PAC 330 Module 7 Group Treatment Methods Example

Ten People, Twelve Weeks: Designing a Structured Stimulant Group From Evidence on Group Treatment and Active Ingredients

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 330: Substance Abuse

Instructor Name

Month Day, Year

Ten People, Twelve Weeks: Designing a Structured Stimulant Group From Evidence on Group Treatment and Active Ingredients

Prairie Hope runs an open process group for clients using methamphetamine or cocaine. Members talk about whatever comes up, new members join at any session and the group has no set curriculum. Staff like its warmth, but about half of new members stop attending within a month, and those who stay say the same few people dominate. The program director asked for a redesigned group based on evidence. This paper proposes one. The group's members, like the program, are invented; the trials and reviews are not.

Group Versus Individual Treatment

Weiss et al. (2004) reviewed research on group therapy for substance use disorders. Group therapy is the most common format in addiction treatment, partly because of its efficiency. In studies comparing group with individual treatment, group therapy was generally as effective, and in studies comparing group therapy with no group, group therapy usually helped. The authors noted that the research base was smaller than the popularity of groups would suggest and that the content of groups mattered: structured groups with specific approaches, such as cognitive-behavioral or relapse prevention groups, had stronger evidence than unstructured ones.

Sobell et al. (2009) tested the same intervention in two formats. Adults with alcohol or drug problems were randomly assigned to receive a cognitive-behavioral motivational intervention, guided self-change, either in groups or individually. Outcomes for substance use were similar in both formats, and clients were similarly satisfied, but the group format required substantially less clinician time per client. The authors concluded that group delivery could extend services without reducing effectiveness.

Active Ingredients

Moos (2007) asked what effective treatments for substance use disorders have in common, drawing on four theories of behavior change. Social control theory points to support, structure and goal direction, which bond people to others and to purposeful activities. Behavioral economics points to rewards for activities that compete with substance use. Social learning theory points to abstinence-oriented norms and models: seeing others stay sober and sharing a group expectation of sobriety. And stress and coping theory points to building self-efficacy and coping skills. Moos argued that effective treatments, whether cognitive-behavioral, twelve-step or community reinforcement, share these ingredients, and that programs should be designed to deliver them deliberately.

The Group's Design

The redesigned group will be closed, beginning with eight to ten members who stay together for twelve weeks, which builds cohesion and allows a structured curriculum. It will meet twice weekly for ninety minutes, led by two trained counselors. Each session will open with a brief check-in in which members report any use and their week's goal, continue with a structured skills topic and close with planning for the days ahead. Members will also take part in prize-based incentives for stimulant-negative urine tests, which have strong evidence for stimulants and supply the rewards Moos describes.

Group Rules

The group will agree on rules in the first session, guided by the counselors. Confidentiality: what members share stays in the group. Attendance: members commit to attending and calling if they will miss. Respect: one person speaks at a time, and members speak from their own experience rather than advising. Coming to group after using: members are encouraged to come and talk about it, but not while intoxicated; a member who arrives intoxicated will be asked to leave that session and will meet a counselor before the next one. Members will not be discharged for relapse.

Facilitation

Two counselors will lead each session, so that one can manage the structured topic while the other attends to members' reactions. The counselors will draw quieter members in and redirect members who dominate, a problem in the old group. They will reinforce members' progress publicly, an abstinence-oriented norm, and model the motivational stance of reflecting rather than lecturing.

Membership and Screening

Members will be screened individually before the group begins. Each will meet one of the counselors to confirm a stimulant use disorder, discuss goals and check for conditions that would make the group a poor fit, such as active psychosis or a crisis requiring more intensive care. Members will be told what the group involves, including the urine testing and incentives, and asked to commit to the twelve weeks. A closed group of eight to ten allows each person time to speak and lets members get to know one another, which the old open format prevented. Clients who arrive after a cycle has started will be offered individual sessions until the next cycle begins, so no one waits without care.

Measuring Outcomes

The program will compare the new group with the old one on attendance and dropout, urine results and members' ratings of group cohesion on a brief scale at weeks four and twelve. Members will also rate their confidence in handling cravings at the start and end. If dropout in the new group falls well below the old group's rate and urine results improve, the program will expand the model.

Responding to a Member Who Relapses

Relapse in group is common and is part of the work. When a member reports using, the counselors will thank them for their honesty, explore what happened using the trigger map from week three and invite other members to share how they have handled similar moments. The member's incentive draws will reset under the contingency management rules, but the member will remain in the group. This approach supports the norm that honesty is welcome, rather than teaching members to hide use.

Conclusion

Prairie Hope's old group was warm but unstructured, and half its members left within a month. Weiss and colleagues show that group therapy can be as effective as individual treatment, especially when structured, Sobell, Sobell and Agrawal show that a structured intervention works as well in groups and saves clinician time and Moos identifies the ingredients that make treatment effective. A closed, twelve-week, structured group built around those ingredients, with incentives and clear rules, gives members more reasons to stay.

References

Moos, R. H. (2007). Theory-based active ingredients of effective treatments for substance use disorders. Drug and Alcohol Dependence, 88(2-3), 109-121. https://doi.org/10.1016/j.drugalcdep.2006.10.010

Sobell, L. C., Sobell, M. B., & Agrawal, S. (2009). Randomized controlled trial of a cognitive-behavioral motivational intervention in a group versus individual format for substance use disorders. Psychology of Addictive Behaviors, 23(4), 672-683. https://doi.org/10.1037/a0016636

Weiss, R. D., Jaffee, W. B., de Menil, V. P., & Cogley, C. B. (2004). Group therapy for substance use disorders: What do we know? Harvard Review of Psychiatry, 12(6), 339-350. https://doi.org/10.1080/10673220490905723