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 519OUTCOME AND COMMENTSTwo outcome studies (Galanter, 1982, 1983) of this project found that theexperimental program, with half the staffing of the traditional modality, wasquite viable in a municipal hospital alcoholism treatment program. Furthermore,retention of inpatients upon transfer to the alcohol clinic was 38%greater than in the control (non-self-help) program; rates of abstinence in outpatientswere no less, and social adjustment over the course of a 12-monthfollow-up was enhanced. The self-help format appears therefore to offer a formatfor institutional treatment that is less expensive and potentially more effective.The following case example illustrates the ethos of the self-help program:A 36-year-old outpatient came to the clinic intoxicated, without a scheduledvisit, and asked to speak with a senior patient whom he knew well. Hehad been in outpatient treatment for 8 months, and had been abstinent forthe last 4 months. Five days earlier, he had begun drinking subsequent to acrisis in his family and had missed his group meeting. He gave a history offalling down a staircase earlier in the day, bruising his head. The seniorpatient he had asked to see and another senior patient were present, andthey encouraged him to seek a medical evaluation. The case was thenreviewed with the primary therapist, who saw him briefly, wrote a referralfor medical assessment, and returned him to the two senior patients’ care.After an hour, the senior patients prevailed on him to go with one of themto the emergency service. One of them took him on the following afternoonto a meeting of an AA group he had previously attended. Thepatient was able to maintain abstinence until his next weekly group therapymeeting, at which time a group member offered to get together withhim during the ensuing week to provide him with some encouragement.Given a need for increased substance abuse treatment services, it is importantto note that counseling staff members (social workers and counselors)comprise 66% of the staffs in all federally assisted alcoholism treatment facilities,which constitute the bulk of publicly supported programs (Vischi, Jones,Shank, & Lima, 1980). The question then arises as to whether these counselingstaffers are used in the most cost-effective way. One problematic aspect of thisissue is illustrated by the finding of Paredes and Gregory (1979) that in alcoholismtreatment programs, the economic resources invested in alcoholism treatmentare not positively correlated with outcome. They concluded that the typeand quantity of therapeutic resources invested are related to the characteristicsof the agencies themselves rather than to a treatment strategy conceived foroptimal cost-effectiveness.Two issues common to most small-group therapies for substance abuse inthe clinic setting are relevant here. In the first place, whether behavioral,