023). Drug Use Among Youth: Facts and Statistics. https://drugabusestatistics.org/teen-druguse/#:~:text=Substance%20Abuse%20Among%20Youth%201%202.08%20million%20or,illicit%20drugs%20in%20the%20last%20month.%20More%20items
•
National Center on Addiction and Substance Abuse at Columbia University. (2004). Criminal Neglect: Substance Abuse, Juvenile Justice and the Children Left
Behind.
•
Richter, L. (2022). Taking Stock of the Downstream Effects of COVID-19 on Youth Substance Use Risk. Journal of Adolescent Health. 71(6).
https://doi.org/10.1016/j.jadohealth.2022.09.007.
•
Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the
2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics
and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
•
Substance Abuse and Mental Health Services Administration (SAMHSA). (2019). Key Substance Use and Mental Health Indicators in the United States: Results
from the 2018 National Survey on Drug Use and Health.
•
Watson, A. E. (2016). Foster Children and Youth in Congregate Care Settings : Overview, Issues, and Reduction Efforts. Nova Science Publishers, Inc.
•
Wadud, A., Prasad, P., V., Rao, M., M., Narayana A. (2007). Evolution of drug: a historical perspective. Bull Indian Inst Hist Med Hyderabad, 37(1):69-80. PMID:
19569453.
•
Youth.gov. (2022). Risk and Protective Factors. https://youth.gov/youth-topics/risk-and-protective-factors
FORGING THE ROAD TO
RECOVERY
C
A Curriculum by Hailey Kivler
Purpose Statement
• To develop an art therapy-based
curriculum for youth with substance use
disorder in an effective residential
group setting that addresses both the
substance use and mental health
concerns.
Problem to
be
Investigated
Ineffectiveness of Current
Substance Use Disorder
Treatment for Youth
Justification
Substance Use & SUD is a
prevalent problem among
youth
•Study found that by 12th grade, two-thirds of students had tried alcohol while two out of ten students
admitted to using prescription medication illegally (Johnson et al., 2014)
•nearly 1 million youths (ages 12 to 17) needed treatment for SUD in 2018, although only 83,000 of them
received services in a treatment center (SAMHSA, 2019).
Barriers to Treatment
•Barriers include racial bias, economic cost of care, and the stigma associated with SUD (Alegria et al.,
2010; Earnshaw, 2020; Farhoudian et al., 2022).
Current treatment methods
found ineffective
•“programs for adolescents using a pure abstinence-based approach (the “just say no” approach)
are ineffective in reducing substance use and abuse” (Marlatt & Witkiewitz, 2002, p. 2)
Untreated SUD in youth can
lead to a cycle of
incarceration
•“contribute to an elevated risk of recidivism, which leads to further, and oftentimes more serious,
involvement with the juvenile justice system” (Fisher et al, 2018, p. 3).
Overall lack of research of arttherapy based treatment for
youth SUD
Terms
Adlerian “Individual” Psychology
• An approach to psychology that emphasizes a “holistic and phenomenological understanding to human
behavior”, stressing the importance of viewing all aspects of an individual including lifestyle and social context
(Carlson & Johnson, 2016). Human behavior is goal-oriented and is often influenced by external factors such as
birth order, the family constellation, personal lifestyles, and social interest.
Art therapy
• “An integrative mental health and human services profession that enriches the lives of individuals, families, and
communities through active art-making, creative process, applied psychological theory, and human experience
within a psychotherapeutic relationship.” (AATA, 2022, para.1)
Recovery
• “A process of change through which individuals improve their health and wellness, live a self-directed life, and
strive to reach their full potential” (SAMHSA, 2012, p. 3).
Residential Treatment
• “Are licensed, community-based facilities that provide 24-hour inpatient care for people with mental health
and/or chemical dependency disorders in a residential treatment setting” (WSDOH, 2022, para. 1)
Terms
Substance
•“This is material abused (e.g. Cocaine, alcohol, marijuana), a medicine (sedative, for example)
or toxin” (Psychology Dictionary, 2013, para. 1)
Substance Use Disorder (SUD)
•“Characterized by recurrent use of alcohol or drugs (or both) that results in problems such as
being unable to control use of the substance; failing to meet obligations at work, home, or
school; having poor health; and spending an increased amount of time getting, using, or
recovering from the effects of using the substance.” (Lipari & Van Horn, 2017, para 1).
