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Substance Abuse Treatment: Group Therapy

Ch 2 Types of Groups Commonly Used in Substance Abuse Treatment

This chapter presents five models of groups used in substance abuse treatment, followed by three representative types of groups that do not fit neatly into categories, but that, nonetheless, have special significance in substance abuse treatment.

Finally, groups that vary according to specific types of problems are considered. The purpose of the group, its principal characteristics, necessary leadership skills and styles, and typical techniques for these groups are described.

Introduction

Substance abuse treatment professionals employ a variety of group treatment models to meet client needs during the multiphase process of recovery. A combination of group goals and methodology is the primary way to define the types of groups used.

This TIP describes five group therapy models that are effective for substance abuse treatment:

  • Psychoeducational groups
  • Skills development groups
  • Cognitivebehavioral/problemsolving groups
  • Support groups
  • Interpersonal process groups

Each of the models has something unique to offer to certain populations; and in the hands of a skilled leader, each can provide powerful therapeutic experiences for group members.

A model, however, has to be matched with the needs of the particular population being treated; the goals of a particular group's treatment also are an important determinant of the model that is chosen.

This chapter describes the group's purpose, principal characteristics, leadership requisites, and appropriate techniques for each type of group.

Also discussed are three specialized types of groups that do not fit into the five model categories, but that function as unique entities in the substance abuse treatment field:

  • Relapse prevention treatment groups
  • Communal and culturally specific treatment groups
  • Expressive groups (including art therapy, dance, psychodrama)

Figure 2-1 lists some groups commonly used in substance abuse treatment and classifies them into the five -model framework used in this TIP. This list of groups is by no means exhaustive, but it demonstrates the variety of groups found in substance abuse treatment settings.

Figure 2-1. Groups Used in Substance Abuse Treatment and Their Relation to Six Group Models [see source page]

Occasionally, discussions in this TIP refer to the stages of change delineated by Prochaska and DiClemente (1984). They examined 18 psychological and behavioral theories of how change occurs, including the components of a biopsychosocial framework for understanding substance abuse.

Their result was a continuum of six categories for understanding client motivation for changing substance abuse behavior. The six stages are:

Precontemplation. Clients are not thinking about changing substance abuse behavior and may not consider their substance abuse to be a problem.

Contemplation. Clients still use substances, but they begin to think about cutting back or quitting substance use.

Preparation. Clients still use substances, but intend to stop since they have recognized the advantages of quitting and the undesirable consequences of continued use. Planning for change begins.

Action. Clients choose a strategy for discontinuing substance use and begin to make the changes needed to carry out their plan. This period generally lasts 36 months.

Maintenance. Clients work to sustain abstinence and evade relapse. From this stage, some clients may exit substance use permanently.

Recurrence. Many clients will relapse and return to an earlier stage, but they may move quickly through the stages of change and may have gained new insights into problems that defeated their former attempts to quit substance abuse (such as unrealistic goals or frequenting places that trigger relapse).

For a detailed description of the stages of change, see TIP 35, Enhancing Motivation for Change in Substance Abuse Treatment(Center for Substance Abuse Treatment [CSAT] 1999b ).

The client's stage of change will dictate which group models and methods are appropriate at a particular time. If the group is composed of members in the action stage who have clearly identified themselves as substance dependent, the group will be conducted far differently from one composed of people who are in the precontemplative stage.

Priorities change with time and experience, too. For example, a group of people with substance use disorders on their second day of abstinence is very different from a group with 1 or 2 years of sobriety.

Theoretical orientations also have a strong impact on the tasks the group is trying to accomplish, what the group leader observes and responds to in a group, and the types of interventions that the group leader will initiate.

Before a group model is applied in treatment, the group leader and the treating institution should decide on the theoretical frameworks to be used, because each group model requires different actions on the part of the group leader.

Since most treatment programs offer a variety of groups for substance abuse treatment, it is important that these models be consistent with clearly defined theoretical approaches.

In practice, however, groups can, and usually do, use more than one model, as shown in Figure 2-1. For example, a therapy group in an intensive early recovery treatment setting might combine elements of psychoeducation (to show how drugs have ravaged the individual's life), skills development (to help the client maintain abstinence), and support (to teach individuals how to relate to other group members in an honest and open fashion).

