How to Work Through Group Treatment for Substance Use

Imagine that for years you have been living a double life because of your substance use addiction. In that double life, you have been dishonest with the people closest to you, have fallen short of your own ideals for yourself. You have unmeasurable amounts of guilt and shame because of your behavior. The consequences of your behavior lead you to seek substance use treatment. Depending on the type of treatment you engage in (i.e. detox, residential, outpatient), you are likely required to participate in group therapy or are strongly recommended to do so. Although you are hesitant and fearful, you agree to participate. You are then expected to be in a group setting (either in-person or via teletherapy) with people you don’t know and asked to:

• Sit in one spot and concentrate for several hours
• Show concern for others in the group
• Self-reflect/be honest about the extent of your problems

What makes this even more challenging is the fact that you are preoccupied with worry about the crisis that brought you into treatment. (“Will I be able to save my marriage? Will I be sentenced to jail?” etc.) On top of that you are still having strong cravings to continue using. The person new to sobriety and group treatment needs to understand the reason these tasks are being asked of them, why they seem so difficult, and ways to work through feeling uncomfortable with the whole process. If this doesn’t occur, then there is a good chance they will discontinue attending before they are able to experience the benefits from substance abuse group treatment. Keep in mind that people get well in a recovering community, not in isolation. This can be via in-person or virtual group treatment, 12-step meetings, etc. Isolation, on the other hand, serves to only feed ongoing addictive behavior.

Let’s look at five reasons group treatment can be challenging and how to work through any feelings of discomfort you might experience as a result.

1. Substance use can lead people to become self-centered and less empathetic toward others.

The sad thing about substance use addiction is that it often leads people to act out of line with their core values. The drug often becomes the person’s top priority and others can be viewed as obstacles that get in the way of their substance use. Naturally one almost needs to become a bit less empathetic towards others needs and one’s actions become a bit more self-centered. If you have spent years neglecting the emotional well-being of loved ones in your life, it isn’t going to be easy to automatically be pulled towards listening to a stranger in the group meeting with you and it’s easy to think “I have my own problems to deal with and don’t have time for theirs”.

Suggestion: One of the principles of recovery is that people need to become less self-centered and more other centered to get well, group is a great way to practice taking the focus off yourself a bit. I encourage people to adopt the mind set of being curious. Get curious about each person’s life story. Potentially by taking an interest, you may find you relate to their journey or their journey pulls at your heart strings-as a result you may find yourself being concerned for them and feeling empathetic.

2. Difficulty concentrating is brought on by Post-Acute Withdrawal Syndrome.

Post-Acute Withdrawal Syndrome (PAWS) is a set of symptoms that occur after one has been sober and is through the acute stage of withdrawal. One symptom of PAWS is difficulty concentrating/focusing for more than a few minutes at a time. If this is occurring in a group setting, it will be frustrating to not be able to stay on task.

Suggestion: Take short, abbreviated notes if something catches your attention; writing down too much may contribute to you losing out on what is being discussed. Utilize fidget objects, sit upright, make eye contact with the speaker, engage-be a part of the discussion-ask questions, provide feedback, etc.

3. Honesty with self and others develops over time, not overnight.

Dishonesty is a learned habit developed over time to maintain one’s addiction and is difficult to stop. To live for years of telling yourself and others half-truths and on some level believing those fabrications (“I can quit anytime, they are the ones with the problem, I’m not that bad, I use like other people, etc.) and then to expect one to have clarity about the truth and begin practicing the habit of rigorous honesty needed to recover, will take time.

Suggestion: Commit to the idea in recovery that “secrets keep you sick and honesty keeps you sober”. Work towards opening up a little more each session, overtime this will become easier and it will feel freeing and increase your confidence and connection with the group.

4. The strong need for instant gratification.

I have heard it said that one of the appealing parts of substance use is, “you don’t have to think better or act better to feel better”, you just take the drug and instantly your state is altered. Much our society is wired this way as well, from wanting fast food to wanting our problems solved immediately. Part of recovery is identifying new healthy means of experiencing gratification and learning how to not trade what you want most in life for what you want right now (delaying gratification). Because of this strong desire, folks will often stop a group program because they lack the skill to delay gratification, as group treatment is a means of preparing you for future sobriety.

Suggestion: Embrace the ideas that “anything worth having is worth working for” and “there are no shortcuts on the road to recovery”. If sobriety and a new way of living is a priority, then it will require a time commitment on your part. Additionally, see recovery as a process, a journey not a destination and look for ways to contribute to the meeting vs. focusing on what you can get out of it.

5. Overwhelming shame.

You probably won’t meet any person with addiction that can’t relate to shame. Shame is believing you are defective, unworthy and unlovable. Being vulnerable and opening up about one’s struggles and challenges is one the most difficult things to do.

Suggestion: There is a recovery saying that goes like this “we are not bad getting good, we are sick getting well.” When you begin to see the truth that your behavior has been driven by the disease of addiction and not driven by a moral failing, then you can put your addiction in the proper context. Remembering that you didn’t choose addiction for yourself, but you can choose recovery.

There are many reasons substance use group treatment can be uncomfortable at times, these are just a few. But the people who can act with courage by facing their fears, identifying and working through the challenges they encounter, will typically experience immense personal growth, encouragement, self-acceptance, new friendships, sobriety and hope that ongoing recovery is possible.