Social Skills Training

Social skills training forms an integral part of both prevention and intervention efforts in addressing the negative effects of substance use. Although former First Lady Nancy Reagan adopted the simplistic slogan "Just Say No" as the centerpiece of her efforts to prevent the initiation of young people into alcohol and other drug use, for many young people and their older adult counterparts, avoiding first or continued substance use is not that simple. The ability to effectively interact with others in an assertive fashion is critical to avoidance of substance use initiation as well as to the process of beginning to change substance use or remain abstinent following a decision to do so.

Social skills training arises from a cognitive social-learning theory perspective that holds that substance use is largely a learned behavior and that changes in this learned behavior can be made through use of behavioral rehearsal, modeling, and changes in how the individual views and evaluates situations in which substance use is likely.

For example, for a young person to avoid initiation into substance use, he or she must be able to effectively refuse the initial offering of substances, feel [Page 839]comfortable doing so, and believe that such refusals will be effective. For an older person already using substances who has made the decision to change that use, the ability to effectively interact with others takes on a more complex importance. It is known, for example, that for many individuals who have decided to reduce or stop substance use, poorly handling interpersonal conflict situations can constitute a trigger of return to previous, undesired levels of substance use. Thus, ineffectively handling an argument with a spouse or other significant person may lead to a sense of discouragement and negative self-image that triggers negative affect, which in turn triggers increased substance use. In addition, the ability to effectively resist perceived or actual social pressure to violate self-imposed use limits (whether they be reduced use limits or abstinence) is often critical to effectively maintaining behavior change. It is not uncommon, for example, for newly abstinent problem drinkers to express concerns about how they will address questions from drinking friends about their shift to abstinence and how they will resist social pressure from those friends to "just have one."

Many individuals in society suffer from deficits in their ability to engage in effective assertive behavior. Deficits take two primary forms, both focusing on an inability of the individual to effectively assert his or her wishes and rights in the face of attempts by others to induce behavior the individual does not want to engage in. The first form is an inability to be forceful and determined in one's assertions (underassertive-ness) or a tendency to be overly aggressive in one's assertions (aggressiveness). Both forms of social skill deficits can interfere with effective behavior with respect to alcohol and other drugs.

These deficits may result from either or both of two sources. The first is simply a lack of the requisite skills to engage in effective assertive behavior; the second is a lack of motivation to do so. The latter may take the form of beliefs that assertive behavior will be ineffective or that one lacks the skills to be assertive when one actually possesses them. Skill deficits require training to alleviate the deficits. Motivational deficits require addressing the thoughts and expectations that drive the avoidance of effective assertive behavior. Social skills training approaches have addressed both of these sources of deficit in assertive behavior.

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