Effectiveness of Cognitive Behavioral Therapy on Adolescent Substance Abusers

Introduction

Substance abuse has acute social consequences, such as increase of committed crimes and immoral acts, degradation of individual and population as a whole, increased mortality especially among youth, increased birth rate of ill and disabled children. Juveniles, children and adolescents are more prone to the above mentioned negative social phenomena of modern society. The adolescence’s period is one of the most significant life stages. There are many sources and beginnings of the subsequent development of personality. This age is more unstable, vulnerable, and tough, as compared to other life stages. Thus, adolescents are dependent on various realities of the surrounded world.

There are many causes and conditions that are conducive to familiarizing teen to drugs. Social factors include dysfunctional family (alcoholism or drug addiction of parents, low standard of living, lack of emotional contact, incomplete family); widespread substance abuse in the community; active promotion of the youth subculture associated with the consumption of drugs and toxicants in the media; inadequate youth policies, the lack of real leisure programs, and unemployment of minors. There are also constitutional-biological reasons (i.e. family history of substance abuse). For majority of children and adolescents, there is no preventive psychological defense to psychoactive substances.

Drug use has the adaptive nature of the activity on artificial bringing consciousness into harmony with reality in the non-realization of certain significant needs. Therefore, in the sociological aspect of drug addiction, it is advisable to consider it not simply as a form of abnormal behavior, but as a result that is capable of causing individual pathological reactions of disorganization of relationship with the social environment. A considerable spread of drug addiction in a particular society at a certain stage of its development can be seen as an expression of social pathology. Drug abuse affects all areas of human activity, prevents spiritual, emotional and intellectual development of individual, connected to the fact that human consciousness is narrowed to meet the needs of only one – the search and taking drugs. A drug addict is danger to society by various forms of deviant behavior, stemming from the fact of acquisition of drugs and their use. The spread of drug addiction leads to socio destructive functions in society and poses a direct threat to social structure.

Problems of substance abuse among adolescents can be resolved by various means and methods. One of the most effective ways to treat abusers is cognitive behavioral therapy. There are individual and group therapy. Individual therapy focuses on personal history and personal experiences but refers to actual interaction of the psychologist and the client. Group psychotherapy is more focused on interpersonal aspects, but also takes into account personal history. A characteristic feature of individual therapy (which cannot be found in group therapy) is more pronounced, direct management by the therapist and commitment on the part of the client. Individual cognitive behavioral therapy is aimed at modeling certain behavioral patterns and learning self-control. The result is that the patient learns to respond to events without the help of banned substances. Psychological correction is often carried out in parallel in order to form the target installation on a healthy lifestyle. Individual psychotherapy is much more secure and confidential. Obviously, no one except a psychologist observes the process of disclosure of the client. The client feels more secure (compared with the group therapy). Another advantage of individual therapy is attention. All attention of the therapist is directed to the client. However, there are particular flaws of this method. They include weak impact and receiving material from the words. To some extent, this limits the value of individual therapy. Therapist can hardly see how the patient behaves with other people and this information can be very valuable to speed up the treatment process. To do this, a doctor inserts a patient in a group of other patients, trying to solve problems together in a therapeutic group. Some therapists believe that even if the patient produces a prosperous impression in individual therapy, he cannot really recover without spending some time in such a group. Others show even more enthusiasm, believing that group therapy can do more for a patient than an individual professional can. In any case, a patient, who does not attend group therapy, loses valuable treatment options.

Group therapy was invented by Jacob Moreno. World War I and Great Depression against the background of the growing popularity of psychotherapy created demand, which was almost impossible to meet by means of individual counseling. Today, there is a variety of methods of group therapy: a panel discussion, psychodrama, design drawing, and music therapy. Highly structured groups with a policy of management style are most often used for the treatment of addicts. The focus of these groups is on behavior rather than emotions. This is done to force addicts to realize what behavior has made them unhappy. Other methods of group therapy are also widely used. Consultants encourage participants to discuss various topics. The fact that substance abusers can find the right solutions to their personal problems is at the heart of such groups’ creation.

In principle, group psychotherapy is not an independent direction in psychotherapy, and represents only a particular method, using which the main tool of psychotherapy serves a group of patients, as opposed to individual therapy. Along with other psychotherapeutic methods, group psychotherapy is applied in the framework of different theoretical orientations that define its originality and specificity: specific goals and objectives, the content side and the intensity of the process, tactics of the therapist, therapeutic target, the choice of teaching methods etc. As an independent direction in psychotherapy, group psychotherapy appears only in the sense that it is considering patient’s social and psychological terms, in terms of his relationships of and interaction with others, thereby focusing not only on the individual and intrapersonal issues, but also on the individual in the totality of his relationships with the outside world. The group serves as a model of the real world, where the patient exhibits the same attitude, values, the same methods of emotional response and behavioral reactions, as in real life.