Overdose
•“Injury to the body (poisoning) that happens when a drug is taken in excessive amounts. An
overdose can be fatal or nonfatal.” (CDC, 2021, para. 24)
LITERATURE REVIEW
C
Adlerian
Major Tenants (Fong et al, 2015)
• Developed by Alfred Adler in the early 1900’s as an alternative to Freud’s Psychoanalytic Theory
• Focus on social, holistic, and goal-directed nature of people
• Looks at people as a whole; indivisible from individual parts
• Differs from Freuds separate Id, Ego, and Superego
5 Major Tasks of Life
• Coping with
• Coping with
• Coping with
• Coping with
• Coping with
problems of social relationships
problems of work
problems of love
the self
existence
***Unsuccessful attempts to navigate lead to psychopathology
Adlerian
Lifestyle
• holistic pattern of beliefs and goals that the person uses for interacting with others and for
measuring self-worth (Fong et al, 2015, p. 210)
• Develops in childhood through experiences; influences present and future
Family Constellation and Birth Order
• Family is first social group and shapes later experiences
• Birth order – first born, middle child, youngest, only child, ect.
• being a first born male or female was a protective factor against SUD while being the youngest
put the youth more at risk of developing SUD (Horner et al, 2012
Social Interest
• “An internal feeling of connectedness to others and their well-being, to the well-being of the
individual” and the desire to need and belong (Fong Chang et al, 2015, p. 207).
• Substance use is driven from a lack of social interest and used as a “means to evade the tasks
of life, including love, friendship, work, and self” (Giordano et al, 2014, p. 116)
Socio-Ecological Model of
Substance Use Disorder
• The model “recognizes the mosaic of interactions
that play a role in addiction, including society and
public policy (laws and regulations); communities;
organizations and personal networks; and our own
individual biological, genetic, and psychological
makeup” (Indiana University, 2022, para. 8).
Note: Adapted from Indiana
University. (2022). Understanding
the Crisis: Addictions.
IndianaUniversity.edu
Note: Adapted from Jalali et al., (2020) The opioid crisis: a contextual,
social-ecological framework
Substance Use
• Mind altering substances have been around since the beginning of time
• the English word Drug was taken from French word Drogue which means Dry Herb and
suggests that earliest drugs were taken and developed from plant sources (Wadud et
al, 2007).
• A substance can be considered “medicine” or a “drug” depending on the
intent of the user and medicinal value
• The use of substances is not considered a substance use disorder unless
the use becomes disruptive or impairing to everyday life
• What is considered disruptive/impairing is unique to everyone
• Moralization of Substance Use & Development of Stigma
• In America: Prohibition Era, Nixon’s War on Drugs
• Creates social barriers to receiving help
SUD: Recurrent use of alcohol or drugs (or both) that results in problems
such as being unable to control use of the substance; failing to meet
obligations at work, home, or school; having poor health; and spending an
increased amount of time getting, using, or recovering from the effects of
using the substance.” (Lipari & Van Horn, 2017, para 1).
Youth SUD
At least 1-in-8 teenagers (12-17) used an illicit substance in the last year
(National Center for Drug Abuse Statistics, 2023)
Most common substances used are alcohol, marijuana, and nicotine
(National Center for Drug Abuse Statistics, 2023)
Monitoring the Future (MTF) study found that vaping (marijuana, nicotine,
and/or flavored liquid) resulted in the largest increase that MTF ever
tracked (Johnson et al, 2014, p.1).
