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

506 V. TREATMENTS FOR ADDICTIONSmain instrument for achieving abstinence, and patients are encouraged toattend AA or to seek other forms of treatment for this purpose. Within this format,a group member can be described as “improved” along a series of 19 possibleareas of growth, irrespective of the severity of his or her drinking.This interactional model was further developed by Vannicelli (1982;Vannicelli et al., 1984), who, unlike Yalom and colleagues (1978), recommendsthat the group leaders strongly support abstinence as being essential tothe patient’s eventual emotional stability. The group leaders firmly endorsesimultaneous use of other supports, such as AA and Antabuse (disulfiram) therapy.In contrast to working with neurotics, whose anxieties provide motivationand direction for treatment, the leaders of such a group of alcoholics are forcedto intervene to provide limits and focus, without generation of more anxietythan necessary. The group therapists resist members’ inquiries into the leaders’drinking habits by instead exploring the patients’ underlying concerns aboutwhether they will be helped and understood. Patients who miss early group sessionsare actively sought out and brought back into the group. Confrontation(particularly of actively drinking members) is used sparingly and only with theaim of providing better understanding of the behavior, thus promoting growthand the necessary goal of activity changes.Interpersonal Problem-Solving Skill GroupsAccording to Jehoda (1958), interpersonal problem-solving skill groups arebased on the premise that the capacity to solve problems in life determinesquality of mental health. Several empirical studies lend some support to thisassumption, suggesting that there is a relation between cognitive interpersonalproblem-solving skills and psychological adjustment. These groups have beenimplemented for alcoholics (Intagliata, 1978) and heroin addicts (Platt, Scura,& Harmon, 1960) with some degree of success. Usually problem-solving skillsgroups are run for a limited number of sessions (frequently 10) and are organizedto teach a multistep approach to interpersonal problem solving. Mostoften, such steps include the following: (1) Recognize that a problem exists; (2)define the problem; (3) generate several possible solutions; and (4) select thebest alternative after determining the likely consequences of each of the availablepossible solutions to the problem. Follow-up studies determined thatgroups with this format were effective in generating specific skills such as anticipatingand planning ahead for problems, even following participants’ dischargefrom the treatment programs. The value of problem-solving skills groups withrespect to other primary modalities of addiction treatment, however, remains tobe determined. It is unclear, for instance, whether these groups contribute tothe overall rates of abstinence achieved in inpatient and outpatient treatmentprograms.