Mixed-Methods Exploration of Group Therapy for Substance Use Disorders: Prospects for Evidence-Based Practice.

Abstract

Evidence-based treatments (EBTs) for substance use disorders (SUDs) often are not utilized in clinical practice or lag years behind in their uptake. One underappreciated dimension of this research-practice gap is a mismatch in treatment modality: Whereas research efforts have focused on individual therapy, the majority of SUD treatment is in group format. In this mixed-methods three-study dissertation, I aim to narrow this gap by exploring how SUD clinicians facilitate group therapy. First, I conducted a national online survey with 566 SUD group therapy clinicians about their most commonly utilized group practices. Survey results confirm that group therapy is the most widely used SUD treatment modality, with especially high prevalence of open groups; clinicians also reported high utilization of EBT components (especially motivational interviewing and cognitive behavioral therapy) but with varying use of 35 specific practices and moderate use of questionable/less-effective practices. For the remaining two studies, I conducted qualitative thematic content analyses of semi-structured interviews with 13 clinicians at three outpatient SUD specialty clinics in the Midwestern U.S. The first qualitative analysis, which also included interviews with clinical directors, focused on organizational factors that facilitate and impede EBT implementation. Results indicate considerable challenges for integrating EBTs within each clinic, in terms of complexities with clinics’ provision of group therapy, exclusive use of open groups, use of treatment structures (e.g., group duration and session length) that are not readily compatible with existing EBTs, and use of a suite of treatments rather than standalone interventions; considerable adaptations are thus necessary to utilize existing EBTs. For the second qualitative analysis, I present complexities and barriers for group therapy facilitation, including use of EBTs, among individual clinicians. Results indicate that clinicians emphasized the importance of providing individualized and engaging treatment, necessitating considerable flexibility for group facilitation; however, clinicians also had serious challenges in this regard, due to complex group dynamics and organizational deficits and barriers (limited group therapy experience, limited quality control efforts, the predominance of psychoeducation, and limited attention to clients’ demographic diversity). For each study, I discuss recommended strategies for researchers and clinicians toward improved innovation and implementation of evidence-based practice.