Supporting transition to recovery through outpatient group therapy for people with substance use disorders

Supporting transition to recovery through outpatient group therapy for people with substance use disorders

In Australia, and worldwide, substance use disorders (SUDs) contribute to a significant burden of disease including increased healthcare utilisation, increased morbidity and mortality rates, and socioeconomic disadvantage (Glantz et al., 2020). Recovery from SUDs often involves lengthy patterns of lapse and relapse seen in cycles of engagement in treatment and return to patterns of substance use (Dennis & Scott, 2007; Dennis et al., 2005; McHugh et al., 2021; McLellan, Lewis, O’Brien & Kleber, 2000; McLellan, McKay, Forman, Cacciola & Kemp, 2005). Currently, most SUD treatment occurs in outpatient settings, with clinician-led group therapy the most prevalent modality (McHugh et al., 2021; Sacks, Banks, et al., 2008; Sacks, McKendrick, et al., 2008; Weiss et al., 2004; Wendt & Gone, 2017, 2018). Despite widespread implementation of group therapies for outpatient substance use treatment, there is a paucity of conceptual frameworks and theoretical underpinnings for group therapy processes in supporting recovery (McHugh et al., 2021; Weiss et al., 2004; Wendt & Gone, 2017, 2018) and understanding the unique experience of recovery for the individual (Anderson, Goodman & Schlossberg, 2022; Stokes et al., 2018; Vanderplasschen & Best, 2021; Witkiewitz et al., 2019). This is particularly the case for non-manualised, openenrolment group programs for SUDs (e.g., groups which allow participant admission at any time and do not have a set length of engagement or treatment program) in comparison to structured closed groups with set admission points, length of treatment, and manualised interventions. The present study aimed to explore the value of Schlossberg’s Transition Theory (STT; Anderson, Goodman & Schlossberg, 2022) in supporting and understanding the transition to recovery from SUDs. Further, the current study aimed to examine change in SUD severity via clinician-led open enrolment outpatient groups using an explanatory-sequential mixed methods research design (Creswell & Plano Clark, 2018). The present research found recovery to be a highly individualised process occurring on an individual timeline in a ii complex and dynamic way. The findings emphasise the unique and individual experience of recovery for each person with or without abstinence (Anderson, Goodman & Schlossberg, 2022; Stokes et al., 2018; Vanderplasschen & Best, 2021; Witkiewitz et al., 2019), facilitating hope in the recovery process (Kelly et al., 2019; Lo Coco et al., 2019; Witkiewitz et al., 2019) and highlighting the role of, and need for, flexibility and adaptability of intervention in a group setting (Wendt & Gone, 2017, 2018). The research reflected a change process for the individual which was consistent with existing recovery literature and aligned with the STT process. An indication of the need for change in the individual was recognised, consistent with movement through the STT transition process (Streifel & Servanty-Seib, 2006). Change in the individual was described in adapted behaviours beyond abstinence in recovery, in changed patterns of substance use, as well as changed roles, learning, assumptions, and perceptions in recovery (Anderson, Schlossberg & Goodman, 2012; Schlossberg, 1981, 2011). This alignment of experiences of recovery processes with STT was demonstrated by participants through the development of resources across the 4S domains of situation, self, supports and strategies (Anderson, Goodman & Schlossberg, 2022; Schlossberg, 1981). With assets and liabilities in the 4S domain recognised as assisting or hindering the recovery and transition process (Anderson, Goodman & Schlossberg, 2022). The findings further emphasised that the facilitation approach and interpersonal style of the clinician facilitating the group were crucial in effective group practice, integral in maintaining boundaries and safety of the group, and supportive of the flexible delivery of the group to meet the needs of the individual and the group as a whole (Anderson, Goodman & Schlossberg, 2022). These findings reflect the role that STT models can have for clinicians in tailoring therapeutic service delivery. Finally, the findings of this research provide an important contribution to the STT and SUD literature and extend the use of STT to SUD group interventions.

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