Group therapy is a cornerstone of alcohol and drug rehab. No matter what addiction treatment paradigm substance use disorder (SUD) sufferers choose in the pursuit of their recovery, some level of group dynamics will invariably be integrated into their programs. In the addiction treatment context, the group therapy process involves the gathering of multiple people struggling with SUD to share their experiences, vulnerabilities, and accomplishments in recovery.
In his renowned and repeatedly cited Theory and Practice of Group Psychotherapy, psychologist Irvin Yalom correctly asserts that most participants feel as though they are “alone in their wretchedness”; the group therapy process is meant to help those in treatment build a community and have a safe and nonjudgmental forum in which they can share their stories and struggles connected with their drug and alcohol use. The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that group therapy can have curative benefits that are not always experienced by the client in individual therapy.
What to Expect with Addiction Group Meetings
Group therapy sessions usually consist of among four to ten participants. Sessions typically last around ninety minutes and either meet weekly or on a timeline in accordance with the parameters of participants’ treatment programs. Meetings are led by an experienced and credentialed facilitator, and group therapy for alcohol and drug rehab can be conducted in an inpatient, outpatient, or partial-hospitalization setting.
In a controlled, supportive, and nonjudgmental environment, participants take turns discussing their positive and negative experiences from the week prior or those ongoing in their lives, and how those experiences have impacted their addiction recovery and overall mental health. After they’ve finished speaking, fellow participants are encouraged to provide affirmation and/or feedback.
Types of Group Therapy
There are many different types of group therapy for addiction, some of the most common including:
- Psychoeducational therapy. Participants learn specific behavioral therapies like anger management, dialectical behavioral therapy (DBT), and motivational interviewing.
- Interpersonal group therapy for addiction. Members talk about how they feel in relation to each other and focus primarily on what’s happening in their lives outside the group. A demonstration of interpersonal group therapy for addiction from Dartmouth University can be found here.
- Hybrid group therapy. Participants discuss their lives both in and out of recovery, and how they’re interconnected.
- Cognitive Behavioral Therapy (CBT). Participants identify and address distorted beliefs and problematic behaviors to cultivate new thinking and behavior patterns.
As far as membership is concerned, there are generally two types of group therapy: fixed and revolving. Fixed groups have the same members throughout the entire process, and are ideal for those who are at similar or identical points within the treatment and recovery processes. These groups also help members establish long-term connections for the basis of lasting relationships.
Revolving groups remain together only as long as each participant accomplishes their goals and may accept other members after that person leaves. Patients choose fixed or revolving groups for different reasons. SAMHSA identifies the primary distinctions between fixed and revolving groups and discusses in-depth the protocols that govern successful administration of both.
Group Therapy Topics for Addiction Treatment
Drug and alcohol use disorder (AUD) is commonly linked to underlying mental illness and is almost always the product of some type of stress or trauma. The purpose of group therapy is to provide a forum in which participants can safely and comfortably discuss these issues so they can receive insights and guidance on how to face these issues without resorting to drug or alcohol addiction.
Patients can explore a range of topics in group therapy, including, but not limited to:
The reality is that group therapy can cover any topics related to those that lead to or perpetuate participants’ substance use issues.
Identity-Specific Group Therapy
Different kinds of group therapy for alcohol and drug rehab are also available based on the identity of the population, including but not limited to men, women, teenagers, LGBTQIA+ patients, single parents, minorities, and more. Each one of these populations faces different factors that lead to and sustain their substance use, and having a group of people who are experiencing similar obstacles helps facilitate the healing process. These groups mirror the dynamics of general-identity groups and include participation in specific therapeutic techniques and, if applicable, social and recreational activities. As the group therapy landscape becomes increasingly inclusive, more and more populations are able to access group therapy that speaks directly to them.
How Long Does Group Therapy Last?
The timeline for group therapy will vary based upon the aims, techniques, and inherent nature of the group. There are essentially two types of temporal paradigms of group therapy for alcohol and drug rehab: time-limited and ongoing. Time-limited groups request that members adhere to the number of meetings and time limits for each session, set forth in the group criteria. Ongoing groups allow patients to attend meetings at their own pace based upon progress and continuing care needs.
