Three cautionary notes Specialized Groups in

Thesevignettesillustratethedifferentinterven-

_{Substance Abuse}

tionsavailable.Nosingleapproachnecessarily

ismoreappropriatethananyother.The

Treatment

criticalquestionisalways,“Isthisapproach _{Avarietyoftherapeuticgroupsthatdonot} themostlikelytosucceedwiththisparticular _{fitinthealready-describedgroupmodelsmay} groupinsubstanceabusetreatment?” _{beemployedinsubstanceabusetreatment}

settings.Someofthesespecializedgroupsare Inadditiontomakingtherightstrategicchoice

uniquetosubstanceabusetreatment(like ofapproach,theinterventionsshouldbedone

relapseprevention),andothersareuniquein at the right time. Treatment as a time-depen-

format,groupmembership,orstructure(such dent process should be the guiding principle

asculturallyspecificgroupsandexpressive when working with people with addictions

therapygroups).Itwouldbeimpossibleto in group.

describeallofthetypesofspecialgroupsthat Finally,whatworksfortheclientwithout mightbeusedinsubstanceabusetreatment.

addictionswillnotalwaysworkwithaclient Thethreethatfollowrepresentacross-section

withaddictions.Consequently,therestofthis ofspecialgroups.

TIPwillbededicatedtoexploringthemodifi-

cationsingrouptechniquethatneedtobe

_Relapse

_Prevention

madewhentreatingpeoplewithsubstance

usedisorders. Relapsepreventiongroupsfocusonhelpinga

clientmaintainabstinenceorrecoverfrom relapse.Thiskindofgroupisappropriatefor clientswhohaveattainedabstinence,butwho havenotnecessarilyestablishedaproventrack recordindicatingtheyhavealltheskillsto maintainadrug-freestate.Relapseprevention

alsocanbehelpfulforpeopleincrisisorwho areinsomewaysusceptibletoareturntosub- stanceuse.

0URPOSEæRelapsepreventiongroupshelp clientsmaintaintheirsobrietybyproviding themwiththeskillsandknowledgeto“antici- pate,identify,andmanagehigh-risksituations” thatleadtorelapseintosubstanceuse“while alsomakingsecuritypreparationsfortheir futurebystrivingforbroaderlifebalance” (DimeffandMarlatt1995,p.176).Thus, relapsepreventionisadouble-levelinitiative. Itaimsbothtoupgradeaclient’sabilityto manageriskysituationsandtostabilizea client’slifestylethroughchangesinbehavior (DimeffandMarlatt1995).

0RINCIPALæCHARACTERISTICSæRelapseprevention groupsfocusonactivities,problemsolving,and skills-building.Theyalsomaytaketheformof psychotherapy.Forinstance,Khantzianetal. (1992)assertthat,becausethesametraitsin personalityandcharacterpredisposepeople tousesubstancesinitiallyandtorelapsedur- ingrecovery,psychodynamicapproachescan mitigatepsychologicalvulnerabilities.Because relapsepreventiongroupsmayusetechniques drawnfromallofthesetypesofgroups,they areconsideredaspecialtypeofgroupin

thisTIP.

Thedifferentmodels forrelapsepreven- tiongroups (Donovanand

Relapse

prevention groups

focus on activities,

problemsolving,

and skills-

building.

Chaney1985) includethosedevel- opedbyAnnisand Davis(1988),Daley (1989),Gorskiand Miller(1982),and Marlatt(1982).All ofthesemodelsare derivedfromprinci- plesofcognitive therapy.Some,such asthatofMarlatt, classifyrelapsepre- ventionasaformof

skillsdevelopment;othermodelstendto emphasizesupport.

Theseapproachesshareanumberofbasicele- ments,includingteachingclientstorecognize high-risksituationsthatmayleadtorelapse, preparingthemtomeetthosehigh-risksitua- tions,andhelpingthemdevelopbalanceand alternativewaysofcopingwithstressfulsitua- tions.Manyoftheseapproachesalsoincrease groupmembers’feelingsofself-

control,sotheyfeelcapableofresisting relapse.(Moreinformationonthetechniques ofrelapsepreventionappearsinTIP34,Brief InterventionsandBriefTherapiesfor

SubstanceAbuse[CSAT1999a].)

