Group therapies for drug and alcohol abusers use affiliation, support, and
peer confrontation to help patients struggling to move from addiction to
recovery. A new Treatment Improvement Protocol (TIP) from the Center for
Substance Abuse Treatment of the Substance Abuse and Mental Health Services
Administration helps define effective group therapy and may help group leaders
improve their skills for running these sessions.
The document, designated "TIP 41. Substance Abuse Treatment: Group
Therapy," says that group therapy is popular because it is both
effective and economical, since several patients can be treated at the same
"In the hands of a skilled, well-trained group leader, the potential
healing powers 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," said the document, the
product of a consensus panel headed by Philip J. Flores, Ph.D., an adjunct
clinical supervisor in the department of psychology at Georgia State
University in Atlanta.
The panel claimed several advantages for therapy groups. Groups allow
members to see how others deal with similar problems; to witness their
recovery; and to learn how to cope with problems, relate to other people, and
gain new insight and information. They can reduce the sense of isolation that
substance abusers feel by providing peer support and pressure to abstain.
Power conferred by the shared experience of abusers can help them confront
members who deny their problems. By extension, a single treatment professional
can help several patients at once, but, as participation grows, the group
members reinforce and expand the work of the leader. Groups add structure and
discipline for people often enmeshed in chaos. They can instill a sense of
Treatment programs draw from five group models:
Running any of these groups requires advanced educational and supervised
clinical training specifically for group therapy, said the TIP.
"People who abuse substances are supremely adept at helping group
leaders make mistakes," said the protocol. "Therapists need to
become well versed in the substance abuse treatment philosophy and techniques
of recovery, including the self-help approaches."
There remains some argument over whether a group leader must be someone who
is also a recovered addict.
"A leader in recovery will probably elicit trust more quickly from
group members," said the consensus panel. "[That], however, does
not automatically make that person an effective therapist. Many counselors in
recovery cannot make the switch from self- to client-centered approaches and
hold rigid views of how to manage the recovery process."
A separate, recent review of 24 prospective, treatment-outcome studies of
group therapy for substance abuse disorders produced mixed results, depending
on the design of the interventions; the populations studied; and the content,
intensity, and length of the treatment.
"Three important patterns emerge from these results," said
Roger D. Weiss, M.D., William B. Jaffee, Ph.D., and colleagues from Harvard
Medical School and McLean Hospital in the November/December 2004 issue of the
Harvard Review of Psychiatry. "Additional specialized group
therapy can enhance the effectiveness of `treatment as usual'; no differences
were found between group therapy and individual therapy; and few differences
were found among types of group therapy, with no particular type of group
therapy emerging as superior to others."
Weiss and colleagues noted the contrast between the widespread use of group
therapies and the paucity of research on the subject. They attributed that in
part to the difficulties of studying group therapy. The structure of group
membership may vary, as do the independence and interdependence of the
members, making measurements of results especially difficult.
TIP 41 is posted online at<www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.78366>.
A free copy, designated as DHHS Publication No. (SMA) 05-3991, may be ordered
by calling (800) 729-6686. An abstract of the study by Weiss et al. is posted