Group Therapy Activities for Substance Abuse & Relapse Prevention

What is the Purpose of Group Therapy?

Group therapy for substance abuse occurs when there is at least one professionally trained therapist who uses interventions based on psychological principles treating more than one individual at the same time. Substance abuse groups offer a number of advantages, including the development of social support, the ability to learn from others, the ability to share information, and a feeling of togetherness such that one does not feel alone in their own issues with their substance use disorder. Most clients benefit from using both group and individual therapy.

There are literally thousands of different activities that can occur in a substance abuse group curriculum, and it would require several volumes of books to list them all. This article will list some of the more common types of addiction recovery group activities that occur in group therapy for substance abuse. It is important to understand that group therapy can only be delivered by a licensed, trained, professional therapist.

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Substance Abuse Group Therapy Activities

Group therapy is a vital aspect in all levels of addiction treatment and continued care, including outpatient treatment and sober living. It is important to understand that outpatient programming and sober living options are excellent resources not only for those who are looking for treatment the first time, but also for those who have relapsed or are on the verge of relapsing. In these settings, patients can thrive from the many activities offered through therapeutic mediums like group therapy. These include:

• Introducing New Members: One of the most common group activities for substance use disorder groups is the introduction of new members into the group and a new member’s explanation of why they are in the group and what their expectations are. Other standard group activities for substance use disorders are typically discussions of personal issues that certain members have, suggestions on how to address these issues, and input or advice from the therapist. Often, when members leave the group, they are given the opportunity to express their gratitude, explain and discuss how the group has benefited them, and discuss their plans for the future.
• Reflect on Requests & Questions: A common ongoing activity in substance use disorder groups is for individuals who have specific requests, questions, or needs to bring these up at the beginning of the group and have the group reflect on them. Relationship issues, the temptation to relapse or an actual relapse, frustrations with treatment, or other issues are commonly discussed among group members with direction from the therapist.
• Discuss Recovery Beliefs: A common activity that occurs in substance use disorder groups is for individuals to discuss where they believe they stand in terms of their own journey of recovery. Individuals are encouraged to discuss aspects of the recovery that they feel they have accomplished and aspects of the recovery they would like to accomplish in the future. Then, other members and the therapist give feedback on these issues.
• Discuss Mental Health: In order to help individuals who are experiencing certain types of psychological conditions, such as depression, anxiety, or stress, therapists often have individuals discuss their own experiences with these issues and how they coped or overcame them. This commonly leads to a discussion of triggers.
• Discussion of Triggers: A common activity that occurs in groups designed to treat substance use disorders is the discussion of triggers and how to identify them. Individuals often share information regarding how they experience triggers and their potential plans for coping or dealing with them.
• Develop Basic Skills: Groups often work together to develop basic skills, such as progressive relaxation, diaphragmatic breathing, visualization, meditation, etc. The therapist most often directs the practice of these skills in the group setting and then individuals have a chance to proactively discuss their experiences. This helps individuals refine many of the skills that are taught in substance use disorder treatment.
• Discuss Communication Difficulties: Groups often spend quite a deal of time discussing issues that relate to communication. A common activity in substance use disorder groups is a discussion of how language influences one’s thinking and behavior. These discussions often lead to recognizing how specific types of words are associated with one’s substance use disorder. Often, therapists will discuss how the impact of certain words can affect recovery, such that the way one expresses things or thinks about things can either enhance or limit an individual’s recovery program.
• Finding Goals: Often, newer members of groups are concerned that without their substance use, they have no options regarding activities or goals. Individuals and groups work on listing alternative activities to substance use and the development of positive goals in these situations.
• Discuss gratitude: Individuals in substance use disorder groups may discuss gratitude in the same manner that is often discussed in 12-Step groups like Alcoholics Anonymous or Narcotics Anonymous. The discussion of gratitude, and identifying things that one should be grateful for, is a very important aspect of group activities for recovering addicts, as individuals with substance use disorders often lose track of the positive things in their lives.
• Best & Worst Moments: Therapists want to relay the fact that value judgments are often very subjective and based on specific conditions. One activity frequently used by therapists to do this is to have individuals list what they believe are the best moments of their lives and the worst moments of their lives. Therapists and other group members then ask them why these particular moments were either good or bad, and if there any similarities or patterns between these occurrences. Individuals engaging in this exercise realize that there is no such thing as an “all good” or “all bad” moment. This often results in individuals seeing how similar the “good” and “bad” experiences in their lives can be, and their value is made in a very subjective judgment. A similar activity is to have individuals in the group list their bad habits, what makes them bad, and any positive aspects to those habits.

