Group Therapy for SUD TIP 41 Share the Wealth Javier Ley DPC Program Mississippi College Fall 2014

TIP 41 Substance Abuse Treatment: Group Therapy What is a TIP? Treatment Improvement Protocol Publication developed by CSAT (Center for Substance Abuse Treatment) which is part of SAMHSA Describes best practice guidelines for topics related to SUD Mixture of research and expert panel clinical experience Can be found at: www.store.samhsa.gov

Group Therapy for SUD Benefits of groups for SUD: Affiliation Peer support Peer confrontation Identification Learning coping skills Witnessing recovery Provide structure and discipline Also addresses other issues that accompany SUD: depression, isolation, and shame

“Identification is the antidote to loneliness, to the feeling of estrangement that seems inherent in the human condition.” Ormont, 1992

Models of Groups Psychoeducational Groups Skills Development Groups Cognitive-Behavioral Groups Support Groups Interpersonal Process Groups

Psychoeducational Groups Teach information on: Addiction and substances Co-occurring disorders Recovery Family dynamics Useful in helping clients move forward from pre-contemplation or contemplation to a preparation stage of change and beyond

Skills Development Groups Cultivate skills to obtain and preserve abstinence Anger management Relaxation and visualization Assertiveness training Groups are relatively small in size (time to practice skills)

Cognitive-Behavioral Groups Cognitive restructuring for new behaviors Cognitive aspect targets beliefs, thoughts, opinions, and assumptions Change maladaptive behavior that leads to substance use Goal oriented Focus on immediate problems

Support Groups Members help each other to maintain abstinence Emotional sustenance in a safe environment Members help each other in management of day to day living Development of better interpersonal skills Improve members self-esteem and confidence

Interpersonal Process Groups Promotes change by intervening in intrapsychic and interpersonal dynamics Attachment to others is a main topic Developmental issues is also a main topic Some psychological and cognitive processes are outside awareness Focus on the here and now interactions between members

Placement Considerations Clients’ needs, characteristics, stages of recovery, and preferences The nature of the available groups Placement should be considered as constantly subject to change Specific placement considerations: Gender Age Interpersonal functioning Racial / Ethnic

Types of Groups Fixed membership group: Revolving membership group: Stable number of members; usually no more than 15 Time limited: members start and finish together a specific number of sessions Ongoing: new members enter only when there is a vacancy; group continues over a long time Revolving membership group: Members join when they are ready for the service; total membership fluctuates Time limited: specific number of sessions Ongoing: members join until accomplishment of goals Heterogeneous groups: Members with different characteristics: age, gender, need, other Homogeneous groups: Members with same characteristics: age, gender, need, other

Stages of Treatment Early Stage of Treatment Client can be in pre-contemplation, contemplation, preparation or very early action stage of change Cognitive impairment and ambivalence about change are common Providing information is important Therapeutic factors of universality and hope for clients Sense of safety

Stages of Treatment Middle Stage of Treatment Client is usually in action stage of change Cognitive capacity begins to return Consider important role of substances in lives of people with SUD From vulnerability to adaptive coping skills Some focus on emotional and interpersonal aspects Engagement in culture of recovery Focus on positive changes from early stage to middle stage

Stages of Treatment Late Stage of Treatment Maintenance stage of change More focus on relational and psychological aspects Some clients explore existential concerns Some clients explore family of origin issues Process oriented groups could be used in this stage

Group Leader “Many therapists do not fully appreciate the impact of their personalities and values on addicts or alcoholics who are struggling to identify some viable alternative lifestyle that will allow them to fill up the emptiness or deadness within them.” Flores, 1997

Group Leader Qualities Constancy Active listening Firm identity Confidence Spontaneous Integrity Trust Empathy

Group Leader Leaders should not make themselves the center of attention Leaders are more active in earlier stages of treatment Leaders assume role of model of appropriate behaviors and less a role of mentor Leaders are sensitive to cultural / ethnic differences and its effects on group dynamics

Group Leader and Cultural / Ethnic Considerations How does the therapist preparation, culture, and ethnicity affect the group? Is the therapist familiar with different special populations, especially those in their community? Does the therapist understand their own thoughts, feelings, and experiences regarding other cultures? Which groups make the therapist feel uneasy or uncomfortable? Are there resources in the community to meet the needs of special populations? Are there systematic barriers or staff attitudes that inhibit cultural sensitivity in the program?

Group Components of the Matrix Model Early Recovery Skills Groups 8 weekly sessions about 90 min each (2 months total) Relapse Prevention Groups 32 sessions, 2 per week about 90 min each (4 months total) Family Education Group 12 weekly sessions about 90 min each (3 months total) Social Support Groups Weekly sessions from month 3 until month 12 about 90 min each The major components of the Matrix Model. The Teen Matrix has two Family Education groups; one for the clients and another for parents. Social support groups often double as alumni groups.

Anger Management Cognitive behavioral in nature REBT Assertiveness training Includes psychoeducation Includes relaxation techniques 12 weekly session group sessions of 90 min each The major components of the Matrix Model. The Teen Matrix has two Family Education groups; one for the clients and another for parents. Social support groups often double as alumni groups.

PDE: Positive Psychology and Treatment of SUD in Nicaragua Akhtar, M., Boniwell, I. (2010). Applying positive psychology to alcohol-misusing adolescents: A group intervention. Groupwork Vol. 20(3), 2010, pp.6-31 Krentzman, A.R. (2013). Review of the Application of Positive Psychology to Substance Use, Addiction, and Recovery Research. Psychology of Addictive Behaviors. 2013 March ; 27(1): 151–165. doi:10.1037/a0029897.

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