Individual Group Intervention

INDIVIDUAL AND GROUP INTERVENTIONS

As an illustration it is assumed that most treatment facilities would like to use evidence based practices so they can ensure their clients will be successful throughout the treatment process. The question is what form of treatment is truly best for the client. Current research has suggestions as far as individual therapy but there is little research on the effectiveness of the varying group therapies for substance use disorder. The literature discusses the numerous variables that are difficult to control when it comes to researching this topic. Morgan-Lopez and Fals-Stewart (2006) expresses that there are many clear barriers that have made the study of substance abuse group therapy very difficult (p. 266).

The interdependence of group members creates a huge influence on the treatment process as well as the rotation of new members in the group. The participants not only have an influence on these groups but they also can impact how the treatment process affects the individual. According to Morgan-Lopez and Fals-Stewart (2006), these barriers create complicated analytic issues for investigators who wish to do research on substance abuse group therapy (p. 265). Miller, Forcehimes, and Zweben (2010) expresses that the presence of one highly disruptive individual could potentially change the dynamic of the entire group which would affect the level of participation as well as the retention rates and outcomes of the group (p. 314). This example brings light to how difficult it may be to determine the effectiveness of group therapies along with the multiple factors that may influence the group outcome. With that being said current research continues to face challenges when determining evidence based practices for group therapy in substance abuse treatment.
Many current substance use programs choose to approach treatment in a variety of ways.

These include: group therapy in a mixed group, group therapy within a gender specific group, group therapy along with individual therapy and lastly individual therapy on its own. Miller et al. (2010) states there are a large array of therapies that have been tried to treat addiction some of which include, cognitive behavioral, psychodynamic, confrontational, gestalt, group process, and motivational interviewing (p.

315).
Jhanjee (2014) explained that one of the most popular evidence based treatments for substance use include using motivational interviewing as a concurrent treatment approach (p. 112). This approach is not a standalone approach but it can be highly effective when used with other psychosocial interventions. Motivational interviewing is a non-confronting style of therapy that works toward appraising the client and meeting them where they are at in the change process (Weegmann, 2002). Cognitive behavioral therapy (CBT) combined with motivational interviewing has been known to increase the effectiveness and treatment adherence for individuals undergoing methadone maintenance treatment (Jhanjee, 2014). CBT uses strategies to recognize and challenge dysfunctional thoughts and beliefs about substance use as well as recognizing decisions that may lead to relapse (Jhanjee, 2014). Individuals who undergo treatment using this form of intervention usually work on social skills, refusal skills, relaxation training, relapse prevention, harm reduction, and learning how to cope with relapses. Cognitive behavioral therapy can be an effective form of treatment for substance abuse that can be applied to individual and group therapy. Jhanjee (2014) also discusses the effectiveness of relapse prevention therapy. These programs include identifying high risk situations, triggers and cravings, developing the social skills they need to handle cravings and other emotions associated with recovery. Relapse prevention also helps individuals process the lifestyle changes that occur when they stop using the substance.
A psychodynamic perspective has also been viewed as a common evidence based practice used to treat substance use disorder. Khantzian (2012) states “that the psychodynamic perspective assumes that addiction is primarily a disorder of self-regulation” (p. 275). These individuals suffer from addiction because they are unable to regulate major aspects of their life such as their relationships, behaviors, and their emotions (Khantzian, 2012). When working with clients that have substance use disorders, clinicians may ask how addictive drugs play a role or help with self-regulation (Khantzian, 2012). Many individuals dealing with addiction may feel overwhelmed with their own emotions, feelings of inadequacy, lack of supportive relationships, and undeveloped self-care. Throughout the psychodynamic treatment process it is important to create a safe and comfortable space where there is mutual respect. Lack of confrontation is also another important aspect of this perspective.
Another treatment approach that can be affective with substance use disorders are holistic interventions (Adedoyin, Burns, Jackson, & Franklin, 2014). Holistic approaches encompass a variety of therapies such as expressive therapy, religious interventions, art therapy, and many more. The general approach for holistic therapy is that they are working toward treating all aspects of the individual to improve treatment outcomes. Therapists that use this form of intervention are helping their clients find personally modified ways to ease their mind, body and spirit as well as finding individualized ways to cope with their substance use (Adedoyin et al., 2014). Holistic approaches shift the focus from the chaos surrounding addiction to the benefits of a healthy lifestyle.
Another common intervention used for substance abuse treatment is solution focused therapy.

