Psychotherapeutic Approaches to Group Therapy for Addiction
Addiction is a serious public health problem worldwide, a national crisis in need of urgent intervention, many precious lives have been lost, young and old are affected accordingly, homes and families are shattered and children are left without hope and future, foster care is on the rise by the minutes, DFCS work load had increased, social services are unable to keep up with the related emergencies, jail centers are filled and psychiatric units have no more openings to accommodate this problem. As a missionary, I can relate to this problem after travelling within and outside of the United States. This is a major issue of concern in psychiatric and mental health services.
According to Wheeler, 2014, Addiction is a primary, progressive, and chronic disease of the brain involving memory, motivation, and other neurological phenomena, a major dysfunction affecting an individual biologically, psychologically, socially, and spiritually; relapse and remission is not uncommon; characterized by pathological pursue of rewards or relief, many impairments and inabilities like lack of control and inability to abstain, craving, dysfunctional emotional responses, lack or no recognition of one’s behavior and interpersonal relationships. Stress and coping with life events like trauma, loss, abuse, illness, chronic pain, depression, and anxiety are inevitable experiences of human life. The biopsychosocial factors in human try to self-regulate and soothe the stress using mood altering substances and behaviors which can be misused or overused, resulting in physical, social, legal, and psychological problems.
As professional, Psychiatric mental health nurse practitioners –PMHNP, it is an important responsibility to understand addiction, immediate intervention, and the appropriate or best treatment of choice to care for the disorders accordingly in order to safe life and for continuity of life (Walden University, 2020). For clarity and better understanding of this week’s topic of discussion, the assignment paper is centered on explaining the psychotherapeutic approach used in the Levy Family Sessions: 1-7 video. To explain the psychotherapeutic benefits of the approach used by the group facilitator, and identify other alternative approach or approaches to group therapy for addiction supported with evidence-based literatures (Walden University, 2020).
Reviewing and Reflecting on this week’s Learning Resources
The provided insights on this week’s learning resources are the integrated models of care that facilitate lifelong recovery and treatments of choice for individuals with addictions, most especially alcoholism and other substances; the urgent need of intervention by the society, the associated family crisis, the lost, and the failures. The provided scenarios of group therapy session are very important as well as the counselling session of intervention getting to know the client as an individual and dealing with the root cause of the problems or the triggers in individual dealing with addiction. There are various psychotherapeutic approaches to caring for individuals with addiction, it is clearly stated in this week’s discussion and video scenarios that there are many “at-risk” populations in the United States of America that are exposed to higher prevalence of Addictions or Substance Use Disorders – SUDs which includes survivors of emotional, physical, and sexual abuse, people with physical, sensory, and cognitive disabilities, people suffering from chronic pain, the unemployed, the limited educated individuals, low socioeconomic status, people with military combat service, lack of job or economic security, people with no health care coverage, homeless and hone foreclosures, and people with depression and anxiety. In addition, the other insights revealed are the increasing suicidal rates following posttraumatic stress disorders as a result of combat or loss of life, traumatic experiences that triggers some bad memories, traumatic brain injury, substance abuse, and the domestic violence associated with military and veteran of war in Iraq, Afghanistan, and other places. The various treatment options were explained in the learning resources like the 12-Step Peer Support Groups which was initially proposed by the Alcoholics Anonymous in 1939 as a useful method of recovery from Alcoholism and other 12-Step groups worldwide (Wheeler, K., 2014).
Identify the psychotherapeutic approach that the group facilitator is using and explain why she might be using this approach.
Viewing the media, Levy Family: Sessions 1-7, was an emotional and challenging video for me in relation to individual within and outside of my family that were affected by this likely experience (Laureate Education, 2013d).
One of the most important things observed in the psychotherapeutic approach of the group facilitator was the initial screening and assessment – titled “SBIRT” – the Screening, Brief Intervention and referral to Treatment, which is the public health approach that was supported by SAMHSA. SAMHSA and NIAAA – National Institute on Alcohol Abuse and Alcoholism, provides grant funding, billing and coding, training materials, resources, and clinician guidelines for healthcare work force and providers on SBIRT skills, screening, and early intervention for individuals with SUDs and those at risk for developing these disorders; universal usage of early intervention for individuals referred to as at-risk substance users in primary care centers, hospitals, emergency rooms, trauma centers, and other community settings (Wheeler, K., 2014).
