Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

23. Group Therapy, Self-Help Groups, and Network Therapy 503modalities; in each case, the mental health professional is provided with anunusual opportunity to step out of the traditional role of the psychodynamictherapist or the psychopharmacologist and examine the ways in which socialinfluence is wrought through the group setting.GROUP THERAPY FOR ALCOHOLISM AND DRUG ABUSEHow to Refer a Patient to Group TherapyAdequate matching of the treatment needs of an addicted individual with themost appropriate group therapy format is important. Psychotherapeutic groupsfor alcoholics, for example, generally fare better when all members are alcoholics,and the focus of the group is on the characteristic behaviors and consequencesof this problem. Usually each group includes from 5 to 12 memberswho meet one to three times a week. Criteria for exclusion include severesociopathy or lack of motivation for treatment, acute or poorly controlled psychoticdisorders, and the presence of transient or permanent severe cognitivedeficits. Those patients who, because of their dual problems—addiction andmental illness—cannot be integrated into single-problem group formats mustbe treated within specialized dual-diagnosis groups and treatment settings(Galanter, Castañeda, & Ferman, 1988; Minkoff & Drake, 1991). Vannicelli(1982) observed that often patients are eventually excluded from the addictiongroup if they are unable to commit themselves to working toward abstinence.Polyaddicted individuals frequently are better integrated within multifocusedgroups. While dependent and nonsociopathic individuals are more easilyengaged in interactional group models, individuals with sociopathic and othercharacter problems are better retained in coping skills groups (Cooney, Kadden,Litt, & Getter, 1991; Poldrugo & Forti, 1988).Group Treatment ModalitiesGroup treatment for alcoholism and other addictions was developed out of generaldisappointment with the results of individual therapy (Cooper, 1987).Table 23.1 presents brief descriptions of different group modalities for treatmentof addicted individuals.Leadership Style and Group AimsThe optimum style for a leader conducting a group for substance abusersappears to be one in which the focus is group- rather than leader-determined, inwhich the leader not only is knowledgeable about substance abuse but also actsas a facilitator of interpersonal process, and in which the group members seek tounderstand each other from their own perspective.