Group Therapy for Addiction

Week 9: Group Therapy for Addiction

Assignment 1: Psychotherapeutic Approaches to Group Therapy for Addiction

Learning Objectives

Students will:

· Evaluate psychotherapeutic approaches to group therapy for addiction

To prepare:

· Review this week’s Learning Resources and reflect on the insights they provide on group therapy for addiction.

· View the media, Levy Family: Sessions 1-7, and consider the psychotherapeutic approaches being used.

· Levy Family Episode 1 Program Transcript [MUSIC PLAYING] FEMALE SPEAKER: You’re not dressed? You’re going to be late for work. MALE SPEAKER: I’m not going to work. I’m sick. FEMALE SPEAKER: Of course you’re sick. You’re hungover. I don’t want the boys to see you like this. Go back to bed. MALE SPEAKER: See me like what? I told you, I’m sick. FEMALE SPEAKER: Well, what do you call it when someone is sick almost every morning, because they drink every night while they sit in the dark watching TV? MALE SPEAKER: You calling me a drunk? FEMALE SPEAKER: What do you call it? MALE SPEAKER: I call it, leave me the hell alone. FEMALE SPEAKER: Baby, you need to stop this. It’s tearing us up. The drinking, the anger– you’re depressed. MALE SPEAKER: You said, for better or worse. FEMALE SPEAKER: My vows don’t cover this. You were never like this before. You’ve changed. I want us back, the way we used to be. MALE SPEAKER: That way is dead. It died when I went to Iraq.

· Levy Family Episode 2 Program Transcript FEMALE SPEAKER: I want to thank you for getting me this Levy case. I think it’s so interesting. Just can’t wait to meet with the client. MALE SPEAKER: What do you find interesting about it? FEMALE SPEAKER: Well, he’s just 31. Usually the vets I work with are older. If they have PTSD, it’s from traumas a long time ago. But Jake, this is all pretty new to him. He just left Iraq a year ago. You know, I was thinking he’d be perfect for one of those newer treatment options, art therapy, meditation, yoga, something like that. MALE SPEAKER: Why? FEMALE SPEAKER: Well, I’ve been dying to try one of them. I’ve read a lot of good things. Why? What are you thinking? MALE SPEAKER: I’m thinking you should really think about it some more. Think about your priorities. It’s a good idea to be open-minded about treatment options, but the needs of the client have to come first, not just some treatment that you or I might be interested in. FEMALE SPEAKER: I mean, I wasn’t saying it like that. I always think of my clients first. MALE SPEAKER: OK. But you mentioned meditation, yoga, art therapy. Have you seen any research or data that measures how effective they are in treatment? FEMALE SPEAKER: No. MALE SPEAKER: Neither have I. There may be good research out there, and maybe one or two of the treatments that you mentioned might be really good ideas. I just want to point out that you should meet your client first, meet Jake before you make any decisions about how to address his issues. Make sense?

· Levy Family Episode 3 Program Transcript JAKE LEVY: We’d be out on recon in our Humvees, and it would get so hot. We used to put our water bottles in wet socks and hang them right outside the window just so the water would cool off of a bit, and maybe then you could drink it. Man, it was cramped in there. You’d be drenched, nowhere to breathe. It’s like riding around in an oven. And you’d have your helmet on you, 100 pounds of gear and ammo. I swear, sometimes I feel like it’s still on me, like it’s all still strapped on me. FEMALE SPEAKER: How many tours did you do in Iraq? JAKE LEVY: Three. After that last recon, I just– There were 26 of us. Five marines in the Humvee I was in. I remember I was wearing my night vision goggles. We passed through a village and everything was green, like I was in a dream or under water. And then there was a flash, bright light just blinded me. There was this explosion. I can’t– I can’t– FEMALE SPEAKER: It’s OK, Jake. Take it easy. I understand this is difficult. There’s something I;d like to try with you. It’s called exposure therapy, and it’s a treatment that’s used a lot with war veterans, especially those struggling with anxiety and PTSD. JAKE LEVY: Exposure therapy? FEMALE SPEAKER: Yes. It’s to help someone like yourself to confront your feelings and anxieties about a traumatic situation that you’ve experienced. It’s a– It’s meant to help you get more control of your thoughts, to make sense of what’s happened, and to not be so afraid of your memories. JAKE LEVY: Put that in a bottle and I’ll buy 10 cases of it. FEMALE SPEAKER: Well, one part of it is learning to control your breathing. And when you practice that, you can learn to manage your anxiety, to get more control of it, not let it control you, to protect yourself. Do you want to try it? JAKE LEVY: Right now? FEMALE SPEAKER: Sure. JAKE LEVY: Why not?

