Group Therapy

Group therapy is a therapeutic modality frequently used to treat people with different addictions (Galanter et al., 1998). Together with individual treatment and the other interventions you may be carrying out, group therapy is of great relevance in several specific treatments for addictions, especially perhaps in people who go to drug addiction centres and self-help associations, where it is an essential part of the treatment.

The objective sought with group therapy is the same as that of individual therapy, but in a group format and with dynamics that develop within each group. It allows the patient to compare himself with others, have support, learn control strategies and techniques, acquire skills, and assume group functioning norms. The central objectives of it are to solve problems and perform tasks that lead to abstinence or allow you to maintain it to finally be able to change your lifestyle.

Prevention of relapse in Addictions

The first use of the substance or having a gambling episode after quitting does not have to represent a relapse; it may just be a fall or a temporary slip. For Marlatt and Gordon (1985), relapse is any return to addictive or problematic behaviour or previous lifestyle after an initial period of abstinence and lifestyle change.

A fall is a brief return to the addictive behaviour at a specific moment, that is, a loss of specific control over the behaviour. This can lead the person to carry out some sporadic consumption. Relapse in addictions can manifest in different ways: return to the previous lifestyle, use substitute drugs, perform random and risky activities or compulsive sexuality, etc. In the case of gambling, the most common way to manifest is to return to play regularly. The same happens in the case of psychoactive substances.

The so-called withdrawal violation effect is a fundamental concept for understanding the relapse process. This effect comprises two key cognitive elements:

• cognitive dissonance (conflict and guilt)
• a personal attribution effect (blaming oneself as the cause of relapse)
• sometimes the anticipation of positive drug or gambling effects

The combination of these three components predisposes the patient to a total relapse.

Model

The relapse prevention model views addictions as an acquired habit that can be changed by applying the principles of classical, operant, and vicarious conditioning. In addition, it gives great importance to the cognitive factors involved in relapse. Relapse prevention strategies are aimed at anticipating and preventing the occurrence of relapses after treatment and how to help patients deal with relapse if it occurs. It is a self-control program where patients are taught to anticipate and deal effectively with problems after treatment or during follow-up. Therefore, relapse prevention can be applied as a maintenance strategy to prevent relapse, or with a more general approach, to change lifestyle.

The main causes of addiction relapse are negative emotional states, interpersonal conflict, and social pressure (e.g., Marlatt & Gordon, 1985). Negative emotional states are situations in which subjects experience a negative emotional state, mood, or feelings, such as frustration, anger, anxiety, depression, or boredom, before or at the same time as the occurrence of the first fall. Interpersonal conflicts include a current or relatively recent conflict associated with any interpersonal relationship, such as marriage, family members, work relationships, etc. Social pressure refers to situations in which the patient responds to the influence of another or other people who exert pressure to involve him again in the consumption of substances.

Relapse prevention strategies

There are three main strategies for relapse prevention: the social support approach, the lifestyle change approach, and the cognitive behavioural approach (Becona, 1999). Cognitive-behavioural techniques for relapse prevention are the most effective. They aim to increase self-efficacy, improve impulse control, promote cognitive restructuring and improve decision-making strategies.

Strategies aimed at lifestyle change are aimed at strengthening the patient’s overall coping capacity and at reducing the frequency and intensity of the irresistible urges and urges to gamble that are often the product of an unbalanced lifestyle.

Among the relapse prevention techniques that are applied are cognitive restructuring programs, training in identifying and controlling stimuli, exposure to stimuli in vivo (real) or at an imagined level, thought arrest, covert conditioning, external reinforcement programs, etc. If, in a high-risk situation, the patient anticipates what could happen to him (for example, when he passes the bar where he usually gambled or the neighbourhood where he bought the substance) and has a strange sensation similar to when he entered and played or used the drug, he can implement different coping strategies, especially when he has emergencies, in order to cope and not fall or relapse into his addictive problem again.