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 509bouts of anger, often directed at his wife, children, and coworkers.Although he had no history of psychiatric or medical problems, he reluctantlyacknowledged that his wife thought he drank too much and that hisboss had strongly demanded that he do something about his angry outburstsand poor job attendance. The patient was referred for individualtherapy, but initial attempts at establishing a therapeutic relationshipfailed. He displayed markedly narcissistic personality traits, which resultedin an often disruptive relationship with the therapist, and he had difficultyin recognizing any interpersonal and mood problems associated with hisalcohol consumption. The patient, however, acknowledged drinking moreand more often than was “healthy” for him. His motivation for treatmentderived from his determination to maintain his current employment andhis interest in learning how to avoid depressive thinking.Both the patient and the therapist felt that no progress was beingmade in individual therapy, and the therapist then referred the patient toalcoholism group treatment. In the group, the patient was exposed to othergroup members’ descriptions of their problems of mood and social relations.On two occasions during the beginning phases of his involvementwith the group, he came to the group while intoxicated. The threat ofexpulsion from the group in the face of these intoxications brought intofocus the similar situation he faced at work, where his drinking was alsojeopardizing his ability to remain employed. Confronted by group membersand therapists alike, he eventually identified a relationship between hisdrinking and his angry outbursts at home and at work. From the outset, hisdrinking was interpreted by other group members as a reflection of hisalcoholism rather than the expression of psychological conflicts. After afew months in treatment, this patient finally felt that he indeed was analcoholic. The absence of drinking was associated with a total remission ofdepressive moods. He eventually made a commitment to abstinence, andhe remained in group treatment for several years.Management of Group Members Who Do NotRemain AbstinentDrinking by some group members is to be expected in alcoholic groups. Fullblownslips or covert drinking by any group member interrupts the group process,elicits drinking-related thoughts and behaviors in other members, andrequires specific and prompt intervention by the group leader. Often, however,a well-managed drinking episode represents an invaluable learning opportunityfor all group members. A slip is not in itself cause for dismissal from the group.A resumption of drinking illustrates to all members the importance of promptidentification and interruption of denial, and the need constantly to ensure theeffectiveness of selected measures for maintaining abstinence. Responsibility forthe slip should be defined to the group as resting entirely on the patient who is