Substance abusers gradually acquire a sense of mutual communication that is very beneficial, especially for people, who were isolated for a long time. The permissive treatment of an individual learns to freely express their thoughts and feelings. It is known, however, that the expression of feelings gives a temporary sense of relaxation, but does not cure psychical conflicts. This can be achieved in the group with the help of some form of analytic treatment. There are three main forms of analysis in group therapy. The first one was developed mainly in England and is called the group analytic therapy. With this method, everything that happens in the group is related to the state of the entire group at any given time, so that an individual knows how other members influence his behavior every minute. The second method is psychoanalytic group therapy, which uses a set of principles and techniques of psychoanalysis, such as free association, dream interpretation and analysis of resistance to recovery. It seeks to examine not only the conscious but also the subconscious images and feelings to achieve a deep reorganization of emotional impulses of the individual. Theory and techniques are borrowed from individual therapy and applied to the events taking place in the group of people, not only between the patient and the doctor. The third method is group therapy of interaction, in which the interactions between patients are analyzed by expanding the ego.

The main advantage of group therapy over individual is that individual therapy gives possibility of acceptance and understanding only by one person. During group therapy, one can be accepted by few people, who honestly share his/her feelings in a joint search for a more satisfying their lives. That is why group therapy provides a more powerful experience. The band also provides opportunities for the establishment of multilateral relations, which is not possible with individual therapy. The group creates an environment, in which one can try out the new technology in social reality. In contrast to individual therapy, group therapy provides real social environment for finding and experimenting with new, more efficient ways of relating to others.

The relevance of research topic is explained by strong growth of the trafficking of narcotic drugs and the number of addicts, the expansion of the geographical boundaries of the non-medical use of narcotic drugs, serious social consequences of mass use of drugs among the various social strata of the youth and lack of scientific elaboration of the problem.

The proposed study will examine and compare the effectiveness of individual and group cognitive behavioral therapies on adolescent substance abusers. There have not been too many studies, which examined the advantages of one of this therapy over another. Furthermore, by investigating the effects of individual cognitive behavioral therapy and group therapy on adolescents, who suffer from substance dependence, this study might be able to clarify the effectiveness of therapies, implications for treatment, and limitations.

Moreover, the study will focus on the distinction between two therapies, as well as their impact on adolescent patients. It is hypothesized that group cognitive behavioral therapy has a bigger effect on adolescent substance abusers, as compared to individual therapy. Moreover, it is supposed that these therapies have a different impact on individuals’ psychology due to the aspect of age.

Literature Review

The effectiveness of interventions of cognitive-behavioral therapy that is based on learning the skills of patients with alcohol dependence and dependence on psychoactive substances is proven in many clinical trials. These studies have provided empirical evidence for effectiveness of cognitive-behavioral therapy for psychiatric disorders in children and adolescents, including depression, anxiety disorders, substance abuse and dependence.

Despite the theme popularity, there is a small amount of scientific literature about the advantages of group cognitive behavioral therapy over individual therapy. There are some specific articles that describe advantages of individual and group cognitive-behavioral therapy. Becker (2013) pays attention to the issue of adolescent substance abuse. The author discusses problems that are related to the disease. Also, Becker characterizes three intervention models that include cognitive behavioral therapy.

Abbott (2002) provides characteristics of the problem of substance abuse and challenges in system of health care that were generated by its popularizing. Montgomery (2002) gives explanations about the role of group therapy, explains its advantages and clinical implications. Along with characteristics, role, and advantages, Vinci, Coffey, and Norquist (2015) provide recommendations on the use of cognitive behavioral therapy. Researchers indicate specific areas, in which therapy can give the most positive outcomes. Marlo and Kalinian (2002) provide a deep analysis of cognitive behavioral therapy and its advantages. However, researchers indicate its flaws, compared to other psychoanalytic methods of therapy of substance abusers. Kemp, Harris, Vurel, and Sitharthan (2007) provide the study of danger of substance abuse among adolescents. Researchers proved the effectiveness of cognitive behavioral therapy in treatment of adolescent substance abusers. Esposito-Smythers, Kahler, Spirito, and Hunt (2011) found that cognitive behavioral therapy for adolescents with problems that are related to substance abuse, as well as suicidality contributed to improvement of the behavior of participants and reduction of the use of additional services. DeVito et al. (2012) study neural effects of therapy on substance abusers. Thus, researchers identify several areas, with which positive outcomes of behavioral therapy are associated. They include impulsivity, attention, control, and attention.