This form of therapy is very person centered and focuses on the strengths and competencies of the individual rather than their failures and flaws. Throughout the literature McCollum, Trepper, and Smock (2003) express the significant impact solution focused therapy has made on the treatment of addiction within the past 20 years. Solution focused therapy can be used in both an individual and group setting. McCollum et al. (2003) gives examples as to how group therapy can help individuals solve their own issues while listening to the experiences and successes of their peers. This is known as vicarious learning and is believed to be a curative factor that is essential to group therapy. An underlying assumption of solution focused group therapy is that the group is always experiencing change. These changes may go unnoticed if the members of the group are only focusing on their problems. Another benefit of solution focused therapy is that it is cost effective and can be completed in a timely matter due to the brief duration versus traditional forms of

treatment.
Amongst the wide variety of treatments that have been discussed Miller et al. (2010) expresses that the effectiveness of individual therapy may be a precursor to similar outcomes when using it in a group format. More specifically some studies have reported better treatment outcomes when used in group formats vs. individual formats specifically for behavioral therapy. In a case study done by Panas, Caspi, Fournier, and McCarty (2003) clinical trials were done comparing the efficacy of group therapy versus individual therapy. Panas et al. (2003) states, “The primary finding was that the type of treatment of group or individual therapy is strongly associated with the achievement of treatment performance measures” (p. 276). The clients who chose to participate more actively in group therapy were found to have higher performance levels for achieving treatment goals as well as the completion of treatment (Panas et al., 2003). This case study also found that clients who completed less than four sessions of group or individual therapy were not likely to achieve positive treatment performance measures. The clinical trials done by Panas et al. (2003) also found that individuals with lower socioeconomic status and with severe substance abuse and mental health issues were less inclined to receive intense forms of treatment. This shows the importance of finding the appropriate forms of treatment for each individual client.
Some forms of treatment that have been found to be ineffective with this population are educational approaches that Miller et al. (2010) refer to as the didactic group. This form of therapy uses educational lectures as well as films to educate clients about addiction. Miller et al. (2010) states “that these approaches have been found to be the least effective out of all the treatment methods that have been studied” (p.315). These kinds of approaches are intended to educate, bring awareness, and use confrontation which has been found to have little benefit to the client (Miller et al., 2010).
Another form of treatment that has been found to be less effective is placing women in mixed groups for substance use rather than gender specific groups. A study done by Greenfield, Cummings, Kuper, Wigderson, and Koro-Ljungberg (2013) looks at the different experiences women have when placed in a mixed group versus a single gender group. From the study the women in the single gender group reported greater levels of satisfaction during the treatment process compared to the women placed in the mixed gender group (Greenfield et al., 2013). The women in the mixed gender group expressed that they had to hide parts of themselves through impression management and they felt the need to protect their image rather than express who they are as a person. Greenfield et al. (2013) explains that throughout the study women in the mixed gender group reported feeling controlled and limited in terms of discussion topics and self-presentation. The women in the mixed group also noted that they were needed to motivate the men to speak up in group therapy. The mixed group also stated that it was a more evident perception that there are differences on how men and women recover from substance addiction. The women in the single gender group stated that they felt a higher sense of safety and group cohesion because they were able to discuss sensitive topics without feeling pressure, being questioned, or any form of potential sexual tension from the male counterparts (Greenfield et al., 2013). Overall this study found that if women did not feel they were viewed by members with respect and dignity then the effectiveness of their treatment would diminish (Greenfield et al., 2013). In terms of substance use treatment the research suggests that gender specific treatment can produce higher performance rates and allow the members to feel comfortable and supported while having their needs met.