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Substance Abuse Group Therapy Topics & Themes:

• Common Themes: Sooner or later in groups for the treatment of substance use disorders, several common themes are brought up. These include the importance of things like good nutrition and how it affects one’s substance use disorder, the importance of physical fitness, the importance of self-care and attention to hygiene, the importance of education and bettering oneself, and the importance of stress relief and getting enough rest.
• The notion of “Letting Go”: An activity that often surfaces more than once in groups for substance use disorders is the notion of “letting go.” This frequently leads to a discussion of forgiveness and how to forgive. Individuals often discuss personal issues regarding resentment and how this can fuel anger and stress, and lead to relapse.
• Anger management: Activities related to anger management skills are common in substance use disorder groups. These activities often surface several times depending on the group and the group members. Therapists provide guidance and instruction on anger management techniques and other group members may share their experiences.
• Experiences with Drugs: Group members will often discuss their experiences with certain classes of drugs, such as alcohol, opioids, stimulants, etc. Therapists can add information based on research as needed.
• Sometimes, group sessions focus on education. For example, the group may listen to a lecture from an expert on the psychobiology of addiction or from other experts regarding relevant topics. Group members who have expertise in various areas may give short talks on specific subjects.
• Trolley Thought Experiment: One of the most famous therapeutic exercises is the trolley thought experiment. This can often be done in groups. The scenario is that a runaway trolley is moving down the train tracks. In the direct path of the trolley, there are five people tied up who cannot move. The trolley is headed directly toward them and if not stopped will kill all of them. You are in the train yard next to a lever. If you pull the lever, it will divert the trolley from hitting the five people by moving it to another track, but unfortunately, on the side track, there is one person that the trolley will hit and kill if you pull the lever. What is the correct choice to make? The idea here is to spur a discussion of ethics and morality, and how to constructively discuss an opinion or explanation and accept criticism.
• 12-Step Groups: Formal therapy groups often discuss the advantages and disadvantages of being involved in 12-Step groups, such as Alcoholics Anonymous or Narcotics Anonymous. Peer support groups are not formal therapeutic groups, as they are not run by professionally trained therapists. Therapy groups often discuss their feelings regarding these groups, and a good therapist can use this as a means to discuss the benefits and disadvantages of all types of interventions.
• “Back in Time” Activity: An interesting activity that some groups engage in is the “back in time” activity. There are number of different applications of this activity, but these generally follow the idea of having members go back in time and meet with their childhood self. What advice would one give to one’s childhood self? This leads to a discussion of how an individual would do things over again if they had the chance to and helps to develop insight on the types of things that individuals need to do currently.
• Abstinence vs. Attempt: A very common discussion in recovery groups is the notion of total abstinence versus an attempt at controlled use. Typically, therapists and addiction medicine physicians prefer abstinence (but not always), and it is important that the pros and cons of these approaches are discussed and reviewed on an ongoing basis. The vast majority of individuals in groups find that abstinence is the most effective approach to recovery for them.
• Need for Support: Understanding the need for support is crucial in recovery. Substance abuse group topics for discussion oftentimes are in regard to  support from family, group members, and friends. The notion of the need for support in recovery is visited repeatedly and a common theme in substance use disorder groups.

In addition, it is always important for group members to discuss any current issues and get advice and support from other members of the group. Often, discussing individual concerns or experiences and the need for advice or support occurs early in the group session and then other relapse prevention group activities are addressed, depending on the particular personal issues discussed or on the goals of the therapist and members of the group. As individuals continue in recovery group activities, they begin to develop very strong bonds with one another. The implementation of new and challenging activities for group members helps to strengthen those bonds.

A number of these substance abuse group activities come from the books Group Exercises for Addiction Counseling and Group Therapy for Substance Abuse: A Stages Of Change Manual.

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