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SUBSTANCE ABUSE.
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Discusses group therapy for adult alcoholic abusers.... More...
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Paper Abstract:
Discusses group therapy for adult alcoholic abusers. Strategies needed for treatment of adults with alcoholic dependence; substance abuse as a mental disorder. Problems of depression in alcoholics. Controversy over the best treatment. Alcoholics Anonymous (AA) and the 12-step program. Popularity of self-help groups. Implications of support group tretment for psychiatric nurse specialists.
Paper Introduction:
GROUP THERAPY FOR ADULT SUBSTANCE ABUSE PATIENTS
This research paper will discuss the strategies needed when using group therapy for treatment of adult substance or alcoholic dependence. Included in the discussion will be an introduction to the topic and a discussion of its significance to group work, a review of current literature of the topic, and an analysis of how a prospective psychiatric nurse specialist, could apply these concepts to group work.
Introduction
Substance abuse disorders are considered some of the most prevalent mental disorders found in the United States, affecting around one in ten each year. While the 12-step program, based on the principles and practices of Alcoholics Anonymous (AA) is the most common form of treatment, it also remains one of the most con
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M. Professional Psychology: Research andPractice, 31(4), 418-422. G., &Flynn, P. While controversy continues regarding the best treatmentfor this depression, cognitive-behavioral treatment (CBT) has been shown tobe effective (Brown & Ramsey, 2 ). These variablesinclude demographic and clinical characteristics. S., Humphreys, K., & Moos, R. Group leadership style was also investigated by Kivlighan andGoldfine (1991) in an earlier study. Davison, K. In particular, group members understood their individualexperience and group events. S., Rutherford, M. While the 12-step program, based on the principles andpractices of Alcoholics Anonymous (AA) is the most common form oftreatment, it also remains one of the most controversial. R. A., & Ramsey, S. Introduction Substance abuse disorders are considered some of the most prevalentmental disorders found in the United States, affecting around one in teneach year. Journal of Consulting andClinical Psychology, 65(5), 778-788. Kivlighan, D. It has also been shown thatgroup leadership is related to group cohesiveness and engagement ofmembers, and that the pattern that develops over time is more importantthan a one-time measurement of group climate. Those with prior 12-step involvement, who havereligious beliefs and behaviors, and believe in the disease model withabstinence as the goal, are more likely to remain in 12-step groups; thuscompatibility is the key to involvement. Leaders focusing on group process instead ofindividual change were more successful. Etheridge, Hubbard, Anderson, Craddock, and Flynn (1997) used datafrom the Drug Abuse Treatment Outcome Study (DATOS) to examine structuraland treatment characteristics for programs used in 1979 to 1981. Thus, it appears that even though depression may be a part ofalcoholism, individual or CBT approaches are less effective and groupremains the most efficacious treatment modality for this group. However, group structure and leadershipstyle are important factors that need considering. Current investigation into the best treatment for alcoholismconsiders that comorbid alcoholism and depression is also a problem in theU.S., found to occur two times more than would be expected by chanceassociations. Further it was found that therapist intentions were moreimportant than overt therapist behaviors. Findings showedthat interpersonal styles of participants resulted in varying reflectionsregarding experiences and leader behavior was a function of groupdevelopment stage. It was concluded that a successful group leader must beable to understand the interpersonal styles of the group members. McKay, Alterman, Cacciola, Rutherford, O'Brien, andKoppenhaver (1997) demonstrated that standard group counseling was moreeffective than individualized relapse prevention for treatment of cocainedependence. (2 ).Give them prizes, and they will come contingency management for treatmentof alcohol dependence. GROUP THERAPY FOR ADULT SUBSTANCE ABUSE PATIENTS This research paper will discuss the strategies needed when usinggroup therapy for treatment of adult substance or alcoholic dependence.Included in the discussion will be an introduction to the topic and adiscussion of its significance to group work, a review of currentliterature of the topic, and an analysis of how a prospective psychiatricnurse specialist, could apply these concepts to group work. This was evidenced by a meta-analysis of1,571 studies with 3,5 patients and family members. Other research has shown that family-couples group therapy treatmentis effective for treatment of drug abuse and more favored, compared toindividual counseling, peer group therapy, and family psychoeducationrequiring didactic instruction. Leader intentions and associatedoutcomes were: therapeutic work was negatively related to engaged climate;safe environment was positively related to engaged climate; andinterpersonal intentions and group structure were related to positiveleader relationship. These findings point back toward the need tofurther understand the strategies needed for group psychotherapy for thispopulation. In a study of 42 alcohol-dependentveterans, those receiving contingency management remained abstinent (69percent) compared to those receiving standard treatment, who again usedalcohol (61 percent). Application of Findings for the Psychiatric Nurse Specialist Research findings have shown that support group treatment is the mostpopular and one of the most effective treatment modalities for thealcoholic or substance abuser. Equally important will be the consideration ofgroup developmental stages, group processes, and interpersonal styles toinsure group similarity, cohesiveness, and retention. Current Literature Review Davison, Pennebaker, and Dickerson (2 ) report on the currentpopularity of the self-help group. (1991). In a comparison of support groupparticipation for 2 diseases in 4 metropolitan areas, results showed thatthis support was used most for diseases with stigmas