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Substance Abuse Treatment: Group Therapy

Ch 1 Groups and Substance Abuse Treatment The natural propensity of human beings to congregate makes group therapy a powerful therapeutic tool for treating substance abuse, one that is as helpful as individual therapy, and sometimes more successful.

One reason for this efficacy is that groups intrinsically have many rewarding benefitssuch as reducing isolation and enabling members to witness the recovery of othersand these qualities draw clients into a culture of recovery.

Another reason groups work so well is that they are suitable especially for treating problems that commonly accompany substance abuse, such as depression, isolation, and shame.

Although many groups can have therapeutic effects, this TIP concentrates only on groups that have trained leaders and that are designed to promote recovery from substance abuse.

Great emphasis is placed on interpersonal process groups, which help clients resolve problems in relating to other people, problems from which they have attempted to flee by means of addictive substances.

While this TIP is not intended as a training manual for individuals training to be group therapists, it provides substance abuse counselors with insights and information that can improve their ability to manage the groups they currently lead.

Introduction

The lives of individuals are shaped, for better or worse, by their experiences in groups. People are born into groups. Throughout life, they join groups.

They will influence and be influenced by family, religious, social, and cultural groups that constantly shape behavior, self -image, and both physical and mental health.

Groups can support individual members in times of pain and trouble, and they can help people grow in ways that are healthy and creative. However, groups also can support deviant behavior or influence an individual to act in ways that are unhealthy or destructive.

Because our need for human contact is biologically determined, we are, from the start, social creatures. This propensity to congregate is a powerful therapeutic tool. Formal therapy groups can be a compelling source of persuasion, stabilization, and support.

Groups organized around therapeutic goals can enrich members with insight and guidance; and during times of crisis, groups can comfort and guide people who otherwise might be unhappy or lost.

In the hands of a skilled, well -trained group leader, the potential curative forces inherent in a group can be harnessed and directed to foster healthy attachments, provide positive peer reinforcement, act as a forum for self -expression, and teach new social skills.

In short, group therapy can provide a wide range of therapeutic services, comparable in efficacy to those delivered in individual therapy. In some cases, group therapy can be more beneficial than individual therapy (Scheidlinger 2000; Toseland and Siporin 1986).

Group therapy and addiction treatment are natural allies. One reason is that people who abuse substances often are more likely to remain abstinent and committed to recovery when treatment is provided in groups, apparently because of rewarding and therapeutic forces such as affiliation, confrontation, support, gratification, and identification.

This capacity of group therapy to bond patients to treatment is an important asset because the greater the amount, quality, and duration of treatment, the better the client's prognosis (Leshner 1997; Project MATCH Research Group 1997).

The effectiveness of group therapy in the treatment of substance abuse also can be attributed to the nature of addiction and several factors associated with it, including (but not limited to) depression, anxiety, isolation, denial, shame, temporary cognitive impairment, and character pathology (personality disorder, structural deficits, or an uncohesive sense of self).

Whether a person abuses substances or not, these problems often respond better to group treatment than to individual therapy (Kanas 1982; Kanas and Barr 1983). Group therapy is also effective because people are fundamentally relational creatures.

Defining Therapeutic Groups in Substance Abuse Treatment

All groups can be therapeutic. Anytime someone becomes emotionally attached to other group members, a group leader, or the group as a whole, the relationship has the potential to influence and change that person.

Identifying a group as "therapy" does not imply that other groups are not therapeutic. In preparing this TIP, the consensus panel debated at length what constitutes "group therapy" and what distinguishes therapy groups from other types of groups.

Although many types of groups can have therapeutic elements and effects, the group types included in this TIP are based on the goals and intentions of the groups, as well as the intended audience of the TIP (especially substance abuse treatment counselors and other substance abuse treatment professionals). Thus, this TIP is limited to groups that (1) have trained leaders and (2) intend to produce some type of healing or recovery from substance abuse.

This TIP describes (in chapter 2) five models of group therapy currently used in substance abuse treatment:

  • Psychoeducational groups, which teach about substance abuse.
  • Skills development groups, which hone the skills necessary to break free of addictions.
  • Cognitivebehavioral groups, which rearrange patterns of thinking and action that lead to addiction.
  • Support groups, which comprise a forum where members can debunk each other's excuses and support constructive change.
  • Interpersonal process group psychotherapy (referred to hereafter as "interpersonal process groups" or "therapy groups"), which enable clients to recreate their pasts in the here -and -now of group and rethink the relational and other life problems that they have previously fled by means of addictive substances.

Treatment providers routinely use the first four models and various combinations of them. The last is not as widely used, chiefly because of the extensive training required to lead such groups and the long duration of the groups, which demands a high degree of commitment from both providers and clients.

All the same, many people enter substance abuse treatment with a long history of failed relationships exacerbated by substance use. In these cases, an extended period of therapy is warranted to resolve the client's problems with relationships. The reality that extended treatment is not always feasible does not negate its desirability.

This TIP does not discuss multifamily and multi -couple groups, which are discussed in TIP 39, Substance Abuse Treatment and Family Therapy (Center for Substance Abuse Treatment 2004).

Even though multifamily and multicouple groups typically are made up of unrelated groups of families, they focus on family relations as they affect and are affected by a member with a substance use disorder. This TIP concentrates on therapy groups, which have a distinctively different focus.

Also outside the scope of this TIP is the use of peer -led self -help groups such as Alcoholics Anonymous (AA) or group activities like social events, religious services, sports, and games.

Any or all may have one or more therapeutic effects, but are not specifically designed to achieve that purpose. Figure 1-1 shows other differences between self -help groups and interpersonal process groups. In most aspects, the comparison would apply to the other four group models as well.

Figure 1-1. Differences Between 12 -Step Self -Help Groups and Interpersonal Process Groups - see source page for Figure, and rest of chapter.