Researchhasdemonstratedthatrelapseiscom- monandtobeexpectedduringtheprocessof recovery(ProjectMATCH1997).Inameta- analysisof24controlledclinicaltrialsevaluat- ingrelapsepreventionprogramsdeliveredin bothgroupandindividualformats,Carroll (1996)foundthatrelapsepreventiongroups wereeffectiveincomparisontono-treatment controlsformanysubstancesofabuse;the groupsweremosteffectiveforsmokingcessa- tion.Carrollalsonotesthatrelapseprevention groupsseemtoreducetheintensityofrelapse whenitoccurs.Groupsalsoappeartobemore effectivethanotherapproachesforclientswho have“moreseverelevelsofsubstanceuse, greaterlevelsofnegativeaffect,andgreater perceiveddeficitsincopingskills”(1996,p.52). Researchalsosuggeststhatrelapseprevention canbeconductedinbothgroupandone-on- oneformats,withlittlemeasurabledifference inoutcomes.Schmitzandcolleagues(1997) comparedrelapsepreventionforcocaineabuse deliveredingroupandindividualformats. Bothdemonstratedfavorableoutcomes;no significantdifferencewasdetectedincocaine useasmeasuredbyurinetests.Clientstreated ingroups,however,reportedfewercocaine- relatedproblemsthanthosetreatedinindivid- ualsessions.Further,McKayetal.(1997) foundthat6monthsafterintensiveoutpatient treatment for cocaine abuse, subjects treated in a group setting displayed higher rates

Types of Groups Commonly Used in Substance Abuse Treatment 30

of sustained abstinence than those treated individually.

Relapsepreventioncarriedoutingroupset- tingsenablesclientstoexploretheproblemsof dailylifeandrecoverytogetherandtowork collaborativelytoisolateandovercomeprob- lems.Becauseofthesedualgoals,relapsepre- ventiongroupsmayimproveclients’qualityof life.However,asSchmitzandcolleaguesnote, itmayalsobethecasethatthegroupexperi- encemakesmemberslesswillingtoreportthe severityoftheirproblemsorcausethemtofeel thattheirproblemsarelessseverebycompari- sontothoseofothers(Schmitzetal.1997).

,EADERSHIPæSKILLSæANDæSTYLESæLeadersof relapsepreventiongroupsneedtohaveasetof skillssimilartothoseneededforaskillsdevel- opmentgroup.However,theyalsoneedexperi- enceworkinginrelapseprevention,which requiresspecializedtraining,perhapsinapar- ticularmodelofrelapseprevention.Leaders also

needawell-developedabilitytoworkongroup processissues.

Groupleadersneedtobeabletomonitorclient participationtodetermineriskforrelapse,to perceivesignsofenvironmentalstress,andto knowwhenaclientneedsaparticularinterven- tion.Aboveall,groupleadersshouldknowhow tohandlerelapseandhelpthegroupprocess suchaneventinanonjudgmental,nonpunitive way—clients,afterall,needtofeelsafeinthe groupandintheirrecovery.Leadersshould knowhowtohelpthegroupmanagetheabsti- nenceviolationeffect,inwhichasinglelapse leadstoamajorrecurrenceoftheaddiction. Additionally,theleaderofarelapseprevention groupshouldunderstandtherangeofconse- quencesaclientfacesbecauseofrelapse.These consequencescanbeculturallyspecific

responses,criminaljusticepenalties,child protectiveservicesactions,welfare-to-work setbacks,andsoon.Thegroupleader,likeany counselor,shouldknowtheconfidentiality rules(42C.F.R.Part2)andthelegalreporting requirementsrelatingtoclientrelapse.

4ECHNIQUES.Relapsepreventiongroupsdraw ontechniquesusedinavarietyofothertypes ofgroups,especiallythecognitive–behavioral, psychoeducational,skillsdevelopment,and process-orientedgroups.Becausethepurpose ofarelapsepreventiongroupistohelpmem- bersdevelopnewwaysoflivingandrelatingto others,therebyundercuttingtheneedtoreturn tosubstanceuseorabuse,potentialgroup membersneedtoachieveaperiodofabstinence beforejoiningarelapsepreventiongroup.

Communal

and

Culturally

In document Group Therapy Treatment for Substance Abuse (Revised) (Page 38-40)