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Chapter 29. Group Therapy

David W. Brook, M.D.
DOI: 10.1176/appi.books.9781585623440.348732

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Group therapy has become the most widely used psychosocial treatment for substance abuse and addiction, and for most patients it remains the treatment of choice. Group therapy has been found to be clinically effective and cost-effective for both the prevention and treatment of substance abuse. The use of group therapy can address some of the relevant psychosocial issues leading to substance abuse, many of the symptoms and difficulties resulting from substance abuse and dependence, and the treatment of co-occurring psychiatric disorders. The etiology of substance abuse is most likely multifactorial, including genetic, developmental, familial, physiological, intrapsychic, interpersonal, sociocultural, and environmental factors and interpersonal attachment issues. Therefore, the treatment of substance abuse and dependence must also be multidisciplinary, using a biopsychosocial framework and including the use of medications; outpatient, inpatient, and residential treatment; and psychosocial interventions. Substance abuse may be regarded as a familial disorder, so that the parent–child mutual attachment relationship, peer interactions, personality and behavioral issues, and cultural factors such as ethnic identification (J. S. Brook et al. 2006), are important areas to explore in group therapy. Such a broad multidisciplinary approach has allowed group therapists to address diverse areas in the treatment of patients (Vannicelli 1992, 1995).

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Table Reference Number

Substance abuse and dependence are biopsychosocial disorders. Group therapy is a particular kind of psychosocial intervention for the treatment of these disorders. However, group therapy may be used in conjunction with other treatment methods, including individual therapy, psychopharmacological approaches, and other methods still in development. Concurrent individual sessions held at appropriate times may enhance the effectiveness of group therapy.

Patients should be encouraged to attend some type of 12-step program in addition to ongoing group therapy treatment, with some exceptions.

Abstinence should be the goal of treatment, although a harm-reduction approach may be useful in the course of achieving abstinence.

The therapist should maintain a relatively active role, regardless of the kind of group therapy approach he or she utilizes.

Substance abuse and dependence may be viewed as chronic, relapsing disorders of the brain with psychosocial, behavioral, and cultural antecedents and consequences. Psychosocial and cultural risk factors (and corresponding protective factors) that influence the development and course of substance abuse include the parent–child mutual attachment relationship, as well as peer and significant other interactions, personality and behavioral issues, and cultural factors, including ethnic identification. Viewed from this perspective, substance abuse and dependence have important familial and group-related etiological components. Not only are family and group issues important in the development of substance abuse, a group approach to the treatment of such issues can have important therapeutic effects. Consequences of substance abuse also almost inevitably involve family members, and are relevant for group therapy.

Because of the chronic nature of these disorders, patients may return to group therapy again and again. Although group therapy may be given in time-limited doses, its use should be viewed as part of a long-term treatment approach often necessary for the successful treatment of these patients. Many patients remain in treatment throughout their lives.

Cultural and linguistic understanding and competence are essential for the effective treatment of substance abusers. Poor communication between the group therapist and the group members will lead to poor treatment outcome and early dissolution of the therapy group.

Relationships in the group and group interactions during the course of the group process come to take the place of "relationships" with substances of abuse and interactions with "people, places, and things" that serve as risk factors for relapse.

Early-stage treatment techniques and goals differ from later-stage treatment techniques and goals.

A number of different types of group therapy use similar techniques with many points in common to treat the adverse effects of the genetic, developmental, and cognitive deficits seen in substance abusers and addicts.

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Sample questions:
1.
The selection of group members for a substance abuse group is an important first step in group therapy. Selection must exclude those who are unlikely to benefit from the group or who might disrupt the group. All of the following would generally be excluded from most groups except patients who. . .
2.
Pre-group preparation sessions are important before beginning group therapy for substance abuse. Which of the following statements regarding these sessions is false?
3.
Alcoholics Anonymous (AA) is the prototype of the 12-step model. However, the word alcohol is actually mentioned only once in the text of the 12 steps. Which step mentions alcohol specifically?
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