• In 2019, 2.7% of youth had a SUD but no Major
Depressive Episode(MDE); 1.7% of youth had
both a SUD and MDE. (SAMHSA, 2020)
• Total of 4.4% of youth having at least SUD in US
• 39% of youth with SUD had a co-occurring disorder
• Treatment for MDE in youth increased in 2019
(SAMHSA, 2020)
• For youth with co-occurring SUD and MDE:
(SAMHSA, 2020)
• 62.5% received only mental health services
• 2.4% received only SUD services
• 1.3% received both SUD & mental health services
• SUD treatment should always include mental
health care
Youth SUD
and CoOccurring
Disorders
Number of drug overdose deaths and deaths involving illicitly
manufactured fentanyl among persons aged 10–19 years (2019-2021)
Youth SUD
• Overdose: “Injury to the body
(poisoning) that happens when a drug is
taken in excessive amounts. An overdose
can be fatal or nonfatal.” (CDC, 2021,
para. 24)
• Can be accidental or intentional
Notes: IMF = illicitly manufactured fentanyl
Adapted from Center for Disease Control (CDC). (2022). Drug
Overdose Deaths Among Persons Aged 10–19 Years — United States,
July 2019–December 2021.
https://www.cdc.gov/mmwr/volumes/71/wr/mm7150a2.htm
• Lacing is when one drug is added to
another; may be done secretly by
dealers to lessen their costs or make
more addictive (Laguna Treatment
Hospital, 2022)
• Threat of overdose is what makes SUD so
dangerous
• “Recovery from alcohol and
drug problems is a process
of change through which an
individual achieves
abstinence and improved
health, wellness, and quality
of life.” (Finch et al, 2020, p.
2)
• In 2011, SAMHSA broadened this
definition even more by
removing the mention of
abstinence as a criterion for
recovery: “a process of selfdirected change through which
individuals improve their health
and wellness, live self-directed
lives, and strive to reach their full
potential.” (Finch et al, 2020, p.
2)
• For youth with SUD, “developmental, legal, and
familial context fundamentally differs in ways that
render adult based conceptualizations of recovery
insufficient”. (Finch et al, 2020, p. 3)
• Aim of the curriculum to encourage abstinence from
substances until adulthood/legal age by empowering
youth with psychoeducation & autonomy to make
their own choices
• Tracking Success: Focus on symptom & use reduction
rather than pure abstinence
Recovery &
Abstinence
Current Treatment
• Can be outpatient or inpatient; Intensive inpatient care is
usually preferred due to serious nature of SUD
• Residential treatment can lack addressing the issues that
contribute to SUD
• Failing to address Co-Occuring Disorders
• At time of aftercare check in one year after residential
treatment, “47 percent of the youth with mental
health issues used marijuana weekly compared to 39
percent of the other youth, 32 percent used
hallucinogens compared to 18 percent of others, and
17 percent had suicidal thoughts compared to 12
percent of the others” (Foxhall, 2001, para. 6).
• Focusing on only abstinence
• Marlatt & Witkiewitz (2002), “programs for adolescents
using a pure abstinence-based approach (the “just
say no” approach) are ineffective in reducing
substance use and abuse” (p. 2)
Barriers to Treatment
Racial Barriers
Economical Barriers
Stigma
•Minorities in the US are less
likely to receive effective
treatment
•“Black adolescents with SUD
reported receiving less
specialty and informal care,
and Latinos with SUD
reported less informal
services” (Alegria et al, 2010).
•Found to be one of the most
expensive types of care in the
United States, limiting the
availability of treatment
depending on economic
status and insurance
coverages (Farhoudian et al,
2022).
•$25,000 and up for at least 30
days (not counting insurance)
•stigma has been defined as a
social process that exists
when labeling, stereotyping,
separation, status loss, and
discrimination occur within a
power context (Link & Phelan,
2001
•“leads to the development of
substance use disorders
(SUDs), undermines SUD
treatment efforts, and drives
persistent disparities within
these crises (Earnshaw, 2020,
p. 1300)”
Individual
• Youth’s biological predisposition to developing SUD and
personality/temperament factors (Youth.gov, 2022).
• Stress and Trauma
• Pain
Interpersonal
Risk Factors
• Lack of social support, isolation
• Exposure through Family
• “approximately 1 in 8 children in the US were living in a household
with at least one parent with SUD” (Lipari & Van Horn, 2017, para.
15).
