The Appalachian tradition of storytelling is being used as a tool to treat drug and alcohol addiction in several Eastern Kentucky communities. Carl Leukefeld, director of the University of Kentucky Center on Drug and Alcohol Research, came up with the idea to use storytelling as a form of treatment after discovering the traditional method of therapy used in many urban areas-role playing-wasn't working well in rural areas.
"With role playing, people put themselves in other people's shoes to help them understand how the behavior of others might be good or harmful. But acting out or being on stage in front of other people tends to make rural people feel uncomfortable," Leukefeld says.
Leukefeld and a team of researchers received a $658,000 National Institute on Drug Abuse grant in 1995 to develop the rural therapy.
The pilot program began in April 1996 in three Kentucky towns-Campbells-ville, Jackson and Somerset-and ended in March of this year. About 90 subjects between the ages of 18 and 65 participated in the study.
The subjects included a control group who received the traditional approach to treatment-a mixture of individual and outpatient group therapy-and those who received the structured behavioral outpatient rural therapy (SBORT). In addition to its storytelling component, the rural treatment combines clinical approaches such as social skills training and "thought mapping" to help substance abusers change their behavior and, ultimately, become drug- and alcohol-free.
SBORT is a two-phase intensive outpatient program consisting of pretreatment and treatment. During pretreatment, patients meet with counselors individually for at least three sessions of 50 minutes each. The counselor works with them to understand the role drugs and alcohol play in their lives and to arrive at a joint commitment for change.
Treatment begins with training that focuses on social skills that are most helpful in establishing and maintaining recovery from chemical dependency. Storytelling and "thought mapping" are used to help clients develop those skills. Thought mapping involves analyzing important incidents before and after the onset problem behavior.
During treatment, subjects meet in groups twice a week for six weeks. The sessions focus on solving problems and changing behavior by teaching different skills, including managing thoughts and fantasies about drug and alcohol use, coping with cravings and urges, relaxation techniques, and using self-help groups such as Alcoholics Anonymous and Narcotics Anonymous. Storytelling is used during the group sessions to help clients relate to the topic being discussed, gain insight into their behavior and learn new skills to change their behavior.
The way it works is simple. Using a technique called "priming the pump," the therapist tells a scripted story in an engaging and artful manner that is designed to elicit stories about the clients' personal experiences. The therapist might tell a story, for example, of a couple early in their marriage who are having trouble communicating because the wife expects her husband to know what's bothering her rather than simply telling him.
The therapist then asks the clients to tell their own stories about mind reading while identifying the hurt feelings, confusion and conflict that can result when individuals in a relationship don't make their needs known to one another. Discussion of the damaging role of drugs and alcohol is also an important part of such sessions.
Currently, Leukefeld and Cynthia Brown, research associate with the UK Center on Drug and Alcohol Research, are analyzing data from the study to see how well the pilot program worked. The study team is looking not only at the participants' level of addiction before and after the rural therapy, but also their opinions about the effectiveness of the treatment.
Anecdotally, however, Leukefeld and Brown think the treatment is working. Preliminary results indicate changes in drug and alcohol use among participants.
"The treatment is making a difference in their lives," Brown says.
A manual will be published to train health-care providers across the commonwealth, including in urban areas, in the storytelling technique. "This approach is creative and it's fun. Patients really get into it," he says, adding that it's helping Kentuckians look closely at themselves and change their behaviors.
Leukefeld and his research team plan to apply for additional funding through the National Institute on Drug Abuse to conduct a clinical trial on the treatment. In addition to Leukefeld and Brown the research team includes Theodore Godlaski, associate professor of psychiatry; Jim Clark, College of Social Work; T.K. Logan, Center on Drug and Alcohol Research; and Lon R. Hays, associate professor of psychiatry.