group therapy activities for substance abuse

group therapy activities for substance abuse Group therapy, alone or in combination with individual psychotherapy, is a
traditional mainstay of substance abuse services. In our experience, group
therapy provides a mechanism for addressing the unfortunately easy campus
acceptance of alcohol abuse as well as the widespread denial and minimization
of substance abuse. When individual psychotherapy reaches an impasse,
participation in a group can “inspire hope and engender the courage and
motivation to try new solutions” (Little, 2002).
Group therapy is particularly appropriate for students given their developmental
status. At an age where forming relationships is central, students
are naturally receptive to their peers’ input and amenable to learning from
their experiences and challenges. Listening in a drug-free and serious context
to how peers cope with substance abuse and other problems, they can more
objectively assess their own situations. Hearing similar stories from others,
they become aware of how drinking aff ects their own lives, and so they slowly
relinquish denial. Our students oft en report that the conversations that take
place in a group simply don’t happen outside that setting.
Of course, college students, like adolescents, can also be negatively infl uenced
by their peers. Drinkers and users tend to gravitate toward others with
similar usage patterns, which can create challenges as well as opportunities
for treatment groups. Without proper planning by the therapist, the members
in mandated group work (discussed further below) may start telling war stories
about their alcohol and drug use, and so reinforce abuse. Th erapists can
handle this danger by working with cotherapists and using their individual
or combined clout to call the process to the attention of the group. Where
appropriate, facilitators can also invite group members to challenge each
other. Oft en, students are concerned about their peers’ behaviors but need
“permission” to say it. Where there are enough referrals, it can be very useful
to integrate voluntarily motivated students with judicially mandated students.
Th e former will be able to address denial by sharing their own experiences in
facing their problems. Also, women are generally more internally motivated
than men, so a coed group oft en works best. Finally, as a last resort, it may be
helpful to remind students in judicially mandated groups that participation is
a privilege and if they cannot use the group constructively, a referral may be
made back to the judicial offi ce or to an off -campus agency.

Th ough formal inpatient and outpatient settings utilize many group modalities
to support abstinence (see Brook & Spitz, 2002), these modalities aren’t
appropriate for most students. Outlined below are the types of groups that we
have adapted to suit college students’ needs.
Psychoeducational Groups Building on the BASICS experience, these may
provide specifi c information about the nature of dependency and how students
can evaluate their own use, including whether or not they are able to
manage moderation.
For the mandated population, a time-limited group with clear expectations
has proven the most eff ective. Since students experience the group as a
judicial sanction, they need to know what will be asked of them to fulfi ll the
requirement. In our experience, three themes are eff ective in a four-session,
time-limited, structured group experience: (1) environmental infl uences on
drinking and drugging, (2) self-evaluation, including the use of drinking logs,
and (3) individual risk factors such as negative consequences of use and signs
of tolerance. Each topic takes one full session, with a fi nal session devoted
to self-refl ection and goal setting for those who are interested in behavior
change.
Another time-limited intervention (three to four sessions) utilizes stages of
change theory (Prochaska, DiClemente, & Norcross, 1992) and motivational
interviewing techniques to raise awareness of consequences and the impact of
substance abuse on students’ lives. Th rough a specifi c cost-benefi t analysis of
drinking, exploration of students’ own values, and discussion of the potential
impact of drinking on their lives, this approach can be eff ective in facilitating
movement from pre-contemplation of change to contemplation to action
(Walters and Baer, 2006).
Skills Development Groups Th ese off er moderation strategies—how to
change drinking behaviors so as to reduce harm. (Sometimes inability to
employ these strategies helps students see the need for abstinence.) Examples of
moderation strategies include eliminating “pre-gaming” (drinking before parties)
and the use of “hard” alcohol, avoiding drinking games, alternating nonalcoholic
and alcoholic beverages, and setting a limit on the number of drinks.
It is oft en helpful to encourage students to evaluate the amount of “energy” it
takes to moderate, as students demonstrating loss of control will continue to
struggle to meet their own goals. Another important harm reduction strategy
is to have a safety plan if moderation fails, such as specifying designated drivers
as well as sober friends to help protect intoxicated students from injury and
risky situations that might lead to assault or unwanted sexual behaviors.
Beginners’ Th erapy Groups Tailored for a more personalized, less structured,
and more open-ended dialogue, these groups are useful for students interested
in evaluating their relationship with alcohol and other drugs. Th ey can be mandated for students who’ve had third off enses or signifi cant negative consequences
and who’ve already completed BASICS and the time-limited group.
Th ese groups seem to work best when composed of both mandated and voluntary
students; everyone is better able to learn from each other about risks
they may be taking.
Recovery Groups Th ese are for clients who want to maintain sobriety, oft en
following formalized substance abuse treatment. Th ese groups are actually
easy to run, because members have some sobriety under their belts and a fair
amount of wisdom accumulated from treatment and life experiences. By sharing
experiences and identifying and processing new challenges, they oft en
do quite well, embracing the work enthusiastically. Th ere is little need for a
cotherapist, since the therapist needs to chime in only occasionally.
Groups in college counseling centers can be open or closed, time-limited or
ongoing. We recommend that students have a mental health screening, individual
motivational work, or individual psychotherapy prior to starting a group.