After the screening and assessment were completed, it was then that the group facilitator decided that the group therapy will be appropriate for this client because it is important to know that not everyone can fit well into group therapy. The selection of a psychotherapeutic approach for a client requires many considerations like the unique needs and character of the client. The selection of psychotherapeutic approach for groups is also very delicate and sensitive because not every approach is appropriate for every group, it’s dependent of their unique needs and characteristics.
Considering the Levy’s family – Jake is the client in need of Psychotherapeutic care, Jake is having Posttraumatic stress disorders from the traumatic experience that he survived as militant in military service in Iraq having explosive combat exposure. This placed him as “at-risk” population who could benefit from SAMHSA –SBIRT clinical assessment and guidelines. This is very common with military veterans. The only personal choice of care for this client at this point in his life was based on biopsychosocial factors of “self-soothe” by self-regulating the feelings, the thoughts, and the emotions using mood altering substances and behavior of alcohol until he feels or remembers nothing (Wheeler, K. 2014). According to Levy Family video and initial screening and assessment by the therapist and the group facilitator, the group therapy approach was useful and necessary for Jake with regards to this addiction; the group involved were all men with PTSD status post combat experiences and exposures who had also served in Iraq and Afghanistan at one time or the other. The group session was started with commonality of service in the military and as veterans and questioning them of their adjustment to home life after war. According to Wheeler, 2014, this is a Trauma-Informed Care psychotherapeutic approach; research showed increase in rate of PTSD, substance abuse, and suicide among military veterans after increased exposure to violence during combat and wars most especially in Iraq and Afghanistan. According to SAMHSA, 2013, and Capone, Eaton, McGrath, & McGovern, 2014, due to combat exposures, the military veterans of Iraq and Afghanistan wars, one in five of the veterans have PTSD or depression, at greater risk for Substance Use Disorders (SUDs), and possibility of co-occurring substance use which has not been confirmed.
Irrespective of the type of trauma, alcohol and drugs are commonly used to numb the pain of the traumatic experience or possibly prevent the memory. Wheeler, 2014, and Bordrog & Wittenberg, 2014, report the use of alcohol and drugs to manage and cope with the associated symptoms of Posttraumatic stress disorders avoiding bad memories, dreams, people or places, reducing or eliminating flashbacks, insomnia, night terrors, or hypervigilance; Trauma-focused Psychotherapeutic care has been effective and it’s usually the treatment of choice. It has been suggested that clinicians and Psychiatric mental health professionals learn the evidence-based treatment approaches of treating the underlying trauma or cause of the PTSD while addressing the alcoholism and use of drugs simultaneous for better outcomes and management. Studies have revealed the success and increased positive outcomes and recovery from SUDs when the symptoms of trauma related to PTSD are spontaneously attended early in the treatment and care (Wheeler, 2014).
Based on the outcomes of the Levy’s video, Psychotherapeutic care and outcomes, the trauma-informed care approach was appropriate for Jake – the clients. According to studies by Purkey, Patel, & Phillips, 2018, the therapeutic sessions of care revealed the provided information, the screening and the assessment prior to care and treatment, client’s opinion was valued and respected, the group worked together supporting one another with strong determination, providing hope of recovery and showing the uniqueness of one another as the symptoms of trauma, the cause or the triggers were revealed, worked with the provider and group facilitator in achieving recovery.
To Determine whether or not you would use the same psychotherapeutic approach if you were the counselor facilitating this group.
Based on the observed outcomes, other researches, and outcomes of studies, I would definitely useful the Trauma-focused care – the Psychotherapeutic approach used by the group facilitator. No matter the cause of the trauma and other associated factors, client’s undergoing Trauma-focused care have shown tremendous improvement and growth, make changes in their personal and family lives, have developed relationships that had helped them in empowering them through their challenges and times of need (Wheeler, K., 2014).
