Chapter 3 - Overview of Group Treatment for Cocaine Addiction

Group treatment sessions are a vital aspect of recovery from cocaine addiction. Groups give clients the opportunity to learn the facts about cocaine addiction and recovery so that they can better understand their drug use problems. Clients also gain strength and hope from each other, learn to use and benefit from social support, and begin to feel valued because they are helping others who are trying to recover from cocaine addiction. Although specific group sessions vary in content and focus during Phase I (weeks 1-12) and II (weeks 13-24), the general purpose of group treatment is to provide members with an opportunity to:

• Acquire information about important concepts and aspects of recovery from addiction to cocaine or other substances. This includes but is not limited to information on:
• Symptoms of addiction dependence and withdrawal
• Factors contributing to addiction
• The recovery process
• Biopsychosocial issues in recovery
• Phases of recovery and common problems experienced in each phase
• Cocaine and other drug cravings
• Social pressures to use substances
• People, places, events, and things that trigger substance use
• Effects of cocaine addiction on family and other relationships
• Self-help groups
• Support systems
• How to cope with feelings
• Guilt and shame
• Relapse risk factors
• Relapse warning signs
• Tools for use in ongoing recovery
• Become more aware of their own problems and issues and how they relate to cocaine addiction and recovery. The group counselor encourages clients to relate personally to the material presented or discussed in sessions.
• Give support to and receive support from each other by providing feedback and sharing problems, successes, hopes, and strength. Through the group experience, group members learn the importance of mutual support. They also learn the importance of confronting negative attitudes and managing unhealthy behaviors.
• Learn recovery coping skills to deal with problems that contribute to or result from the addiction, to reduce the chances of a relapse to cocaine addiction and to improve functioning. These coping skills include cognitive, behavioral, and interpersonal skills that can be used to manage the various challenges of recovery.

Both the content and the process of group treatment for cocaine addiction are important. Content refers to the “what” of group therapy, that is, the specific topics, problems, or issues discussed in the sessions. The specific content areas covered during the 12 sessions of Phase I are described in Chapter 5 of this manual. Process refers to the “how” or the “method” of the group. Process is how the group counselor conducts the group so that differences among group members are considered. Group counselors should strive to maintain a balance among the three key elements of the group: the individual member; the topics, themes, or problems discussed; and the group as a whole. The counselor should protect the group process by encouraging members to be on time, participate actively in discussions, listen to each other, and provide support and feedback.

Group counselors function as educators and counselors, and they use a variety of interventions to conduct group sessions in both phases of treatment. These interventions include:

• Providing information about addiction and recovery and clarifying issues and answering questions related to the content of the sessions, particularly in Phase I.
• Helping members relate personally to the psychoeducational concepts discussed. The group counselor tries to get members to relate less intellectually and more personally to the material.
• Facilitating group interaction among clients so that all members participate and share their thoughts, feelings, and experiences.
• Validating issues or struggles presented by individual members. If a group member is struggling with relapse, the group counselor acknowledges the struggle without being judgmental and tries to elicit support from other members of the group.
• Modeling healthy behaviors. This may involve providing positive reinforcement or modeling healthy communication with others.
• Challenging counterproductive activities and behaviors. This may involve giving a group member feedback on his or her current behavior and pointing out behaviors that interfere with the group’s ability to achieve its goals.
• Monitoring drug use or “close calls.” The group counselor structures group sessions to discuss episodes of substance use as well as strong cravings or close calls. Members can learn a lot from each other’s mistakes.
• Encouraging attendance at self-help groups, particularly 12-step groups. This therapy model supports a positive view of AA, NA, and CA programs. However, it is recognized that some group members won’t attend 12-step meetings but may benefit from other types of self-help programs.
• Motivating members to talk directly to each other when sharing their opinions, discussing experiences, or providing feedback. The group counselor should be less of an “expert” and more of a facilitator during discussions of recovery concerns, problems, and issues.

Group counselors should encourage all members of the group to participate in every session by voicing their opinions, feelings, and experiences as they relate to the topic covered. Group counselors should draw quiet members into the discussion by asking them direct questions or seeking their opinions (e.g., “John, what is your experience with the issue of denial?” or “Madge, how do you relate to what’s been discussed about relapse warning signs?”). Group counselors should not let a member dominate the group discussions and should set limits as needed (e.g., “Carlton, I appreciate the fact that you have a lot of ideas to offer the group. Let’s hear from some other members now to see how they relate to….” or “Lisa, it’s great you have so many experiences or ideas to share, but we want to make sure others get a chance to talk, too.”).

