How does group therapy for substance abuse work?

Rationale

By the time a person reaches the point of seeking treatment for substance abuse, he or she most likely has become alienated from friends and family because of poor behavior resulting from long-term substance abuse. Therefore, as the recovering abuser steps into a community of persons facing similar concerns, the most important benefit of group therapy is a reduction in 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 others in recovery are coping with the process, gaining feedback, encouragement, and insight. Group therapy participants also develop or relearn social skills, namely, how to interact with others while sober.

On a practical level, group therapy is cost-effective, as a single psychotherapy professional helps several persons at a time, keeping costs down. By participating in a low-cost group therapy program, substance abusers in recovery may gain a substantial return in treatment for their financial investment.

Models

The Substance Abuse and Mental Health Services Administration (SAMHSA), part of the US Department of Health and Human Services, endorses five group-therapy models as effective approaches to substance abuse treatment. These models involve 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 and provide them with information about the behaviors, risks, and effects of substance abuse. Psychoeducational groups raise awareness of the science behind the problems of substance abuse, enabling participants to understand why they need medical and psychological help. These groups also help participants understand their own behaviors, the stages of the recovery process, and what resources are available to help them cope during recovery.

Skills development groups help participants develop special skills for recovery. Chiefly, these groups help the abuser learn how to abstain from drug or alcohol use. According to SAMHSA, these development groups should teach social skills and skills that address substance refusal, communications, anger management, parenting, and money management.

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 nonjudgmental forum where participants may openly discuss their experiences and struggles with substance abuse. 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, nonjudgmental discussion. Types of group therapy 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 among members, and the group dynamic as a whole.

Structure

Because the appropriate placement of a person into a particular model of group therapy is important, a care provider first evaluates the substance abuser’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 caregiver 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 through 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 group. 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 a 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, and an explanation of the rationale and goals for the therapy. The middle phase centers on two things: the leader providing group members with information, including facts about substance abuse or feelings expressed by participants in the group, and on moving participants forward in the process of recovery. The middle phase is the time for participants to connect their experiences 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. The leader then summarizes the process and suggests how participants can continue to move forward in the process outside the group therapy environment.

Alternative Approaches

In 2010, one care provider introduced an online group-therapy community. The interactive twelve-step substance abuse group therapy program, accredited by the Commission on Accreditation of Rehabilitation Facilities, is designed to help abusers who are seeking initial help for the recovery process.

In 2009, the journal Anthrozoos published the results of a study of applying animal-assisted therapy
(AAT) to 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 abuse. 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, however, urged counselors and psychotherapists to apply AAT not as an isolated or replacement method for group therapy. Rather, AAT should be used 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 dogs provided for an enhanced substance-abuse recovery process, they concluded.

Bibliography

Brook, David W., and Henry I. Spitz. The Group Therapy of Substance Abuse. New York: Haworth Medical, 2002. Print.

Cleland, Charles, et al. “Moderators of Effects of Motivational Enhancements to Cognitive Behavioral Therapy.” American Journal of Drug and Alcohol Abuse 31.1 (2005): 35. Print.

Minatrea, Neresa B., Joshua C. Watson, and Martin C. Wesley. “Animal-Assisted Therapy in the Treatment of Substance Dependence.” Anthrozoos 22.2 (2009): 137. Print.

“SAMHSA Guide Supports Benefits of Group Therapy.” Addiction Professional 3.3 (2005): 60. Print.

Substance Abuse and Mental Health Services Administration. “Substance Abuse Treatment: Group Therapy, Quick Guide for Clinicians Based on TIP 41.” Washington, DC: Dept. of Health and Human Services, 2005. Print.