Group of people sitting close to each other and communicating.

There are a number of group approaches to recovery that can be very beneficial to individuals in treatment for substance use disorders. The major forms of groups used in recovery are group therapy and social support groups, such as 12-Step groups.

Group Therapy

The term psychotherapy, often referred to as simply therapy, describes a specific type of intervention where a formally trained individual (the therapist) applies certain interventions that have been developed from established psychological principles in order to assist people in changing their behavior, feelings, and thinking, or to help people in reaching specific goals. Based on this formal definition, the distinguishing factors between therapy and other group processes are the uses of a formally trained therapist (typically someone who has completed some postgraduate training and has a license to practice therapy), the use of specific psychological principles as interventions (e.g., not the use of medications, surgery, or techniques that are not considered to be based on validated psychological principles), and an intent to help an individual change something or reach some goal. Group therapy is very broadly defined and simply the application of therapy by one or more therapists to two or more individuals in the same session.

There are a number of different types of group therapy, including:

  • Marital or partners therapy, which is group therapy designed specifically for romantic partners
  • Family therapy, where individuals in the group are all related in some manner
  • Group therapy focused at some form of achievement, such as group therapy focused on dealing with stress
  • Group therapy focused at interventions to treat some specific type of mental health disorder, such as substance use disorders, bipolar disorder, specific personality disorders, depression, etc.

When considering the difference between what qualifies as formal therapy and other types of interventions, it is important to understand the difference between therapy (e.g. psychotherapy) and some activity that is “therapeutic.” The term therapy in the current context implies the formal definition listed above. The term therapeutic describes a subjective feeling of receiving some form of benefit associated with relief of distress or with the acquisition of some skill or understanding. Psychotherapy describes a specific form of intervention that is delivered by a specific type of individual. Any number of activities can have therapeutic benefits, such as a stroll in the park, a hot shower, listening to music, participating in therapy, participating in social support groups, etc.

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Social Support Groups

Social support groups are not specific types of therapeutic interventions in that they do not utilize the direction of a formally trained therapist. Instead, most of these groups are organized and administrated by individuals who have the specific issue that the group is addressing.

The most commonly recognized social support groups are those in the 12-Step model, such as Alcoholics Anonymous, Gamblers Anonymous, Narcotics Anonymous, etc., and support groups for families of individuals with specific issues, such as Al-Anon, a social support group designed for friends and relatives of individuals with alcohol use disorders and other substance use disorders. Social support groups can have specific agendas, routines, and even offer a targeted intervention program, such as the 12-Step model. While these groups are not forms of group therapy, much of their effectiveness occurs as a result of the advantages associated with group processes that also occur in group therapy.

Advantages Associated with Group Processes

Both of the major types of groups used in recovery share many of the same advantages. These advantages are based on the theories of group decision-making, the understanding of group processes, and studies of the processes of group therapy. According to various sources, such as the books The Theory and Practice of Group Psychotherapy, The Handbook of Group Counseling and Psychotherapy, Group Dynamics, and Group Processes, groups offer a number of advantages to reaching goals or accomplishing change.

  • Individuals who participate in groups aimed at helping them recover from substance abuse or for support with other mental health issues, group members learn from their associations with others in the group that they are not alone in their specific problems and issues. It becomes comforting to them to know that others share many of their same struggles. This can foster a sense of identity, feelings of belonging, and the release of stress and guilt.

  • Groups offer a variety of opinions, viewpoints, and potential solutions that members may not be exposed to elsewhere.

  • Members in group therapy and support groups develop working relationships that allow them to address issues more effectively. Positive working relationships (often referred to as the therapeutic alliance in therapy and as group bonding or group cohesiveness in other forms of groups) have been demonstrated to be crucial factors for positive outcomes in recovery.

  • Group interactions result in multiple levels of support. In addition, a group member can also support others. Giving and receiving support and encouragement help members to develop a broader sense of shared goals that fosters recovery.

  • Recovery groups are often composed of individuals at different stages of recovery. This can inspire individuals in the early stages of recovery and help individuals in the later stages of recovery to remember the struggles they went through and to give back to others.

  • Groups are often noted to be effective means of transferring information. Groups offer effective means of learning new skills from others and even the development of unique ways to approach older situations.

  • Groups offer individuals the opportunity to learn proactive behaviors by simply modeling the behaviors of other members. For example, individuals in groups often learn to share their own feelings, take responsibility for themselves, show concern for others, etc.

  • One of the primary factors that is associated with recovery groups is the notion that these groups develop their own identity over time. People have a need to belong to something, and many people find that their personal development occurs much more efficiently when they are involved with other individuals in a proactive interpersonal context. Often, this is referred to as group cohesion, where the members in a group feel a sense of acceptance, belonging, and validation of themselves and of the group.

  • While groups represent cooperative efforts, they tend to place responsibility and accountability on the actions of each individual member of the group. Accepting responsibility for one’s actions is a significant factor associated with positive outcomes in recovery from substance use disorders.

  • Group members often find that they develop a greater understanding of themselves through the process of interacting with others and feedback they get from other members.

  • A therapeutic phenomena known as catharsis occurs when individuals experience relief from certain types of emotional distress as a result of expressing their feelings. When group members share their experiences to a supportive collective, they often obtain relief from remorse, resentment, guilt, and shame simply as a result of being able to freely express themselves in an accepting and supportive environment.

  • Individuals in groups report that they have far better insight into motivations for their behavior and reasons for their actions based on their interactions in the group.

  • Interestingly, group members often begin to identify with other members in the group in a way that resembles relationships they have with certain family members or significant others. In formal psychotherapy, this is often referred to as transference, which has its own therapeutic effects.

  • The benefits of recovery groups often extend outside the group environment. Individuals make lasting friendships that provide important support in all aspects of their daily lives.

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Potential Disadvantages of Group Processes

Even though there are a number of important advantages to recovery groups, it would be irresponsible not to mention some potential disadvantages that can occur as a result of participating in recovery groups.

  • Group therapy results in the attention of the therapist being divided among the members of the group as opposed to being focused solely on one specific individual as occurs in individual therapy. This means that individuals may not receive interventions directly suited at any special needs they have.

  • When people are participating in group recovery sessions and disclose confidential information, they may risk privacy. Even though it is understood that members of the group are not to discuss the issues and information that are shared in the group environment, there’s no guarantee that all group members will adhere to this requirement.

  • The timing of group meetings is typically fixed and often cannot be adjusted to fit one’s schedule.

  • Some people are not motivated to participate in a group setting. These individuals may not participate and receive the full benefits of the group.

  • Sometimes, individuals who are in groups may begin to break off and form exclusive cliques or subgroups within the larger group environment. This can disrupt the benefits of the group process and should be discouraged in recovery groups.

  • Not everyone is appropriate for group recovery. Individuals that are suffering from severe mental health disorders (e.g., severe personality disorders or a psychotic disorder) are often not initially appropriate for group interventions. Other individuals may be extremely manipulative, aggressive, or extremely shy. In other situations, certain individuals may feel out of place in groups, particularly if most members of the group are not relatable to them.

  • Sometimes, groups contain too many members. Ideally, therapy groups function best when there are 8-12 members, and social support groups often function more efficiently with 10-20 group members. When groups are composed of too many members, they often lose many of their advantages.

Part of a Comprehensive Recovery Program

Rehab group on psychology support meeting, closeup

Despite some potential disadvantages to recovery groups, for the most part, the benefits of these groups outweigh any potential disadvantages. Research investigating the effectiveness of group therapy suggests that group therapy is at least as effective as individual therapy, and in some cases, it may have advantages over individual therapy.

Individuals who have attended recovery groups for a fairly significant length of time learn to pick and choose the groups that they feel that are most beneficial for them. Typically, this choice is made by individuals based on the perceived bond that the individual has with other group members and the ability for all group members to effectively share their problems and get advice without being judged.

Most often, group therapy and peer support groups are recommended are part of a comprehensive addiction treatment program. Generally, members also participate in some form of individual therapy, at least initially.