Group counselors should provide positive reinforcement to both the group and individual members to foster group cohesion and trust. Reinforcement should be given even when a member talks about a lapse or relapse (e.g., “Luwanda, it’s good that you talked to the group about your recent relapse and asked for their input.”).

A key component of group sessions is realistic feedback about members’ attitudes or behaviors. When possible, the group counselor should encourage group members to provide feedback to another member who shows negative attitudes or behaviors (e.g., “Mike, what do you think about Jack’s statement that NA meetings are a waste of time?” or “Liz, what do you think about Jack’s statement that a few beers or joints won’t hurt, that as long as he stays clean from cocaine he’ll be OK?”). Similarly, positive feedback can be elicited from group members to support efforts made by another member (e.g., “What do others think about how Fran was able to resist her strong urge to smoke crack?”).

The group counselor also can provide direct feedback to an individual client or to the group by simply commenting on what he or she has observed. This type of intervention serves as a “model” for the other group members to use to provide feedback. It also provides members of the group with an opportunity to hear the group counselor’s perspective on an individual member (e.g., “John, I notice that when other members give you feedback, you interrupt them or argue with them.” or “Mary, you did a great job talking about how your addiction really messed up your life. It takes a lot of courage to be so honest.”) or on the group (“I notice that the discussion has shifted away from the topic of relationships in recovery to….” or “Your group did a nice job today talking about the ways AA and NA can aid recovery.”).

At times, a group member is in a state of crisis because he or she has suffered a recent lapse or relapse. The group counselor can enlist some group members to help this member explore the lapse/relapse so that he or she may learn from it and develop a way to stop it. Other life problems may create crises for some group members, as well. Although the group counselor can adhere to the principle of “disturbance takes precedence,” in Phase I, the group counselor must guard against spending too much time helping individual members resolve specific crises at the expense of reviewing the psychoeducational material pertaining to recovery. The group leader can see a member with a serious crisis before or after the group meets or during a scheduled appointment the next day. This member also can be encouraged to discuss the current crisis with an AA/NA/CA sponsor or with friends.

In this GDC model, group treatment for cocaine addiction is provided in two phases. These phases coincide approximately with clients’ needs in recovery, although individuals in recovery progress at their own pace. Clients are expected to begin Phase I as soon as they start the stabilization phase of treatment. Starting in groups right away provides them with group support in the early phase of recovery and helps them in their efforts to initiate abstinence.

The treatment groups have a rolling admissions policy. That is, a client may enter the group at any session because a single recovery topic is covered completely within each session during Phase I. The counselor tries to make each recovery topic equally beneficial for all clients, regardless of what stage of recovery they are in.

Phase I of the group treatment involves the first 12 weeks of therapy and is structured and psychoeducational in nature. Each Phase I session uses a curriculum with specific objectives that relate to an important aspect of addiction and recovery. Phase I provides an overview of the key issues in early recovery related to addiction, the recovery process, and relapse prevention.

A more “open” problem-solving approach is used to discuss current concerns and problems during the next 12 weeks in Phase II. Clients set the agenda for discussion during each group session in this phase. More specific details of Phase I and Phase II groups are provided in Chapters 5 and 6 of this manual.

The group counselor meets with each client before starting Phase I or II group sessions. During this orientation session, the counselor discusses how important recovery groups are in the addiction treatment program. Participating in recovery groups can help clients establish and maintain abstinence by providing additional structure and “positive peer pressure” to encourage them to follow through with recovery-oriented activities. Clients are told that they will learn important information about addiction and recovery and begin to develop coping skills to aid their recovery. The group provides supportive contact with caring, well-trained counselors as well as with peers who are working on their own recovery. The counselor also informs the client about the logistics of the group sessions and reviews the focus of Phase I and II (see Appendices A and B).

Group rules also are reviewed during the orientation, and the client signs a form agreeing to abide by these rules. The rules encourage clients to come to group sessions free of the influence of cocaine or other substances, make a commitment to attend weekly group meetings, call to explain why he or she was absent from any group meetings, discuss close calls or actual episodes of cocaine or other substance use, and maintain confidentiality.

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