Group Therapy: Substance Abuse Treatment
Along with individual therapy, family therapy, and medication management, group therapy is an indispensable element of effective substance abuse and mental health treatment. Group therapy is a broad term for any type of therapy aimed at creating symptom reduction and recovery in two or more people 1,2.
Group therapy is an option that can be as effective as individual sessions.
Group therapy will have a trained leader conducting the session 3. Unlike family therapy, the members in group therapy will not usually have a pre-existing relationship outside of sessions.
Group therapy sessions can be conducted in varied therapeutic settings and levels of care, including 1:
For someone committed to ending their drug use and beginning a period of recovery, group therapy is an option that can be as effective as individual sessions 3.
Group therapy has a number of advantageous elements that equal or surpass individual therapy, such as the ability to 3:
- Offer members education about the recovery process.
- Provide support and motivation from peers to maintain recovery goals.
- Give members the opportunity to observe issues encountered by others in recovery and observe their methods of problem-solving.
- Empower group members by encouraging them to offer assistance and feedback to other members.
- Teach healthy coping skills to manage daily stressors without resorting to substance use.
- Boost structure and routine in the lives of group members.
- Build a sense of optimism, self-worth, and belief in the group members.
- Develop relationships between group members that can be used outside of sessions for support and encouragement.
- Effectively treat many individuals simultaneously with one therapist, allowing those clients quicker access to therapy.
- Utilize therapeutic tools (such as challenging irrational beliefs and confronting poor decision-making) to modify behaviors.
Is Group Therapy Right for Me?
People interested in attending a therapy group will need to be matched up with a group that suits their individual needs. Before placing a recovering individual in a group, a provider will consider the individual’s 3:
- Treatment preferences.
- Unique needs.
- Emotional stability.
- Stage in recovery.
Some people will not be a fit for group therapy based on their current status. This therapeutic method may be inappropriate for those who 3:
- Refuse group therapy as a viable treatment option.
- Cannot maintain confidentiality and are at risk for breaking group rules.
- Are currently in crisis with severe, unmanageable symptoms.
- Struggle to build suitable relationships.
- Experience extreme stress around other people and new situations.
Other groups, like women and adolescents, require special considerations when it comes to placement in a therapy group. Some evidence shows that women who participate in women-only groups may have better outcomes than those in groups with men 3. Also, there is some risk that adolescents in group therapy may actually encourage/reinforce substance use with each other 4. Leaders of adolescent groups must be aware of this risk and actively manage it 4.
If group therapy is recommended for you, there are 5 separate models of group sessions that you may encounter:
- Psychoeducational groups.
- Skill development groups.
- Cognitive behavioral therapy groups.
- Support groups.
- Interpersonal process groups.
With a knowledgeable and proficient treatment professional, any model can offer strong benefits; however, certain models may better fit your individual needs. Additionally, some therapy groups may take advantage of several models during the course of the meetings, meaning that they shift from one model to another.
The primary focus of a psychoeducational group is to offer education and information regarding general themes of substance use, mental health, related behaviors, and the consequences of these behaviors. These groups might resemble a classroom setting, as the material will be presented through audio, video, or a lecture format 3.
Psychoeducational groups can be helpful for many situations as it teaches members 3:
- To recognize the impact of substance use.
- About their condition, the barriers to recovery, and how to live a drug-free life.
- Beneficial skills like relaxation, meditation, healthy eating, and anger management.
Skill Development Groups
In skill development groups, the group leader will have a similar position as a teacher, but here, the material provided will be more specific to the group members and their individual needs. Skill development groups will depend more on the group interacting with each other rather than only the leader speaking to them 3.
The group sessions will focus on a skill that contributes to the members’ ability to remain abstinent from drugs. Potential group topics include 3:
- Handling triggers to engage in substance use or related behaviors.
- Positively interacting and communicating with others.
- Identifying and modifying responses to anger.
- Improving parenting skills.
- Managing financial responsibilities.
Cognitive-Behavioral Therapy Groups
Cognitive-behavioral therapy (CBT) is a widely used evidence-based style of therapy that operates on the idea that negative behaviors are learned and reinforced over time. To change these behaviors, the individual must work to modify the thoughts, feelings, and behaviors that contribute to substance use 2. One example of a thought that may contribute to continued substance use is “I’m a bad person; I don’t deserve to be sober.” By modifying damaging thoughts and beliefs, the individual can accomplish the changes needed to sustain recovery.
To accomplish these changes, a CBT group will 3:
- Identify the members’ distorted beliefs and problematic behaviors.
- Teach and encourage the use of new thinking and behavior patterns.
- Offer relapse prevention training.
