BUT A THERAPIST-LED GROUP IS PREFERRED
Why Groups Work and How They Help Participants
Research now shows that any group participation is as valuable as AA 12 Step participation. Treatment centers, counselors, and courts routinely require people to attend AA 12 Step groups as part of their treatment plans or conditions of probation. Fortunately, the researchers at Harvard’s Recovery Research Institute (RRI) published this article:
- Findings: Non-12 Step Groups seem to be as effective in supporting change as 12 Step Groups.
WOW — great news!
Self-help groups include SMART Recovery, LifeRing, Women for Sobriety, All Recovery Meetings, Recovery Dharma/Refuge Recovery and all manner of less informal groups.
Remember AA and the 12 Steps are simply one of many behavior change models. This report reviews studies that show any group process is as effective as attending AA and other 12 Step Groups in effecting behavior change.
Now – based on this study – people can respond by finding groups that fit their needs and interests. In particular, attending groups led by a counselor is a valid alternative to attending 12 Step groups.
Participant-Described Benefits of Self-Help Groups[1]
1. Perspective: Listening to other members describe how they dealt with problems promoted self-awareness and an ability to adopt new perspectives.
2. Being Connected to Others: The importance of friendship and bonds among group members; being accepted despite their past; stability and safety provided by the group; and the importance of giving and accepting support.
3. Developing Skills: Learning tools that they can transfer to other areas of their lives, including avoiding triggers, setting goals, self-monitoring, and other coping skills.
4. The Value of Group Activities: These activities allowed participants to develop new interests and promoted a sense of achievement. Participants said new activities were a substitute for time previously spent using.
5. A Change in Self: Recovery groups provided the hope many individuals needed to be able to change. Many individuals attributed their recovery entirely to group involvement, the change in self allowing them to recover.
Most people trying to quit or in early recovery are told to attend groups, but not the reasons why to attend groups. The attitude is “Yours is not to reason why, yours is to do and try.” This authoritarian approach is no longer effective or appropriate (if it ever was). The RRI information as quoted here is excellent information to give to people considering attending a group or recommended to attend a group. It explains the benefits from group attendance.
Psychological Theories Underlying Beneficial Effects of Groups[2]
According to RRI, groups reflect four psychological theories:
1. Social Control Change: Bonding between group members, goals set by the group, and structure.
2. Social Learning Theory: Learning group norms and emulating role models.
3. Behavioral Choice Theory: Rewarding activities other than substance use.
4. Stress and Coping Theory: Building coping skills and self-efficacy to manage the stressors that lead to use.
These theories explain why group participation is such an important component of a recovery program or plan. But it can be any group, not just a 12 Step group.
The bullet point summary of the benefits includes the following:
- Bonding and support
- Goal direction
- Structure to follow
- Available role models
- Expectations of positive and negative behavior
- Involvement in protective activities
- Effective rewards
- Identifying high-risk situations
- Building self-confidence
- Developing coping skills
- Giving back
- Presence of like-minded individuals
- Developing self-awareness and reflection skills
What a great list for counselors and professionals assisting the family in managing the recovery process and for evaluations of progress from that last drink.
The Importance of Group Participation for Substance Users
Many years ago, I read a book on groups with a specific emphasis on the benefits of groups for substance users. The author noted that for alcoholics and addicts, groups were more important to achieving sustained recovery than individual therapy. I believe this is an accurate statement if the group is a safe place for participants and participants can identify with their group members. This is one reason why specialized groups can be much more powerful generators of recovery than generic groups. Business executives, LGBT, women, minorities, pilots, doctors, lawyers, the affluent and prominent, etc. all benefit from feeling comfortable with others from a common background.
Problems With 12 Step Groups, Including AA
Many people refuse to attend or quit after several meetings for many different reasons:
- Reference to God and recitation of the Lord’s Prayer
- Concept of Powerless – minority groups and women reject this idea
- Exploitation of new participants by group members (13th stepping women, a common problem)
- Dictatorial direction by sponsors and other long-time members
- Misinformation and downright bunk presented at meetings
- Uneven and variable meeting content
- Ineffective/inaccurate, dangerous or punitive advice regarding relapse and family relationships
The latter comments highlight the downside of self-led volunteer groups with required or recommended attendance. People in early recovery or trying to quit are thrown into what can often be an antitherapeutic, exploitative environment.
