1. Addiction Intervention
In Group Settings
Rama Gerig
SUD DBT
Therapy
Models of GT
Support
Group Social
Reinforcement
Clients
Clinicians
2. Objectives
Characteristics of individuals with Substance Use
Disorders (SUDs)
Group Intervention Factors on SUDs
Mutual Self-Help Group (MSHG)
Social Workers and MSHG
Integration of Therapeutic Treatment and MSHG
Research
3. Characteristics
PERSONALITY & BEHAVIORAL
RISK FACTORS: (Brook, 2001)
Sensation Seeking
Unconventionality
Anti-social or rebellion
Low Self-Esteem
Poor Emotional Control
(Anger)
Risky and/or Violent Behavior
Substance abusers are most
vulnerable to relapse within
the first 3 months of initiating
abstinence (Lash et al,. 2001).
GROUP INTERVENTION
FACTORS:
Can change the balance of
risky behaviors…
Major factor is abstinece and
the maintenance of sobriety...
Some group members have
had a “deeper change in
personality” (Brook, 2001)
National Institute on Health
“that group therapy can be
more beneficial than individual
therapy in some
circumstances...” (Addiction-
Treatment.com)
SUDs (Chronic relapsing disease of the brain with psychosocial, behavioral,
and societal consequences…)
4. MSHG (i.e. 12-Step Programs)
They are ‘self-governing groups
whose members share a common
health concern and give each other
emotional support and material aid,
charge either no fee or only a small
fee for membership, and place high
value on experiential knowledge in
the belief that it provides a special
understanding of a situation. In
addition to providing mutual support
for their members, such groups may
also be involved in information,
education, material aid, and social
advocacy in their communities.’
(Kelch, 2014)
Completely Voluntary
De Facto System Of Care
Fully Organized By Members
Fellowships, Peer Groups,
Mutual Aid Groups…
Focus On Higher-power, God
And Powerlessness
There Are +94 Different MSHG
In The U.S.
According To The U.S.
Department Of Health And
Human Services…
5. Social Workers and MSHG
Majority Of Substance Abuse
Programs In U.S. Incorporate
Components Of 12-step Principles
Incumbent On Workers To Be
Familiar With Literature And
Efficacy Of 12-Step Programs
(Kelch, 2014)
12-Step Programs Are An Adjunct
To Psychotherapy
Some Patients Cannot Afford
Long-term Clinical Care
Provides Clients With Ongoing
Support And Social
Reinforcement (Lash Et Al, 2001)
OUR GOAL IS TO RESTORE
OUR CLIENTS TO FULL
PSYCHOSOCIAL
FUNCTIONING
12-steps As An Adjunct Can
Provide:
Altruism - Helping Others
Universality – Accepted
Instillation Of Hope – Hearing
Other People’s Experience
Imitative Behaviors –
Observing Others With
Similar Problems (Yalom,
2005)
Caution – Avoid Burnout; Strongly Recommended To Use Personal
Therapy And Continual Supervision (Yerks, 2012)
7. Research - Are MSHGs Helpful?
(1993) -A meta-analysis done on patients in medical settings
demonstrated that patients attending AA during or after
professional treatment are more likely to show improvement
than those that do not.
(1997) – The number of AA visits in the first 3 years was
significant predictor at 8 years of continued sobriety.
(1998) – Veteran’s Affairs Longitudinal; n=3,018 found
abstinence rates twice as high at 1 year than those that did
not attend; 18 months the same result were found with
alcohol use.
(2001) – Social Reinforcement; Salem’s Veteran’s Affairs; 43
graduates from 28-day program compared to 38 graduates;
Clients receiving social reinforcement were 68.8% vs. 49.4%
more likely to attend sessions
8. References
Brook, D. W. (2001). Introduction to the special issue on group therapy and substance abuse.
International Journal of Group Psychotherapy, 51(1), 5-10. doi:10.1521/ijgp.51.1.5.49731
Emrick, C. D., Tonigan, J. S., Montgomery, H., & Little, L. (1993). Alcoholics Anonymous: What is
currently known? In B. S. McCrady & W. R. Miller (Eds.), Research on Alcoholics Anonymous:
Opportunities and alternatives (pp. 41–77). New Brunswick, NJ: Rutgers Center of Alcohol Studies.
Fiorentine, R. (1999). After drug treatment: Are 12-step programs effective in maintaining abstinence?
American Journal of Drug and Alcohol Abuse, 25, 93–116.
Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., & Haberle, B. (2004). Self-help
organizations for alcohol and drug problems: Toward evidence- based practice and policy. Journal of
Substance Abuse Treatment, 26, 151– 158
Kelch, B. P. (2014). 12 Steps for best practices in referral to mutual self-help groups. Journal of Groups in
Addiction & Recovery, 9(3), 222-236. doi:10.1080/1556035x.2014.943550
9. References
Lash, S. J., Petersen, G. E., O'connor, E. A., & Lehmann, L. P. (2001). Social
reinforcement of substance abuse aftercare group therapy attendance. Journal
of Substance Abuse Treatment, 20(1), 3-8. doi:10.1016/s0740-5472(00)00140-9
Ouimette, P. C., Moos, R. H., & Finney, J. W. (1998). Influence of outpatient
treat- ment and 12-step group involvement on one-year substance abuse
treatment outcomes. Journal of Studies on Alcohol, 59, 513–522.
Understanding Group Addiction Counseling. (n.d.). Retrieved June 24, 2016,
from http://www.addiction-treatment.com/research/group-addiction-
counseling/
Yalom, I. & Leszcz, M. (2005) The theory and practice of group
psychotherapy. (5th ed.). New York: Basic Books
Yerks, S. (2012) Countertransference knowledge and substance abuse
treatment. Master of Social Work Clinical Research Papers.
http://sophia.stkate.edu/msw_papers/106
10. "Goldilocks, I just think you're awfully judgmental. 'Too, hot, too cold,
too hard, too soft.' You need to be content with what you have."—
Greg N., Wenatchee, Wash. (AA Grapevine)
Editor's Notes
Personality and behavioral risk factors for substance use and abuse include sensation seeking, unconventionality, antisocial or rebellious behavior, low self-esteem, poor control of emotions, especially the expression of anger; and engaging in risk-taking or violent behavior.
The use of group therapy to change the balance of risk and protective factors can lead to changes in behavior and can both decrease the likelihood of the occurrence of substance abuse or addiction, and decrease the adverse effects of drug use and abuse. Group therapy can also be a major factor for change, leading to abstinence and the maintenance of sobriety and recovery. In addition, group therapy, in some patients, can bring about deeper changes in personality and decrease the likelihood or the severity of relapses.
1. Groups are excellent forums to foster self-examination, especially in the do- main of feelings, and the characterologic defenses and behaviors that mask patients’ feelings.
2. Groups provide powerful antidotes for problems with self-esteem.
3.Groups foster effective connection with others and facilitate a process to examine how and why individuals operate to make such connections unlikely
or impossible.
4. Groups are extremely beneficial in helping individuals face their behavioral dysregulation and their problems with self-care.
5. Groups are contexts where people seeking help can be remarkably sensitive and sensible in meeting each other’s needs.
6. Groups are contexts in which it is very difficult to practice “pretend and pretense.” That is, you might not know what you are feeling (even if you are acting as if you did), or you can posture and deny your vulnerability and act as if you are okay (when you are not), but in effective groups others will gently and supportively confront your denial and defenses.
Also strongly recommended is continual supervision, and even personal therapy, as this population presents challenges to success that can affect a clinicians’ confidence, can elicit strong countertransference feelings, and will expose the clinician to stories of trauma, relational failures, and despondent feelings (Forrest, 2001; Yerks, 2012). The substance use disorder clinician needs to stay realistic and positive.
Addiction literature also demonstrates the utility of 12-Step programming in supporting recovery, and the 12-Step approach is commonly integrated into addiction treatment programs.
The Center for Dependency, Addiction and Rehabilitation (CeDAR) at the University of Colorado Hospital has successfully developed programming that integrates DBT and 12-Step philosophy
1. Group psychotherapy is more interactive. 2. A group leader can actively maintain a needed focus. 3. A group leader can more efficiently maintain the correct timing of needed
interventions. 4. A group leader can function to stimulate needed responses and contain and
forestall disruptive or counterproductive interactions. 5. A group leader can set limits on destructive or unacceptable group interactions.
6. A group leader can both analyze and catalyze processes that help group members appreciate the reciprocal relationship between the distress they suffer and their characterological defenses, and how this interaction is intimately interwoven into their penchant to adopt the use of addictive sub- stances and behaviors.
7. A group leader can speak instructively, authoritatively, and, if necessary, even charismatically to draw attention to what a member or members need to hear to insure their safety, sanity, and sobriety.
