Thoughtful Approach Enhances Care in Group Treatment Settings

During this week’s West Coast Symposium on Addictive Disorders, Andrew Kurtz, MA, LMFT, clinical specialist with the University of California - Los Angeles' Integrated Substance Abuse Programs, presented sessions on a pair of key topics: best practices for improving engagement in group treatment settings and developing recovery support services along the continuum of substance use disorder (SUD) treatment.

Before presenting at the Symposium in Palm Springs, California, Kurtz spoke with Addiction Professional about evidence-based SUD treatment practices in a group context, factors that contribute to reduced engagement in treatment, and keys for developing a recovery support services framework.

Editor’s note: This interview has been edited for length and clarity.

AP: Can you share some examples of evidence-based practices for treating SUD in a group context? Are there reasons these interventions lend themselves to a group setting?

Kurtz: The usual evidence-based practices for substance use disorders that are used in individual treatment have been shown to be effective in group settings as well­—motivational interviewing, cognitive behavioral treatment, and contingency management. The most significant change in the application of these approaches in a group setting is the way in which a group facilitator manages group dynamics. With that comes considerations for how the group is formatted and structured (open versus closed, process versus skill-based). These approaches are effective due to the focus on foundational aspects of recovery such as stabilization, support, and consistency. 

AP: What are the 2 principles of motivational interviewing to apply in group treatment?

Kurtz: The first principle that is involved in group treatment, and potentially most important, is expressing empathy. When focusing on the complexity of behavior change in treatment, creating a connection with individuals and modeling for the group, the importance of each of the group members’ experiences will facilitate conversation about the challenge of making difficult choices. The second is to roll with resistance. This is an important skill as a facilitator in a group setting, as it is incredibly easy to become distracted by unanticipated discussions or topics in the group that detract from the plan for the group. It can also assist the facilitator to recognize that what we think of as “resistance” may actually be an opportunity for the facilitator to highlight the process of the group in a meaningful way.  

AP: What factors contribute to reduced engagement in treatment among individuals with SUD and co-occurring chronic health conditions?

Kurtz: Limited insight is commonly reported by providers as a challenge among individuals with co-occurring SUD and chronic health conditions. While certain disorders may exacerbate limited insight, it is important for providers and organizations to keep in mind the ways in which systems and resource distribution/allocation can hinder and discourage an individual from seeking services. If the service system is overly complicated with long wait times and little guidance or if the patient does not feel their identity as an individual is “seen,” engagement can be impacted before an initial meeting is even established.  

AP: What are the most important keys/best practices to consider when building a framework for recovery support services within the SUD treatment continuum?

Kurtz: It is important to keep in mind the recovery begins before someone steps foot into a formal treatment setting and will continue long after the individual is discharged from that facility. While a singular organization may not be solely responsible for restructuring institutions and systems to better support recovery, having conversations with patients/clients about how to create connections and supports at a community level can improve functioning in recovery. 

AP: Is there anything else you would like to mention that we have not yet touched on?

Kurtz: Much like with our clients, it can be difficult to step outside of our norm or what we are used to, even if we recognize the utility of a new practice or additional procedure/project. My hope is that both of these presentations offer an opportunity to reinforce successes that providers are already experiencing while encouraging thoughtfulness for enhancing care in ways that are meaningful for the client. 

References

Kurtz A.  Best practices for group treatment: engagement and intervention strategies. Presented at: West Coast Symposium on Addictive Disorders. June 2-4, 2022. Palm Springs, California.

Kurtz A. Recovery Support services along the continuum of substance use disorder treatment. Presented at: West Coast Symposium on Addictive Disorders. June 2-4, 2022. Palm Springs, California.