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

2. 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:

3. 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

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

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

6. 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

7. 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)

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

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

18. 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

19. 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?

20. 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.

21. 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.

22. 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 March ; 27(1): 151–165. doi: /a

23. Thanks!!!!