Here is the problem with 12 Steps groups for the affluent, well-known and women:
We normally have our guard up.
However, in attending AA, we are told to be more open, trusting, and honest about who we are in order to benefit from group interactions and sponsorship. Unfortunately, there are people in meetings to take advantage of newcomers – sell them drugs and otherwise exploit sexually or financially. There are also participants who appear to be sincere, but have dual agendas – gain a client, find a sexual partner, tout their relationship with a famous person, borrow money, etc. It is a minefield, particularly for young people who have fewer skills in identifying potential victimizers. Fortunately, the RRI Report supports attendance at non-12 Step groups run by a qualified professional, which should reduce potential for exploitation.
Professionally-Led Groups Preferred
In my experience, groups led by professionals are far better than self-led groups because the professional can keep the group on track, identify members in crisis, make sure boundaries are maintained, provide guidance on issues, and assess progress. It is also far better to pay out of pocket for groups than try and go through insurance. Finally, professionally led groups can help preserve the privacy and anonymity of group members – a particular problem for the affluent, well-off and well-known.
Why do I say to avoid insurance? Insurance requires ongoing documentation for the reasons for attending group, and you want to avoid creating an insurance record that will follow you forever. Plus, insurance limits the number of sessions. Finally, the quality of health care provider therapists is said to be lower due to high case load demands from health care companies. Upshot: Go private therapist and pay out of pocket for your group experience.
My AA Experience
I attended AA meetings regularly for five years because it was a safe place to gather my thoughts and hear from other people about their experiences. However, it seemed like a tough recovery environment for many attendees – lots of mixed advice and long-winded repetition. I stopped attending when members I knew from treatment expressed their resentment at my five-year medallion ceremony because I was affluent.
My experience in attending AA is that meetings are not, in fact, anonymous. People probe to try and figure out who you are, where you live, etc. It is said that treatment center personnel leak names, as do group members. My most beneficial experiences were attending groups led by a counselor and volunteering with group members at a local homeless shelter.
To reiterate, I would not recommend 12 Step recovery groups to the well-off and well-known – the pitfalls outweigh the benefits. Find a good group led by a counselor and start your own group. I have been in a men’s group with friends for over 30 years, and that has been helpful.
The Recovery Research Institute (RRI) out of Harvard publishes a monthly newsletter reviewing research on effective approaches in treating substance use disorders.
Each month I will select several impactful topics of interest to family, friends, and users in recovery or considering quitting or cutting back.
- RRI has really good information that often contradicts or significantly modifies current recommendations from treatment centers, professionals, and amateurs offering advice as “interventionists.”
RRI is a non-profit. I hope readers who find their research beneficial will consider donating to RRI. See RecoveryResearch.org. There is an incredible amount of misinformation about addiction and recovery that is downright dangerous, given the lethal nature of SUDs. Time to turn to science from reliable institutions.
Personal Insight Note: Addiction Field Lacks Intellectual Firepower
Fifteen years ago, I was lying on a hospital table waiting for a cortisone injection into my hip by a doctor trained at Harvard and MIT. It dawned on me that the addiction field lacked the intellectual firepower prevalent in treating other diseases.
- People involved in addiction services tend to be a self-selected group in recovery representing one percent of the population.
The math on this group, using some general assumptions is: 10% of the population is addicted. 10% of this 10% is in recovery – 1% (10% of 10%) is the pool drawn to working in the addiction field. This is a tiny group to draw from, and many lack the skills and innate talent to be effective counselors and services providers, let alone the professional ethics and boundaries to work with people in distress.
The advent of academic research from respected universities is a welcome and much needed addition to the field.
[1] RRI Bulletin, p. 8 May 2021
[2] RRI Bulletin, p. 10 May 2021