Community/Peers
• Peer Pressure in Schools
• Availability of care
• Accessibility to substances
Society
• Public Opinion on Substances/Media
• Laws and norms that are favorable towards substances, such as the
more recent nicotine vaping marketing advertisements towards
teenagers, can impact a youth’s perception about the dangers of
drug use (Youth.gov, 2022).
Youth SUD
& COVID-19
Lockdown increased risk
factors but lowered access
to substances (Lundahl &
Cannoy, 2021)
Opioid overdoses
skyrocketed due to lack of
in-person treatment and
social supports (Richter, 2022)
Vulnerable Youth
• Foster Care
• Group Homes: Foster youth congregate care lacks family-based care; increases risk factors
(Watson, 2016)
• Juvenile Justice System
• Juvenile Justice System fails to address SUD or provide treatment while in juvenile detention (The
National Center on Addiction and Substance Abuse at Columbia University, 2004)
• Low reliance on adolescent self-reporting utilized by most of the research, the failure of justice
and other systems to routinely assess youth for either current drug use or indicia of drug use
(e.g., “resiliency” or “protective” factors), and confidentiality and other restrictions pertaining to
access to juvenile justice system information. (Cooper, 2009, p. 2)
• “Art therapy is an integrative mental health and human
services profession that enriches the lives of individuals,
families, and communities through active art-making,
creative process, applied psychological theory, and human
experience within a psychotherapeutic relationship” (AATA,
2022).
• Art therapy offers a non-judgmental means of expression
that explores the deeper issues behind substance use in an
alternative manner than traditional talk therapy.
• benefits art therapy brings in SUD treatment include
decrease in denial, reducing opposition towards
treatment, providing an outlet for communication and
lessening shame (Aletraris et al, 2014)
• helps to target rigid defenses and denial, fostering insight
and awareness, encouraging emotional expression,
enhances self-esteem and promotes creativity and
problem solving in SUD clients (Hanes & Rojas, 2022).
Art Therapy
and Youth
SUD
Curriculum Structure
• 10 Week Curriculum; 1h 30 mins
• Begins with Introduction, Ends with
Termination
• 8 weeks in-between based upon elements of
the socio-ecological model of substance use
C
disorder
• Individual, Interpersonal,
Community/Peers, and Society
• Intended to be used in a residential setting,
assuming youth are receiving other services
including individual therapy and
psychoeducation on mental health &
substances
• Facilitated by Master’s leveled art therapist
Week 1 (Introduction) Forging Direction:
The Road Drawing
Activity
•Intro: Introductions, Rules
•Check-in: “Tell us your name, where you are from, and one unique fact
about yourself”.
•“For this project, I would like for you to create an image of a road. There are
no right or wrong responses to this prompt. Some things to think about: What
is your road made of? Where does your road lead to? What surrounds the
road?”
Processing Prompts:
•
•
•
•
What was your road made of and where
did it lead to?
Were there any signs that assisted the
road? What about any hazards
surrounding the road?
Where do you believe you are on this
road right now?
How do you feel this could be related to
your personal journey and recovery?
Goals
•Begin to envision what recovery looks like for each participant
•Evaluate where participants are in road to recovery
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint,
Paintbrushes, Construction Paper, Plain Paper, Paint, Textile Fabric
Week 2: (Individual) Looking Back –
Timeline of My Life
Activity
•Check-in: “Think about a high and low of the last week. Take about five
minutes to think and then we will share.”
•“For this activity, I would like you to create a timeline of your life. Think about
moments in your life that have defined you, from birth to this point in time.
There are no right or wrong ways to develop this timeline.”
Goals
Processing Prompts:
•
•
•
•
What are the most impactful events that
happened in your life?
Are there any patterns that you notice?
Have there been events that have made
you stronger? Are there any events that
have made you feel vulnerable?
Try to identify when you first started using
substances. Was this related to any
particular event?
•Examine specific events that have influenced substance use
• Identify protective and risk factors developed through participants
experiences
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint,
Paintbrushes, Construction Paper, Plain Paper, Paint Paper, Air Dry Clay,
Modeling Clay, Clay Tools, Textile Fabric, String, Beads,
Week 3: (Individual) Processing Trauma –
Body Map
Activity
•Check-in: “If you were an animal, what animal would you be and why?”