· Levy Family Episode 4 Program Transcript FEMALE SPEAKER: So do you want to try to go back to what you’re telling me before? LEVY: I can try. It was night. We were out on patrol. I remember it was so hot packed in our vehicle. Suddenly there was an explosion. We got tossed into a ditch. And somehow I made it out, and I could see it was the Humvee behind us. It’s whole front end was gone. It had hit a roadside bomb. Our vehicle had just driven past it, just mistriggering it. But not them. They didn’t make it. FEMALE SPEAKER: Remember how we practiced. Slow your breathing down. Inhale and exhale from your abdomen. LEVY: Thank you. FEMALE SPEAKER: And just take your time. Whenever you are ready. LEVY: So the bomb went off. I managed to get out. I had my night vision goggles on. And I could see the Humvee, the one that got hit. It’s whole front end was gone. And there’s this crater in the road. And inside it I could see– I could see Kurt’s– our platoon Sergeant, he was lying there everything below his waist was gone, blown off. And he was screaming. Screaming like nothing you’d ever heard. And then he was looking at me. And he was screaming for me to kill him. To stop his suffering. He was yelling, please. Please. And someone tried putting tourniquets on him. But the ground just kept getting darker with his blood. And I was staring into his face. I had my rifle trained on him. I was going to do it. You know. He was begging me to. I could feel my finger on the trigger. And I kept looking into his face. And then I didn’t have to do nothing. Because the screaming had stopped. He’d bled out. Died right there. And all I could think was I’d let him down. His last request, and I couldn’t do it. I couldn’t put a bullet in him so he could die fast not slow. FEMALE SPEAKER: I can see and hear how painful it is for you to relive this story. Thank you for sharing it. Do you think this incident is behind some of the symptoms you’ve been telling me about? LEVY: When I go to sleep at night, I close my eyes, and I see Kurt’s there staring at me. So I don’t sleep too good. That’s why I started drinking. It’s the only way I © 2013 Laureate Education, Inc. 1 Levy Family Episode 4 can forget about that night. So I drink too much. At least that’s what my wife yells at me. We’re not doing too well these days. I’m not exactly the life of the party. I left Iraq 10 months ago. But Iraq never left me. I’m afraid it’s never going to leave me alone.

· Levy Family Episode 5 Program Transcript FEMALE SPEAKER: It was such an intense story. I just kept seeing things the way he did, you know. The weird green of his night-vision goggles, his sergeant screaming for Jake to kill him. I just keep seeing it all in my head. [MUSIC PLAYING] MALE SPEAKER: Why, do you think? FEMALE SPEAKER: Why what? MALE SPEAKER: Why do you think you keep thinking about this story, this particular case? FEMALE SPEAKER: I don’t know, maybe because it’s so vivid. You know, I went home last night, turned on the TV to try to get my mind off it. And a commercial for the Marines came on, and there was all over again– the explosion, the screams, the man dying. Such a nightmare to live with, and he’s got a baby on they way. MALE SPEAKER: Could that be it, the baby? FEMALE SPEAKER: Maybe. That’s interesting you say that. I mean, the other vets I work with are older, and they have grown kids. But Jake is different. I just keep picturing him with a newborn. And I guess it scares me. I wonder if he Levy Family Episode 6 Program Transcript FEMALE SPEAKER: I know three of you did tours of duty in Iraq, and the others in Afghanistan. So I just wanted to follow up on that, talk about how you’re adjusting. [MUSIC PLAYING] MALE SPEAKER 1: You say adjust to, but there’s no adjustment. You’re just thrown back into your life like you’re supposed to pick up where you left off, but that’s a joke. Two years ago, I was dug in, pinned down by 50 Cal sniper fire, just praying the chopper would get me out alive. Now, the hardest part of my day is standing in the grocery store trying to decide if I want yellow or brown mustard with my hot dogs. JAKE: Nah, two six packs or a case. FEMALE SPEAKER: You find that you drink more than you used to? JAKE: Why not ask him if he finds he’s eating more hot dogs than he used to? BILL: You know why? JAKE: Why is that? Oh great, Buddha. BILL: Because I’ve been where you are. You talk about booze like it’s some joke, but nobody’s laughing. You can’t get adjusted to anything when you’re trying to get loaded. JAKE: I guess you won’t be joining me for a drink at the bar later. I was going to buy. FEMALE SPEAKER: No, that’s a good point, Bill. Sometimes we do things to avoid dealing with unpleasant feelings, like adjusting to life back at home. JAKE: What do you know about it? Give me a break. Back off, or I’ll make you. BILL: I drink too much too. But I’ve had enough of you mouthing off. JAKE: My wife’s had enough of me too. She’s the reason I’m here. We never used to fight. I never used to drink so much, but now I can’t stop myself from doing either. FEMALE SPEAKER: So why do you drink too much? © 2017 Laureate Education, Inc. 1 Levy Family Episode 6 BILL: It’s the only way I can shut it out, images of what I saw over there, horrible things that no one should ever have to see. I wake up some nights and I hear mortar rounds coming in. And I reach for my helmet and my weapon, but they’re not there. So I freak out. And then I see pretty curtains. TV’S on. And then I remember I’m at home. I realize I’m not going to get blown up after all. FEMALE SPEAKER: Thanks for sharing, Jake. You make a good point. It can seem a lot easier to self medicate rather than face the fears, the bad memories that we have. So what do you think? What are some other things, maybe, you do to avoid the challenge to being a civilian again?’ll be able to deal with it.

