What Group Therapy Looks Like in Rehab

You are about to sit in a circle with strangers and you do not know whether this hour is treatment, a meeting, or a place where your story leaves the room. Group therapy in a substance use program is a clinical hour. SAMHSA's TIP 41 defines the groups it is talking about as groups with trained leaders and a primary intent to help people recover from substance use problems. That definition stops at the door of a mutual-help meeting. Alcoholics Anonymous and Narcotics Anonymous are not the groups this protocol describes. SAMHSA's public treatment page makes a similar split in everyday language. Therapy and counseling usually happen with a licensed behavioral health professional, one to one or in a group. Peer support groups are listed as a separate kind of help.

In the hands of a skilled leader, SAMHSA says, a treatment group can offer services comparable in effect to individual therapy. The forces it names, affiliation, support, and peer confrontation, are not always present in a solo session. That is a reason programs use groups. It is not a reason to place every person in every group.

If someone is in immediate danger, call 911. For a mental health crisis, call or text 988. A group hour is not emergency care.

The kinds of groups you are likely to see

SAMHSA sorts the common clinical groups into five models. The names on a schedule may differ. The jobs are these:

• Psychoeducational groups teach about substance use and its consequences.
• Skills-development groups practice abilities needed to start and keep abstinence, including managing anger and coping with urges.
• Cognitive-behavioral groups work on the thoughts and actions that lead back to use. The longer explanation of that method, which can be individual or group, is the CBT guide.
• Support groups give members a place to share practical information about getting through the day without substances.
• Interpersonal process groups look at relationship patterns and earlier experiences that feed substance use or get in the way of recovery.

Three other kinds show up often enough that SAMHSA lists them beside those five. Relapse-prevention groups are built for that job. Skills and the plan, not how to lead the group, stay on the relapse-prevention guide. Communal and culturally specific groups bring a community's own healing practices into the work. Expressive groups use art, dance, or psychodrama when words are hard. Programs also form groups around one shared problem, such as anger.

Membership can be fixed, with the same people throughout, or revolving, with new people joining when they are ready. Either kind can run for a set number of weeks or continue without a fixed end date. None of those formats is automatically the right one. Fit is the point.

Who the group is for, and who should wait

SAMHSA says appropriate placement starts with a thorough assessment of the person's needs, wishes, and ability to participate. Evaluators look at how the person functions with others, motivation to abstain, stability, stage of recovery, and whether they expect the group to help. Most people can be in a mixed group. What matters is that members share similar needs. Some people need a more alike group, for example an all-women group or a group matched by age. SAMHSA names severe personality disorder as one reason for that kind of placement. Ethnicity and language matter too. A person who cannot follow a fast discussion because of language should not be left to guess. The leader is supposed to understand how culture shapes both substance use and group participation.

Some people, SAMHSA says, are probably not suitable for certain groups, or for group therapy at all. The list includes people who refuse to participate, people who cannot keep group agreements, people in the middle of a life crisis, people who cannot control impulses, and people who experience severe internal discomfort in groups. Professional judgment still has to weigh the substances, how long use has gone on, the setting, and the stage of recovery. A person who is stable may need social skills, emotional work, or help reconnecting with a community. A person in crisis may need a different service this week.

Before the first group, SAMHSA says the leader should meet each person individually. That meeting is where the alliance starts, where you agree on the aim, where the leader explains how groups work, where anxiety about joining can be named, and where the group agreement is reviewed. The agreement covers confidentiality, physical contact, substance use, contact outside the group, participation, and how someone leaves. SAMHSA calls acceptance of that agreement, before joining, the single most important factor in the success of outpatient therapy groups. The first month is described as especially critical for staying in. Preparation, involvement, reminders, and practical help such as child care or transportation are the retention tools the protocol names. Those are program duties. They are not a script for you to run a group of your own.

NIDA adds a specific caution. Group therapy can provide social reinforcement for a drug-free life, and established methods such as contingency management and cognitive behavioral therapy are sometimes adapted to groups. Particularly among adolescents, though, group treatment can cause unintended harm. Members, especially in groups of highly delinquent youth, can reinforce drug use and undo the point of the therapy. Trained counselors are supposed to monitor for that. The setting page for teens is the adolescent intensive-outpatient guide. An adult group and a teen group are not the same risk.

What the hour is like as treatment goes on

SAMHSA ties the leader's job to the person's stage. Early on, people are often unsure about stopping, rigid in their thinking, and limited in problem-solving. Peers can land a point that a lone authority figure cannot, because many people with substance use disorders have had adversarial relationships with authority. That is an observation in the protocol, not an invitation to be confronted by strangers on day one.

Later in care, SAMHSA says thinking often clears while the urge to use can remain, because the comfort of past use stays vivid. Some people become steady enough for conflict, emotion, or practical needs such as parenting or work. Family therapy has its own safety limits and is a different service. A multifamily lecture is not that service.

Meetings, counseling, and medicine stay different

A 12-step meeting can be valuable and still not be group therapy. Mutual help is described on the 12-step guide and the SMART Recovery guide. SAMHSA treats peer support as separate from counseling with a licensed professional. You can use both. One does not check the box for the other.

The other half of what many programs schedule is individual counseling. NIDA says positive outcomes have been found when group therapy is offered along with individual drug counseling. A week of groups with no one-to-one hour is a question to ask, not a standard you have to accept sight unseen.

Medication is not cancelled by the group schedule. NIDA says medication should be first-line treatment for opioid addiction, usually combined with behavioral therapy or counseling, and that medications exist for alcohol and nicotine. For stimulants or cannabis, no medications are currently available, so treatment is behavioral. Do not skip a dose because group ran long. The opioid medicines, without a dose, are the medication guide.

Federal confidentiality rules for covered programs are the privacy guide. SAMHSA says people who cannot protect members' privacy under that rule are not suitable for the group. Ask what the program does if someone breaks the agreement.

What to ask before you join

1. What type of group is this hour, in the sense SAMHSA uses: education, skills, cognitive-behavioral, support, process, or something else?
2. Who leads it, and what training do they have?
3. What does the confidentiality agreement actually say, and what happens if someone breaks it?
4. Is there a one-to-one meeting before the first group?
5. If the members are adolescents, how does the program watch for talk that encourages use?

Search FindTreatment.gov and ask what the group schedule is this week, not only whether the site says "group therapy." Call or text (800) 653-9376 if you want help comparing programs.

Additional Resources

Sources cited on this page:

• SAMHSA TIP 41: Substance Abuse Treatment: Group Therapy
• SAMHSA TIP 41: Executive summary (NCBI Bookshelf)
• NIDA: Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)
• NIDA: Treatment and Recovery
• SAMHSA: Treatment types for mental health, drugs, and alcohol
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions