Alcohol & Alcoholism Vol. 40, No. 2 © Medical Council on Alcohol 2005; all rights reserved
BOOK REVIEW
The Group Therapy of Substance Abuse. By D. W. Brook and H. I. Spitz. The Haworth Press, New York. £35.50. 480 pgs. ISBN 0 7890 1722 2
This book pools the knowledge, skills and expertise of a wide variety of clinicians to provide a comprehensive examination of the different approaches, settings, uses and implications of group therapies in treatment of substance abuse. Each chapter, whilst elaborating on a theme as the book progresses, can also stand alone as a treatise on its specific subject matter. This enables the reader to utilize the book as a resource to focus on particular areas of interest and use the references provided as a springboard for further reading.The first section explores the different schools of thought on group treatment, including cognitive, behavioural and psychodynamic theories. It begins with an ethical discussion on managed health care and the tension between economy versus efficacy. Whilst acknowledging the value of brevity of treatment, it is suggested that this is not a panacea for all. What may enable group therapies to thrive, both here and in the USA lies in their cost benefits. Complex group dynamics are illustrated in later chapters, using vignettes and the personal insights of the author, making them easily understandable.
Section two focuses on the ‘nuts and bolts’ of how to structure groups in specific treatment settings with varying goals. It is full of practical advice on matters such as the style of the group leader, the number of groups, how they should be phased, and the use of contracts. An analysis of self-help groups is also included.
Sections three and four look at different populations divided into demographic and diagnostic categories. Each chapter reviews the relevant research, background and pertinent issues for the populations under review. The chapters include populations who are often not traditionally identified as suitable for group work, including the elderly, schizophrenic and medically ill substance abuser.
The last section examines research evidence, highlighting problems in research design and the difficulty in providing research evidence that includes both the process and outcome of group therapy.
Finally, the book ends by illustrating some of the ethical issues involved in group therapy and in particular, the dilemma of confidentiality. Whilst clients can usually rely on the professional principles of their therapists, they have little control over the integrity of fellow group members and can be subject to indiscreet exposure or even blackmail.
One criticism of the book is that because each chapter is written by a different author, there is some repetition and minor differences in the pitch of information, with some authors assuming a broader knowledge base than others. Overall, however, it provides a wealth of information in a readable form, which provokes further thought and questions.
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