associated, such aswith AIDS, alcoholism, and cancer (breast and prostate). M. For example, the leader may need to focus on hope,universality, and acceptance during initial engagement stages and thenshift the focus to catharsis (while maintaining acceptance) for individualstages. Journal of Consulting and Clinical Psychology,68(2), 25 -257. Prizes averaged $2 . I., Cacciola, J. Agroup of 36 participants classified therapeutic factors. Depression is an important consideration in the treatment ofsubstance abuse. Group development stage is important.Future psychiatric nurse specialists need to incorporate these principlesin the group treatment of this population. A test of Yalom'shypotheses about leadership priorities. The fact that CBT has been shown to beeffective for some individuals but results in less treatment participationfor the alcoholic, may support this notion. M., Hubbard, R. Journal of Counseling Pychology, 38(2), 15 -158. C. Studies have identifiedpossible factors associated with self-help participation. Family therapy hadhigher treatment retention rates. L., & Kranzler, H. However, Mankowski, Humphreys, andMoos (2 1) reported that the use of CBT for treatment of substance abusewith didactic instruction results in less attendance and improvement than12-step group treatments. References Brown, R. While leadershipbehavior may be important in some settings, leadership intention was shownto be a more important variable for this population. Journal of Consultingand Clinical Psychology, 65(5), 768-777. M., Martin, B., Cooney, J. M., & Goldfine, D. Thus the leader of agroup for treatment of adult substance abuse must be aware of theirintentions as well as their behaviors. (1997). P., & Koppenhaver, J. American Journal of Community Psychology, 29(4),537-563. Cohesion is related to betteroutcomes since it allows for the group member to feel as if they belong andare accepted and supported by other members. (2 1). Lower levels ofparticipation were associated with diseases such as heart disease.Lifetime self-help group participation rates are around 25 million andyearly participation includes 3 to 4 percent of the population. In addition, the success rate offamily therapy points further to the importance of and the need forunderstanding the group process. Theauthors further report that the self-help concept comes from the beliefthat individuals who face a similar challenge can help each other merely bybeing together and sharing their experiences. Does group climate mediatethe group leadership-group member Outcome relationship? E. Studies also reveal that a focus on group process is more beneficialthan a focus on the individual or the use of didactic instruction, fortreatment of the alcoholic. Positive leadership style led to more memberbenefit. These groups vary instructure, including those professionally facilitated (6 percent) andthose being peer member only. Stanton, M. Petry, Martin, Cooney, and Kranzler (2 ) reported on anotherapproach that has resulted in successful treatment of alcohol dependence,that of contingency management. W., & Dickerson, S. AmericanPsychologist, 55(2), 2 5-217. Whether the 12-step program is effective or not or how it works remains unclear. M. Morgenstern, J., Labouvie, E., McCrady, B. (2 ). (2 1) further report that AA is the most used formof help for alcohol and substance abuse problems. R. WhoTalks? (2 1). M., & Tarrant, J. Endorsement of therapeuticfactors as a function of stage of group development and participantinterpersonal attitudes. Psychology of Addictive Behaviors,11(4), 244-26 . The popularity of the 12-stepprogram cannot be ignored. Similar goals and values increase attraction andgroup involvement. Treatmentconsisted primarily of group supportive therapy and urine monitoring toprevent relapse. R., Alterman, A. S. Kivlighan and Tarrant (2 1)researched and tested Yalom's hypothesis that group climate is a mediatingfactor related to leadership and outcome. (1997). A review of 135 previous studiesshowed that leader structure was consistently positively related to groupmember outcomes. (2 ). Kivlighan, D. Thereforegroup strategies must be understood. (1997). The social psychology of illness support groups. Petry, N. Age and higher educationlevel predict attendance. D., & Shadish, W. Group Dynamics: Theory, Research,and Practice, 5(3), 22 -234. Treatment Core elements included posttreatment involving12-step groups. L., Anderson, J., Craddock, S. S., Kahler, C. CBT goals and activities werefound to be negatively related to group involvement. Group counseling versusindividualized relapse prevention aftercare following intensive outpatienttreatment for cocaine dependence initial results. Individual andcontextual predictors of involvement in twelve-step self-help groups aftersubstance abuse treatment. McKay, J. J.,O'Brien, C. The authors studied groupleaders (n = 43) and group members (n = 233) and recorded intentions andclimate/satisfaction after 8 sessions. It may also support thepossibility that group cohesion is a bigger factor in depression thancognitive structures for this group. This procedure is considereduseful factor for group treatment. (1997). Mankowski et al. P., Pennebaker, J. Mankowski, E. It wasalso concluded that the leader behavior must be a function of thedevelopment stage. W., & Frey,R. The experience of a physical illness is theleading reason for self-help group participation. Yalom's hypotheses regardingrelationships between group participant interpersonal style, groupdevelopment stage, and therapeutic factor endorsement was investigated. Etheridge, R. H. In astudy of 1 patients who received an intensive 12-step substance abusetreatment, one and six month follow-up assessments demonstrated thatincreased affiliation with AA led to better outcomes (Morgenstern,Labouvie, McCrady, Kahler, & Frey, 1997). Psychological Bulletin, 122(2), 17 -191. It was concluded thatstrategies must include methods to strengthen this compatibility betweenindividual and group goals. Outcome, attrition, andfamily-couples treatment for drug abuse, a meta-analysis and review of thecontrolled, comparative studies. Treatment structure and program services in the drugabuse treatment outcome study (DATOS). Addressing comorbid depressivesymptomatology in alcohol treatment. Affiliation with alcoholics anonymous after treatment a studyof its therapeutic effects and mechanisms of action.
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