As the name suggests, the principle focus of a support group is to offer care and understanding to all members of the group. This support will come from the group leader and from one member to the others. The leader will help members to improve their interpersonal skills as they engage in group discussion, share experiences, and help each other resolve their challenges 3.
The therapist will demonstrate the desired level of communication, model respectful interaction, and provide positive reinforcement for members 3.
Interpersonal Process Groups
Interpersonal process groups attempt to promote healing in members through an understanding of psychodynamics (the way individuals function psychologically). The group leader will note and process 3:
- How each member is feeling and functioning in the group.
- How the members are interacting with each other.
- How the group is performing as a whole.
A focus will be on emotional development and childhood concerns that, when left unresolved, lead to poor decision-making, impulsivity, and unhealthy coping skills. By resolving these issues, the person can improve their judgment.
With interpersonal group therapy, the content covered in each group session is secondary. Rather, the leader looks to see how the group members are behaving and interacting in the present and how their present is being influenced by their past.
A Note on Self-Help Groups
12-step groups and other self-help groups are not considered group therapy. Although they occur in a group setting with people that did not have a preexisting relationship, they lack one key component of group therapy: a professional facilitator.
Group therapies employ various types of mental health professionals to lead the groups. Self-help groups may utilize peer leaders or have a collective approach. Self-help groups provide great assistance to people in recovery, but they are not a professional group therapy option 2.
Group Therapy Categories
Based on the way the group is conducted and who participates in it, different subtypes exist for each of the aforementioned group therapy models.
Fixed and Revolving Groups
Groups can either be fixed or revolving. A fixed membership group is one that begins and ends with the same members throughout. Once the group is initiated, new members are not usually added. These groups generally have less than 15 members and are appropriate for people that are at similar points in their recovery 3.
Revolving membership groups are named for their ability to change members at any time. When someone is appropriate for the group, they will join and then leave when the time is right. These groups will be run constantly with an ever-changing collection of members 3.
Time-Limited and Ongoing Groups
Fixed and revolving groups can be divided further into time-limited or ongoing groups 3:
- Time-limited groups will ask members to attend for a specified length of time or number of sessions.
- Ongoing groups will allow members to attend indefinitely based on their symptoms and overall progress.
Each type has strengths and weaknesses, and which one will be best will depend on the unique needs of the individual. All versions can be effective.
Stages of Group Therapy
Regardless of the model or category of the therapy group, it will progress through three general stages. They are 3:
- The beginning phase—getting started. In this phase, the members will become oriented to the process and learn the group rules and goals.
- The middle phase—where change is made. The middle phase should consume the majority of someone’s time in group therapy. Here, the therapist will use their skills to trigger changes in thought patterns and modify behaviors to move towards treatment goals. This is also where meaningful connections between members will be made.
- The ending phase—moving to closure. Ideally, the relationships with leaders and members will not end abruptly. Any run of regular group therapy must come to an end at some point; however, this end point should be projected gradually to allow for adequate recognition of the accomplishments made over the course of therapy and for addressing any anxiety and/or sadness over the group coming to a close.
Group Leader Roles and Responsibilities
The qualifications and experience of those who lead therapy groups will vary somewhat. Examples of people that can lead groups include 5:
- Social workers.
- Licensed or certified substance abuse counselors.
Some terms like facilitator, therapist, or clinician are used generally and do not denote specific training or experience.
Leaders should have the following qualities to ensure an effective group 3:
- The ability to maintain a consistent, safe, supportive environment to promote abstinence.
- A strong sense of self to manage group members’ symptoms as well as the impact group sessions have on them personally.
- The ability to listen actively and make the group members feel heard.
- The use of empathy, the ability to understand what the client is experiencing.
- The capacity for projecting self-assurance and expertise that provides a role model for members.
- Creativity and flexibility to react to unexpected, unplanned situations as they present.
- A strong sense of ethics that is maintained as challenging situations arise.
- Trustworthiness that promotes openness between members and the therapist.
- The ability to use humor and levity when appropriate to balance difficult moments.
Some groups will employ a team of therapists to better manage sessions. In substance abuse treatment, all leaders will work professionally to 3:
- Link the connections between substance use and thoughts/feelings.
- Limit conflict.
- Boost motivation.
- Build coping skills.
Group therapy is a preferred option in many situations for people in various stages of recovery. If you or someone you know could benefit from participating in a therapy group, call 1-888-744-0069Who Answers? to begin the process and find treatment appropriate.
- Substance Abuse and Mental Health Services Administration. (2016). Treatments for Substance Use Disorders.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- Substance Abuse and Mental Health Services Administration. (2015). Substance Abuse Treatment: Group Therapy – Quick Guide for Clinicians.
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
- Substance Abuse and Mental Health Services Administration. (2015). Behavioral Health Treatment and Services.