Groups for Belonging: a group-based loneliness intervention for people attending treatment for alcohol and other drug use

Arm 1 (Treatment): Groups for Belonging Groups for Belonging (G4B) is a group-based, theory-informed loneliness intervention for people accessing alcohol and other drug (AOD) treatment, G4B involves 6 x 2-hour sessions delivered over a 4 to 6-week period, with intervention length dependant upon the length of the program offered by respective AOD treatment sites. Sessions of G4B explore the following themes across sessions: Session 1. Session 1 explores the relationship between loneliness, substance use, and health. This session uses activities and discussions to develop participants’ understanding of how and why their relationship with others is important to their health, wellbeing, and treatment goals. Out of session practice involves monitoring episodes of loneliness in preparation for Session 2. Session 2. The theme of session 2 is managing loneliness, and mapping the social world. In session 2, participants engage in activities where they learn strategies to manage loneliness, and start to work through what their social world currently looks like via a social identity mapping exercise. Participants are encouraged to review this social identity map to further consider their current social groups as personal practice (i.e., homework). Session 3. Session 3 focusses on the theme of valued relationships. Participants in session 3 navigate how their personal principles and values might help them seek out meaningful relationships with others, particularly those that are supportive of their treatment goals. Activities involve introducing participants to the notion of values, how social groups may or may not reflect personal values, and strategies for managing difficult feelings, such as mindfulness work. Mindfulness practice is encouraged as personal practice and developed further in Session 4. Session 4. Session 4 centres around stigma and reconnecting with groups participants previously engaged with. Through activities and discussions, participants are encouraged to work through the barriers they may be facing in connecting with others (e.g., stigma), and strategies they may implement to overcome these barriers, including mindfulness and managing set backs. Attempts to reconnect and further mindfulness practice are set as personal practice tasks. Session 5. Session 5 centres on building social connections, and leads on from session 4 by working with participants to develop strategies for meeting new people and groups that foster belonging. Activities centre around the development of strategies to join new social groups, goal setting, and navigating barriers to achieving social goals. Participants are encouraged to take steps towards social goals as personal practice. Session 6. Session 6 wraps up Groups for Belonging with a focus on maintaining progress. The core outcome of this session is working with participants to take what they have learned in Groups for Belonging to the outside world. Participants are guided through discussions that focus on overcoming barriers to connecting, including mistrust, and fear of showing feelings. Next steps are provided, with encouragement to continue to work towards social goals to combat loneliness, and build their personal sense of belonging. Groups for Belonging will run as a face-to-face closed group, delivered within the site where the consumers are currently attending treatment, with membership fixed at the beginning of each iteration of the intervention (n sites = 13 sites randomised to the treatment condition, stratified by service type (residential/day program). Multiple iterations of Groups for Belonging will run at each site. The number of iterations, and the number of people within iterations at each site will depend on the capacity of the site; however, it is intended that there will be approximately 10 people per group, and two-iterations of Groups for Belonging per site (n = 20 people per site). The intervention is manual guided, including a client workbook and a facilitators manual. The manual and client workbook were specifically designed for this intervention. Groups for Belonging will be facilitated by an experienced clinician employed by The University of Wollongong and co-facilitated by a staff member employed at the treatment site. Treatment completion is defined as missing no more than two consecutive weeks, and where catch-up work was completed. Catch-up work is defined as a research clinician facilitated ‘make-up session’ that will be held 45 minutes prior to the next session of Groups for Belonging. While attendance is voluntary, participants will be made aware that regular attendance of sessions is likely to result in them getting the most out of the Groups for Belonging program. To monitor fidelity to the intervention, staff involved in delivery of Groups for Belonging will complete formal training and weekly supervision led by clinical psychologists (investigators, II and GD). Training and monthly supervision will also be provided (by AB) to an independent Fidelity Assessor, who will be based at the University of Wollongong. All intervention sessions will be audio-taped in order to rate fidelity to the intervention. The trained Fidelity Assessor will rate a random allocation of 20% of treatment sessions (stratified by session and trial site) for adherence to intervention content and competence in intervention delivery. Intra-rater reliability procedures will be conducted with 20% of the fidelity-assessed treatment sessions to ensure consistency of fidelity assessor ratings of each session. A subset of 10 participants across sites who have participated in G4B will be recruited to complete a 30 minute semi-structured qualitative interview about their experience with G4B. Participants will be asked what works well, what does not work well, and what could be improved in future.