Group therapy is generally divided into three phases:
- Beginning (Introduction) – Participants learn the group’s aims, time parameters, therapeutic techniques, and all other pertinent information.
- Middle (Application of Therapy) – Therapists or facilitators work with the group through applicable therapies to affect behavioral change and cultivate healthy emotions.
- Ending (Closure) – Participants gradually or abruptly curtail their attendance at meetings after they meet the established criteria for successful completion.
The time it takes to complete these steps will vary based on group dynamics and patients’ overall progress.
Who Leads Group Therapy Sessions?
Group therapy moderators are usually mental health professionals who are trained to administer whatever type of therapy the group offers. Some types of group leaders may include social workers, psychologists, psychiatrists, or substance use counselors.
SAMHSA recommends group leaders be able to:
- Adjust their professional styles to the particular needs of different groups
- Model group-appropriate behaviors
- Resolve issues within ethical dimensions
- Manage emotional contagion
- Work only within modalities for which they are trained
- Prevent the development of rigid roles in the group
- Avoid acting in different roles inside and outside the group
- Motivate clients in substance abuse treatment
- Ensure emotional safety in the group
- Maintain a safe therapeutic setting
- Curtail emotion when it becomes too intense for group members to tolerate
- Stimulate communication among group members
Does Group Therapy Work?
Group therapy not only works; it has become a fundamental element of modern behavioral health care. The process of group therapy has been universally endorsed by institutional authorities within behavioral health care. The American Psychological Association (APA) reports that individuals are choosing group therapy in an outpatient context as a more affordable and supportive alternative to one-on-one counseling. in the context of addiction care, group therapy occurs right alongside individualized counseling and specialized supplemental modalities that address each patient’s unique care needs. The process can also help those who have been victims of acute trauma such as sexual or other types of assault, terminal illness, and more.
Benefits of Group Therapy
Group therapy helps to humanize addiction, trauma, and other types of mental health issues and provides a positive and supportive sounding board to destigmatize these issues. It also helps participants step outside their own situations and get objective and constructive feedback regarding their conduct, care needs, and decision-making. Researchers and clinicians have written extensively on the clinical and lifestyle benefits of group therapy, including one comprehensive piece published by Psych Central editor Margarita Tartakovsky, M.S.
Some of the primary benefits of group therapy for drug and alcohol rehab include:
- A sense of community. Simply put, group therapy helps participants to feel less alone. This support gives patients the confidence and emotional strength they need to maintain recovery in their daily lives.
- Ability to empathize. Group therapy helps participants draw strength from their ability to help others and to use their experiences to inform and guide their own conduct.
- Ability to access and articulate emotions. Group therapy helps participants find their own voices and use them to enrich their own recovery and support fellow participants.
- Accountability. Perhaps most importantly, group therapy provides a safety net to help participants avoid relapse in high-stress situations by talking it out with their group and getting objective insights.
- Education. Participants learn about the disease of addiction and develop behavioral coping mechanisms in a safe, supportive, and collaborative setting.
- Empowerment. Group therapy helps participants develop a sense of stability, routine, structure, and confidence.
- Relapse prevention. Participants gain the tools they need to effectively avoid relapse during the more stressful parts of the recovery.
- Positive thinking. Participants are better able to cultivate optimism and positive thought patterns to apply to daily life in recovery.
Logistically speaking, group therapy can provide needed support during vulnerable periods and provide immediate assistance with re-entry into treatment, should participants experience a setback.
Group Therapy after Treatment
While actual clinical group therapy for alcohol and drug rehab may cease after treatment, patients are encouraged to attend group meetings well after their rehab program has concluded so they can have an ongoing network of support and increasingly stronger safety net to avoid relapse. There are group meetings all over the country through organizations like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Self-Management and Recovery Training (SMART), and others.
Very often, the transition out of treatment into everyday life can be the most challenging part of the recovery process. Attendance at group therapy meetings is crucial to help patients get emotional and, at times, logistical support they need to continue to rebuild their lives and maintain their sobriety. Issues like family estrangement, job loss, and physical- and mental-health factors are just some of the issues that those new to the recovery process face as they complete their treatment program; regular participation in post-treatment group therapy helps make these issues more manageable. Many rehab facilities will offer contact information for local group therapy meetings as part of outgoing patients’ aftercare plans.