· Levy Family Episode 7 Program Transcript FEMALE SPEAKER: How did you find out? MALE SPEAKER: There’s a guy who served in our platoon. He didn’t call. Wrote an email. He said it would bother him too much if he talked about it. Sorry to be the one who tells you that Eric committed suicide last night. The last time I saw him, he said he was adjusting to civilian life pretty well. His girlfriend told me it wasn’t true. She said he told everyone he was doing fine. But the nightmares kept after him even when he wasn’t sleeping. It just tore him up. I guess he decided he’d had enough. He ended it with a service revolver. Marine to the end. FEMALE SPEAKER: I’m sorry, Jake. MALE SPEAKER: Thank you. You know, I spend almost every night in front of the TV, drinking until I can’t remember anything else. But I read that email last night, and I didn’t drink a drop. I just kept thinking about Eric. You know we went through Parris Island together? FEMALE SPEAKER: I didn’t know that. MALE SPEAKER: Yeah. I didn’t turn on the TV, either. I went straight to the computer. And before I knew it, I was reading about veterans and suicide. They say about 22 veterans commit suicide every day, 22. That’s like one every hour. Makes it sound like we’re time bombs. Makes you wonder which one of us is going to go off next. FEMALE SPEAKER: You sound glad that you didn’t drink last night. MALE SPEAKER: Yeah. I’ve been trying to quit for my wife. But that email– you know what else I read online? I checked all over with the VA, but it doesn’t look like they do anything to help prevent suicide. I mean, they offer help if you ask for it, but no prevention. Who’s going to ask for help, right? They train you to be stronger than everyone else, to endure. Asking for help is just not something most men do. FEMALE SPEAKER: Do you need help, Jake? MALE SPEAKER: I need a lot, but not like that. I’m not ready to check out yet. I got a baby on the way. © 2017 Laureate Education, Inc. 1 Levy Family Episode 7 I found out something else. I was reading about this veteran who committed suicide in another state. And they started this program in his memory that brings other vets together to help each other. FEMALE SPEAKER: Peer counseling? MALE SPEAKER: Yeah, that’s it. And I spent the whole rest of the night thinking, why don’t we have something like that? We should be reaching out to all vets, not just those who are already getting mental health services. I’d even volunteer to get something like that going. FEMALE SPEAKER: Well, that’s a great idea. But we’d need to find the money for a program like that. I mean, our budget is maxed out. We’d have to lobby the state legislature for the funding. MALE SPEAKER: Well, I’ll do it. I’ll write the letter. I want to try. FEMALE SPEAKER: Well, OK. MALE SPEAKER: I can’t let Eric go without doing something for him. For me, too

The Assignment

In a 2- to 3-page paper, address the following:

Identify the psychotherapeutic approach that the group facilitator is using, and explain why she might be using this approach.

Determine whether or not you would use the same psychotherapeutic approach if you were the counselor facilitating this group, and justify your decision.

Identify an alternative approach to group therapy for addiction, and explain why it is an appropriate option. Support your position with evidence-based literature.

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

· Standard 6 “Evaluation” (pages 65-66)

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

· Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565–596)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

· Chapter 13, “Problem Group Members” (pp. 391–427)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Gamble, J., & O’ Lawrence, H. (2016). An overview of the efficacy of the 12-step group therapy for substance abuse treatment. Journal of Health & Human Services Administration, 39(1), 142–160. Retrieved from http://jhhsa.spaef.org/

Note: Retrieved from Walden Library databases.

Kim, J. W., Choi, Y. S., Shin, K. C., Kim, O. H., Lee, D. Y., Jung, M. H., … Choi, I. (2012). The effectiveness of continuing group psychotherapy for outpatients with alcohol dependence: 77-month outcomes. Alcoholism: Clinical & Experimental Research, 36(4), 686–692. doi:10.1111/j.1530-0277.2011.01643.x

Note: Retrieved from Walden Library databases.

Allyn & Bacon (Producer). (2000). Motivational interviewing [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 102 minutes.

Laureate Education (Producer). (2013d). Levy family: Sessions 1-7 [Video file]. Baltimore, MD; Author.

Psychotherapy.net (Producer). (2015). Group therapy for addictions: An interpersonal relapse prevention approach [Video file]. Mill Valley, CA: Author.

Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 83 minutes.

Psychotherapy.net (Producer). (2000a). Cognitive therapy for addictions [Video file]. Mill Valley, CA: Author.

 

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