For years, group counseling has been the workhorse of addiction treatment. Many addiction professionals, old and new, automatically assume this treatment method to be effective. There is a solid belief in this modality despite opposing viewpoints.

Why is the belief so strong? For one, group therapy has been around for a long time, nearly 50 years. Anything that’s been around that long is automatically assumed to work. Another reason is that most addiction programs in the country use it. The Institute of Medicine (1998) estimates nearly 92 percent of all treatment programs in the country offer this intervention. The general consensus is that if more 90 percent of treatment programs use it, then it must work. Lastly, many professionals believe in the effectiveness of group because there are numerous antidotal stories touting its success. But, is group counseling all that effective?

According to some sources, the quick answer is that no convincing evidence exists to demonstrate group therapy effectiveness, a general research finding that may upset a few people. So, let’s take a closer look at the data. For the reader’s information, the research base for the above statement has been taken mostly from recent books. The cited books have accumulated research information from journal articles into broad readable summaries.

Direct substance abuse findings
The first summary research finding comes from the Institute of Medicine (1998), which notes that general group counseling sessions, especially the confrontational ones, demonstrate little effectiveness in terms of better or longer lasting outcomes following treatment. Essentially, the same finding has been noted in Miller and Hester (1986), Roth and Fonagy (1996), plus Doweiko (2006). In particular, all of these note that limited evidence exists to indicate group therapy is an effective intervention. In fact, McCrady (2001) further states that women could be somewhat inhibited in a group setting because of the shame-based issues associated with this population.

In the same vein, the latest Technical Assistance Protocol (TIP # 41) was recently published specifically for group counseling in substance abuse (CSAT, 2005). Notably, no section exists in TIP #41 that addresses the effectiveness of group therapy. That is, it does not list a set of summarized articles that support substance abuse group effectiveness. At best, it lists two 20 year-old articles purporting research effectiveness of group therapy and one article that purports that group therapy is more effective than individual therapy. From a publication of this stature, one would expect a substantive section on research that demonstrates support for group therapy effectiveness.

Finally, a report from a 2003 National Institute of Drug Abuse (NIDA) sponsored group science meeting indicated that fewer than 20 controlled studies on the effectiveness of substance abuse group therapy had been published to date. The members of this group science meeting concluded that it was difficult to draw conclusions about the efficacy of group treatment for drug abusers based on the limited data (NIDA, 2003).

There is some research data on group effectiveness from the non addiction realm. One such source is Corey (2004), which is considered to be one of the better and more extensive tomes on group therapy. In the book there is a statement that data accumulated from 45 years of research (and this is general group counseling, not substance abuse directly related findings) indicates only modest research for group effectiveness. Corey further notes that the data points to little difference between individual and group counseling outcomes.

These overall non-supportive results may be due in part to the types of research conducted on group therapy, and of the notorious and serious methodological problems associated with this type of research. There are many variables to be explored in groups that make it difficult to research adequately.

The positive research
Despite all this non-supportive data, there is some data that supports group therapy effectiveness. This data comes via an interesting route, and with a tiny twist.
The twist — this data does not directly address substance abuse groups. However, once you read it, you can easily apply the information to substance abuse groups. The route to group effectiveness runs through group cohesiveness (Burlingame, Fuhriman, & Johnson, 2002). This cohesiveness lies in the same realm as the data suggesting strong outcomes based on a solid professional relationship, which have been noted several times in previous research to practice columns.

The cohesive authors cite several studies that indicate a linear and positive relationship and client improvement. However, there is a caveat that the concept — cohesion is difficult to measure and, therefore, is difficult to research. Cohesion can be defined as a group member’s felt sense of acceptance and support. Clients who reported having these feelings noted more symptomatic improvements. Such improvement also was reported from group members who felt a strong level of acceptance and understanding from their group leaders.
Based upon the research of positive group results, it would behoove counselors to focus on cohesion elements of group therapy (Burlingame, Fuhriman, & Johnson, 2002). For example, focus on creating an atmosphere that is conducive to group members: relating to other group members; feeling understood; feeling protected; feeling comfortable; liking the group; feeling accepted; feeling warm feelings from the group leader.

Also, the group leader should try to attain these states early in a group session.

Research you can do
Trying to find evidence for the support of group therapy effectiveness is going to be difficult. However, one simple and not necessarily strict controlled study you could try would be to create a baseline of your present group attendance (e.g., note attendance, level of interaction etc), and create a small list of negative symptoms from each group member (e.g. level of drug and alcohol use, judicial involvements, etc).

After taking a few weeks to establish that baseline, use the aforementioned elements for a period of time. Then, tabulate a second baseline using the same parameters used on the first. Finally, compare the baselines. This is fairly simple and not very controlled, but could yield some useful results, at least for your own information.

Summary
The data presents mixed findings, and so it does for group effectiveness. Yet, it is important to note that as of this time, no summarized research findings stand out that appreciably support this workhorse of the addiction field. However, while the existing data doesn’t particularly support the effectiveness of a group approach, that conclusion does not mean one should abandon its use.

The focus on cohesion which, in turn, contributes to better outcomes seems to be a promising research path. Again, it is interesting that this cohesion element is similar to the robust alliance research noted previously in this column. That is, better clinical outcomes are strongly associated with a strong professional relationship.

Michael J. Taleff, PhD, CSAC, MAC, is an instructor at the University of Hawai’i at Manoa and West Oahu campuses, and an instructor at National University (Hawaii branch). He can be contacted at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

References
Burlingame, G.M., Fuhriman, A., & Johnson, J.E. (2002). Cohesioni in group psychotherapy. In J.C. Norcross (Ed.) Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. (pp. 71-87). New York: Oxford.
Center for Substance Abuse Treatment. (2005). Substance abuse treatment: Group therapy. Treatment Improvement Protocol (TIP) Series 41. DHHS Publication No. (SMA) 05-3991. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Corey, C. (2004). Theory and practice of group counseling (6th ed.). Belmont, CA: Thomson.
Doweiko, H.E. (2006). Concepts of chemical dependency (6th ed.). Belmont, CA: Thomson.
Institute of Medicine (1998). Bridging that gap between practica and research: Forging partnerships with community-based drug and alcohol treatment.

This article is published in Counselor,The Magazine for Addiction Professionals, December 2005, v.6, n.6, pp.50-51.

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