Substance abuse (drug) rehab advice: Group cohesion

Inpatient therapy is normally provided within the context of a therapeutic community. The Minnesota Model of treatment actually suggests that the therapeutic community is a chief agent of change. Members of the group provide each other with feedback on blind spots in their recovery and also confront behaviour not conducive to recovery. The group provides support to its members and a sense of belonging.

Group cohesion is a measure of how much the members of a group want to stay in that group. If a group has no cohesion then its members will drift off, possibly to form smaller groups that are more attractive. If the therapeutic community is an important part of treatment then we should look at ways to improve the group cohesion. Of course, implicit in this statement is the assumption that a cohesive group will be a more effective instrument of change for its members. This seems to be a reasonable assumption given the functions outlined in the first paragraph.

Cohesion can be improved in several ways:

1) Time spent together: Group members who spend time together will become more familiar with their common issues and concerns. This will allow them to spot blind spots in their peers more effectively, and to be sensitive to their peers emotional needs.

2) Group size: A very large group does not allow much time for one-on-one interaction. It also makes it more difficult for the group to focus on a common goal if there are many members all with divergent opinions and agendas.

3) Severity of initiation: Generally, the harder it is to gain admission to a group the more valuable you will perceive that membership to be. Clients in a drug or alcohol rehab center have generally had unpleasant experiences which led them to seek treatment. This common problem helps to bond the group.

4) Gender of the members: Women generally report to be closer to each other than men do. This could be explained by cultural expectations of the role that women play. In Western cultures women are expected to be less competitive. This might foster cooperative behaviour in women.

5) External threats: A group will bond more closely together in the presence of a common enemy. Stressing the importance of working together to overcome the disease is a good way to help the group improve cohesion.

6) Previous successes: It is common for clinics to allow clients who have graduated from the program to attend follow-up "aftercare" sessions at the facility. Such clients are normally allowed limited or supervised access to the current therapeutic community, many of whom will remember the client. It helps the therapeutic community to see these success stories.

Many addicts and alcoholics come to treatment feeling "apart from" society. It is hardly surprising given the antisocial behaviour that is required to sustain alcoholism and addiction! Becoming a member of a supportive group allows the client to feel "a part of" a community, which can provide a powerful positive draw to sobriety.

12 step treatment facilities will seek to integrate their clients into the 12 step fellowships. Certainly one of the functions that these fellowships provide is a place where the alcoholic feels welcome, accepted, and part of something larger than herself. Group cohesion improves the ability of the group to help the alcoholic. Indeed the 12 step literature states that "Our common welfare should come first; personal recovery depends upon A.A. unity". Cohesion is highly valued even outside of a treatment setting.