Crits-Christoph, P., Johnson, J.E., Connolly Gibbons, M.B., & Gallop, R. (2013). Process predictors of the outcome of group drug counseling. Journal of Consulting and Clinical Psychology, 81(1), 23-34.
The authors report that 93% of the substance abuse treatment programs in the United States use some form of group counseling and majority of these are based on 12 -- step programs that require abstinence and the philosophy that is typically advocated in these programs such as getting a sponsor, following the 12 -- steps, etc. In addition, the authors cite evidence that group counseling is considered particularly effective for substance abuse and that there are several mechanisms by which group counseling is thought to be effective. These mechanisms include: the therapeutic alliance, group cohesion, self-disclosure, and feedback from group members and the counselor. In order to test if these variables contribute to the outcome of group counseling for cocaine dependence the authors did a four-site study of 487 patients in group sessions for cocaine addiction. The dependent variables were monthly cocaine use, next session cocaine use, and duration of abstinence. There were also two secondary outcomes measured as mediator variables which were the endorsement of the 12-step philosophy and beliefs regarding addiction. The findings indicated that self-disclosure, participation in the group sessions (and attendance), and the amount of advice given to members were either not related to improvement or negatively related to improvement. Developing a positive therapeutic alliance with the group counselor and positive reinforcement from the counselor were related to better outcomes overall.
The study has solid methodology and the findings are relevant to understanding how group counseling can assist individuals with substance abuse problems. From a process variable approach the study suggests that the therapeutic alliance may be a crucial factor in assisting individuals with substance abuse issues and that group counselors should consider developing the therapeutic alliance with such clients. Thus, in understanding how group counseling is effective for substance abuse this article is very useful in providing direction for practical and future research purposes.
J. (1997). Group counseling vs. individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: Initial results. Journal of Consulting and Clinical Psychology, 65(5), 778-788.
This study is a bit older, but has some very interesting findings. Typically severe cocaine dependence is initially treated with an intensive outpatient program followed by a longer term aftercare counseling program. The researchers in this study were interested in the differences in standard group counseling (STND) or individualized relapse prevention (RP) for cocaine abusers. Ninety-eight male veterans with lifetime diagnoses of cocaine dependence were randomly assigned to the two treatment conditions. The dependent variable was cocaine use during the treatment (five months) and during a six-month follow-up. Before entering the study the patients participated in a four-week IOP. Thorough histories were taken for each participant. There were other mediating variables that one would expect to be associated in this population including high lifetime rates of depression, anxiety, alcohol abuse, and antisocial personality disorder although still comparable with rates of these issues in non-veteran samples of cocaine users. There were several interesting results. Several predictor variables were investigated and the analysis indicated that baseline beliefs about self-efficacy were good predictors of abstinence from cocaine during the follow-up treatment. Overall the STND group had better outcomes than the RP group; however, these findings were more salient during the first three months post treatment and not at months four through six. There was a patient x treatment interaction that indicated that clients who failed to sustain from cocaine use during the IOP phase actually were more successful in sustaining abstinence with RP than STND. The researchers hypothesized that the subgroup probably did not buy into the philosophy of the STND group regarding that particular treatment's adherence to 12 -- step principles and found the more relaxed RP standards suitable to their philosophies. The researchers also did an interesting analysis of the events surrounding relapse in all of the participants and found these relapses to be associated with multiple variables including such things as sensation seeking, being exposed to cues associated with former use, and not engaging in social support.
The study offers some interesting insights into group counseling for severe substance abuse disorders. First it suggests that self-efficacy is an important construct that contribute significantly to the outcome of severe substance abuse and group counselors might want to include exercises for strengthening such beliefs early on. Secondly, it also highlights the need to consider individual variables such as pre-existing beliefs, social supports, and the identification of cues when working with this particular group in counseling sessions. Thus, this study is an excellent supplement to the understanding of treating severe substance abuse with group counseling.
Petry, N.M., Weinstock, J., & Alessi, S.M. (2011). A randomized trial of contingency management delivered in the context of group counseling. Journal of Consulting and Clinical Psychology, 79(5), 686-696.
The researchers note that contingency management interventions (CM) have been extremely effective in treating substance abuse orders, but are almost universally applied to individual counseling situations, whereas majority of treatment for substance abuse is applied in group counseling formats. The researchers also note that the research indicates that attendance in group counseling sessions for substance abuse is often very poor. Attendance to counseling sessions is an important predictor of outcome for counseling for all types of situations including substance abuse. Two hundred and thirty-nine participants were randomly assigned to group counseling sessions with CM to improve attendance (the CM consisted of a drawing where the participants could win money) or standard group counseling sessions without CM. The CM group demonstrated significantly higher attendance rates over the course of the study (about an additional 1.6 weeks of attendance) and statistically higher rates of abstinence over the study; however, the proportions of negative urine samples collected by both groups was not affected. Moreover, the CM treatment was not associated with long-term abstinence; however, the researchers note that increased attendance rates during treatment are associated with long-term abstinence. Thus the researchers consider the CM to be an important component for group counseling for substance abuse.
The study has some interesting suggestions regarding attendance rates in substance abuse groups. Apparently some external incentive may lead to better attendance in these groups and better attendance in the group has been associated with longer abstinence periods. However, it is unclear if just having participants achieve documentation by the group counselor as to their attendance as a CM or the type of CM use in this particular study would be effective. Since many people in substance abuse groups participate as some type of legal or occupational requirement perhaps simply requiring attendance and proof of attendance is sufficient. More research is needed as to how CM can improve substance abuse group counseling outcomes.
Prendergast, M.L., Messina, N.P., Hall, E.A., & Warda, U.S. (2011). The relative effectiveness of women-only and mixed-gender treatment for substance-abusing women. Journal of Substance Abuse Treatment, 40(4), 336-348.
Women with substance abuse issue often have histories that are significant for such things as abuse or trauma during childhood, relationships as adults and adolescents that are significant for violence, issues with criminal activity, involvement with child protective services, dependence on others for support and higher rates of homelessness than men. In order to evaluate the effectiveness of group counseling for women with severe substance abuse issues the researchers studied women in either substance abuse counseling groups consisting of women only (WO) or mixed groups of women and men (MG). The researchers had four specific hypotheses: (1) women in the WO groups would demonstrate less substance abuse, (2) women in the WO groups would have less criminal activity, (3) women in the WO group would have…