Along with group therapy, family therapy is worth of scientists’ attention and counselors, who find solutions of the issue of substance abuse. Thus, Henderson, Greenbaum, Dakof, and Liddle (2010) found that multidimensional family therapy proved to be more effective than individual cognitive behavioral therapy. Researchers argue that therapy without the regard to its theoretical orientation is able to provide desirable decrease in substance use. Also, Hogue, Dauber, and Stambaugh (2006) studied the impact of early therapeutic alliance. Thus, researchers compared the results of individual and family counseling. In family therapy, strong parent alliance predicted the reduction of drug use. Moreover, Hogue, Dauber, Liddle, and Samuolis (2004) found that family focus on therapy of substance abusers predicted higher rates of post treatment improvement in the use of drugs.

Range and Marlatt (2008) study the effectiveness of the use of cognitive behavioral therapy for treatment of alcohol and drug use disorders. They found that this method of treatment can become an alternative to other methods of substance abuse treatment. Also, Beck (2012) discusses advantages of cognitive behavioral therapy in comparison with third wave therapies, and its benefits in treating substance abuse. Morganstern et al. (2001) studied counselors’ attitude and perceptions of cognitive behavioral therapy in regard to the treatment of substance abuse. The researchers found high rate of gratification with therapy. The research demonstrates the possibility of using technologies of cognitive behavioral therapy as means of treatment of substance abuse.

Greenfield, Cummings, Kuper, Wigderson, and Koro-Ljungberg (2013) focused on women’s experience in the treatment of substance abuse. The research provides evidence of the effectiveness of group therapy. The researchers argue that group support allows focusing on gender-relevant issues and topics that support their recovery. This increases positive outcomes of treatment. Paddock, Hunter, and Leininger (2014) provide research of the effect of group cognitive behavioral therapy on symptoms in the process of treatment and during post-treatment period. Parker, Page, and Hooke (2013) study the dependence of the effectiveness of group cognitive behavioral therapy on self-esteem of patients. Researchers found that self-esteem scores of patients before treatment influenced outcomes of therapy.

Using particular studies and provided empirical evidence, Waldron and Kaminer (2004) found that both group and individual cognitive behavioral therapies contribute to reductions in use of substance among young people. They provide an evidence for high efficacy of group method of therapy. The research is focused on the improvement of outcomes and engagement techniques.

Nevertheless, there are many researchers, who do not recognize group counseling superior than other methods of psychosocial treatments for substance abusers. Particularly, Waldron and Turner (2008) argue that treatment approaches, including multidimensional therapy, functional family therapy, and group cognitive behavioral therapies as well as other models of treatment of substance abuse are equally efficacious.

The studies support the need of further investigation of the problem of the effectiveness of individual and group cognitive behavioral therapies on adolescent substance abusers, supporting the opinion that substance abuse cause a severe damage for the mental condition of patients and can even cause death.

It is expected that young participants will show higher rate of recovery, using group therapy. It is not stated that individual cognitive behavioral therapy has no impact on adolescents’ recovery. However, it is supposed that substance abusers, especially those aged 15 to 25 years, are mostly amenable to treatment with the use of group therapy. This justification can be explained by the fact that work in group is focused on interpersonal communication, exchange of experiences that allows acquiring social skills and ability to interact in a relationship.

Method

Participants

Approximately 65 patients, who are treated with the use of group cognitive behavioral therapy, and 35 patients, who receive treatment using individual therapy, will participate in the proposed study. Among the sick participants, there are people, who suffer from anorexia nervosa and bulimia nervosa. Participants must be at least fifteen years of age and older. Majority of the group consists of female participants (74%). Men represent another part of it (36%). All of them are recruited through the Internet and remain anonymous. All participants agreed to take the participation in the study voluntarily.

Design

The study will have non-experimental design that does not need a manipulation of situations, circumstances or participants. The study will depend on the comparative analysis, which means assessing two groups of variables: individual and group.

Procedure

The participants for this research will be recruited through the Internet by using well known social websites. The study will be described as a study investigating the current views on individual and group therapies and their impact on participants. This research will be completely anonymous. Participants will not have to give the identifying information. They will just need to complete the questionnaire. First, participants will answer questions regarding their gender and age information. Then, they will be exposed to the issue of substance abuse and their life experience in regard to this problem. This type of study helps to get the data from a large number of people in a short time limit. The questionnaire is used to determine the effectiveness of treatment of substance abuse, as well as evaluate the interconnection between psychological effects of individual and group cognitive behavioral therapies and personal characteristics of participants.

The experience of physical, psychological and social changes as a result of therapies will be studied. It is crucial to analyze the participants’ evaluation of outcomes of both methods of cognitive behavioral therapy. The questionnaire will focus on the questions about experience of substance abuse, treatment process, and effectiveness of the recovery.

Measures

Psychological effectiveness of individual and group therapies in lives of the participants will be assessed using semistructured interviews in order to evaluate their interpersonal relations, functioning at school or work, in recreational activities, household chores, as well as the individuals’ global satisfaction of their lives. The ratings will be made using a five-point scale, which is ranging from one (no impairment) to five (severe impairment). Most attention will be paid to the psychological effect of both therapies’ methods.

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