•“For this activity, we will be creating a body map. Chose a partner to help
trace your body on a life sized sheet of paper. After this, take a moment to
close your eyes and envision how your body feels. Use art materials to map
out the different feelings.”
Goals
Processing Prompts:
•
•
•
•
How did this activity feel?
Were there any parts that surprised you?
Were there any areas that you feel pain?
Has substance use influenced any parts of
your body?
•Show how trauma impacts the physical body
•Examine how drugs impact the body
•Encourage social support
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint,
Paintbrushes, Large Rollable Paper
Week 4: (Interpersonal) Family of Origin –
Genogram
Activity
•Check-in: “Now that we’ve been meeting for a few weeks, I’m wondering what are
your goals from these sessions?”
•“Take a moment to think about your family, whether biologically related to you or
people you consider like family. Including yourself, create a genogram or family tree
including yourself and how these important people are connected to you. Use patterns,
words, lines, shapes to identify specific connections. You can include a legend that
depicts what each symbol means, if you’d like too. Try to include as many people as you
can that have come to impact your life”.
Goals
Processing Prompts:
•
•
•
Who are some of the people that you
included in your genogram?
Are there any patterns or similarities
between the people and yourself? Any
differences?
Are there any relationships you consider
toxic? Any relationships that are healthy
and supportive?
•Explore familial connections
•Create a physical representation of family systems
•Understand impact of family relationships and drug use
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes,
Large Rollable Paper, construction paper, colored tape, stickers
Week 5: (Interpersonal) Birth Order –
Kinetic Family Drawing/Sculpture
Activity
•Check-in: “What is your earliest memory from childhood? Take a few minutes to write or
draw this memory.”
•“For this activity, I would like you to create a drawing or sculpture of you and your family
doing something together. Think of your immediate family and the household you grew
up in. Include yourself, siblings, parental figures or other family members/family friends
that were impactful to you and that you lived with.”
Goals
Processing Prompts:
•
•
•
Who is in the drawing/sculpture and what
are you doing together?
Looking at Adler’s birth order roles, what
do you feel like your role was? Does the
personality description resonate with you
or do you feel like you connect with a
different description?
Who do you have the best relationship
with? Who do you have a strained
relationship with?
•Examine the roles and relationships within immediate family
• Understand how birth order affect’s youth personality and personal experience
• Examine how personality factors and familial role contributes to substance use
Materials
•Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes,
Paper, Construction Paper, Clay, Fabric, Textiles, Beads, Aluminum Foil
Week 6: (Community/Peers) Exploring
Supports – The Tree of Life
Activity
• Check-in: “How do you want to be perceived or thought of by others?”
• “For this activity, we will be creating a Tree of Life representing social connections. The first step is
to envision and draw a tree with roots, a trunk, and a crown. In the roots sections, include
pictures and/or words that represent social connections, any
people/groups/organizations/places that have influenced who you are as you were growing
up. On the trunk, write your name and include anything you feel represents you in the present.
On the crown of the tree, include leaves/branches of social connections that you would like to
keep, ones that you would like to form, and ones that you would like to disconnect or fall off like
dead leaves.”
Goals
Processing Prompts:
•
•
•
•
What connections have defined you to
this point in your life?
How do you feel others view you now in
the present?
What connections would you like to form
or keep? What connections would you
like to severe?
Have you noticed any connections that
are positive, neutral, or negative?
• Explore social connections and supports
• Determine if connections are positive, neutral, or negative
• Explore social impacts of substance use
Materials
• Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes, Paper,
Construction Paper
Week 7: (Community/Peers) Recovery
Groups – Group Mural
Activity
•Check-in: “Think of the people that you were close with before joining this group. How
will they influence your newfound view of recovery? How will they support your
recovery?”
•“For this activity, I want you all to image what your recovery looks like. Work
collaboratively to share this wall space for your creation. You may work together or
independently, but try to be aware of how the space you chose impacts and relates to
what others are creating around you.”
