Group therapy for substance abuse
Group therapy for substance abuse is a therapeutic approach that fosters recovery through shared experiences among individuals confronting similar challenges. Recognized as a vital part of the recovery process, group therapy helps reduce feelings of isolation often experienced by those struggling with addiction. Participants benefit from peer support, learning coping strategies, and developing social skills within a nonjudgmental environment. Various models exist, such as psychoeducational groups, cognitive-behavioral groups, and support groups, each tailored to meet the diverse needs of individuals based on their backgrounds and recovery stages.
The structure of group therapy typically includes an initial phase where ground rules, including confidentiality and expectations, are established. As therapy progresses, members share their experiences, gaining insights and encouragement from one another. This communal approach not only enhances personal understanding of substance use but also reinforces skills necessary for sustaining sobriety. Recent adaptations, such as online group sessions and the incorporation of animal-assisted therapy, have expanded accessibility and enriched the therapeutic experience. Overall, group therapy serves as a comprehensive, culturally sensitive resource that supports individuals on their journey to recovery from substance abuse.
Group therapy for substance abuse
DEFINITION: Group therapy, a critical component of the substance abuse recovery process, is promoted by the US Substance Abuse and Mental Health Services Administration as a cost-effective treatment for substance abuse. Although group therapy is important to a comprehensive treatment plan, it does not replace core mental health and physician services that focus on substance abuse treatment.
Rationale
By the time a person reaches the point of seeking treatment for substance abuse, they most likely have become alienated from friends and family because of poor behavior resulting from long-term substance abuse. Therefore, as the individual in recovery 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 and 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, individuals who abuse substances 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 an individual who has a substance use disorder depends on their 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 individual who uses substances 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 individuals 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 individual’s background, needs, and stage of recovery. Depending on the individual’s circumstances and preferences, the care provider matches them 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 individual’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 they 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 an 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 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 individuals who are seeking initial help in the recovery process. Such approaches became more common in 2020 when many locations used for group therapy were closed during the COVID-19 pandemic. Meetings such as Alcoholics Anonymous, Narcotics Anonymous, and Gamblers Anonymous adapted to the environment and held meetings online, created mobile applications, and increased online resources. Though these program adaptations were born of necessity, many changes became permanent fixtures in these twelve-step programs. The addition of online options allowed the programs to reach more people in rural areas.
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 they perform 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 they 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. This was further confirmed in studies of inpatient and outpatient substance abuse treatment, including treatment for a dual pathology.
Bibliography
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