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 517tomizing alcoholism treatment to individual needs. It describes a type of therapyin which the goal is to engender patients’ active participation in AA. Itregards such active involvement as the main treatment element promotingsobriety. The study found it to be effective and equal to other treatmentsemployed, namely, MET and CBST (Nowinski, Baker, & Carroll, 1995).Institutional Self-Help Treatment GroupsMost ambulatory programs for substance abuse treatment are modeled afterones used in general psychiatric clinics. They rely primarily on professionallyconducted individual and small-group therapy. Whether there are more costeffectiveoptions or more potent ones has yet to be fully explored. One alternativeapproach to conventional institutional treatment is based on psychologicalinfluence in a self-help group context and is designed to allow for decreasedstaffing. Such an approach to group treatment is designed to draw on the principlesof zealous group psychology observed in freestanding self-help approachesto addictive illness, such as those of AA and the drug-free therapeutic communities,but at the same time serves as the primary group-based modalityemployed in an institutional treatment setting. In other words, it can beemployed in institutional settings, such as hospitals and clinics, and still capturethe psychological effect of freestanding self-help groups.In a study conducted on this treatment model (Galanter, 1982, 1983), primarytherapists were social workers and paraprofessionals experienced in alcoholismtreatment, supervised by attending psychiatrists. One social worker andone paraprofessional treated patients in the experimental self-help treatmentprogram, and two members of each of the latter disciplines treated the controls;the self-help program therefore operated at half the usual staffing level. Theprogram included an alcohol clinic attached to an inpatient detoxification unit.The control and the experimental self-help programs illustrate the contrastbetween institution-based self-help groups and conventional care. In the study(Galanter, 1982, 1983), the programs operated simultaneously and independentlyin the outpatient department. Therapists in each program were encouragedto perfect their respective clinical approaches, and each group of therapistsreceived clinical supervision appropriate to its needs and experience. Differencesbetween the two programs are outlined here to illustrate the operation ofinstitutionally grounded self-help group care.ORIENTATION PROGRAMIn the control (traditional) group setting, two primary therapists served ascoleaders of a group for their own patients, and attendance in each sessionranged between 8 and 15 patients. In the self-help program, the same formatwas used, but groups were led by patients of the primary therapists who hadestablished sobriety and had demonstrated a measure of social stability over sev-