Group Therapy for SUDTIP 41

Share the Wealth

Javier LeyDPC Program

Mississippi CollegeFall 2014

TIP 41 Substance Abuse Treatment: Group Therapy

What is a TIP?

Treatment Improvement ProtocolPublication developed by CSAT (Center for Substance Abuse

Treatment) which is part of SAMHSADescribes best practice guidelines for topics related to SUDMixture of research and expert panel clinical experienceCan be found at: www.store.samhsa.gov

Group Therapy for SUD

Benefits of groups for SUD:1. Affiliation2. Peer support3. Peer confrontation4. Identification5. Learning coping skills6. Witnessing recovery7. 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

1. Psychoeducational Groups

2. Skills Development Groups

3. Cognitive-Behavioral Groups

4. Support Groups

5. Interpersonal Process Groups

Psychoeducational Groups

1. Teach information on: Addiction and substances Co-occurring disorders Recovery Family dynamics

2. Useful in helping clients move forward from pre-contemplation or contemplation to a preparation stage of change and beyond

Skills Development Groups

1. Cultivate skills to obtain and preserve abstinence2. Anger management3. Relaxation and visualization4. Assertiveness training5. Groups are relatively small in size (time to practice

skills)

Cognitive-Behavioral Groups

1. Cognitive restructuring for new behaviors2. Cognitive aspect targets beliefs, thoughts, opinions, and

assumptions3. Change maladaptive behavior that leads to substance

use4. Goal oriented5. Focus on immediate problems

Support Groups

1. Members help each other to maintain abstinence2. Emotional sustenance in a safe environment3. Members help each other in management of day to day

living4. Development of better interpersonal skills5. Improve members self-esteem and confidence

Interpersonal Process Groups

1. Promotes change by intervening in intrapsychic and interpersonal dynamics

2. Attachment to others is a main topic3. Developmental issues is also a main topic4. Some psychological and cognitive processes are outside

awareness5. Focus on the here and now interactions between

members

Placement Considerations

1. Clients’ needs, characteristics, stages of recovery, and preferences

2. The nature of the available groups3. Placement should be considered as constantly subject

to change4. Specific placement considerations:

Gender Age Interpersonal functioning Racial / Ethnic

Types of Groups1. Fixed 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

2. 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

3. Heterogeneous groups: Members with different characteristics: age, gender, need, other

4. Homogeneous groups: Members with same characteristics: age, gender, need, other

Stages of Treatment

1. 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

2. 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

3. 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

1. Constancy2. Active listening3. Firm identity4. Confidence5. Spontaneous 6. Integrity7. Trust8. 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?

1. Is the therapist familiar with different special populations, especially those in their community?

2. Does the therapist understand their own thoughts, feelings, and experiences regarding other cultures?

3. Which groups make the therapist feel uneasy or uncomfortable?

4. Are there resources in the community to meet the needs of special populations?

5. Are there systematic barriers or staff attitudes that inhibit cultural sensitivity in the program?

Group Components of the Matrix Model

1. Early Recovery Skills Groups 8 weekly sessions about 90 min each (2

months total)

2. Relapse Prevention Groups 32 sessions, 2 per week about 90 min

each (4 months total)

3. Family Education Group 12 weekly sessions about 90 min each (3

months total)

4. Social Support Groups Weekly sessions from month 3 until

month 12 about 90 min each

Anger Management

Cognitive behavioral in natureREBTAssertiveness training

Includes psychoeducation

Includes relaxation techniques

12 weekly session group sessions of 90 min each

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.

Thanks!!!!