Therefore, the descriptions of the groups in this chapter are of ideal, pure forms that rarely stand alone in practice. It must be acknowledged, too, that the terms used to describe groups are not altogether clear -cut and consistent. In different treatment settings, programs, and regions of the country, a term like "support group" may be used to refer to different types of treatment groups, including a relapse prevention group.

Despite such discrepancies between neat theory and untidy practice, little difficulty will arise if the group leader exercises sound clinical judgment regarding models and interventions to be used. One exception to this assurance, however, should be noted. Close adherence to the theory that dictates the way an interpersonal process group should be conducted has crucial implications for its success.

Five Group Models

Figure 2-2 summarizes the characteristics of five therapeutic group models used in substance abuse treatment. Variable factors include the focus of group attention, specificity of the group agenda, heterogeneity or homogeneity of group members, open -ended or determinate duration of treatment, level of facilitator or leader activity, training required for the group leader, length of sessions, and preferred arrangement of the room.

Figure 2-2. Characteristics of Five Group Models Used in Substance Abuse Treatment [see source page]

Psychoeducational Groups

Psychoeducational groups are designed to educate clients about substance abuse, and related behaviors and consequences. This type of group presents structured, group -specific content, often taught using videotapes, audiocassette, or lectures.

Frequently, an experienced group leader will facilitate discussions of the material (Galanter et al. 1998).

Psychoeducational groups provide information designed to have a direct application to clients' livesto instill self -awareness, suggest options for growth and change, identify community resources that can assist clients in recovery, develop an understanding of the process of recovery, and prompt people using substances to take action on their own behalf, such as entering a treatment program.

While psychoeducational groups may inform clients about psychological issues, they do not aim at intrapsychic change, though such individual changes in thinking and feeling often do occur.

Purpose. The major purpose of psychoeducational groups is expansion of awareness about the behavioral, medical, and psychological consequences of substance abuse.

Another prime goal is to motivate the client to enter the recovery -ready stage (Martin et al. 1996; Pfeiffer et al. 1991). Psychoeducational groups are provided to help clients incorporate information that will help them establish and maintain abstinence and guide them to more productive choices in their lives.

These groups also can be used to counteract clients' denial about their substance abuse, increase their sense of commitment to continued treatment, effect changes in maladaptive behaviors (such as associating with people who actively use drugs), and supporting behaviors conducive to recovery.

Additionally, they are useful in helping families understand substance abuse, its treatment, and resources available for the recovery process of family members.

Some of the contexts in which psychoeducational groups may be most useful are

Helping clients in the precontemplative or contemplative level of change to reframe the impact of drug use on their lives, develop an internal need to seek help, and discover avenues for change.

Helping clients in early recovery learn more about their disorders, recognize roadblocks to recovery, and deepen understanding of the path they will follow toward recovery.

Helping families understand the behavior of a person with substance use disorder in a way that allows them to support the individual in recovery and learn about their own needs for change.

Helping clients learn about other resources that can be helpful in recovery, such as meditation, relaxation training, anger management, spiritual development, and nutrition.

Principal characteristics. Psychoeducational groups generally teach clients that they need to learn to identify, avoid, and eventually master the specific internal states and external circumstances associated with substance abuse.

The coping skills (such as anger management or the use of "I" statements) normally taught in a skills development group often accompany this learning.

Psychoeducational groups are considered a useful and necessary, but not sufficient, component of most treatment programs.

For instance, psychoeducation might move clients in a precontemplative or perhaps contemplative stage to commit to treatment, including other forms of group therapy.

For clients who enter treatment through a psychoeducational group, programs should have clear guidelines about when members of the group are ready for other types of group treatment.

Often, a psychoeducational group integrates skills development into its program. As part of a larger program, psychoeducational groups have been used to help clients reflect on their own behavior, learn new ways to confront problems, and increase their self -esteem (La Salvia 1993).

Psychoeducational groups should work actively to engage participants in the group discussion and prompt them to relate what they are learning to their own substance abuse. To ignore group process issues will reduce the effectiveness of the psychoeducational component.

Psychoeducational groups are highly structured and often follow a manual or a preplanned curriculum. Group sessions generally are limited to set times, but need not be strictly limited.

The instructor usually takes a very active role when leading the discussion. Even though psychoeducational groups have a format different from that of many of the other types of groups, they nevertheless should meet in a quiet and private place and take into account the same structural issues (for instance, seating arrangements) that matter in other groups.

Continued - see source page