Goals
Processing Prompts:
•
•
•
•
How did this activity feel?
What was it like working with others in
this process?
Were there any conflicts or any
compromises?
How can working with others support
your recovery?
•Provide new perspectives on recovery
• Encourage social connection
•Model healthy relationships
Materials
•Acrylic Paint, Paintbrushes, Wall Space (inside or outside), Sidewalk Space or Large Cloth
(at least 10ft x 8ft)
Week 8: (Society) Self-Concept vs Social
Identity – Dual Self-Portrait Collage
Activity
• Check-in: “What is your role in society? Take a few minutes to write or draw your ideas.”
• “Today we will be creating a dual-self portrait based on our ideas of self-concept and social
identity. Self-concept is the ideas you have about yourself, while social identity is how you feel
you fit into the world around you. To start the portrait, create an outline of yourself being as
detailed or as vague as you prefer. Once finished, draw a line up and down through the center
of the outline. Label one side “How I view myself” and the other side “How others view me”. Take
the rest of the time using art materials and collage materials provided to fill in the space within
your outline.”
Goals
Processing Prompts:
•
•
•
•
• Examine self-concept vs. social Identity
• Compare aspects of self-concept and social identity
• Make connections to protective and risk factors of substance use in both self-concept and
social identity
How are the sides of your portrait similar? How
are they different?
How does substance use influence the sides of
your portrait?
If you could change anything about the portraitMaterials
for the future, what would you change and
• Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes, Paper,
why?
Construction Paper, Magazines, Old Books, Text Cut Outs, Pictures
It can be hard when our idea of self and social
identity do not match or are not similar. How
can your ideas of self and how others view you
change to become more aligned with one
another?
Week 9: (Society) Overcoming the
Stigma of Addiction – Group Mandala
Activity
• Check-in: “Are there any stigma’s that exist for individuals that use substances? Have you ever
felt judged by others? What did this feel like?”
• “Each of you will receive a part of a piece of paper that together form a circle. For this activity, I
want you to think about what your have brought to this group over the course of weeks we’ve
been meeting. What parts did you play? How did you impact others? What was your overall role
in our group? Please draw or paint your response to these questions on the piece of paper. At
the end, we will attach all of the pieces to form a circle or mandala that represents our group.”
Goals
Processing Prompts:
•
•
•
What do you think your role was in this
group?
How have you overcome the negative
stigmas you’ve faced?
How does this group defy the social
stigmas put against us?
• Show how each individual impacts the group
• Display how each individual part put together creates meaning and connection
• Encourages connection and social interest
Materials
• Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes, Paper,
Construction Paper
Week 10: (Termination) Letting Go of
Addiction – Torn Paper Transformation
Activity
• Check-in: “What was your favorite thing we did during these sessions? How do you feel ending
the sessions? What does recovery look like for you?”
• “For this activity, I want you to write, draw, and/or paint what you felt like when you first entered
into group therapy. Think about your mindset and thoughts of substance use. When finished, rip
or cut up this piece of paper into smaller pieces. Use these pieces, art materials, and a new
sheet of paper to create your current mindset. Think about what you’ve learned about yourself,
substance use, and what recovery is like.”
Goals
Processing Prompts:
•
•
•
How has your mindset transformed from
the first session to now?
What are the most important insights
you’ve learned about yourself?
Do you feel like you will still use
substances after this group?
• Examine past before engaging in group therapy
• Examine present values and beliefs
• Leave group with a clear understanding of what recovery looks like for each individual
Materials
• Pencils, Colored Pencils, Pens, Markers, Acrylic Paint, Watercolor Paint, Paintbrushes, Paper,
Construction Paper
Discussion
Personal
Experience
witnessing SUD in
Family Members
Working in an
Adolescent
Residential Facility
for youth SUD
Not officially test; validity and
reliability not assessed
Limitations
Not all may connect with Art
Therapy Modality
Intended for use within a
residential setting
Curriculum relies on social
aspect of group therapy
Areas for Future Research
Could curriculum
be used with
adults?
Further research
into art therapy
with SUD
Differences of the
socio-ecological
model of
substance use from
youth vs adult
Q&A
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