Measuring affiliation in group therapy for substance use disorders in the Women's Recovery Group study: Does it matter whether the group is all-women or mixed-gender?

Abstract

Background and Objectives A Stage II, two-site randomized clinical trial compared the manualized, single-gender Women’s Recovery Group (WRG) to mixed-gender group therapy (Group Drug Counseling; GDC) and demonstrated efficacy. Enhanced affiliation and support in the WRG is a hypothesized mechanism of efficacy. This study sought to extend results of the previous small Stage I trial that showed the rate of supportive affiliative statements occurred more frequently in WRG than GDC. Methods Participants (N=158; 100 women, 58 men) were 18 years or older, substance dependent, and had used substances within the past 60 days. Women were randomized to WRG (n=52) or GDC (n=48). Group therapy videos were coded by two independent raters; Rater 1 coded 20% of videos (n=74); Rater 2 coded 25% of videos coded by Rater 1 (n=19). Results The number of affiliative statements made in WRG was 66% higher than in GDC. Three of eight affiliative statement categories occurred more frequently in WRG than GDC: supportive, shared experience, and strategy statements. Discussion and Conclusions This larger Stage II trial provided a greater number of group therapy tapes available for analysis. Results extended our previous findings, demonstrating both greater frequency of all affiliative statements, as well as specific categories of statements, made in single-gender WRG than mixed-gender GDC. Scientific Significance Greater frequency of affiliative statements among group members may be one mechanism of enhanced support and efficacy in women-only WRG compared with standard mixed-gender group therapy for SUDs.

Treatment Interventions for Women With Alcohol Use Disorder

“…In a series of three studies on putative mechanisms of change in WRG, secondary analyses of the pilot and/or larger RCT data from studies just described here above, showed that more affiliative statements were made in WRG than GDC 66 , 67 and that more affiliative statements were associated positively with women’s drinking outcomes during and 6 months after treatment, particularly in the WRG condition. 68 Sugarman and colleagues created and piloted (for feasibility, acceptability, and satisfaction) a web-based, gender-specific individual psychoeducation intervention based on WRG content.…”

Sex and gender differences in substance use disorders

“…Participation in gender-specific treatment is also associated with greater satisfaction, enhanced comfort, and feelings of safety among women (Greenfield, Cummings, Kuper, Wigderson, & Koro-Ljungberg, 2013), and increased continuity of care following discharge (Claus et al, 2007). Qualitative data from the WRG study found higher rates of verbal affiliation in women in the WRG compared to those in mixed-gender drug counseling (Greenfield, Kuper, Cummings, Robbins, & Gallop, 2013; Sugarman et al, 2016); thus, gender-specific treatments may create an environment of enhanced affiliation, which may in turn lead to better outcomes.…”

Group interventions

“…A women-focused same-gender group intervention may enhance longer-term clinical outcomes among women with substance use disorders[ 22 ]. Affiliative statements such as supportive, shared experiences, and strategy statements were more in women-focused group intervention than in mixed gender group intervention[ 23 ]. Women felt more safe, greater acceptance of different aspects of their self, having their needs met, developing familiarity and confidence, empathy, morality, group cohesion and perceived increased support in women-focused group intervention on gender-relevant topics played an important role in supporting their recovery[ 24 25 ].…”