Salem Press | 2011 | Salem Health: Addictions & Substance Abuse
Essay title: Group Therapy for Substance Abuse
Also known as: Drug and Alcohol Rehabilitation
Definition: Hailed by the Substance Abuse and Mental Health Services Administration (SAMHSA) as a cost-effective treatment for substance abuse, group therapy is an important tool of the substance abuse recovery process. Nonetheless, though group therapy is a critical component of a comprehensive treatment plan, it is not a replacement for core mental health and physician services specializing in substance abuse treatment.
Rationale By the time an individual reaches the point of seeking treatment for substance abuse, he or she most likely has become alienated from friends and family due to poor behavior resulting from abusing substances over a period of time. Therefore, as the recovering substance abuser steps into a community of individuals facing similar battles in overcoming substance abuse, the most important benefit of group therapy for substance abuse is a reduction of the feeling of social isolation. This sense of community experienced in group therapy rewards participants with peer support and the feeling that they are not alone in the recovery process. Participants benefit by learning how other recovering substance abusers are coping in the recovery process. They gain feedback, encouragement and insight from individuals with the credibility of experiencing first-hand the challenges associated with overcoming substance abuse. Group therapy participants also develop or relearn social skills — namely, how to interact with others while sober.
In addition, on a practical level, group therapy is cost-effective. The services of a single psychotherapy professional are tapped for several individuals at a time. Therefore, by participating in low-cost group therapy program, individuals suffering from substance abuse may gain a substantial return in treatment for their financial investment.
Models SAMHSA endorses five group therapy models as effective approaches for substance abuse treatment: psychoeducational groups, skills development groups, cognitive-behavioral/problem-solving groups, support groups, and interpersonal process groups. The appropriate model for a substance abuser, depends on his or her life experience and psychological background.
Psychoeducational groups inform participants about substance abuse, providing them with content about the behaviors, risks, and impacts of substance abuse. Psychoeducational groups raise awareness of the science behind the problem of substance abuse, enabling participants to understand why they need medical and psychological help to overcome substance abuse. It also helps them understand their own behavior, stages of the recovery process, and which resources are available to help them cope during recovery.
Skills development groups help participants hone special skills for recovery, chiefly in how to abstain from drug and alcohol use. According to SAMHSA, skills development groups should teach refusal skills, social skills, communications skills, anger management skills, parenting skills, and money management skills.
Cognitive-behavioral groups are especially important during early recovery, as they help participants identify the psychological factors leading to substance abuse. Participants are guided in exploring their thoughts, beliefs, and feelings as they relate to their substance abuse behavior. Negative thoughts and beliefs, such as feelings of failure and inadequacy, are uncovered and addressed. The goal is for participants to resolve destructive, errant beliefs about their potential and worth so that they can move forward in the recovery process.
Support groups are valuable for treating substance abuse in that they offer a nonjudgemental, open forum where participants may discuss their experience and struggle with substance abuse with reduced anxiety. Ground rules for discussion are important for facilitating an environment where recovering substance abusers may freely express feelings and events related to recovery. The psychotherapist leading the support group models active listening, positive feedback, and appropriate, nonjudgemental discussion. Group therapy types include relapse prevention groups, communal and culturally specific groups, and expressive groups.
Interpersonal process groups apply psychological process-oriented methods to promote substance abuse recovery. Interpersonal groups focus on individual members, interpersonal interaction between members, or the group as a whole.
Structure Because the appropriate placement of an individual into a particular model of group therapy is important, a care provider first evaluates the substance abuser client’s background, needs, and stage of recovery. Depending on the substance abuser’s circumstances and preferences, the care provider matches him or her with a group type and group leader equipped to treat any adjunct issues the person has, such as psychological disorders or traumatic experiences. The care giver also considers the substance abuser’s gender, age, race, ability to cope, stage of recovery, and interpersonal skills.
At the first meeting, the group therapy leader establishes participant expectations and ground rules via a presentation of a “group agreement.” Issues addressed in the agreement usually include confidentiality, physical contact, use of substances, contact outside the group, financial obligations, and actions that would lead to expulsion from the groups. Though the leader will require that participants accept the agreement, it is unlikely that he or she will discipline or dismiss members for violating the agreement. Rather, if a participant defies the rules of the agreement, the leader will use the situation as a discussion point and part of the group-therapy process.
There are three phases of group therapy: beginning, middle, and end. The beginning phase includes explanation of the group agreement and ground rules, as well as an explanation of the rationale and goals for the therapy. The middle phase centers on the leader feeding the group with information, whether facts about substance abuse or feelings expressed by participants in the group, and moving participants forward in the process of recovery. The middle phase is the time for participants to connect their experience and struggles to knowledge about substance abuse and the recovery process. During the end phase, the group leader provides closure by acknowledging what was shared and learned by participants, summarizing what they gained toward recovery and suggestions for continuing to move forward in the process. Alternative Approaches In 2010, eGetgoing introduced the option for an online, virtual community of group therapy. The CARF (Commission on Accreditation of Rehabilitation Facilities)-accredited, interactive 12-step substance abuse group therapy program is designed to help individuals initially seeking help, as well as those further along in the recovery process.
In 2009, Anthrozoos published the results of a study of applying animal-assisted therapy (AAT) as part of group therapy for substance abuse. Researchers concluded that, among clients who had no fear of or abusive tendencies toward dogs, the therapeutic process was significantly improved by adding a therapy dog to sessions. Connection to the recovery process through therapy is critical for clients in overcoming addiction and substance abusing practices. Toward that end, therapy dogs assist in attaching clients emotionally to the recovery process by reducing their anxiety so that they may disclose feelings and thoughts about their experience of substance abuse. Researchers urged that counselors or psychhotherapists not apply AAT as an isolated or replacement method for group therapy. Rather, they ought to utilize AAT as a complementary technique within the group therapy setting and process. A therapy dog becomes valuable as a healing presence in group therapy as he or she performs therapeutic “tricks” during sessions, such as bringing a tissue to a client who is crying and moving to the client who is speaking so that he or she may touch the dog while sharing feelings. “The dog was available when called, was nonjudgmental, and predictable in her responses,” the researchers wrote in their study. The effects were an enhanced substance abuse recovery process, they concluded.
Brook, David W., M.D., and Henry I. Spitz, M.D. The Group Therapy of Substance Abuse. Haworth Medical Press, 2004.
Cleland, Charles, et al. “Moderators of effects of motivational enhancements to cognitive behavioral therapy.” American Journal of Drug and Alcohol Abuse 31.1 (Feb. 2005): 35.
Minatrea, Neresa B. and Joshua C. Watson and Martin C. Wesley. “Animal-assisted therapy in the treatment of substance dependence.” Anthrozoos 22.2 (June 2009): 137.
“SAMHSA guide supports benefits of group therapy.” Addiction Professional 3.3 (May 2005): 60.
“Study: group therapy should be integrated for patients with co-occurring bipolar disorder and substance abuse.” Alcohol & Drug Abuse Weekly (8 Jan. 2007): 6.
Substance Abuse and Mental Health Services Administration (SAMHSA). Substance Abuse Treatment: Group Therapy, Quick Guide for Clinicians Based on TIP 41. Washington, D.C.: U.S. Department of Health and Human Services Center for Substance Abuse Treatment (CSAT), 2005.
Web Sites of Interest eGetgoing, www.egetgoing.com.
The Substance Abuse and Mental Health Services Administration, www.samhsa.gov.