Dennis C. Daley, PhD, Antoine Douaihy, MD, Roger D. Weiss, MD, and Delinda E. Mercer, PhD
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Group therapies are used widely in the treatment of substance use disorders (SUDs) with and without co-occurring psychiatric disorders. These are often the main forms of treatment in residential rehabilitation, psychiatric hospitals, therapeutic communities, halfway houses, intensive outpatient programs, and aftercare or continuing care programs. The term “group therapy” refers to milieu, psychoeducational, coping skills, therapy groups, and other groups.
GOALS OF GROUP THERAPIES
The ultimate goal of addiction treatment is to enable an individual to achieve and maintain abstinence, but the immediate goals are to educate the individual about addiction, treatment, and recovery; help motivate him or her to stop or reduce drug or alcohol use; minimize the medical and psychosocial complications of addiction; and improve functioning and quality of life. Group therapies help patients achieve these goals by creating a milieu in which members of a group can bond with each other, thus reducing the stigma associated with addiction and the humiliation of having lost control of one’s own behavior. Treatment groups provide a context in which addicted persons can gain support, encouragement, feedback, and confrontation from peers who understand from personal experience how addicted individuals think, feel, and act, including the manipulations, schemes, and diversions they sometimes use to rationalize their substance use and other maladaptive behaviors.
ORGANIZATION OF GROUP THERAPIES
Group therapies for SUDs usually fall into one of the following categories.
Milieu
Milieu groups are offered in residential programs. A group may review the upcoming day’s schedule, discuss issues pertinent to the community of patients, ask each patient to state a goal for the day, or have patients listen to and reflect on the reading of the day. A wrap-up group may review the day’s treatment and recovery activities and provide participants a chance to reflect on their experiences and insights gained from the day’s activities.
Psychoeducational
These provide information about specific topics related to addiction and recovery, using a combination of lectures, discussions, media, behavioral rehearsals, and written assignments.
Coping Skill
These are aimed at helping patients develop or improve their intrapersonal and interpersonal skills. These may teach problem-solving methods and stress management, cognitive, and relapse prevention strategies.
Therapy or Counseling
These groups are less structured and allow participants to discuss their problems, conflicts, or struggles. These groups focus more on insight and raising self-awareness than on education or skill development.
Obstacles to Group Therapy
Problems the leader may encounter and have to address with group members include lateness, absenteeism, showing up under the influence of substances, hostility, lack of participation, boredom with the group, low motivation to change, relapses, focusing too much on external issues, proselytizing and hiding behind AA/NA, and playing cotherapist.
EMPIRICAL VALIDATION OF GROUP THERAPIES
Controlled trials of group interventions are limited, and many studies report results from “programs” that involve multiple components (i.e., individual plus group, multiple types of group treatments, or group plus other services). Most randomized clinical trials showed significant reductions in drug use, improved health, and reduced social pathology.
Reasons for Dropping Out of Group Treatment
In a National Institute on Drug Abuse–funded Collaborative Cocaine Treatment Study, patients were asked about the reasons for early termination of treatment. The reasons most commonly cited were time problems; the relapse to use or the desire to use; not finding group sessions helpful; wanting a different treatment, such as individual therapy; improvement in the problem; other unspecified reasons; unwillingness to participate in treatment; and need for hospitalization. Dropout rates are higher among clients in groups compared to individual therapy.
Need for Physician Support
Physicians and other professionals who do not provide group therapies can play a significant role in supporting and facilitating patients’ participation in groups. They can educate, encourage participation, and collaborate with group therapists.
COUNSELOR TRAINING AND SUPERVISION
Counselor Training
Group counselors or therapists should be skillful in conducting group therapy sessions. Areas of knowledge include types and effects of substances, treatment options, recovery and relapse prevention, mutual support programs, medication-assisted treatment options, and family issues. The clinician should be familiar with the Twelve-Step programs of AA and NA and other Twelve-Step programs for addiction and with alternative mutual support programs and resources for patients. Counselors should have an understanding of “group process” issues, stages of groups, multiple interventions to conduct groups and engage members, and how to balance the “content” (what is discussed) and the “process” (how member engage in the group).
Counselor Supervision and Consultation
Group counselors, especially those with less experience, benefit from regular supervision and/or consultation on groups they are conducting. Observing experienced group leaders conduct group sessions, coleading groups with these colleagues, and letting these senior staff observe and discuss group sessions are some strategies to help group leaders improve their competence and skills in conducting groups.
LIMITATIONS OF GROUP THERAPIES
One of the most common limitations of group therapies is an overemphasis on group treatment at the expense of individual treatment. Although patients are able to identify many benefits of groups, most feel that they also want individual treatment as there are problems or issues that they do not want to discuss in group sessions.
KEY POINTS
1. Group therapies are the most common psychosocial intervention used in addiction treatment programs in the United States.
2. Groups provide clients with the chance to learn information about addiction, recovery, and relapse and learn coping skills to manage the challenges of recovery.
3. Despite limited research on group therapies for addiction, there is evidence that these therapies are effective with clients with all types of SUDs in reducing substance use and improving health and quality of life.
REVIEW QUESTIONS
1. Group treatments provide a context for clients to (select all that apply):
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