Activities in Addiction Group Therapy
The process of addiction group therapy consists of multiple activities that allow participants to work through the behavioral aspects of their SUD. Addiction group therapy activities help promote personal growth, socialization, and communication. Group therapy includes a wide range of activities, including common practices like reading and verbally sharing stories in a structured and supportive setting.
Other social and more physically collaborative activities can often include:
- Art therapy
- Music therapy
- Wilderness adventures
- Game nights
Group therapy programs can include virtually any collaborative activity that promotes camaraderie, trust, friendship, support, and interpersonal communication. These activities can also help group members develop confidence in themselves and in people outside of therapy.
Group Therapy Worksheets
Another common group therapy exercise is the completion of worksheets that reinforce lessons and wisdom learned during meetings. These worksheets can be completed either at meetings or independently and cover a wide range of topics, including but not limited to:
- Family involvement
- Anger management
- Personal accountability
- Anxiety management
- Reality therapy
- Mindfulness exercises
- Chore completion
- Poetry and creative writing
- Dietary tracking
- Sleep tracking
- Personal strengths and weaknesses
- Confidence building
- Relapse prevention
These worksheets are commonly tailored to participants’ ages, genders, and any co-occurring mental health issues.
Is Group Therapy Right for Me?
Before patients enter any kind of group therapy paradigm, they must usually undergo a clinical assessment to determine their eligibility in accordance with established criteria.
Group therapy is generally not recommended for:
- Those suffering from acute medical diagnosis for which in-depth clinical care is needed.
- Those with trust issues and a documented difficulty to cultivate healthy relationships.
- Patients suffering from anxiety that is triggered by meeting and interacting with new people.
- Patients with behavioral issues that may violate confidentiality or be seriously disruptive to group progress.
- Patients who are deeply afraid of or resistant to sharing their experiences with others.
Many of these issues can be worked on to help patients eventually become eligible for the process.
How to Join an Addiction Recovery Group
Addiction recovery groups are offered in a wide range of paradigms. While many treatment centers heavily integrate group therapy into the fabric of their programs, it is not always necessary to enter a treatment facility to engage in group therapy for addiction. Churches and other community organizations can offer guidance toward supportive group programs. AA and NA also offer group meetings all over the country. In a clinical sense, the process of joining a therapy group for addiction recovery usually starts with seeing a mental health professional who will be able to coordinate the process. This professional will either run the group themselves or refer participants to specialized group programs.
What Is the Cost of Group Therapy for Addiction?
One of the immediate primary advantages of group therapy is its relative affordability. The typical cost of group therapy is half of that of individualized intervention. Insurance coverage is similar for both group and individual therapy. Typically group therapists charge a fixed price per member for one-hour and ninety-minute sessions. The average price of a one-hour session per member is from $35 to $50, and from $45 to $60 for a ninety-minute session. Most managed care companies cover group much the same as individual therapy, so ask your provider for more information. In the case of addiction recovery, group therapy usually occurs as part of an overall treatment program for which patients usually pay a flat fee, which may be covered by their insurance provider. Addiction treatment can be quite costly, particularly inpatient rehab programs.
Embracing Group Therapy for Lasting Recovery
Many are reluctant to try group therapy for alcohol and drug rehab because they don’t feel comfortable sharing their private experiences or putting so much of themselves out there. The reality is that group therapy strips any sense of pretense, judgment, or ego and assembles individuals who are all going through similar issues—there’s no reason to be ashamed or afraid of the process. Don’t let the fear of judgment or stigma stop you from getting the help you need. If you or your loved one are battling SUD, group therapy can be an ideal clinical resource to help you start your recovery, build a community of support, and overcome drug or alcohol addiction for good.
- nextsteptherapy.ie – Yalom’s Therapeutic Factors
- store.samhsa.gov – Substance Abuse Treatment: Group Therapy
- youtube.com – Practice Demonstration – Groups for Clients with Co-Occurring
- ncbi.nlm.nih.gov – Substance Abuse Treatment: Group Therapy
- apa.org – Power in numbers
- psychcentral.com – 5 Benefits of Group Therapy
- aa.org – Welcome to Alcoholics Anonymous
- na.org – Narcotics Anonymous WORLD SERVICES
- smartrecovery.org – Meeting Outline