Alternative approach to group therapy for addiction.
The alternative psychotherapeutic approach for addiction is the 12-Step Peer Support Groups, an effective treatment initially proposed by the Alcoholic Anonymous in 1939 used for recovery from alcoholism and as a foundation for other 12-step groups throughout the world. The 12-step peer support group is associated with positive outcomes with guiding principles in which the clients are allowed to share their personal stories, experiences, their weaknesses and strength and their hope and aspirations into recovery as a member of the alcohol anonymous (Wheeler, K., 2014). According to Teeters, Lancaster, Brown, & Black, 2017, PTSD and the symptoms is prolonged and intensified with the use and consumption of alcohol, leading to increase in the symptoms of depression, and anxiety or possibly insomnia.
Other psychotherapeutic approaches are the integrative therapies of EMDR, the dialectical behavioral therapy (DBT), and Mindfulness practice which have offered promising positive treatment outcomes in dealing with PTSD and the underlying cause of trauma (Wheeler, K., 2014). In addition, the motivational interviewing approach has encouraged and helped with drug-free and healthy living lifestyle on many individuals with addiction problems; changing their talk and determination to make a difference; creating confidence and will power (Wheeler, K., 2014 and Madson, M. B., Schumacher, J. A., Baer, J. S., & Martino, S., 2016). Other therapeutic approaches are the solution focused therapy used for couples and families, a family based therapy that intervenes in the client’s personal issues, the spouse, and possibly the whole family restoring and healing the family’s dysfunctional relationships relating to the traumatic experience and addictions. Studies and Research had support the use of family and couple therapy in addressing and dealing with SUDs and PTSD, very effective and efficient (Wheeler, 2014). Studies showed the success of family therapy in parenting, social issues, violence, depression, family conflicts, unemployment, and other family associated problems promoting effective and efficient treatment outcomes (Lander, Howsare, & Byrne, 2013).
In conclusion, the SAMHSA and the NIAAA have important clinical guidelines, grants, training programs, and support for health care professionals with regards to psychological issues of addiction, drug use, and Substance abuse that have been proved effective by several evidence-based practices. It is necessary that professional take advantage of these wonderful opportunities so as to better themselves and be effective care provider in their fields of specialties (www.SAMHSA.gov and www. Niaaa.nih.gov).
Bodrog, B., & Wittenberg, E. (2014). Veteran readjustment: What we went through and how to help us. Presentation at HealthPartners, Bloomington, MN.
Capone, C., Eaton, E., McGrath, A. C., & McGovern, M. P. (2014). Integrated Cognitive Behavioral Therapy (ICBT) For PTSD and Substance Use in Iraq and Afghanistan Veterans: A Feasibility Study. Journal of Traumatic Stress Disorders & Treatment, 3(4), 1000134.
Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: from theory to practice. Social work in public health, 28(3-4), 194-205.
Laureate Education (Producer). (2013d). Levy Family: Sessions 1-7 Video File. Baltimore MD: Author.
Madson, M. B., Schumacher, J. A., Baer, J. S., & Martino, S. (2016). Motivational Interviewing for Substance Use: Mapping Out the Next Generation of Research. JOURNAL OF SUBSTANCE ABUSE TREATMENT, 65, 1–5. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsat.2016.02.003
Purkey, E., Patel, R., & Phillips, S. P. (2018). Trauma-informed care: Better care for everyone. Canadian family physician Medecin de famille canadien, 64(3), 170-172.
Walden University. 2020. Week 9: Group Therapy for Addiction. Retrieved from https://class.content.laureate.net/a2f24e590e07bcc4719006f7747476f9.html
Wheeler, K. (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse. A How-to Guide for Evidence-Based Practice. (2nd Ed.). New York, NY: Springer. Chapter 16. “Psychotherapy Approaches for Addictions and Related Disorders.” (pp 565-596).
Also see: Practicum Sample
More to read: Counseling and Psychotherapy Literature Review